Author: Pat Kelleher

In 2011, the Centers for Medicare and Medicaid Services launched the “Meaningful Use (MU) initiative to incentivize certain sectors in the US health care system to move toward electronic health records (EHR) that would be used in a meaningful manner that allows for the electronic exchange of information to improve continuity and quality of care. Significant financial incentives were provided to “eligible providers” – essentially defined as hospitals and physician practices. More than $20 billion was spent and more that 600,000 eligible providers were enrolled. Home health, behavioral health and skilled nursing facilities were not eligible.

Now, it seems there is some limited acknowledgement that it may be time to rethink that. In a proposed rule relative to interoperability just published in the Federal Register, CMS is including – as a Request for Information – an ask for any feedback as to how to improve data interoperability for providers that have as yet received any incentives for using electronic health records.

“Transitions across care settings have been characterized as common, complicated, costly, and potentially hazardous for individuals with complex health needs. Yet despite the need for functionality to support better care coordination, discharge planning, and timely transfer of essential health information, interoperability by certain health care providers such as long term and PAC, behavioral health, and home and community-based services continues to lag behind acute care providers,” the proposed rule says.

CMS acknowledges that a contributing factor to the lag in Interoperability among post-acute care providers was that they were not eligible for incentives under the program formally known as meaningful use. CMS asks for input on specific ways it could financially help these sectors adopt and use technology.

CMS also asks for feedback on measurement concepts and quality improvement steps that could feasibly be applied to post-acute care, behavioral health and home and community based-services providers. Given that mandate in the IMPACT ACT that certain patient assessment data should be standardized and CMS is interested in feedback as to what parts of that data set — or the whole IMPACT Act data set — would be appropriate to include.

Adding some fuel to what may be an obvious fire (no incentive = limited movement) is a just published study in the Journal of the American Medical Directors Association that examined gaps in communication between hospital and home health care staff, concluding that some could have serious medical consequences.

The authors surveyed nurses and staff at 56 home health agencies throughout Colorado. Participants were sent a 48-question survey covering communication between hospitals and agencies, patient safety, pending tests, medication schedules, clinician contact and other areas. Although almost all (96 percent) respondents indicated that Internet-based access to a patient’s hospital record would be at least somewhat useful, fewer than half reported having access to EHRs for referring hospitals or clinics. No surprise: getting medication doses right due to conflicting information was identified as a major problem.

Their conclusion: Future interventions to improve communication between the hospital and HHC should aim to improve preparation of patients and caregivers to ensure they know what to expect from HHC and to provide access to EHR information for HHC agencies.

Comments to CMS will be due in April. Date not yet announced.

Return to www.thinkhomecare.org.

As has been announced by MassHealth in numerous webinars, bulletins and most recently member mailings, effective March 1, 2018 MassHealth will begin enrolling the majority on their non dual,  under 65 years of age eligible members into one of three types of Accountable Care Organizations, or one of two Managed Care Organizations .  As outlined in this provider bulletin, there are  12 different Accountable Care Plan Partnerships, and  three Primary Care ACO Plans.

Member should all have been noticed about which plan they have been assigned  as of November 2017, and their enrollments are all effective March 1, 2018. Members will have between March 1 and May 31 2018 to switch plans.  After June 1 they will remain in a fixed enrollment until Feb 2019.

MassHealth is hosting series of important webinars and live trainings for providers between Jan and March, see dates and sites in the same Provider Bulletin.

It is imperative that agencies serving MassHealth patients attend one of these trainings.  At these training Masshealth we will covering issues around eligibility verification and how to establish if a patient’s insurer has changed, as well as what plans are required to do to ensure continuity of care for patients who may be switching plans.  Most of training information will also be posted to the Delivery Reform Provider resource website.

All patients who are switching to an ACO or an MCO should have received written notice already.  These patients are being directed to www.masshealthchoices.com if they need to verify plan information or want to switch their plans.

The large number of patients facing a change in the management of their care promises to cause confusion especially for home health patients for whom continuity of service is particularly critical.  HCA of MA asks members to keep HCA informed about the transition  process.

North Attelboro resident Carole Darrah her daughter Grace, along with nurse Judy Blanchard, were one of a number a families featured in media coverage in the past week about efforts to raise MassHealth payment rates for Continuous Skilled Nursing Services to very medically complex children and your adults.

According to the Sun Chronicle story:

“Grace was born with Trisomy 9 Mosaic, a rare chromosomal abnormality that left Grace in need of continual care. She wasn’t supposed to make it to her first birthday, but after four months in the neonatal intensive care unit, she was able to go home — with the promise that a state-funded home care nurse would assist the Darrahs in the day-to-day care of their daughter.

So far, Carole Darrah says, that promise has only been partly true.

The Darrahs are authorized for 56 nursing hours a week through MassHealth, which funds various amounts of home medical care based on each family’s needs. But in five years the Darrahs have only been able to fill 40 hours at most, leaving the rest of Grace’s medical care on them. Carole Darrah has had to quit her full-time job and sacrifices sleep and alone time for her daughter’s health. She and her husband haven’t had time alone since they left the hospital five years ago.”

There are approximately 900 families in the Commonwealth who are qualified for nursing services through this program.   Their stories are all similar to the Darrah’s and were featured in this news pieces:

• 5.17.17, The Sun Chronicle: “Push for Higher Nursing Pay Stars Close to Home for North Attleboro Family”
• 5.16.17, Burlington Union: “Families in Burlington and Beyond Face the Stress When it Comes to a Shortage of Skilled Nurses”
• http://burlington.wickedlocal.com/photogallery/WL/20170516/NEWS/516009971/PH/1?start=2

Senator Barbara L’Italien has filed a Senate budget amendment (#512) that would provide $4.5 million for increases to this program.  While it is a long way from the $14 million, that the families and the agencies believe is needed to make their salaries competitive in the market, it is an important start.

HCA of MA working with the family led Pediatric Home Nursing Coalition and members agencies to secure this funding.