Author: Pat Kelleher

Pat Kelleher is Executive Director of the Home Care Alliance of Massachusetts.

ACOs Expanded in Massachusetts

Last week, CMS announced 106 new ACOs, bringing the total approved by CMS since passage of the Affordable Care Act to 250. The nine newly designated “Shared Savings”  ACOs in Massachusetts are:

Accountable Care Organization of New England (led by Mercy Medical Center President & CEO Dan Moen); Cambridge Public Health Commission (Cambridge Health Alliance CEO Patrick Wardell); Cape Cod Health Network ACO (Cape Cod Health’s Sr. VP, Managed Care Jack Lipomi); Lahey Clinical Performance Accountable Care Organization (Lahey Health System Chief Network Development Officer Gregory Bazylewicz, M.D.); Pioneer Valley Accountable Care (CEO of Baycare Health Partners Stephen Sweet, M.D., affiliated with Baystate Health System); Southcoast Accountable Care Organization (Southcoast Hospitals Group President & CEO Keith Hovan); Total Accountable Care Organization DBA Collaborative Health ACO (President of MetroWest Accountable Healthcare Organization Bethany M. Gilboard); Winchester Community ACO (Winchester Hospital Board of Directors member Dale Lodge); and Accountable Care Clinical Services (Chairman and CEO of Accountable Care Associates, Dr. Philip F. Gaziano).

Here is the official list from CMS of all 106 ACOs and their contact information.

In other ACO news, this week’s  MHA Monday Report reports that Boston’s Beth Israel Deaconess Medical Center (BIDMC) has redesigned  their existing Pioneer ACO.  They are entering into a partnership with the 1,600 physician Beth Israel Deaconess Physician Organization to create the newly designed Beth Israel Deaconess Care Organization (BIDCO).

According to a press release from BIDMC, “The hospitals and physicians will work in 50-50 partnership within BIDCO, sharing governance, joint contracting, and risk. It is designed to accommodate community hospitals and physicians that are not owned or employed by BIDMC, and results in a restructuring of the current Beth Israel Deaconess Physician Organization to add hospital ownership for purposes of jointly contracting with payers in the future.” The hospitals and physicians will jointly invest $12 million annually for five years to improve the coordination of patient care among hospitals and physicians, as well as to increase the ability of caregivers to focus on population health management.

The Beth Israel Deaconess Physician Organization had previously been designated by CMS as one of only 32 Pioneer ACOs – a designation recognizing groups that had taken an early lead in coordinating care for patients across care settings. That Pioneer designation transfers to the BIDCO.

Return to www.thinkhomecare.org.

Congratulations To Our Emerging Leaders

The 2012 graduates of the Emerging Leaders programThe 2012 graduates of the Emerging Leaders program
The 2012 graduates of the Emerging Leaders program

This week was Graduation Day for our 2012/13 Emerging Leaders Class. The Emerging Leaders program is a collaborative effort between the Home Care Alliance of MA and Suffolk University’s Moakley Center for Public Management.  Students in the program attend classes – taught by Suffolk faculty – one full day a month for nine months. Upon completing the program, they receive a Certificate in  Home Care Management, as well as course credits to apply towards a master’s level program at Suffolk.

In a ceremony attended by family, friends and faculty, the graduates heard from class speaker Michelle Landry about how the students bonded over, and overcame,  their fear of writing class papers and about the value of the course information.   Keynote Speaker Meg Doherty, CEO of NVNA and Hospice, congratulated the class on their commitment to learning and leadership despite the sacrifices made and the disruption to their lives and that of their families.  “As leaders,” she told the class, “you will not just do a job, but make a difference.”

Congratulations to this year’s graduation class:  Barbara Belony, Jose DeLaRosa, Janez Hicks, Michelle Landry, Mary O’Malley, Michelle Sweeney, Jenna Tarara, Bernadette Ward and Kathy Wisenski.

Return to www.thinkhomecare.org.

Northeast Leadership Summit – Boston, 2013

don berwick

Registration is now open for the Northeast Home Health Leadership Summit being held at The Colonnade Hotel from January 22 to 24.

This year’s lineup of speakers includes Dr. Bill Thomas, an international authority on geriatric medicine and eldercare, who is revolutionizing the concept of ‘aging’ as we conventionally think of it. His passion will bring new and eye-opening thoughts on how we should view people as they grow old.

The Summit is also pleased to have Dr. Don Berwick, M.D., former Administrator of the U.S. Centers for Medicare and Medicaid Services, who will share his perspectives on the tremendous unrealized potential in health care delivery. Dr. Berwick will recommend how we can take part in shaping a system that satisfies our patients, using our limited resources intelligently, and continuing to support our mission of caring.

To further echo Dr. Berwick’s message, Mary Ann Christopher, President and CEO of the Visiting Nurse Service of New York, will share how home health leaders can play a leading role when it comes to transitions in care, quality of care and preventing re-hospitalizations as a vital partner to our community hospitals.

December 21 is the deadline to take advantage of early-bird pricing.  Full details are available at www.nehomehealthsummit.com, including registration and hotel information and an overview of this signature event, which is designed expressly for home health leaders. Register today!

Return to www.thinkhomecare.org.

Boston Globe Letter on Home Health and Readmissions

The following was published in the Boston Globe on Sunday, November 11th:

To the Boston Globe:

A renewed attention on the part of the health care delivery system in general, and hospitals specifically, to keeping people who have been hospitalized from quickly returning is welcome and long overdue (“Hospitals look to lower readmission rates,” G section, Nov. 5). However, in focusing on some new programs and services, the story seemed to miss the solution with a long track record of success. For more than a century, home health care as delivered by visiting nurses and other professionals has been the most valuable and valid means to support patients and minimize complications following a stay in a hospital.

These nurses have knowledge about the patient’s health and what in the home environment may be an obstacle to a patient’s medical progress. Yet, our experience is that far fewer patients are referred for home health services than could benefit from them, generally because of a lack of understanding of qualifying rules for coverage.

As we broaden the post-acute-care safety net, it’s important to remember that visiting nurses, who heal and teach, are most successful at delivering what patients need to avoid a return hospital visit.

Patricia  Kelleher, Executive Director

Home Care Alliance of Massachusetts

Return to www.thinkhomcare.org.

NAHC’s Preliminary Summary of PPS Rule

The following was prepared and shared by Bill Dombi of the National Association for Home Care:

The Centers for Medicare and Medicaid (CMS) issued the final rule regarding 2013 payment rates late Friday. The proposal includes the 2013 Market Basket Index (MBI) update of 2.3%, the required 1 point reduction under the Affordable Care Act, and the previously set 1.32 percent case mix creep adjustment. CMS retained the 1.32% creep adjustment rather than increasing it to the potential 2.18% level to account for the full coding weight change through 2010. The main change from the July 5 proposed rule is a reduction of the MBI from 2.5 to 2.3%. The change was due to the use of updated, more recent data.

The rule also includes a most of the proposed policy clarifications regarding the face-to-face rule, Hospice quality data indicators, surveys scheduling, and the imposition of intermediate sanctions for CoP noncompliance. CMS estimates that the net impact on HHAs is a $10 million overall reduction in payments in 2013. This is a smaller negative impact than the proposed rule. While the base rates would increase, the impact of the wage index changes lowers total expenditures. Continue reading “NAHC’s Preliminary Summary of PPS Rule”

MassHealth To Hold Briefing on Primary Care Redesign

The Commonwealth of Massachusetts Executive Office of Health and Human Services, Office of Medicaid (MassHealth) will be hosting a town hall meeting specifically geared towards health care providers regarding the Primary Care Payment Reform initiative.  This is an opportunity for providers to interact directly with Dr. Harris and share their thoughts, comments, concerns regarding the initiative. The goals of the MassHealth Primary Care Payment Reform initiative are to improve access, patient experience, quality, and efficiency through care management and coordination, and to integrate behavioral health care with primary care. The proposed model is designed to support the delivery of primary care through practices consistent with a patient-centered medical home with integrated behavioral health services.

The first of four town hall meetings is set up to provide a general program overview which will be given by MassHealth Director Dr. Julian Harris. The details of this meeting are as follows:

Date: Wednesday, October 23, 2012

Time: 6:30– 8:00 PM

Location: Morse Institute Library

14 East Central Street, Natick, MA 01760

The web site below includes more information on this initiatives and information regarding upcoming provider town hall meetings.

http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/primary-care-payment-reform-initiative.html

Alliance Members Talk Care Transitions, CON With State Survey Head

Madeleine Biondolillo, MD, the Director of Health Care Safety and Quality at MA Department of Public Health  informed home health executives this week that efforts by the state to support better care transitions may eventually become more deliberate – possibly by adding care transitions “compliance” to the state survey process.  In a discussing her Division’s plans with the executives,  Dr.  Biondolillo indicated a strong preference for “leveraging her Department’s regulatory clout”  to drive improvement in the patient care experience.   She shared a draft survey tool that DPH developed with the nursing home industry and  that surveyors could eventually incorporate into the state survey process. The tool has been tested in four long term care facilities to date and has been shared with CMS as a possible national model for survey reform. The form incorporates resident/patient interviews using the 3-Item care Transition Measure (CTM-3), which Biondolillo suggested has the endorsement of the National Quality Forum for use in evaluating transition quality.

In response to questions and comments from some of the home health executives at the meeting, Dr Biondolillo:

–          reflected on the possibility of introducing a determination of need (DON) process  in Massachusetts for home health saying the DON rules may be reopened for changes in the coming year.   The compelling argument for home care or hospice would, she said, be quality of care based, not economic.

–          indicated a willingness to assist the Home Care Alliance  in getting physicians and hospitals to understand the complex Face to Face rule

–          expressed from her own personal experience as a physician support for home health efforts to change  Medicare practice to allow Nurse Practitioners to sign plans of care

–          agreed with sentiments expressed by at least one home health executive that there may be more that can be done to educate physicians that different patients may benefit from different post acute paths (i.e, directly  with support home) rather than following a standard for all patients path through a rehab hospital and/or nursing home

Don Berwick, MD heads 2013 Northeast Home Health Leadership Summit Line-Up

Its not too soon to make plans to be in Boston on Jan 22-24, 2013 for the  2013 Northeast Home Health Leadership Summit.  For your consideration:

  • Our theme this year is “The Magic of Leadership”.
  • We will be returning to The Colonnade Hotel, 120 Huntington Ave. Boston – across from the Prudential Tower.
  • Our keynote speaker is Don Berwick, MD, former Administrator of the Centers for Medicare and Medicaid Services
  • Other speakers include:  Dr. William Thomas on “Elderhood Rising: The Dawn of a New World Age and Sarah McKinnon on “From a Good Boss to a Great Leader.  Bates Communications will be presenting “Speak Like a CEO” (a personal consultation will be available on Day 2 for an additional fee); and we have some other “magical” presenters in the lineup.
  • The pre-conference session will focus on utilizing data as a management and marketing tool.
  • The Summit website at www.nehomehealthsummit.com has hotel information up now and registration information shortly.

Return to www.thinkhomecare.org.

HHQI Campaign to be Revived

The now dormant Home Health Quality Improvement (HHQI) National Campaign will be relaunched with a free webinar for interested industry participants on  September 18 at 2:00 – 3:30 pm.   The webinar will be repeated from 4:00 – 5:30 and then posted for permanent viewing at the HHQI website:  http://www.homehealthquality.org.

The HHQI is a federal effort to improve quality through the dissemination and use of  evidence-based educational tools, individualized data reports and a variety of networking opportunities for home health and cross-setting providers.

The September 18th Webinar will detail  campaign enhancements and feature accounts of how home health providers have applied HHQI resources in the past to make an impact on their patients.

Be Prepared: Audit Activity on the Increase

Locally, regionally and across the nation, home care agencies are reporting increased federal scrutiny.  Every agency should be especially attentive to regulatory compliance.

The Boston Office of the HHS Inspector General is visiting many agencies across New England to conduct an audit of OASIS processes, with a focus on proper and timely submission of the OASIS to the state. They are looking closely at evidence of the OASIS transmission to the State before the submission of the claim, as well as at each agency’s process to review “fatal errors” and validation reports. We believe as many as 70 agencies may ultimately be asked for records.  We have not heard of any results or payment penalties as yet as a result of these audits.

Agencies also report that as a result of the submission of their Medicare Provider Enrollment Application (CMS 855a), federal inspectors are visiting on site to verify – often with camera’s – that the physical address reported on the form is operational.

Finally, it appears the ZPIC – Zone Program Integrity Contractors – are moving into home health. Unlike RACs which just look at  overpayment issues, the ZPICs are tasked with assisting HHS in discovering fraudulent practices.  A fairly detailed legal explanation of the roles of these federal contractors can be found here.

Return to www.thinkhomecare.org.