The next CMS Home Health, Hospice, & DME Open Door Forum is scheduled for tomorrow, Wednesday, July 10, 2012 at 2:00pm ET.
To participate in this conference call, please dial (800) 837-1935 and use the conference ID 52259092. Participants are not required to RSVP and are asked to dial in at least 15 minutes prior to the call start time.
Health and Human Services (HHS) Secretary Kathleen Sebelius announced today the approval of 89 new Accountable Care Organizations (ACOs). The 89 new ACOs have entered into agreements effective July 1 with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. Among the 89, there are two in Massachusetts:
The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives to 154. Of these, there are already five entities in Greater Boston designated as Pioneer ACOs by CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) announced last December. There are an additional two physician practice demonstrations, one south of Boston, the other on Cape Cod.
For 2012, CMS has established for all ACOs 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.
Video files and Q&A from the CMS Hospice Quality Reporting Data Collection Training webinars conducted in April are now available. There are two zip files located under Related Links on the Hospice Quality Reporting Spotlight Section webpage. One zip file contains four versions of the structural measure training videos and the other zip file contains four versions of the NQF #0209 measure training videos. There are four versions of each section of the training so hospices may choose to view either captioned or uncaptioned versions using either MP4 or Windows Media Video. The Q&A are located in the Downloads section on the same page.
In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
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How and how much Medicare pays for post acute care and where there is room for reform was the subject of the featured presentation at the Alliance’s annual meeting by Al Dobson of the Washington think tank Dobson/DaVanzo. The analysis was part of the Clinically Appropriate and Cost‐Effective Placement (CACEP) Project, which D/D has been engaged in on behalf of the Alliance for Home Health Quality and Innovation (AHHQI). According to Dobson, the data present a powerful case for rethinking the role of home health not only for patients leaving hospitals, but for deterring hospitalizations for patients residing in communities. “The home health community has recognized that it is more cost‐effective than facility‐based settings,” said Dobson, “but until now, has lacked the data analyses to support anecdotal evidence.”
One of the study’s findings is that of those patients referred for some form of post acute care, 38% are referred for home care; but these patients represent less than 30% of post acute payments. Dobson also presented data on the range of patient pathways following an acute stay suggesting that globally paid providers and bundled demonstrations are going to take a hard look at these with an eye toward both costs and outcomes and with a goal of simplification.
The CACEP study has now produced three working papers, all of which are on the AHHQI website, free of charge.
All three branches of government, the Governor’s office, the State Senate and the House of Representatives have all now weighed in with versions of health care marketplace reform. Even with little time left on the legislative calendar and a state budget to craft, there seems no doubt that something will pass, perhaps quickly and with limited public input beyond what was provided to legislatures in the bill crafting stages.
All of the bills are about market and delivery system reform, with a strong emphasis on health care economics, payment reform at a very global letter and physician practice issues (medical homes, tort reform). There is very little in either bill about specific sectors beyond hospitals and physicians. In each bill there are limited mentions of “downstream” providers such as home health, hospice or adult day health. Workforce training has some prominence in both legislative branch proposals, as does Health IT (with home care a named recipient of possible funds). WBUR’s Commonhealth blog has a concise summary of the legislative proposals.
Where does this leave the debate and what does it mean for home health? At a very macro level, the Home Care Alliance has been working with a Coalition or providers and insurers on some principles to achieve sustainable reform without enormous disruption. The Coalition position is that any law must balance the need to reduce costs with a recognition that the health care sector is a key part of the state’s economy and that any measure must not lead to excessive reduction of jobs.
The Coalition is looking to support a bill that: 1) includes a voluntary (rather than mandatory) transition to integrated, globally paid systems; 2) preserves some fee-for-service payment where it makes sense in the market; and 3) includes a reasonable and attainable spending growth target, which the Coalition put at getting total health spending to 1% above the states Potential Gross State Product (PGSP) within three years and to even with PSGP within five years. By contrast the House and Senate bills call for a more aggressive glide path for health care spending, with the House looking at limiting growth to one half percent below PSGP. At a breakfast meeting with the Boston Chamber of Commerce this week, the governor indicated some support for the Coalition’s spending targets and voluntary transition process.
In terms of home care and hospice, it is clear that all bills envision a more integrated and accountable approach to care delivery. From what we have seen and heard relative to integration efforts that are already moving forward (Pioneer ACOs, medical homes), hospital utilization is targeted to go down and more care will be delivered in the home, both traditional home care/hospice and new chronic, palliative, and care transitions services. The goal is to be sure that these services are provided by the entities in this state that have the skills and experience to do it correctly.
However, the message from legislators is that much of what home care and hospice needs to do to ensure this may lie less in legislative language and more in market visibility: in having confidence in what we do, in being able to be more nimble pricing, and in demonstrating our effectiveness in reducing health care costs and delivering on quality.
The Alliance is supporting – beyond the Coalition principles above – reform language that would make more specific the language that exists in each bill about including home care services in integrated systems ACOs (Beacon ACOs, as the Senate bill calls them) and assuring our representation on certain governing task forces, such as that which will allocate state IT funds.
At the same time, we are also seeking to protect home cares services in the dual eligible demonstration and have invited Attorney General Martha Coakley’s office to our Annual Meeting to be sure that her efforts at looking the balance or imbalance in market power includes more than hospitals. We have published and made available to all provider groups and members a brochure on Home Care Role in a Global Payment Model.
Both our Board and our Legislative Committee are engaged in these efforts, but we need and welcome more member feedback about how we can continue to refine and advocate for a common industry position that assures home care a central role in the next chapter of healthcare reform.
Health reform in Massachusetts is an ever moving river of change. New legislation is expected within the month from both the Massachusetts Senate and House offering plans for more and faster delivery system reform. In February, the state began moving at an even faster pace to implement legislation from last session entitled “An Act to Promote Cost Containment, Transparency and Efficiency in the Provision of Quality Health Insurance for Individuals and Small Business.”
Ostensibly, this new law is intended to guide and govern the establishment of selective or tiered (and presumably less expensive) health plan offerings. The law charges the Massachusetts Department of Public Health with promulgating regulations requiring the uniform reporting of a standard set of health care quality measures by each “health care provider facility, medical group, or provider group.” The idea behind this new and potentially quite expansive quality data collection (and reporting) is to allow business who are buying (and consumers who are choosing) these selective network plans to make decisions based on comparable quality measures. These quality measures may also eventually aid state government in measuring the performance of various and soon to be operating integrated healthcare systems, such as ICOs, ACOs, and PCMHs.
Not counting ex officio government officials, the Committee has only six members who are charged with selecting these measures. While the Committee has significant discretion, the enabling legislation established some priorities and data sets that they must consider, including – for hospitals- using some data from the CMS process measures, HCAHPS and HEDIS.
At their most recent meeting, the Committee considered the 170 data elements contained in these three hospital measure sets and began narrowing it down – based on evaluation of validity, reliability and practicality (ease of accessing) – to 30 or 40 elements that may emerge as strongly recommended for inclusion in what would become a standard quality measure set for the state.
The legislation also instructed that the Committee consider as quality improvement priority areas: care transitions and care coordination, behavioral health and post acute care. The Committee has yet to tackle these areas and has been clear that their areas of initial focus remain hospitals and community health centers. Although the Committee did in March solicit public opinion as to others measures to consider beyond the hospital ones mentioned above (and the Alliance did send in comments), as the Committee is structured only recommendations will be truly considered that are put forth by one of the six committee members.
This Committee is moving quickly. Post acute care and care transitions are on the agenda for their April 12th meeting in Boston.
Once again last week, home care was in the news in a major press statement from CMS and on national television. Unfortunately, the stories weren’t about the patients and families receiving incredible comfort and care from our skilled teams, or about hospitalizations prevented, or healing advanced. The news was about the indictment of Dallas physician Jacques Roy – accused of running a 485 factory that “certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States.” Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past five years, for services totaling $375 million. Five people have been indicated and Medicare payments to 78 agencies have been suspended.
The Home Care Alliance of Massachusetts has tried to lead when it comes to ensuring an industry that is ethical and trusted by patients and referrals sources. Several years ago, we added a Code of Business Ethics to our membership application. We have taken a strong stand against unchecked growth, supporting language in the Affordable Care Act that gives the federal EOHHS Secretary to impose temporary moratoriums in areas that have sufficient coverage and unsustainable growth. In 2010, we suggested in a letter to Secretary Sebelius that the the 25% growth of new agencies in four years in Mass deserved some EOHHS attention. We have expressed concerns to federal and state regulators about the deemed accreditation process, whereby new agencies gain entry into the market, and about the need to make it more rigorous, We have published – mostly for our referral partners in physicians offices and assisted living – several pamphlets (“Keeping It Legal”) on referrals, kickbacks and other prohibited practices.
This week we in response to the Texas news, the Visiting Nurse Assoiciation of America called on CMS “to use its authority to put a temporary moratorium on home health until better controls to prevent waste, fraud and abuse can be put in place. Enforcement,” VNAA said, “is not enough.”
Next week, the Board of Directors of the Home Care Alliance will be meeting. What do the members think should be our position on the “Texas situation?”
Today’s (January 23, 2012) issue of Home Health Line reports that “pressure from government auditors may lead to the revival” of the TPL demonstration that ran for seven years in Massachusetts, Connecticut and New York and that handled resolution of home health payments through a sampling rather than a case by case medical review. The source of this information is an unnamed “industry official. ”
At this point in time, the Home Care Alliance has not heard of any specific intent to reinstate the demonstration – although we have asked that it be done in meetings at CMS in Washington and locally, and in comments to the new federal office examining care for dual eligibles. The Alliance has been invited to present issues with the current TPL process at meeting at CMS Boston office in mid-February.
Prior to the February meeting at CMS, the Alliance has meetings scheduled with NHIC and MassHealth to discuss process and recoupment issues. In previous direct emails, we have asked that members who have cases in which recoupments were made in error, HHABNs were lost or mishandled, or records were lost or mishandled to please provide this information in as much detail as possible to either Tim Burgers or Pat Kelleher, as soon as possible.
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This past week, Helen Siegel, our Director of Regulatory and Clinical Affairs retired after 17 years of supporting our member agencies in all issues clinical, QI, and regulatory. Helen took more calls than anyone in our office and responded to any and all questions sent her way. Her knowledge and presence will be missed.
As part of her send-off, her peers at the Alliance prepared this for her:
Twas the night before Christmas, At the Alliance, Park Square
Not a creature was stirring, was noone there?
No stockings were on the desks or the walls
Not even the blue tree with disco glitter balls.
No TPL calls, no help me to start
No meetings, no minutes, not a single faxed chart.
The staff were all quietly digesting the news
Helen’s departing, who’ll fill her shoes?
No visions of sugar plums, no candy canes
Can sweeten the blow, can help ease the pain.
When all appeared lost, Tim said, I have a plan
We’ll write to Santa, yes, Santa’s our man.
We’ll ask him to find someone…not naughty but nice
Who can take all these calls, and give good advice.
And if he could, perhaps someone who knows,
face to face and QI, and maybe the SCOs.
The email was sent and then we waited and waited
I guess even we knew our wish too inflated.
For even for Santa the task proved too rough
A replacement for Helen, that’s just not his stuff.
Skills like these, well the fact that years to hone,
Good thing Helen still has her cell phone!
But tis the season of miracles and light
One by one, the eight candles bring hope, and burn bright
So with hope for the future, and a fate we can’t fight
Happy Retirement, Helen
And to all, a good night!
Happy Holidays and Peace and Joy in 2012.
Think Home Care Blog 