Category: Advocacy

March on Washington Part I

Home Care Alliance members With Senator John Kerry

The Home Care Alliance was pleased to join members from Hebrew Senior Life Homehealth  Care, Overlook VNA, Partners Home Care, VNA of Boston and VNA of Middlesex East in Washington, DC this week to make sure that as health reform’s changes move forward in the coming years, home care and hospice are treated fairly and our patients’ interests are protected.

The days included briefings with staff from 8 of our 11 Congressional offices and a Senate breakfast briefing that featured remarks from Senators Susan Collins, John Kerry (see photo with Alliance delegation) , Chuck Grassley, Russ Feingold,  Ben Cardin, Jeff Merkley, Amy Klobuchar, and John Thune.  Senator Scott Brown and his staff also met with some members of the delegation.

Rey Spadoni, Executive Director VNA of Boston with Senator Scott Brown

More will be written soon on these meetings and the message delivered; and some video and pictures will be posted to our Facebook page.

The member agencies that took the time and expense to travel to Washington and speak to home care’s issues deserve the appreciation of all Home Care Alliance members.

—-  Pat Kelleher

March on Washington from Home

The Home Care Alliance will be in the nation’s capitol on April 11-13 for the NAHC “March on Washington.”

For those who cannot make it to Washington DC, you can still participate in the “March” by calling your federal representatives and asking for their support of home care. NAHC has made background information and recommendations available and the office information for the state’s federal legislators are below. Make the call or send an email from our Legislative Action Network!

Not sure who your elected officials are? Click here.

  • Congressman John Olver
    202-225-5335
  • Congressman Richard Neal
    202-225-5601
  • Congressman McGovern
    202-225-6101
  • Congresswoman Tsongas
    202-225-3411
  • Congressman Tierney
    202-225-8020
  • Congressman Barney Frank
    202-225-5931
  • Congressman Lynch
    202-225-8273
  • Congressman Capuano
    202-225-5111
  • Congressman Markey
    202-225-2836
  • Congressman Delahunt
    202-225-3111
  • Senator Brown
    202-224-4543
  • Senator Kerry
    202-224-2742

Care Transitions And Home Care

For the many who have expressed interest, what follows is an update from the perspective of home care and the Home Care Alliance on Care Transitions – and the intersection with STARR efforts in this state.   A number of members are already involved in many of these efforts, but more input is welcome and needed.

The Alliance’s Care Transitions Task Force has met several times to continue work on a document we are calling our “Opt In” framework:   “Optimum Performance Standards for Transferring Patients To and From Home Health Care.” We have a good first draft and various pieces are being rewritten by Task Force members.     This will be a tool we provide to member agencies;  but it will also serve as a framework for partner providers to help them understand what they can expect when making a referral to home health.  This group will meet again in Brockton on April 27th at 11am.

Two additional efforts are underway in relation to the IHI STAAR project.  IHI is working with their project team on a Field Guide for Home Health – which will mirror those that have already been published for Physician offices and Skilled Nursing Facilities. These Guides – which I am happy to forward to anyone would like them – focus on encouraging use of evidence based best practices in the area of readmission reductions.   Some of these practices  – obviously  – have to do to with what happens during  “handovers.”  We have had a call with IHI on the outline for home health,  and several members have agreed to spend some time with IHI in Cambridge on either April 29 or 30 on actually beginning to draft the full document. Cheryl Pacella of Hebrew Senior Life HomeHealth Care is playing a lead role in facilitating this.

Additionally, the STARR project is looking at reducing readmissions through an ‘Enhanced Admission” tool. Given that our agency members on STARR teams – as well as those of us on the STAAR Steering Committee – have identified that hospitals may NOT be appropriately identifying who needs and could benefit from home health care, the team is looking at potentially modifying a QIO tool developed as part of HHQI to recommend be used as part of a process for screening all – or high risk patients – for home care.  We are needing to do a thorough industry review of this tool and make recommendations to IHI.  This will eventually be discussed on a STAAR home health call.  These calls are now open to any  interested agency (see previous post to this blog.)

Finally, one of the first action items from the state’s Care Transitions Plan will be to revise the three page discharge form to meet information needs of sending and receiving health care entities.   A Task Force with HCA representation will start meeting this month. As available, we will share for input with  this group.

These are all ambitious projects that can not be done without member input.  If you are not yet involved, it’s not too late to be so.  Just reply here or send me an email.     Thank you to all who have been supporting these efforts.

Pat Kelleher

Return to www.thinkhomecare.org.

Key Home Health and Hospice Provisions Included in Health Reform

With all the changes through the process, it was difficult at times to keep up with the provisions of national health reform that applied to home health and hospice.

Luckily, the National Association for Home Care & Hospice (NAHC) has released the key provisions for both home health care and hospice, and included the general employer requirements.

For more information, see HCA’s other blog posts on what the house passed and the House “reconciliation” summary, or type “health reform” into the blog’s search feature.

Return to www.thinkhomecare.org.

Elder Affairs Releases Nine Principles for Aging Well

At an event held at UMass Boston with Governor Deval Patrick, Executive Office of Elder Affairs Secretary Ann Hartstein released the “Nine Principles for Aging Well.”

The Home Care Alliance, as part of the Elder Stakeholders group that regularly meets with AARP and Secretary Hartstein, assisted in the formation of these principles, which includes:

  • To have access to affordable long-term services and supports that can sustain individuals in the setting of their choice, including a consumer’s full participation in managing services.
  • To lend meaningful support to caregivers to preserve the beneficial impact caregiving has upon the caregiver, the person depending upon them and society at large.

These principles will be used to guide Elder Affairs and the Governor as they move forward with an aging agenda for the future (Click on the above image for a larger view).

Return to www.thinkhomecare.org.

Health Care Reform and Home Care: What We Know Today

On Sunday, March 21st the US House of Representatives passed historic Health Care Reform Legislation.   The bill that passed is that which emerged from the Senate Finance Committee and that passed the Senate at the end of 2009.   As has previously been reported,  the Senate version of reform has been – for home care – less damaging than bills that had previously passed the House. While indications are that there may be some changes to Medicare provisions in the “reconciliation” bill being debated this week in the Senate, there is no indication that there will be changes to the home care language.  What we should expect for home care will be:

• A delayed and phased approach to rebasing of home health payments (rebasing would begin in 2014 and be phased in over four years, as compared with the House’s proposal of complete rebasing in 2011);

• Rejection of the Medicare Payment Advisory Commission’s proposed acceleration to 2010 of the 2011 case-mix creep adjustment;

• Preservation of the full market basket update for 2010, with 1 percentage point reductions off the market basket in 2011, 2012, and 2013

• Reinstatement of the rural payment differential (add-on) at 3 percent from April 1, 2010 until Jan. 2, 2016.

The federal long term care program – the CLASS act – is in,  as are demonstration and pilot programs for providing chronic care management, transitions in care, and post-acute care management.  All of these should involve home care.

Additionally, effective in 2014, employers of more than 50 people will be required either to provide coverage or pay a penalty for not offering health insurance to employees. (It is unclear at this point how federal insurance mandates will be handled in relation to the Massachusetts mandates already in place.)

The National Association for Home Care has called the bill “a combination of new opportunities for home care — and threats to the viability of the home health services community.”

With many of the home care cuts  delayed, and demonstration projects to help shape, we will need every voice in Washington to make sure our issues continue to be heard above the continuing health care reform roar.

Health Reform Reconciliation Summary

With a historic vote set for this weekend where the US House of Representative will vote on the Senate’s health reform proposal, there will again be changes to what may eventually be the final package.

In addition, there will be a House supplement or reconciliation bill with provisions from the House proposal. For more information, see the House Committee on Rules Section-by-Section summary of The Health Care & Education Affordability Reconciliation Act of 2010.

Return to www.thinkhomecare.org.

What’s Next for Health Care Reform in Massachusetts?

Three days of hearings by the Mass Division of Health Care Finance & Policy (DHCFP) on Health Care Cost Trends in Massachusetts started with a bang as the Attorney General of Massachusetts Martha Coakley released and testified on a report from her office detailing how clout and market share and not quality contribute to wide variation in reimbursement and drive prices up in Massachusetts.

Also being considered and discussed by state officials are data on payment variation submitted by insurers – such as these from Harvard Pilgrim Health Care, which also appeared in the Boston Globe.

At stake in the discussions are some very immediate proposals by the Governor to expand the authority of the state’s Division of Insurance to approve or deny health insurance premium increases.  Longer term, these hearings are about degree of regulatory oversight of premium and rate setting, urgency and viability of global payments and/or systemic payment reform and ultimately, perhaps, the success or failure of the Massachusetts  universal health insurance law.

For those who are interested in what may shape health care reform in Massachusetts for the near future, the event is available through Live Streaming: http://vpc.umb.edu:8080/ramgen/broadcast/live.rm

Or view the powerpoint presentations as they are posted at DHCFP website.

Otherwise stay tuned.

Return to www.thinkhomecare.org.

Alliance Board Approves ACO Position

The Home Care Alliance Board of Directors approved an official position for the organization on Accountable Care Organizations, including guiding principles that the home care industry would like to see included as payment reform moves closer to a reality.

To support a care model that is appropriately inclusive of a robust community health care network, the Home Care Alliance of Massachusetts believes that the Accountable Care Organization design must:

•    Recognize the value of true clinical integration between acute and post acute care

•    Consider carefully the current composition of the home health care industry, their unique patterns of care delivery  and their dual role as providers of both post acute services and (Medicaid) long term care, and

•    Include in the infrastructure design some explicit direction on the use of home health services that supports inclusion of existing quality providers and avoids unintentional development by ACOs of duplicative community care services.

Download the ACO position document for more information and contact the Alliance with any questions or comments.

Return to www.thinkhomecare.org.

Home Care, Palliative Care and Advanced Illness Management

The CHAMP program at the Center for Home Care Policy & Research of the Visiting Nurse Service of New York has developed a useful website that consolidates many evidence based tools and studies aimed at promoting high quality home based care.   In a new posting on their community blog, Dr Eric Widera of the Division of Geriatrics at UCSF discusses the power home care agencies have to provide innovative care that can integrate the palliation of symptoms, care coordination and advance care planning earlier in a patient’s disease trajectory. Included in his discussion of this timely issue – given the STAAR and End of Life Care Expert Panel projects in Massachusetts – is a link to CHAMP’s Evidence Brief on Advanced Illness Management.   Does this look like something your agency is already doing? Or could be? Comments welcome.