A key tenet of the Massachusetts Quality Improvement Initiative is an efforts to improve the flow of patients – and information – from one health care setting to another. The state’s broad plan is laid out in it’s recently released “Strategic Plan for Care Transitions.” Care transitions are an obvious choice as it is an area in which data indicate Massachusetts can do better. The federal AHRQ 2008 state rankings place Massachusetts seventh overall for health system performance, but 33rd in avoidable hospital admissions and costs. For your consideration: How can home health care contribute to an improved care transitions infrastructure? In terms of medication reconciliation? Chronic care symptom management? Screening for readmission risk? The state’s attention to this issue, can be home health’s opportunity to shine. Your comments and ideas are welcome.
Category: Advocacy
HCA Offers Comments on State HIT Plan
The Massachusetts eHealth Institute (MeHI) posted their draft of the state Health IT plan, a roadmap meant to guide Massachusetts towards establishing electronic health records (EHRs), and are accepting comments until February 16.
MeHI was recently designated by the Governor as the Regional Extension Center (REC) for the state. The REC, according to their website, “provides direct assistance and best practice tools to assist health care providers, especially primary care providers, in their meaningful adoption of EHRs.”
The Alliance suggests home care and home health agencies offer comments on the plan so that the industry can be more involved in the implementation process.
Here are the comments, by section, offered by HCA:
Section 1: Executive Summary
In improving “person focused” health care (Goal 1), improving the quality and safety of health care across all providers, and having that quality of care be consistent and predictable (Goal 2), home health should be looked upon to more effectively achieve that mission. The involvement of home health would further improve the efficiencies in HIT that will slow the growth of health care spending (Goal 3).We agree and support that interoperable health records (strategy 3) should be in all clinical settings and while 40 percent of providers use EHR’s, the number goes above 75 to 80 percent when dealing with home health agencies in Massachusetts.
Home health would also serve as an asset in supporting care coordination, patient engagement and population health (strategy 4).
Section 2: Intro
Typo under future state regarding prescriptions and refills.Section 3: Multi-Stakeholder Governance
Under the graphic of how Ad Hoc Workgroups participate in the decision making process (Figure 3.2), we hope that the workgroups will recognize home health as an “option for MeHI to pursue” and that we will be identified as a gap “in knowledge or representation.”Section 4: Establish a Privacy Framework to Guide the Devlopment of a Secure HIT Environment
Meaningful use care goals are reflected in home health. For instance, clinical decision support, enhanced care coordination and exchanging meaningful information across the health care team are a few areas of expertise for home health.Section 5. Implement Interoperable Electronic Health Records in all Clinical Settings and Assure They Are Used to Optimize Care
Since hospitals and doctors are priority providers, other providers could be a part of the loan program to jump-start their involvement.Section 6. Develop and Implement a Statewide HIE to Support Care Coordination, Patient Engagement and Population Health
Home health may not be involved in an HIE, but the experience of home health agencies’ use of EHR’s could also be looked to for lessons and guidance.Section 7. Create a Local Workforce to Support HIT Related Initiatives
No CommentsSection 8. Monitor Success
No CommentsSection 9. Path Forward
No Comments
Appendix A: Terms and Definitions
No CommentsAppendix B: Additional Services Considered for the Statewide HIE
No CommentsGeneral Comments
Realizing that home health is not a “priority provider,” and knowing that all provider types will eventually be roped in, I tried not to belabor each individual section with ties to how home health should be included.The state plan has to follow certain guidelines set by the ONC, but it is our hope that home health will be among the next round of providers that are implemented. With that said, we support the vision of implementing Health IT in all clinical settings (pg 32) for the purpose of better patient self-management.
Thank you for taking and considering our comments.
Return to www.thinkhomecare.org.
New Advocacy Message: Support Nurse Delegation!
As previously posted on this blog and the Alliance’s February 5 newsletter, the legislature’s Joint Committee on Public Health advanced a major HCA legislative priority regarding nurse delegation.
The legislation, known as Senate Bill 860, An Act Relative to Home Health Aides, is now being considered by the Joint Committee on Health Care Financing.
The proposal, submitted by the Home Care Alliance and filed by State Senator Richard T. Moore, would refine the Commonwealth’s Nurse Practice Act (NPA) to allow nurses to delegate the administering of certain medications to qualified home health aides in the home setting.
To help this bill advance further, a new advocacy message is available on the HCA website’s Legislative Action page. Send and spread the message to help make home health care services more efficient.
To learn more, see HCA Board President Patricia O’Brien’s testimony to the Public Health Committee.
Return to www.thinkhomecare.org.
McGovern Sends Delegation Letter Requesting Meeting with CMS on TPL
Congressman Jim McGovern has sent a letter to CMS Acting Director Cyndy Mann with a request that Mann meet with him and the Home Care Alliance on continuing the Third Party Liability (dual eligible) demonstration project.
The demonstration allows decisions about the appropriate payer for home health services to Medicare/Medicaid dual eligible elders to be handled by a 200 case sampling rather than a case by case review.
“Annual review of two hundred cases per state has been a better systemic solution than previous practices in which thousands of cases, with immense red tape, make their way through multiple levels of review and appeal,” said the McGovern letter.
Joining Congressman McGovern in signing on from the Massachusetts Congressional Delegation were Representatives Capuano, Delahunt, Frank, Lynch, Markey, Olver and Tsongas.
MassHealth administrators have also written to CMS this week, urging that the demonstration project be extended.
The demonstration has been a tri-state effort with New York and Connecticut, whose associations have been working hard advocating for an extension as well.
Return to www.thinkhomecare.org.
Major HCA Legislative Priority Advances
The state legislature’s Joint Committee on Public Health has favorably reported out Senate Bill 860, An Act Relative to Home Health Aides.
The proposal is a major legislative priority of the Home Care Alliance and would refine the Commonwealth’s Nurse Practice Act (NPA) to allow appropriate nurse delegation practices to include delegation of medication administered by home health aides in the home setting.
More information will follow soon, along with advocacy action, so be sure to check back.
Return to www.thinkhomecare.org.
Statewide HIT Plan Released, HCA Seeking Comments
On Friday, Jan 29, The Massachusetts eHealth Institute released its “Massachusetts Draft State-wide HIT Plan” for a two-week public comment period. The plan outlines a number of goals for the expanded use of electronic health records and initiatives to improve the sharing of health information across care settings. The goals outlined in the draft document include:
Goal 1: Improve access to comprehensive, coordinated, person-focused health care through widespread provider adoption and meaningful use of certified EHRs.
Goal 2: Demonstrably improve the quality and safety of health care across all providers through HIT that enables better coordinated care, provides useful evidence-based decision support applications, and can report out data elements to support quality measurement.
Goal 3: Slow the growth of health care spending through efficiencies realized from the use of HIT.
Goal 4: Improve the health and wellness of the Commonwealth’s population through public health programs, research, and quality improvement efforts enabled through efficient, reliable and secure health information exchange processes.
The plan addresses these goals through six specific strategies. Each strategy is detailed in a separate chapter of the Plan:
Strategy 1: Establish Multi-Stakeholder Governance.
Strategy 2: Establish a Privacy Framework to Guide the Development of a Secure HIT Environment.
Strategy 3: Implement Interoperable Health Records in all Clinical Settings and Assure They Are Used to Optimize Care.
Strategy 4: Develop and Implement a Statewide HIE Infrastructure to Support Care Coordination, Patient Engagement, and Population Health.
Strategy 5: Create a Local Workforce to Support HIT Related Initiatives.
Strategy 6: Monitor Success.
Unfortunately, the plan focuses almost exclusively on hospitals and physician’s offices. Home health is discussed only once:
“All providers must eventually adopt interoperable and certified EHRs in order for the Commonwealth to realize measurable improvements in quality, safety, efficiency, and population health. However, like the federal government, the Commonwealth will need to prioritize efforts and address specific types of providers first. Once the majority of physicians and acute care hospitals have adopted EHRs, other types of health care settings or providers–such as dental, chiropractic, long term care, home health, behavioral health, and pharmacy– will be included in subsequent state efforts.”
The Alliance is drafting comments to urge that home health be brought into the plan as early as possible to bring care coordination into the home setting. Alliance members encouraged to submit your own comments by February 14. (Please forward copies of your comments to James Fuccione, Director of Legislative and Public Affairs, at jfuccione@thinkhomecare.org).
Return to www.thinkhomecare.org.
Governor Releases FY2011 Budget
Governor Deval Patrick released his budget blueprint for fiscal year 2011 and the proposal is kind to most health services, including home care, despite a bleak fiscal forecast.
Medicaid Director Terry Dougherty led a MassHealth budget briefing and revealed that Health and Human Services was one of two secretariats (Along with Veterans’ Services) that saw an increase in funding under the Governor’s budget. Chief among the line items that are of importance to the Home Care Alliance is the MassHealth Senior Care (4000-0600), which was increased $374 million, and MassHealth Fee for Service (4000-0700), which was increased $113 million.
Under the state’s Aging Service Access Points program (ASAP), items were level funded, including Purchased Services, Home Care Case Management, and the Enhanced Community Options Program.
Also of note is a $99 million increase for Personal Care Attendants, Adult Foster Care, Adult Day Health and Day Habilitation programs.
In all, Dougherty said they are assuming an increase in FMAP by $607 million and anticipating a 3 percent increase in MassHealth total enrollment. The Governor also filed a $200 million supplemental budget for MassHealth, as well.
However, the proposed budget relies heavily on new revenue sources to balance accounts, which is a troubling trend since the Legislature must pass new taxes and remove tax incentives to continue the funding the Governor proposes. In an election year, this may prove to be a difficult effort, and we hope that legislators will recognize the benefit the Home Care industry offers to the health care system as they deliberate upon what will likely be a more lean FY11 budget. House Speaker Robert DeLeo has already indicated through the media that his House budget, due in the spring, will not include a tax increase.
Some of the proposed new revenues include removing sales tax exemptions for “other tobacco products” along with candy and soda. The soda and candy tax ban, in particular, is meant to raise nearly $52 million for public health services.
Even with that hurdle, this Governor’s budget is relative good news for the Home Care Alliance who will begin advocacy directed at the legislature as they formulate their own budget proposal. The Alliance will also be pushing legislative priorities such as Nurse Delegation of Medication Administration, Falls Prevention, and telehealth along with our work on payment reform.
The Alliance will push for these and other initiatives that are cost-saving or cost-neutral while improving patient care and making easier the work of HCA members.
Return to www.thinkhomecare.org.
New Advocacy Message: Preserve Community-Based Services
A new advocacy message regarding the state budget is available on the Alliance’s Legislative Action Network! Let the Governor know you want home and community-based services preserved.
Just fill out your contact info and click send to do your part to advocate for home care!
Return to www.thinkhomecare.org.
Work Continuing from EOHHS Summit
The Alliance is still accepting thoughts, suggestions and concerns from members to bring to the follow-up meetings to the Health and Human Services Summit.
In late November, Governor Deval Patrick and Health and Human Services Secretary Judy Ann Bigby convened a Massachusetts Human Services Summit to gather ideas and suggestions on how state government, and human service providers and organizations, could move forward in the current economic situation.
The event, held at UMass Boston, was attended by 300 providers, advocates, consumers and others, including Home Care Alliance staff and several Alliance members. Attendees were broken into three groups that focused on “Improving Access to Client Centered Services,” “Strengthening the Capacity of Human Service Organizations,” and “Sustaining a Quality Human Services Workforce.” Participants were charged with addressing these questions:
1. What are the two to three major barriers (other than funding) that get in the way of working smarter and better?
2. What can we do together to remove these barriers?
3. What can state government and its private sector partners do to encourage and support innovation, both separately and in collaboration?
Alliance staff has been among those invited back to participate in follow-up workgroups who will continue to address these issues. For more info, visit the Human Services Summit website.
The Alliance would welcome any comments or suggestions on any of the above subjects so that we can be fully prepared to contribute. Workgroups will meet in mid-January. Please contact James Fuccione at the Alliance with any submissions.
Return to www.thinkhomecare.org.
NAHC Opposes So-Called Super MedPAC in Senate Bill
The National Association for Home Care & Hospice (NAHC) reported that the recently-approved Senate version of health care reform, the Patient Protection and Affordable Care Act, includes a provision to establish an Independent Payment Advisory Board (IPAB).
According to NAHC, the 15-member board’s primary task would be to make recommendations to Congress on extending the solvency of and slowing cost growth in Medicare, beginning in 2015 and forward. The Congressional Budget Office (CBO) estimates that the IPAB proposal would save $28.2 billion over 10 years.
Based on conditional Medicare spending triggers, IPAB recommendations would take effect unless Congress proposed an alternate plan. The provision in the Senate bill also requires that IPAB submit proposals to contain Medicare cost growth to the president, who in turn must submit proposals to Congress for immediate consideration. IPAB would be prohibited from submitting proposals that would ration care, increase revenues, or change benefits, eligibility, or Medicare beneficiary cost-sharing (including Parts A and B premiums). NAHC believes it is likely that the reductions would have to come from reimbursement rates for health care providers.
NAHC stated that they oppose this provision because it gives IPAB too much power and the 15-member board, appointed by the President, would be unlikely to have strong representation from home care and hospice. Nahc also stated that they have expressed their concerns to Senate and House leadership.
Visit our Legislative Action Center to write your own message to your federal representatives to voice your thoughts on this provision and send one of the pre-written messages to oppose cuts to home care.
Return to www.thinkhomecare.org.
Think Home Care Blog 