Category: News & Media

Celebrate and Raise Awareness: November is National Home Care and Hospice Month

Every year, the home care and hospice community celebrates and raises awareness of the services that help keep people independent and at home for National Home Care & Hospice Month and National Family Caregivers Month in November.

With the Joint Select Committee on Deficit Reduction debating proposals to reduce the nation’s debt by trillions of dollars, the advocacy focus for this year must focus on opposing suggestions to impose copayments on Medicare home health services. A message also has to be sent that home care paid it’s fair share, $39.7 billion over ten years to be exact, for implementing the Affordable Care Act as well as how the industry has been thrown years of regulatory reductions.

Home care and hospice are cost-effective methods that care for people in the setting where they are most comfortable and familiar. Please help the Home Care Alliance raise awareness of these important issues and services, but also celebrate the great work performed by aides, clinicians, managers and all staff that make those services possible.

Here are some ways to celebrate and raise awareness for National Home Care & Hospice Month:

For Providers –

Press Release: Tailor this press release on National Home Care and Hospice Month to include information about your agency and the services you provide. Then, distribute to your local newspaper and/or local senior newsletter (Please contact the Alliance if you would like assistance or have any questions). There is also a separate press release template for hospices.

Op-Ed/Letter to the Editor: Select from the Opinion-Editorial drafts below depending on your interest (HCA would be happy to work with agencies on more specific or localized op-eds or letters to the editor).

For Everyone –

Facebook: Go to the Home Care Alliance’s Facebook page and click “like” on the most recent status regarding Home Care Month.

Twitter: add the hash-tag #homecaremonth to your tweets this month and especially if you’re helping celebrate and raise awareness.

Posters: Download and print the posters below. Post in your home or office, or send to friends and colleagues.

Advocacy: Send an email advocacy message to legislators from HCA’s Legislative Action Center.

Resources for Caregivers:

-Order the Home Care Alliance’s new 2012 Guide to Private Home Care Services and see HCA’s other helpful publications.

–Alzheimer’s Disease caregiver tip sheet from the National Family Caregivers Association.

–Guide to Advance Care Planning from the National Hospice & Palliative Care Organization.

-Information on the Home Care Alliance’s Home Care Accreditation Program.

-Read President Obama’s Proclamation to honor National Family Caregiver’s Month.

Return to www.thinkhomecare.org.

A Challenge to Home Care

Interesting and at least a bit encouraging, the CMS Director Don Berwick references home health as an essential part of a coordinated, seamless, patient centered care team in his October 20th, editorial in the New England Journal of Medicine (“Making  Good on ACO’s Promise). But, Dr Berwick leaves home health out of the definition of what will be required of applying entities to become Medicare’s first ACOs.  Dr Berwick presents  a vision in which Medicare beneficiaries “should find their care experience enhanced by a program that supports providers in engaging with their patients to deliver on the three-part aim: better care for individuals, better health for populations, and lower cost growth through improvements in care.”

Clearly Dr Berwick’s  vision is one that we all of share.  “Coordinated care,” he writes, ” is meant to allow providers to break away from the tyranny of the 15-minute visit, instill a renewed sense of collegiality, and return to the type of medicine that patients and families want.”  In this brave new world of coordination and collegiality, it will still be up to home care  to “sell” these organizing entities that home care has long understood and practiced patient centeredness, and that we have experience to spare and to share.

The Alliance is committed to helping us rise to Dr Berwick’s challlenge.

Find a full copy of the rule, here.


CLASS Act – Over Before it’s Begun

Once again, the needs of an aging nation in terms of support for long term care have been pushed aside with HHS Secretary Kathleen Sibelius’ announcement that the Obama Administration will not proceed with plans to implement a federally coordinated, voluntary national long term care insurance plan – known as the CLASS act

According to today’s Wall Street Journal, HHS officials gave up after “actuaries spent 19 months attempting to design a voluntary long-term care insurance program that met the requirements of the law.”  That called for making sure the program would remain fiscally solvent and pay for itself for at least 75 years.

Although the Class Act provision is little linked to the Affordable Care Act provision around providing basic health insurance universally, its  demise has inched open further the door to those who seeking to dismantle all of ACA piece by piece.   Senate Minority Leader Mitch McConnell (R., Ky.) said. “It is worth remembering that the Class Act is only one of the unwise, unsustainable components of an unwise, unsustainable law.”

Just what is unwise and unsustainable in your opinion: providing basic coverage and seeking a collective and shared solution to an aging society?   Or doing nothing?

Reports: CLASS Act Program is Being Removed from Health Care Reform

News outlets across the country are reporting on the elimination of the CLASS Act (Community Living Assistance Services and Supports), which would have provided a modest long-term care insurance benefit to help elders access community care services and remain in their homes.

This provision would have been a boost to home health, but research and reports by Health and Human Services found that there was no way to ensure that the program would be sustainable and the official announcement to repeal the program came late Friday afternoon.

The move itself, aside from political posturing, does not change the fact that there is “an enormous need” for long term care insurance as HHS Secretary Kathleen Sebelius put it. The New York Times quoted Secretary Sebelius as adding “At $75,000 a year for a nursing home and $18,000 a year for home health care, most families cannot afford to pay out of pocket.”

Return to www.thinkhomecare.org.

“At $75,000 a year for a nursing home and $18,000 a year for home health care, most families cannot afford to pay out of pocket,” she said.

HCA Issues Statement on Home Care Copay Proposed by President

In response to President Barack Obama’s proposal to impose a co-payment on Medicare home health services, the Home Care Alliance has issued a release to the press. Any home care agencies or concerned advocates is encouraged to follow up with local media and make the public aware of this proposal.

Below is the Home Care Alliance’s statement:

President Proposes Home Health Copays to Help Reduce Federal Deficit

Industry Calls Copayments an Inappropriate Burden and a Tax on Most Vulnerable Elders

Boston, MA – With the debate over the federal budget debt ceiling heating up, the Home Care Alliance of Massachusetts has joined organizations from across the nation in vehement opposition to President Barack Obama’s proposal to impose co-payments for Medicare Home Health Services.

What began as a recommendation to Congress by the Medicare Payment Advisory Committee (MEDPAC) is now entrenched in discussions over how the country will raise revenues and reduce spending.

“It has been shown in many studies that copayments are an inefficient and regressive ‘sick tax’ that falls most heavily on the poorest and oldest Medicare beneficiaries,” said Patricia M. Kelleher, the Executive Director of the Home Care Alliance of Massachusetts. 

Congress eliminated home health copayments in 1972 as part of a Medicare modernization effort that concluded that such copayments fell disproportionately on the home health users with the highest Medicare expenses and the worst health status. Moreover, they discouraged using home health in lieu of more expensive nursing facility stays. As recently as 2003, Congress rejected a home care co-pay proposal for the same reasons.

President Obama’s proposal calls for a copayment of $100 per Medicare episode and excludes Medicare episodes immediately following a hospital stay. The measure would only apply to new beneficiaries beginning in 2017 and is estimated to save approximately $400 million over 10 years.

“Imposing of a copayment would continue an assault on the Medicare home health benefit that witnessed $39.7 billion in cuts passed by Congress last year,” said Kelleher. “Additionally, on January 1, 2011, Medicare added a new impediment to accessing services by requiring that homebound elderly and disabled patients, as well as hospice patients, will now need to have a ‘face-to-face encounter’ with a physician or nurse practitioner in order to receive home health services under Medicare.”

Most home health users are age 75 or older and in very poor health.  A Commonwealth Fund Report recently found that individuals of all incomes with fair or poor health status or age 85 and older spent almost 30 percent of their income already on uncovered medical care, primarily due to Medicare gaps, deductibles and copayments. Additional publications, including the New England Journal of Medicine, have released findings that an increase in such copayments lowers utilization and increases hospitalizations.

“Home health agencies in Massachusetts have supported aggressive efforts to slow growth of home health spending, including testifying in support of a moratorium on new agencies,” said Kelleher. “Asking patients to pay more is not the answer.”   

Return to www.thinkhomecare.org.

Blue Cross AQC Contract Examined

An article in this week’s New England Journal of Medicine takes an interesting look at the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract in terms of its impact on cost and quality and lessons it may hold for broader attempts to move towards global payment, locally and nationally.

The report – Health Care Spending and Quality in Year 1 of the Alternative Quality Contract – was compiled by researchers at the Harvard Medical School, the Heller School and Boston University. According to the report the AQC contains three distinguishing features.  First, physician groups, in some cases together with a hospital, enter into 5-year global budget contracts (rather than standard 1-year contracts).   Second, AQC groups are eligible for pay-for-performance bonuses up to 10% of their budget, with performance measures of ambulatory care and hospital care each contributing to half of the calculation of the bonus. Third, AQC groups receive technical support from BCBS, including reports on spending, utilization, and quality, to assist them in managing their budget and improving quality.

At present, the authors report, there are 321 PCP practices and more than 4000 physicians in the AQC.   The very general findings:

  • AQC was associated with modestly lower medical spending and improved quality in the first year after implementation.
  •  AQC quality bonuses are much higher than those in most pay-for-performance programs in the United States, since they apply to the entire global budget rather than to physician services alone or PCP services alone.
  • Procedures, imaging, and testing accounted for more than 80% of the savings. Savings derived largely from less spending on facility services in the outpatient setting. There were no significant changes in spending for inpatient care or for physician services.

The question raised is: are savings at least for this non Medicare population more in “shifting outpatient care to providers who charged lower fees” than in behavior change?  If so, what lessens are here for broader global payment models, especially those that involve Medciare and Medicaid?

 

State Bill Filed to Expand Hospice Coverage

According to a report by State House News Service, a bill was recently filed by a group of legislators that would expand hospice coverage to about 120,000 more residents on MassHealth.

Senate Bill 1999, An Act extending hospice care to the MassHealth basic and MassHealth essential programs was filed by Senator Patricia Jehlen and seeks what its title states. Hospice coverage, according to State House News, is available to about 1 million MassHealth recipients, but not to roughly 120,000 who are on more restrictive plans known as MassHealth Basic and MassHealth Essential.

The inspiration for this bill comes from a report assembled by the Massachusetts Commission on End-Of-Life Care, which was established by the legislature in 2009 to study issues surrounding end-of-life care and how such care is provided in the state.

The Home Care Alliance applauds the initiative to expand hospice coverage so that people can fulfill their preference to receive end-of-life care in their homes. While approximately 67 percent of Massachusetts residents say they would prefer to die at home, only 24 percent actually do, according to statistics compiled by the commission, the Massachusetts chapter of AARP, and the state Department of Public Health.

The legislation has been referred to the Joint Committee on Health Care Financing and the Alliance will continue to provide updates on this proposal as it becomes available.

Return to www.thinkhomecare.org.

HCA and Fred C. Church Collaborate on Promotion for WEEI Sports Radio

Thanks to Fred C. Church Insurance, the Home Care Alliance has an ad on WEEI Sports Radio (850-AM) that promotes the Alliance’s member home health agencies and especially the Home Care Accreditation Program for private pay home care agencies.

Hear the ad with the Alliance’s Associate Director Tim Burgers below, which is currently running on WEEI.

Return to www.thinkhomecare.org.

Alliance Meets with New Medicaid Director

photo of Julian HarrisThe Governor appointed a new Director of Medicaid in June and the Alliance has had the opportunity to meet with Dr. Julian Harris (pictured left) twice since he began acclimating to his new role.

HCA staff joined other advocates in a meeting that involved personal and organizational introductions to the new Director as well as a mention of a few top issues for each organization as it pertains to MassHealth activity. Prior to that, Alliance staff was among a small group of providers meeting with Health and Human Services Secretary JudyAnn Bigby and other officials on the Dual Eligibles Care Integration Project, which Dr. Harris sat in on.

According to a press release issued by the Governor’s office, Dr. Harris currently practices primary care at the Southern Jamaica Plain Community Health Center and hospitalist medicine at the Cambridge Health Alliance, both of which serve populations with high levels of participation in MassHealth and other state health programs. He is a clinical fellow on the faculty at Harvard Medical School and a senior resident in internal medicine and primary care at the Brigham and Women’s Hospital and its affiliated Southern Jamaica Plain Community Health Center. He formerly served at the World Bank, where he was charged with day-to-day management of the World Bank Institute’s AIDS program. He also worked on national health payment and delivery system reform for an international client at McKinsey & Company.

The Alliance looks forward to working with Dr. Harris on the challenges and opportunities for home care and MassHealth members.

Return to www.thinkhomecare.org.

Mass State Website Looks To Add Home Health Compare Data

At its July meeting, the Massachusetts Quality and Cost Council (QCC) put on its agenda for the coming year a plan to place CMS  Home Health Compare data on its consumer education website.  The state’s My Health Care Options website was established by the Mass QCC as a resource for patients and families looking to make informed health care choices. The majority of the data on the site to date have been on hospital and medical practice quality and costs, with a new update of these data posted in January 2011.

Home health care was identified in the QCC’s Three Year Reporting Pla as “a vital service to the aging population and  an important area of information for consumers.”  The Council is exploring options to download the CMS data in a consumer friendly format, as opposed to simply placing a CMS website link.  The costs and feasibility of this are being reviewed prior to the Council’s next meeting.

Are consumers or other referral sources using CMS data now? Will  it get more visibility on the state’s website?  What are your thoughts?