This week, the Alliance’s parent-provider skilled nursing campaign received national media coverage. The campaign seeks higher reimbursement rates from MassHealth for continuous skilled nursing services. Currently, agencies are unable to compete for nurses with area hospitals, and has led to a 37% nurse turnover rate, and nearly 24% of MassHealth-Authorized service hours going unfilled.
On Sunday, The Boston Globe featured a front-page story into the life of one of the parents caring for a child in the Massachusetts Continuous Skilled Nursing Program. Noelia Ferreira has gone over 100 days without a skilled nurse coming to her home to care for her daughter Abi. The article beautifully explains Noelia’s struggles to find adequate care and her commitment to keeping Abi safe at home.
As a result of this front page feature, WGBH invited Noelia and MA Pediatric Home Nursing Care Campaign founder, Angela Ortiz, to be interviewed by host, Jim Braude. Footage of the interview can be viewed here.
The campaign is leveraging this exposure to raise awareness and momentum in our fight for adequate reimbursement rates. Please visit www.mychildcantwait.com to write or call Governor Baker urging action.
As is always the case, the annual Our Time to Shine awards ceremony was filled with emotional moments about the challenge-reward dynamic that is working in home care. Our two Home Health Aides of the Year — Gach Clamp of Emerson Hospital Homecare and Nancy Quinlan of Aberdeen Home Care — were both supremely eloquent about the personal family care giving experiences that led them to second careers in home care.
It was, however, our Home Care Champions – the parent-led Massachusetts Pediatric Home Nursing Care Campaign (pictured above) – that really pulled together the story and impact of home care. Campaign founder Angela Ortiz – speaking for fellow parent awardees Lisa Burgess, Sue McCarthy, and Lauri Medeiros – described their campaign to get nursing reimbursement rates from MassHealth raised for the nurses caring for their children.
Angela painted an impassioned picture of the lives of these families, especially when hours of care that are needed and authorized go unfilled. She explained the tremendous family strain, particularly affecting the siblings, and the countless admissions to hospital ICUs. This unnecessary pain and suffering that could be mitigated, she said, with more home nursing support.
Angela wove themes into her talk from her daughter, Ayla’s, favorite movie, The Wizard of Oz, and the love that is the basis of all these families do to care at home for their medically complex children. The hours of work the families have put into the campaign, and the partnership with the agency providers that has formed, serve as a model for any advocacy group. While there is much more relief needed to get the Continuous Skilled Nursing rates to a place where agencies can compete with specialty hospitals for nurses, the state has raised rates by nearly 5% in one year, a direct result of this tireless campaign.
When the parents show the courage to stand up at a hearing to tell their story and they are fueled – said Angela – by the message behind Dorothy’s journey “There is no place like home.”
We couldn’t agree more, Angela. Congratulations: It’s an honor to work with you.
James Fuccione, former Director of Legislative and Public Affairs for the Home Care Alliance, was extensively quoted in an article in the Springfield Republican today. The article, “Personal care attendants have less training, checks than other home care workers,” by Shira Schoenberg, Statehouse reporter for the Republican, compares background checks and training requirements for workers in the state Personal Care Attendant program with workers employed by home care agencies that provide services under the Executive Office of Elder Affairs home care program.
Though a statement published in a Boston Globe online article, MassHealth revealed that their first round of home health agency audits uncovered $22.5 million in improper billing.
Nine home health agencies were involved in the initial audits conducted in response to steep spending growth in the MassHealth home health program. As the Globe article points out, the majority of that spending growth is driven by 62 companies that have come online since 2013.
In response, the Home Care Alliance is making its statement on the audits available. The full text of the statement is copied below:
Home Care Alliance of MA Statement on MassHealth Audits
BOSTON, MA – MassHealth announced today that audits of home health providers have uncovered more than $22 million in improper payments. The audits were initiated in an effort to identify the sources of recent dramatic spending growth on MassHealth home health services.
The Home Care Alliance of Massachusetts, a nonprofit trade association representing home health and home care providers, has been working side-by-side with the state Medicaid office staff since these audits were announced. The Alliance supported and continues to support MassHealth’s efforts to ensure appropriate services are being provided. This includes a temporary moratorium on new providers, and a prior authorization process for approving home health care services. In the months since the latter measure was put in place, both sides are in constant communication to relay concerns and suggestions. After years of lax oversight, Governor Baker’s administration has put a long-overdue emphasis on program accountability to assure that only eligible MassHealth members receive the in-home services they need to preserve their health and well-being.
“Massachusetts is fortunate in having some the best home health providers in the country and we support MassHealth in these efforts because we want to preserve the high standards of quality that patients and their families should expect,” said Patricia Kelleher, Executive Director of the Home Care Alliance of MA. “These audits only help to prove what our organization has been saying for years: There needs to be better state oversight as well as a higher bar of entry into the market.”
“Many of the MassHealth enrollees that our member agencies see have severe and persistent mental illnesses, and the multiple medications that they take can cause additional medical problems that require ongoing medical attention,” added Kelleher. “The agencies who do this work feel that they are a huge part of the health care safety net, providing valuable services to patients and families who otherwise would be placed in costlier care settings and/or become a detriment or even threat to their communities.”
The decision to add new management controls was driven by growth in utilization of the benefit particularly between FY 2013 and FY 2015. At present approximately 32,000 MassHealth enrollees are using home health services on an annual basis. Of these approximately 7,000 are receiving home health to assist in managing a mental or behavioral health condition, 4,000 are under age 21 and 9,300 are over age 61.
“Although MassHealth has not shared the specific audit results with us, we will continue to push for better standards and support program integrity efforts on behalf of all agencies that are playing by the rules and providing great care,” said Kelleher.
Home care had a prominent place in this year’s “Salute to Nurses,” a special section published every year in the Boston Globe recognizing the work of nurses in every health care setting.
The compassionate and high-quality care of nurses from several home care agencies were recognized, including CareGroup Parmenter Home Care & Hospice, Comfort Home Care, Emerson Hospital Home Care, Hallmark Health VNA & Hospice, and Home Health VNA. Many more stories from patients, their families and nurse colleagues highlighted cases where a nurse from a setting other than home care arranged for post-acute services or follow-up in some way.
Although it wasn’t from a traditional home care agency, another article was dedicated to Allison Neff, a nurse in Boston Medical Center’s “Elders Living at Home” Program. The article explains:
Neff joined the Elders Living at Home Program, which prevents homelessness among seniors, in 2008. Her job is to conduct home visits to ELAHP patients who don’t qualify for visiting nurse services provided by the state, but who need assistance with some aspect of their health. Many of her patients are at imminent risk of losing their housing, or were homeless and are now transitioning into housing.
The Home Care Alliance will be recognizing all levels of home care staff at the annual Innovation Showcase & Star Awards on June 14th. Clinicians, aides, managers, physicians and other home care champions can be nominated for recognition at the event’s website.
Home care is a tough and rewarding career, but now working for a home care agency could be one of the best places to be employed in general.
Several Home Care Alliance member agencies made a strong showing on the Boston Globe’s “Top Places to Work 2014,” where employee satisfaction surveys are used to judge how well companies treat their workers. This methodology propelled four agencies to be recognized on the annual list.
Comfort Home Care earned the top spot under the “large employer” category with an employee amount between 250 to 999.
In the “mid-size” company rankings with an employee number between 100 and 249 workers, three home care agencies made the list: Visiting Angels of Newton and Canton (#6), Able Home Care (#22), and Community Nurse & Hospice Care (#31).
Among the survey statements are the following:
■ Direction: “I have confidence in the leader of this company.”
■ Execution: “New ideas are encouraged at this company.”
■ Connection: “My job makes me feel like I am part of something meaningful.”
■ Management: “My manager cares about my concerns.”
■ Work: “This company encourages different points of view.”
■ Pay and benefits: “My pay is fair for the work I do.”
■ Engagement: “This company motivates me to give my very best at work.”
The Globe invited 1,660 companies to participate in the 2014 Top Places to Work survey. Of those, 366 organizations employing more than 336,000 people went all the way through the process, allowing the Globe to conduct a confidential survey of their workers.
The Home Care applauds the agencies in the “Top Places to Work” ranking and all agencies that keep people healthy and independent at home.
The latest available quality performance measures from Medicare’s Home Health Compare database for all Alliance member agencies was posted this week to the PatientCareLink website. The website is hosted by the MA Hospital Association, and the home health data is posted through a joint agreement between the Home Care Alliance and MHA.
To view the updated reports, visit www.patientcarelink.org and click on the “Healthcare Provider Data” tab and then “Home Health Agency Data” and then “Select an Agency.” The reports now incorporate data for the period July, 2013 – June, 2014, for all measures except measure #30, which is for the period of April, 2013 – March, 2014. In addition to each home care agency’s individual performance, the PCL pages also provide a comparison to the U.S. agency average scores.
“Providing high quality, safe patient care is a top priority for Massachusetts home healthcare agencies,” said Patricia Kelleher, Executive Director of the Home Care Alliance MA. “The home health data on the PCL site can be very useful to patients and their families. In addition, the partnership between hospitals and home health agencies on PCL furthers positive working relationships along the entire continuum of care, which can only improve patient safety and quality overall.”
NPR’s Talk of the Nation had a lengthy segment on the growing use of telemedicine, especially in home care. In addition discussing the benefits to patients with limited mobility or access to specific services they need and Medicare’s current refusal to reimburse for remote doctor consultations, the segment included a letter from the Alliance’s own James Fuccione, starting at 19’09”:
[HOST NEAL] CONAN: Here’s an email question that has some aspects of that that I wanted to ask you about, this from James [Fuccione] in Massachusetts: The Home Care Alliance of Massachusetts is advocating for Mass Health, [the] state Medicaid program, reimbursement of telehealth used by home health agencies.
Many agencies part of our association use telehealth already because it improves their quality and efficiency. They use wireless weight scales, blood oximeter, blood pressure cuffs, et cetera, and depending on their condition. So in other words you can collect data over these same circuits.
[DR. KAREN] EDISON: Right.
CONAN: Do you use that as well?
EDISON: Yes, so we do a lot of telehome care and remote monitoring here in Missouri. One of our large home health agencies in the southwest part of the state is probably the leader in that area. One of the challenges, of course, is the inter-operability of the health information systems. So as health information technology matures, and the companies become more inter-operable, they can talk to each other and transmit information easily.
You know, as that gets – as that whole industry matures, this is going to get easier and easier so that instead of the home health agency monitoring those patients, actually the patients – patient-centered health care home or medical home, their actual health providers would be monitoring those patients on a daily basis.
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