Payment Reform In Massachusetts Moves Forward

This month, researchers from the RAND Corporation presented a policy brief, Controlling Health Care Spending in Massachusetts, to the state’s Health Care Quality And Cost Council (HCQCC).  Massachusetts’  Division of Health Care Finance and Policy commissioned RAND to develop a menu of potential cost containment strategies. The report provides analysis of 12 possible interventions that the researchers conclude have the most promise to cut spending in Massachusetts. More than 75 broad approaches were initially considered.

Five of the top six approaches in the RAND report deal with health care payment and are consistent with the recommendation by the state’s Special Commission on the Health Care Payment Reform to move away from a predominantly fee-for-service system. Included are a recommendation and several scenarios around implementing bundled payments as a way to incentivize  better coordinated care. The model looks at bundled payments for certain hospital conditions for adults aged 18- 64. Also included in the model are major changes in payments to Academic Medical Centers, expanded Health Information Technology, and reduction of resource use at end of life.

The HCQCC is expected to begin looking at various timelines for implementing these recommendations in September.

Providers to Receive Letters for TPL Claims Beginning September 8, 2009

Providers should expect to see letters from “Commonwealth Medicine” representing the MassHealth TPL (Third Party Liability)  Unit on or about September 8, 2009. The letter, which will take the form of an “Initial Overpayment Notice,” will list those claims for dually-eligible beneficiaries that MassHealth has identified as requiring a Medicare determination of coverage. MassHealth is the payer of last resort and as the subrogee for these beneficiaries is requesting that you begin the demand bill process to determine if Medicare should have been billed for these services.    The claims in dispute are for Federal Fiscal Year 2008 or dates of service October 1, 2007 through September 30, 2008.

In preparation for this initiative, the Alliance in cooperation with MassHealth held 2 workshops for providers in July and August.  The process and expectations were discusses by representatives of the TPL Unit and the Provider Outreach and Education department of National Government Services reviewed the “demand bill” process.

For a copy of the TPL Powerpoint which includes an excellent timeline,  click here. For a copy of the NGS presentation discussing the demand billing process, click here

2009 Compensation and Benefit Surveys Available

We’re pleased to announce that the 2009 Compensation & Benefits Survey Reports are now available for purchase on our publications store.

The 2009 Compensation & Benefits Survey Reports provide salary and professional rate ranges for all positions in the home care industry. They are indispensable tools for HR managers, proving a quick and accurate reference of industry pay standards for your employees.

The Alliance publishes two surveys: one for Medicare/Medicaid certified agencies, another for private duty agencies.  Both display state-wide results, as well as data based on geographic area and agency size.

The 2009 surveys contain information about prevailing pay and benefits for the full range of positions in home care agencies.  Both surveys list pay and benefits figures for dozens of positions, including: executive, administrative, supervisory, care giving, and clerical positions.  In addition to listing state-wide results, the surveys also publish figures organized by geographic region and company net revenue.

Health Leaders Media: Study of Physicians Use of Home Health Services

A  survey conducted by the Massachusetts Medical Society in collaboration with the Home Care Alliance has shown that a vast majority of physicians believe home health care services provide multiple advantages in improving health care quality and reducing costs without compromising outcomes, but administrative burdens, reimbursement issues, and lack of access to the services are regarded as main barriers to using these services.

Health Leaders Media wrote a story on the study results that came out July 1st, an excerpt of which can be seen below. You can read the entire article by clicking here.

Slightly more than half of the doctors who responded to a physician survey in Massachusetts last fall said they kept patients in the hospital longer than necessary because of a lack of access to home health services, according to a new report.

But most of the doctors said they were aware that use of such agencies can safely reduce days of hospitalization and their cost as well as emergency room utilization, an increasing priority in the health reform agenda.

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Alliance Submits Statement on Rate Legislation

While the Alliance and its members were busy at the 2009 Spring Conference and unable to verbally testify at a June 3 public hearing before the Joint Committee on Health Care Financing, the Alliance was able to submit written testimony.

The statement dealt with two bills, both Alliance priorities: S.535, An Act to Establish an Equitable Rate of Payment for Medicaid Home Health Services, and S.552, An Act Requiring an Analysis of Medicaid Home Health Rates.

Click here to view the Alliance’s Testimony.

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