Home Care Accreditation Reaches 60 Agencies

The Home Care Alliance is proud to announce that the Home Care Accreditation Program offered to private pay agencies, has now reached 60 providers!

See our press release on this important milestone below:

Home Care Accreditation Program Reaches 60 Agencies

New Stricter Standards for Private Pay Home Care Providers

Boston, MA – With brand new standards that are more stringent to protect patients, improve quality care and promote ethical business practices, the Home Care Accreditation Program offered by the non-profit Home Care Alliance of Massachusetts for private pay home care providers, continues to grow and has now reached it’s 60th agency.

“These new standards for Accreditation raise the bar for agencies, which only can lead to positive things for patients looking to remain independent in their homes,” said Home Care Alliance Executive Director Patricia Kelleher. “We hope the public realizes that this simply isn’t a stamp of approval, but a strong display of our commitment to quality and assurance that these agencies are meeting strict standards. Families deserve that peace of mind that their loved ones are receiving the best services out there.”

In the absence of meaningful licensure requirements for providers of home care services in Massachusetts, the Home Care Alliance established this Accreditation Program for Private Pay agencies, which do not receive reimbursement from Medicare or Medicaid.

The standards were developed over several months in consultation with 14 agencies throughout the Commonwealth.  These standards require that agencies submit an application and documentation to the Home Care Alliance of Massachusetts.  Alliance staff and member agencies then review the application to ensure that applicants meet all of the standards. Recently, the Home Care Alliance’s Board of Directors approved stronger standards that are meant to show the organization’s commitment to maintaining quality services.

Agencies seeking accreditation answer questions in fifteen categories, including training requirements, administrative protocols, and business practices.  They are required to show documentation in answer to questions regarding service plans between clients and the agency, procedures around responding to complaints, and their oversight of caregivers.

“We wanted to provide leadership for an area that is becoming more and more important in Massachusetts,” added Kelleher, “These standards highlight our agencies’ best practices, which will help guide members of the public as they choose who will take care of their loved ones in their homes. We aim to approve as many private care agencies as we possibly can in Massachusetts to prove our state’s commitment to quality home-based care.”

A full list of accredited agencies from across the state, and more information about the Accreditation Program standards, is available at www.thinkhomecare.org/accreditation.

Return to www.thinkhomecare.org.

HCA Comments to Federal Deficit Reduction Committee

With a home health copayment and other potential hazards hanging in the balance, the Home Care Alliance sent off an official letter to the Joint Select Committee on Deficit Reduction to reiterate strong opposition to what would amount to a “sick tax” on certain Medicare patients.

Following up on the recent visit to Washington DC, the letter was sent to the co-called Super Committee, which includes Massachusetts Senator John Kerry, and was copied to the state’s Congressional Delegation. The letter was especially timely, as a group of Alliance members and staff met last week with Senator Kerry to discuss specific concerns.  

The Alliance particularly targeted a recent proposal from President Obama to institute a copayment for Medicare home health services. If passed, the copayment would amount to $100 per 60-day episode on certain Medicare beneficiaries beginning in 2017. The copayment would not be imposed for episodes following a stay in an acute care facility and would apply to patients receiving five or more visits.

The Alliance’s letter, aside from opposing the copayments, also points out that Massachusetts has not experienced the same growth in the number of home health agencies as other parts of the country.  The Alliance argues that such broad payment reductions or copayments are punishing the wrong people and not targeting offenders of fraud and abuse. The Alliance also offers alternatives like a moratorium on new certified agencies, better targeting fraud and abuse in areas of substantial growth, and further capping outlier payments.

Agencies and concerned advocates are encouraged to submit comments opposing the copay and offering alternative solutions as mentioned in the Alliance’s letter to the Joint Committee on Deficit Reduction by visiting the comment submission page of their website.

The Alliance also has the opening remarks of Committee Co-Chair Senator Patty Murray (D-Washington) on the HCA YouTube page and will continue to provide updates as they become available.

Return to www.thinkhomecare.org.

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?

 

Alliance Comments on Proposed PPS Rule

The Home Care Alliance of Massachusetts today submitted comments to CMS on the proposed rule for Medicare home health PPS.  In our comments, we recommend that CMS rescind the across-the-board 5.06% case mix reduction and instead use its enforcement authority to identify and prosecute those few agencies that inflate their billings.  The Alliance urges CMS to conduct a comprehensive review of the case mix system, with involvement of home health industry experts.

Regarding the proposed wage index changes and in light of the new rural floor wage index for hospitals in Massachusetts, we urge CMS to establish a policy to set the wage index for home health agencies to be equal to the wage index of the largest hospital within each CBSA if that hospital has been re-classified to another CBSA or qualifies for the rural floor wage index.

The Alliance also urges CMS to waive the Face-to-Face documentation requirement for patients discharged from an acute or post-acute care setting within 14 days of the home health admission, and recommends that CMS provide additional clarification to the “confined to the home” definition (and provides clarification and guidance to Medicaid programs to reduce wasteful TPL initiatives that hinge on the definition.

Alliance member agencies are urged to use the Alliance’s comments as a model to submit their own comments on the www.regulations.gov website.

Cong Markey Briefs Health Care On Debt Ceiling Discussions

Yesterday, Congressman Edward Markey conducted a briefing for members  of the health care and health research communities on the debt ceiling discussions and the possible impact on these sectors going forward.   Although the Super Committee has received a significant amount of the attention, the debt discussions will actually occur in three steps.

The first step will include a cut of $900 billion. These cuts must be effective on 10/1/2011. Medicare and Medicaid cannot be included in this first cut, but all other federal spending including defense and non defense can be considered.

Step 2 is the Super Committee, comprised of six Senators and Representatives. The budget target for this Committee is $1.2 trillion.  Their work must be done by Sept 23rd and if recommendations are made, must be voted on by Dec 23rd.  The bring a proposal forward will require 7 or the 12 votes.  In Senate, a simple majority vote will be needed to pass.

According to Markey, this group “will go from 0 to 60 miles per hour” to meet the September 23 deadline and for this group “everything is on the table.”    This group has broad latitude to propose changes in benefits or  program design in terms of federal entitlements, including Medicare and Medicaid benefits and program design;  eligibility and contributions to Social Security;  defense spending, tax rates, “loopholes”  and contributions, etc.  Markey indicated that all of the Republican appointees have pledged to support no new revenues, which will make this Committee’s work more difficult.

Should the Super Committee not reach consensus, the process will move to Step 3, which would be a an automatic cut on 10/1/13 of $1.2 trillion in spending, 50% of which would come from “security” and 50% from non security spending.  Under this scenario, the sole restriction is that Medicare cuts would be set at 2%.

Congressman Markey engaged the group in discussing:

What is you message to the Super Committee?

What would you recommend that Super Committee members do if there are no revenues and only cuts to achieve the goal?  Is moving to Step 3 preferable to this scenario?

Is a Step 3, i.e. 2% cut in Medicare in Oct 2013 sustainable?

Question to Home Care:   What is your message to Congress on this?

Join Us for Falls Prevention Awareness Day

This year’s Falls Prevention Awareness Day will be taking place from 10:00am to 12:00pm on September 22 in the Great Hall of the Massachusetts State House. The event will feature speeches by State Senator Richard Moore and Executive Office of Elder Affairs Secretary Ann Hartstein.

Once again, clinicians, community activists, state officials and honored guests will gather to raise awareness that falls are both common and costly. Efforts are in place in our state to introduce falls prevention activities across the health care continuum and into the daily lives of older adults. Join the Massachusetts Falls Prevention Coalition and our experts to help prevent falls across all settings. Presentations will be made by the VNA of Boston and other providers with falls prevention programs.

Attendance is free and there is no registration for the event. Simply RSVP to James Fuccione at HCA (jfuccione@thinkhomecare.org) or Alissa Weintraub at Mass Senior Care (aweintraub@maseniorcare.org).

The mission of the Massachusetts Falls Prevention Coalition is to promote healthy lifestyles, behaviors and strategies to reduce the incidence and severity of falls and fall related injuries across the lifespan in Massachusetts.

Return to www.thinkhomecare.org.

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.

Advocacy Needed During August Recess to Avoid Cuts and Co-Pays

A so-called Debt Reduction Super Committee evolved out of the federal debt ceiling debate and will be charged with reducing the federal deficit over the next ten years.

Although cuts to entitlement programs and home health co-payments are on the table as options, a potential bright spot was reported this week in that US Senator John Kerry (D-MA) is among the members appointed to the Super Committee. Kerry was instrumental in getting cuts to home health reduced as part of health care reform.

Even with the work of Senator Kerry, Medicare home health payments are still taking a $39.7 billion hit over the next ten years. Additionally, CMS is proposing a 5.06% reduction in payments for calendar year 2012. Both of those points need to be raised when this committee considers even deeper cuts that could drastically impact agencies and patients.

Home health co-pays are another option that must be broadly opposed. Seniors could be forced to pay as much as $150 per 60-day episode of home health care, which would only push those who cannot afford it or unwilling to pay into costlier care.

Below are issues and materials that advocates can use to contact the Massachusetts Congressional Delegation, not just during August recess, but as the discussion of the Super Committee progresses. There are also materials and advocacy messages that can be used to urge Congressional support of other home care initiatives.

Advocates should be contacting their Congressperson, as well as Senator Kerry, to ask that they in turn urge the Super Committee to oppose home care cuts and copays.

Home Care Co-Pays & Medicare Cuts:

Support Home Health Access Protection Act:

Support Home Health Planning Improvement Act:

See a list of other issues, talking points, and messages available on the HCA Legislative Action Center. You can also compose your own message here.

Return to www.thinkhomecare.org.

 

Public Hearing on Temporary Nursing Agency Regulation

The state’s Division of Health Care Finance & Policy (DHCFP) is holding a public hearing and accepting written comments on amendments to regulations regarding temporary nursing services.

According to an official hearing notice, DHCFP is required to review and establish maximum rates that temporary nursing agencies may charge facilities annually. The proposed regulation is estimated to result in an increase of 4.13%, or $2.56 million, in aggregate provider expenditures for temporary nursing services.

It should be noted that eighteen of the 108 nursing facility rates decrease, all in Health Service Area 3 – Merrimack Valley, due to a decrease in the median reimbursement paid to permanent staff at nursing facilities in that region, according to the notice.

The hearing will take place at 10:00am on Wednesday, September 7th at DHCFP Headquarters, located at 2 Boylston St in Boston. For more info on the regulation, visit the regulation page on DHCFP’s website (See or search 114.3 CMR 45.00)

Return to www.thinkhomecare.org.