With Recent Hot Weather, Residents Urged to Check on Elderly

With temperatures reaching the 90’s, residents across Massachusetts are urged to check on elderly relatives, friends, and neighbors.

The state’s Department of Health and Human Services has posted a website on Summer Heat Precautions, which can be viewed by clicking here. Seniors in the city of Boston, where Mayor Tom Menino has declared a “heat emergency,” can call the Elderly Commission at 617-635-4366 or the city’s 24-hour hotline at 617-635-4500 for assistance.

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Home Health Plays Critical Role in Patient Medication Adherence

The New England Healthcare Institute (NEHI) recently completed a study finding that patients who do not take their medications as prescribed by their doctors cost the country’s health care system $290 billion per year.

NEHI conducted the study “Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease,” which found that the billions of lost dollars come in the form of unnecessary hospitalizations and increased medical risks for the one-third to one-half of all patients who do not take their medications properly. The NEHI study also noted that creating “health care teams,” which would include home health workers among other health care professionals, is one of a few solutions to  improving medication adherence.

Click here to read the Alliance’s Press Release on the NEHI study.

Other solutions addressed in the NEHI study included patient engagement and education, payment reform where positive outcomes would be rewarded, and leveraging health information technologies like electronic health records.

To find out more about the study, visit http://www.nehi.net/.

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OASIS-C Final Version

The final version of OASIS-C is now available on the CMS website and the implementation date is January 1, 2009.   The guidance document will be available as soon as the OASIS Education Coordinator training is completed in September, 2009.  Also posted is a crosswalk from the current B1 version to this final version of “C.”

On October 26th & 27th, the Alliance is sponsoring a 2-day workshopat the Sheraton Hotel in Framingham  to assist providers in the transition process.  Registration information is now available.

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

Health Care Reform Update: End-of-Life Provision Cut from Senate Proposal

Although a provision allowing Medicare to reimburse doctors who voluntarily counsel patients and their families on end-of-life issues and care was dropped from a Senate version of a health care reform proposal, a separate House version has kept it intact.

The Senate Finance Committee’s ranking Republican member, Senator Charles Grassley of Iowa, said the provision could be “misinterpreted” and would not be included in the committee’s proposal.

According to the Boston Globe, the end-of life provision, written by Oregon Democratic Congressman Earl Blumenauer, would cover counseling sessions for end-of-life issues like “living wills, making a close relative or friend a health care proxy, hospice care, and information about medications for chronic pain.” The counseling sessions, the Globe reports, “would be covered by insurance every five years, and more frequently for the seriously ill.”

Thanks in part to former Alaska Governor Sarah Palin, the provision was “misinterpreted” by many as Senator Grassley feared and subsequently spun into what has become known as the “death panels” proposal, where, Palin and others allege, the government would decide who is treated.

In the Globe article, Congressman Blumenauer dubbed references to the so-called death panels or euthanasia as “mind numbing” since “the bill would block funds for counseling that presents suicide or assisted suicide as an option.”

Click here to read the Boston Globe article on the end-of-life provision.

A Los Angeles television news station highlighted hospice care as a cost-saving alternative to expensive and extraneous treatment in their report on the end-of-life provision, which can be viewed by clicking here.

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CMS Publishes HHPPS Updates for CY 2010

The August 6, 2009 Federal Register sets forth an update to the home health prospective payment system for calendar year 2010.  In addition, CMS proposes changes to the outlier policy and a submission of OASIS data as a condition of payment.  This  rule also proposes changes to the language clarifying “skilled services” and seeks input on physician/patient interaction associated with the home health plan of care.

It is important that the industry comment on these proposed changes. Comments are due to CMS by September 28, 2009 at 5PM. Please send a copy of your comments to the Alliance: hsiegel@hcalliancema.org

For a copy of the complete document, click here (large file, please allow a few moments to load).

State Steps Up Defense Against Flu

State public health officials have adopted emergency regulations to allow dentists, pharmacists and paramedics to provide the H1N1 flu vaccine for the upcoming fall flu season.

As reported on State House News and in the Boston Globe, the Public Health Council made the decision in light of budget resrictions and the need to protect millions of state residents against the H1N1 virus. According to State House News, the Springtime wave resulted in 1,383 confirmed cases and 10 deaths in Massachusetts.

The emergency regulations go into effect on September 14 and accompany an additional 75,000 doses of  the vaccine purchased by the Department of Public Health. The 885,000 doses this year are up from 810,000 doses a year ago. State House News reports that “Another 2.2 million doses are expected to come from the private sector, including commercial vaccinators, health care providers and health care facilities.”

For more information, click here to read the story from Boston.com on the new precautions.

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New Issues of Update Available

The July 31 and August 7 issues of Update are now available for download on our newsletter archive.

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CNN Story Highlights Impact of Possible Home Health Cuts

A proposal in the US House of Representatives, known as the “Tri-Committee” Health Reform Bill, would take $56.8 billion over ten years from the Medicare home health payment, according to the Congressional Budget Office (CBO) and the National Association for Home Care & Hospice (NAHC).

CNN reported on a 12 year old California girl getting care from a team of home health professionals. The story highlights how that care is threatened by potential cuts in the Tri-Committee bill.

Click here to read the CNN story and please visit our “contact your legislator” page to send a message to your federal representatives in an effort to oppose cuts to home health. Just fill in your contact information and click “send” to deliver the message.

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