Tag: CMS

Centers for Medicare & Medicaid Services

Partnership for Patients Introduces Patient Safety Webinar Series

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The Partnership for Patients and the National Priorities Partnership are promoting a free webinar series to help advance patient safety practices and improve both the partnerships between health care providers and the processes within organizations.

The first two webinars are titled “Creating and Sustaining Successful Partnerships between Hospitals and Community Organizations” and “Using Tools to Enable Rapid Cycle Improvement within Your Organization,” which are taking place on February 15th and 23rd, respectively. Visit the webinar series website to sign up.

Also, check out the Home Care Alliance’s calendar of events to find upcoming webinars and teleconferences.

Return to www.thinkhomecare.org.

CMS adds Guidance on Independence at Home Demonstration

CMS has offered guidance in the form of additional FAQ’s on the Independence at Home Demonstration, which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

Based on the opportunity for home care agencies to partner with physician practices on this project, the Home Care Alliance held a conference call on the program and made a presentation and other resources available on a previous newsfeed post.

Return to www.thinkhomecare.org.

HCA Informs Members on Pioneer ACO and Independence at Home Programs

The Home Care Alliance held a well-attended conference call to inform members about two major programs recently announced by CMS:

First, the Department of Health and Human Services announced the first 32 organizations in 18 states that will participate in the new Pioneer Accountable Care Organization (ACO) initiative. This program is operated by the CMS Innovation Center under Section 3022 of the Affordable Care Act. Selected Pioneer ACOs include “physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country.” Five of those organizations are in Massachusetts:

  • Atrius Health Services
  • Beth Israel Deaconess Physician Organization
  • Mount Auburn Cambridge Independent Practice Association (MACIPA)
  • Partners Healthcare
  • Steward Health Care System

This Pioneer ACO Presentation was given by HCA Executive Director Pat Kelleher on the call and explains some of the points that home care agencies should be aware of as the initiative moves forward.

The CMS Center for Innovation also has a site full of resources on Pioneer ACO’s including FAQ’s and brief summaries of the selected ACO’s.

WBUR’s CommonHealth Blog had a feature on Pioneer ACO’s and asked each of the five accepted systems in Massachusetts what the program will mean for patients.

The second program announced was a solicitation for the new Independence at Home Demonstration Program (IAH), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

HCA also gave this presentation on the Independence at Home Demonstration on the conference call for members to explain that home care agencies can be a major partner to physician practices, despite the fact that the program is directed by a physician or nurse practitioner-led practice with experience in making home visits.

The IAH Demonstration’s webpage also has FAQ’s as well as the solicitation and application.

The Alliance will pass along any more information as it becomes available.

Return to www.thinkhomecare.org.

 

CMS Announces Independence At Home Demonstration Program

CMS continues to roll out initiatives from the Affordable Care Act in an attempt to test new ways to improve health care and lower cost.

The latest in this line of programs and funding opportunities is the Independence At Home Demonstration (Section 3024 of the ACA), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

According to the Independence At Home (IAH) Program Solicitation, in order to be involved in the Demonstration, “practices must be individual physicians or nurse practitioners or interdisciplinary teams composed of various members such as physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting staff.” The program itself is designed to provide comprehensive, coordinated, continuous and accessible care to high-need patients and to coordinate health care across all treatment settings.

Even though primary care is the lead in the IAH demo, the focus is on delivering care to patients in their homes and getting beneficiaries what they need to remain independent. In other words, the program could actually be of significant benefit to the home care industry as a whole because primary care practitioners will be making check-ups in the home and witnessing how patients function in their day-to-day environment. Based on those visits, the practices will be identifying services – like home care and other community based services – that help keep people out of costlier settings and the ER.

Practices are required to use electronic health systems and remote patient monitoring, both of which are used by many home health agencies. Also, practices must be available 24 hours per day, seven days per week to carry out plans of care. Applicable beneficiaries must have at least two chronic illnesses, must need human assistance with two or more Activities of Daily Living (ADL’s), have had a non-elective hospital admission within the last 12 months and have used acute or sub-acute rehabilitation services within the last 12 months.

HCA encourages agencies to see the other guidelines, which are laid out in the IAH Solicitation and a summary is provided in a PowerPoint provided on the IAH program webpage.

Return to www.thinkhomecare.org.

CMS Care Transition Program Update and Guidance

Masspro, the state’s quality improvement organization, held a conference call on the CMS Community Based Care Transitions Program and provided some useful guidance for those looking to apply or reapply for funding.

Based on a CMS call with QIO’s, there were three common elements that tripped up applications from community based organizations, hospitals and other partners:

  • Firstly, in many applications, CMS said that it was not clear that the community-based organization was eligible and did not fit the criteria laid out in the solicitation, fact sheets and Q&A’s.
  • Second, many applications included budget items that were outside of what CMS would fund. For instance, CMS will only fund activities directly related to the intervention and not indirect costs like data collection. CMS is also said to be aiming for an across-the-board 20 percent reduction in readmissions for the program collectively as an attainable and reasonable target. Budgets within an application should reflect that element.
  • Lastly, CMS found that there were a lack of community partnerships in the applications they reviewed. Looking at the seven successful applications, it is clear that there is a large group of partners serving a relatively broad geographic region.

In addition to the Masspro call, CMS has once again updated their CCTP webpage to include panel review dates for incoming applications through March 27th. Also, summaries of all seven of the successful applications are now posted.

The Home Care Alliance will continue to provide guidance and assistance to home care agencies interested in applying and will connect any hospital or community partners looking for home care agencies in their area.

Return to www.thinkhomecare.org.

CMS Posts Final Rule for 2012 PPS Rates

CMS this week posted the final rule for Medicare home health PPS rates for calendar year 2012.  The finalized rates are slightly better than the proposed rates that CMS released in July, due to the fact that CMS has accepted industry recommendations to phase-in the case mix creep adjustment over two years, applying a 3.79% adjustment in 2012 and reserving 1.32% for 2013. Still, the 2012 national standard episodic rate of $2138.52 is a reduction from the 2011 rate of $2192.07.

The final 2012 rate is represents a 2.4% reduction from the 2011 rate, the result of a combined 2.4% market basket index inflation update, a 1% reduction in the inflation update required by the health care reform law, and a 3.79% case mix creep adjustment.
The final rule also adjusts the case mix weight for every HHRG to adjust for budget neutrality after removing eliminating hypertension as a factor in the calculation.  The rule also reduces the weights on high-therapy episodes and increasing weights on non-therapy episodes.

See this spreadsheet listing the updated rates for all HHRG’s in each MA geographic region.

In addition to setting forth updates to PPS, the final rule included some minor changes regarding face-to-face (F2F) encounters.  CMS is removing the modifier “attending” from the regulatory language to describe physicians who qualify as the physician who cared for the patient in an acute or post-acute facility. Most people considered the word ‘attending” to mean a community physician and not the in-patient physician.

Acknowledging that the Affordable Care Act did not preclude a patients’ acute or post-acute care physician from informing the certifying physician (physician who signs the 485) regarding their experience with the patient for the purpose of the F2F encounter requirement as an NPP can, CMS is also amending the F2F language to allow the acute or post-acute care physician to inform the certifying physician regarding the F2F.  The “community physician” could then complete the necessary documentation.

CMS believes these modifications allow additional flexibility in the process, making it easier for providers. Members with questions about the F2F changes can contact Helen Siegel at the Alliance office.

This finalized regulation will be the subject of an in-depth review by representatives of Blacktree Healthcare Consulting during the Alliance’s 2011 Financial Management Conference November 30 in Waltham.  Be sure to register today!

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.

 

CMS Community-Based Care Transitions Program Update

The Centers for Medicare and Medicaid Services (CMS) has provided new guidance and updates on their Community-Based Care Transitions Program.https://i0.wp.com/www.gmcf.org/transitions/images/transitions_image.jpg

New panel review dates for submitting applications beyond August 18th have been posted and are as follows:

  • October 6 & 7, 2011 – Applications must be received by September 6th to be considered for this review.
  • November 15 & 16, 2011 – Applications must be received by October 14th to be considered for this review.
  • November 30 & December 1, 2011 – Applications must be received by October 28th to be considered for this review.

Secondly, more than a full page of new guidance has been added to the program’s Question & Answer section. Below are a few examples:

  • Q: How shall we anticipate to cover up front costs? I heard that CBOs would be paid a per eligible discharge rate that is determined by target population, interventions proposed, anticipated volume and expected reduction in readmissions (cost savings) Can you give a concrete example of how this payment methodology would work?

A: Because this program seeks to build off of earlier care transitions initiatives and requires applicants to have a track record in the delivery of care transition services we are not paying “start up” costs. CBOs will be paid on a monthly basis for services delivered in the previous month. This payment will be whatever the agreed upon per eligible discharge rate is multiplied by the number of eligible beneficiaries served in the previous month. Please refer to the budget worksheet available on our program webpage for additional guidance on developing the per eligible discharge rate.

A: These are the patient experience measures that CBOs will be required to collect and report during the program. We will provide the instruments to awardees at the time of award.

The Home Care Alliance has also made a webinar available on the experiences from a previous CMS care transitions demonstration program that worked through 14 QIO’s across the US. The webinar focuses on, among other things, drawing from the Home Health Quality Improvement campaign’s Best Practices Intervention Package.

More info from this newsfeed on care transitions is available here.

Return to www.thinkhomecare.org.

CMS Proposes Medicare Home Health Payment Changes for 2012

The Centers for Medicare and Medicaid Services (CMS) have issued a proposed rule regarding payment changes as well as revisions to the physician face-to-face and therapy assessment rules.

Below is a summary of the most noteworthy aspects of the proposed rule provided by the National Association for Home Care & Hospice (NAHC):

1.       Proposed 2012 payment base episode rates are reduced to $2112.37 from the current $2192.07. This is a reduction of approximately 3.56%.

2.       The rate changes are due to a proposed 2.5% market basket index inflation update, a 1 point reduction in the MBI under the health care reform law, and a 5.06% case mix creep adjustment.

3.       The increase in the case mix creep adjustment is due to the evaluation of 2009 coding weight changes. CMS found that ¾ of the coding increases was a result of increases in therapy visits above the 14 and 20 visit thresholds.

4.       The 3.56% rate reduction will impact individual providers unevenly. CMS proposes to make significant changes in coding weights by eliminating hypertension as a factor in the calculation, reducing the weights on therapy episodes, and increasing weights on non-therapy episodes. Providers with high volumes of therapy cases could see greater net rate reductions. A provider-specific analysis using the provider’s particular case mix is the only reliable way to assess impact.

5.       CMS proposes to change the face-to-face rule and allow one physician to do the encounter and report the information to another physician who completes the certification and plan of treatment documentation. This should help in circumstances where a patient is under the care of a hospitalist who transfers the patient to a community physician.

6.       CMS proposes to clarify the therapy assessment standard where more than one discipline is involved.

The proposed rule on rates is in line with what had been expected. Nevertheless, that does not turn a lemon into lemonade. The change on the face-to-face rule is appreciated, but will only make a slight improvement as the documentation requirements remain a problem.

CMS also posted the proposed rule on the Medicaid face-to-face encounter requirements. The proposal aligns the Medicaid time frames with the Medicare time frames while providing some flexibility to states to determine other aspects such as the content and form of documentation. The proposal also reaffirms CMS’s position that a homebound requirement in Medicaid home health is not permitted and that services can be provided outside the home. Finally, the proposal offers clarifications on the coverage of medical supplies and equipment.

Another summary is available in a press release issued by CMS with a few more specifics on payment. The Home Care Alliance is working on a specific analysis regarding the payment changes based on the northeast’s wage index and will have that available soon.

See links to the specific proposed rules in the Federal Register below:

 

Return to www.thinkhomecare.org.

New Materials and Guidance for CMS Care Transitions Program

A pair of presentations with helpful information and resources regarding the CMS Community-Based Care Transitions Program have been made available.

For home health agencies interested in applying or just getting started with the process, this CMS PowerPoint provides a good summary of the information, helpful links and resources, and answers to some of the more frequently asked questions.

Another helpful set of presentations sponsored by the Commonwealth Fund is available and includes a webinar with audio featuring:

  • Anne-Marie Audet, M.D., M.Sc., moderator, vice president, Quality Improvement and Efficiency, The Commonwealth Fund
  • Eric Coleman, M.D., M.P.H., director, Care Transitions Program, and professor of medicine at the University of Colorado Health Sciences Center
  • Garry MacKenzie, M.D., medical director of cardiology services at McKay-Dee Hospital Center in Ogden, Utah
  • Janice Fitzgerald, R.N., director of quality and medical management at Baystate Medical Center in Springfield, Mass.
Lastly, there have been a lot of questions regarding how to proceed with the “root cause analysis” in the application. A very helpful resource to assist in this matter is available courtesy of the Care Transitions Quality Improvement Organization Support Center (QIOSC).
More updates and resources will be provided by the Home Care Alliance as they become available.