Report on the Massachusetts Serious Illness Coalition

The MA Serious Illness Coalition pushes to bring awareness and focus on end-of-life issues.

“It is my goal that every nursing school in MA embrace that a nursing student must see a dying patient with the same fervor that they embrace that every nurse must see a baby being born.”
— Susan Lysaght Hurley, PhD, RN
Director of Research, Care Dimensions, Inc

Last week, the Massachusetts Serious Illness Coalition hosted its annual meeting welcoming more than 100 attendees to the JFK Library in Boston. The message from the Coalition’s leadership – as articulated by Blue Cross Blue Shield MA President and CEO – is that “the momentum is building.” From the Coalition’s beginnings less than five years ago, Dreyfus has focused on a long-term strategy to achieve the Coalition’s six goals. These include the ideas that everyone in Massachusetts 18 years or older has a designated health care decision-maker and that all Massachusetts clinicians have appropriate training to communicate comfortably with patients around advanced care planning and serious illness. Dreyfus has likened the work to that done in years past on smoking and on car seats, where steady force and public messaging achieved near-universal changes in public thinking.

The progress on clinician education – from a provider association perspective – is perhaps the most engaging and encouraging news. Dr Atul Gwande, as eloquent as ever, declared that the work to date has shown that: “People have priorities in life beyond just surviving, but you must ask them. Suffering happens when care doesn’t match our priorities.”

In addition to a public education campaign about engaging in advanced care planning conversations, Dr. Gwande announced that the Coalition is in talks with all four Massachusetts medical schools about a cooperative effort to require training of med students in serious illness communication as a graduation requirement.

But it was Dr, Hurley’s remarks that struck home for the home health and hospice agencies in the Coalition. In addition to the above comment, Dr. Hurley spoke of being a young nurse “totally unprepared as to how to talk to the dying.” Along with her subcommittee co-chair Anne Marie Barron of Simmons College, she is working on recommendations on core competencies for nursing education related to serious illness care. These are to be presented in the near future to the Massachusetts Association of Colleges of Nursing. What a great achievement that would be!

For those following the Coalition’s work, these may also be of interest:

  1. End Games, an Academy Award-nominated short documentary on hospice and palliative care executive produced by Shoshana Ungerleider, MD. It premiered at Sundance Film Festival in 2018 and was acquired by Netflix.

2. The Coalition’s public message research and draft public facing marketing approaches.

Commendable progress!

Return to www.thinkhomecare.org.

HCA and Northeastern University Partner on Nurse Symposium in June

These days, it seems like every week a new report is published sounding the alarm of a rapidly aging population across the United States and a shortage of workers prepared to care for this barreling silver tsunami. So much of the media coverage and research is focused on the paraprofessional workforce.

See for example, these reports/publications:

However, the Home Care Alliance member surveys indicate that the problem is broader than just a shortage of home health aides. The availability of a trained nursing workforce to meet a growing home-based health care delivery system is also emerging as an issue. Compounding challenges are impacting our ability as an industry to attract nursing students into home and community-based settings after nursing school.  That is why, on June 7th the Home Care Alliance of Massachusetts and Northeastern’s School of Nursing are hosting a symposium on the very topic of building a home care nursing workforce at Northeastern University from 9AM – 3PM.

The event, titled: Nursing Call to Action: Building a Nursing Workforce to Deliver Complex Care at Home, will bring together more than 25 nursing schools and 25 home health providers for a day-long session. The program will kick-start a dialogue brainstorming new approaches for preparing and exposing Massachusetts nursing students for an increasingly intensive health delivery system in the home.

This event will look past the issue of reimbursement rates or ever-changing reforms at CMS, and instead will focus on four key areas:

  1. Identifying knowledge and skills gaps for LPN/RN new-grads and what changes can be made to address the gaps and develop competencies in executing highly complex services
  2. Elevating the visibility to nursing schools of the growing demand for home-based services and the need to expose students to possible careers in home care nursing
  3. Identifying strategies on recruitment as new-grads and experienced nurses prepare for possible careers in home care nursing
  4. Identifying barriers and strategies to get home health agencies more involved in clinical placements for nursing students

If you would like more information on this event, please reach out to Jake Krilovich. Please note: There is limited space for this event!

PDGM Fix Introduced, Advocacy Needed

Last week, a bipartisan group of senators, led by Sen Susan Collins (R-ME)  introduced what will be a most important legislative priority for HCA of MA this year.  Senate bill (S.433) will curtail the so-called $1 billion “behavioral adjustment” cut under the Patient Driven Groupings Model (PDGM) to which all of home health is transitioning in 2020.  Among, many other changes, PDGM will move home health from a 60 to a 30 day payment unit. This is the most significant change to home health payment since the Prospective Payment System was introduced in 2000.

The Congressional action that called for a home health payment overhaul required that the new payment model be budget neutral against current spending levels. However,  the legislation also allowed that CMS to consider “behavioral  adjustments” defined as industry actions that would be taken to increase payment under the new model, unrelated to patient case mix changes. CMS has used this authority very broadly to institute a payment adjustment in the first year of PDGM based on “assumptions” of behavioral changes, and that adjustment calls for a 6.42% base rate reduction, or a possible $1b reduction in payments.

S 433 would prohibit CMS from making any pre-rate change reductions based on assumptions and instead to phase in any adjustments (either up or down) based on observed evidence (i.e., data supported) changes in provider behavior. The objective would be to achieve budget neutrality by 2029. This later piece addresses concerns the Congressional Budget Office (CBO) expressed regarding whether a similar bill introduced last session was truly budget neutral. S.433 also would allow Medicare advantage plans and Center for Medicare and Medicaid Innovations (CMMI) to waive the “confined to home”  provision when in the best interest of a Medicare beneficiary.

Regardless of the “behavioral adjustments,” the PDGM model is expected to have a tremendously varied impact state by state and agency by agency.  A significant amount of this impact is related to a Congressional  requirement that the payment model no longer use the volume of therapy as a payment level determinant.  (Something MEDPAC has been calling on CMS to do for years.)   The state of Florida, where therapy visits average 10.45 per episode of care is set to “lose” the most – projected at $141 million.  California on the other hand, where the average therapy utilization per episode was 5.76,  will be the largest gainer.  MA (need numbers from Tim)  Note: S 433 does not seek to make changes to the structure of the payment model that produces these changes.

It is important to reflect on CMS’ proposal in 2017, Home Health Groupings Model (HHGM) and how we arrived to where we are today. At the time, HHGM represented similar changes to the payment model, without soliciting industry feedback and some estimates predicting a 15% reduction in payments. As a result, the industry unified itself behind one message: that CMS withdraw its proposal and engage stakeholders to come up with an alternative. Upwards of 13,000 emails were sent to Congress from the industry, 49 members of the U.S. Senate and almost 160 members of the U.S. House of Representatives signed onto letters to CMS echoing the request to withdraw HHGM. This was a remarkable show of mobilization by the industry and we’ll need it again to make modifications to PDGM.

At present there is no bill in the House, but it is expected that one will be forthcoming.  Strong early sign on support is critical to keeping this bill moving and HCA of MA will be urging members to contact the MA delegation to support S.433 and the companion house legislation to be introduced. Stay tuned for these advocacy alerts in our weekly newsletter and advocacy messages in the coming weeks.

HCA will also be hosting a number of member events to prepare for the payment transition.  While the full day PDGM programs in March in Northampton are sold out, there will be a high concentration of sessions on PDGM at the New England Home Care Conference and Trade Show in on June 5 -7 inn Falmouth. Watch here for more details.

In the meantime, send a message here to Senators Warren and Markey about the need for their support on this issue. 

Let’s do this home care – we cannot sustain $1 billion in cuts based on assumptions, not facts!

Talking Home Care: NAHC’s Calvin McDaniel on the 2018 Midterm Elections

Calvin McDaniel of NAHC joins us to talk about the implications of the 2018 Midterm Election on the home care industry.

Kelleher and McDaniel

On this week’s edition of Talking Home Care, we are joined by Calvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC). Calvin oversees NAHC’s legislative priorities on Capitol Hill, and collaborates with the Alliance and other state associations on shared, industry-wide priorities.

Our discussion recaps the 2018 Midterm Elections and what to expect in the 116th Congress, which will be seated in January 2019. Enjoy!


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 29 minutes; Size: 23.2 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

GuestCalvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC).

2018 Midterm Elections Recap (Updated Monday, 11/19):

  • Democrats regained control of the US House of Representatives, gaining 37 seats so far and holding a majority of 233 seats to Republicans’ 198 seats.
  • Republicans held control of the US Senate picking up two seat as and expanding their Senate Majority to 52 seats to Democrats’ 47 seats. The Mississippi senate seat is heading toward a run-off election on November 27th.
  • On the state level: Democrats flipped nearly 400 state legislative seats nationwide, flipped seven Republican-held governor seats, and took full control of the legislature and Governors’ mansion in seven states.
  • Lastly, three states: Idaho, Nebraska and Utah voted to expand Medicaid. And a fourth state, Maine, elected a democratic governor, who will likely do the same.
  • Overall, nearly 116 million voters cast ballots, representing over 40% of eligible voters and represents the largest midterm voter turnout in 104 years.
  • It is expected that Representative Richard Neal (D-MA) will become the Chairman of House Ways & Means, and Representative Jim McGovern (D-MA) will become the new Chairman of the Rules Committee. This greatly increases the Massachusetts’ Congressional Delegation influence on Capitol Hill.

The most important takeaway from our conversation with Calvin is that HCA members should prepare for an incredibly active two years of advocacy. Take hold of your responsibility to engage your elected officials on behalf of your organization and join us in the fight on the many issues facing our industry. Be it an email to a legislator, inviting them to your offices for a tour or on a home visit, or taking time to join us in D.C. for one of the many fly-in events, it takes an army of voices to accomplish a common goal. To get involved, email Jake Krilovich.

Return to www.thinkhomecare.org.

Talking Home Care: Amanda Oberlies on “No on MA Ballot Question 1”

The Alliance’s Pat Kelleher &
ONL’s Amanda Oberlies

Should health care facilities have their nurse-to-patient ratios defined by law? That’s the question put to Massachusetts voters this coming Tuesday. Amanda Oberlies of the Organization of Nurse Leaders joins us to discuss why her organization (and the Alliance) oppose Massachusetts Ballot Question #1. Their conversation covers:

  • Who’s behind the ballot question and why?
  • What is the intersection of staffing-ratios and quality?
  • How does California’s experience with a similar law correlate to the MA proposal?


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 30 minutes; Size: 24 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

Guest: Amanda Stefancyk Oberlies, PhD, MBA, RN, CENP, is the Chief Executive Officer of the Organization of Nurse Leaders (ONL).

Resources:


Talking Home Care LogoDon’t want to miss the next episode of Talking Home Care? Subscribe through iTunes, Google Play, or accessing its feed directly.

Return to www.thinkhomecare.org.

Talking Home Care: Pat Ahern on Palliative Care 101

Pat Ahern of Care Dimensions
Pat Ahern

Pat Ahern of Care Dimensions joins us for the eighth episode of the Talking Home Care Podcast. As the CEO of the largest and most experienced palliative care agency in the region, Pat’s an authority on palliative care, hospice, and related issues. In a conversation with Alliance Executive Director Pat Kelleher, Ahern discusses:

  • Palliative care’s role as a “midwife at the other end of life”;
  • Dementia care;
  • Payment reform;
  • Referral sources;
  • Nurse recruitment and training; and
  • Physician involvement.


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 26 minutes; Size: 12 MB). If you enjoy it, please give us a five-star review so others can find it as well.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

GuestPatricia Ahern, joined Care Dimensions in 2017 as president and CEO. With more than 30 years of leadership in healthcare and an MBA, she has the clinical and strategic business skills, and a true passion for the mission, that enables her to provide Care Dimensions’s vision and leadership.

Resources: More information about Care Dimensions.


Talking Home Care LogoDon’t want to miss the next episode of Talking Home Care? Subscribe through iTunes, Google Play, or accessing its feed directly.

Return to www.thinkhomecare.org.

Statement on Boston Globe Article: A Stranger in the House

Boston, MA – The Home Care Alliance of Massachusetts issued the following statement in response to the two-part Boston Globe article titled “A Stranger in the House” printed September 16th and 17th:

The Home Care Alliance and its members have a zero-tolerance policy when it comes to patient abuse. Over many years we have worked with the Department of Public Health, Elder Affairs and Health and Human services to address issues of elder abuse and billing fraud. Our members take very seriously the responsibility of ensuring the safety and quality of care being delivered to their clients.

These Boston Globe articles confusingly lump three different classes of workers together: personal care attendants employed directly by consumers in the PCA program, aides hired through a home care agency, and workers hired directly by consumers in the underground marketplace.

While the article cites 20 cases of agency-hired workers committing abhorrent crimes in ‘recent years,’ it fails to contextualize the fact that home care agencies have employed over 75,000 workers and delivered care to more than 600,000 elders in the past five years.

We have long advocated for the Commonwealth to develop a licensure process and we support state legislation (H.344) which we believe would enact baseline consumer protection standards for private pay home care agencies. We also advocated for recently enacted legislation to license certified home health agencies.

In failing to adequately explain the structure of the home care system in Massachusetts, readers are left confused and scared. At a time when aging-in-place is a statewide priority, we should be working on solutions that expand access to these services and protects consumers in the setting that they prefer: home.

About the Home Care Alliance of Massachusetts:

With a mission to unite people and organizations to advance community health through care and services in the home, the Home Care Alliance of Massachusetts is a non-profit trade association and advocacy group providing representation, education, communication, advocacy and – ultimately – a voice for the state’s home health industry. Founded in 1969, the Alliance has grown to represent more than 160 home care and home health agencies across the state. For more information, visit www.thinkhomecare.org.