Health News Round Up: Week of September 15-21

A Choice of Community Care, in Your Own Home
New York Times
For 51 years, Catherine Mack has lived in a four-bedroom house in Haddon Township, N.J. Even at age 96, she has no intention of leaving.
Joining other older adults at a nearby retirement community doesn’t appeal to her, although the facility is attractive and has a great reputation. Read more.


Transitional Care Improves Patient Outcomes
Fierce Healthcare
Adding to the growing body of evidence of the benefits of transitional care, a review of medical literature in the Annals of Internal Medicine found that some hospital-led interventions can improve outcomes for adult stroke and myocardial infarction patients. Read more.


Communication key to improving care transitions
Healthcare Finance News
A recently released health policy brief examining the efforts in the U.S. healthcare system to improve care transitions concludes that simple solutions would go a long way to improving patient care and saving costs.
Read more.


Worried about Medicare readmission penalties? Try Home Monitoring
Mobile Health News
Perhaps you’ve seen last month’s report from Kaiser Health News that more than 2,200 hospitals—almost two-thirds of all U.S. acute care facilities—face Medicare payment deductions starting Oct. 1 because too many patients with three common but treatable conditions were readmitted within 30 days of initial discharge. That’s going to cost those hospitals a total of $280 million during federal fiscal year 2013. Read more.


Top 5 fields for job growth heavy on healthcare, service
Springfield Sun News
Federal and state employment projections show that the most promising professions for jobs are in the service, retail and health care industries. Read more.


Health IT Solutions to Reduce Readmissions
Fierce Healthcare
In an effort to curb readmissions, hospitals should invest in health technology, including medical records, information sharing and telemonitoring, Jonathan H. Burroughs, president and CEO of The Burroughs Healthcare Consulting Network, wrote in Hospital Impact. Of the 5 million hospital readmissions in the United States, more than two-thirds are preventable, amounting to an annual cost of $25 billion, Burroughs wrote last week.Read more.

Health News Round Up: Week of September 8-14

Home Health Aides: The Front Lines of the Future
Huffington Post
When Sandra Santos*, who is frail and elderly, fainted in her kitchen, her home health aide Angela knew just what to do, calling 911, initiating CPR, and remaining calm throughout. “She didn’t leave my mother’s side,” marveled Mrs. Santos’s daughter. “She handled the situation until help arrived and continued to be professional and level-headed. My family and I were very lucky to have her with our mother that day.” Read more.


HuffPo to America’s Youth: Senior Living Industry Wants You
Senior Housing News
A career in the senior living industry is not something many young people aspire to, but considering the rapidly expanding older population and the potential that creates, maybe it should be on more youths’ radars, writes the Huffington Post. progress report on the Money Follows the Person (MFP) program. Read more.


GOP, Democrats Unite on Home Care
Life Health Pro
The Republicans and Democrats both talk about the need to strengthen the U.S. home care system in their 2012 campaign platforms.
Val Halamandaris, the president of the National Association for Home Care and Hospice (NACH), Washington, is welcoming the platform references to home care.
Read more.


Healthcare jobs grow amid steady national unemployment
Fierce Healthcare
Hospitals added 5,700 jobs in August, bringing the total to 17,000 additional jobs in the healthcare industry, the Bureau of Labor Statistics (BLS) said Friday.
While national unemployment still hovers at 8.1 percent across industries, healthcare, along with the food and drinking market and professional and technical services, saw boosts in employment last month. Read more.


Cut hospital admissions, boost satisfaction with house calls
Fierce Healthcare
As the industry looks to cut unnecessary visits, recent research in the American Journal of Managed Care suggests hospitals consider making house calls.
That’s because the house-call model is associated with lower admissions and higher satisfaction among elderly patients with multiple chronic conditions, American Medical News reported. Read more.


GOP and Democratic Platforms Agree: Aging in Place is Essential
Reverse Mortgage Daily
While they may not agree on much, the Republican Party and Democratic Party seem share some common ground when it comes to one important issue: aging in place for seniors.
Both parties’ platforms, released during their national conventions over the past couple of weeks, include home care for the aging population. Read more.


Reducing Readmissions: It’s Harder than it Looks
Hospital Impact
A centerpiece of the Center for Medicare & Medicaid Services’ efforts to enhance the value of healthcare is to reduce preventable hospital readmissions. The volume and cost of these readmissions is significant.
Read more.

How Accountable Care Organizations Are Thinking About Home Care

Guest Author, Rodney Hornbake, M.D.

I practice medicine in a quiet corner of Connecticut half way between New York and Boston.  But despite my location, I am in close proximity to two Accountable Care Organizations (ACOs).  There are now four in our state approved by CMS and in operation.  Several more are expected to be approved to begin operation January 1, 2013 and one of these will cover the entire state.  Elsewhere, physician organizations and hospital systems are beginning to act as if they were already accountable for the quality and value of the services they provide.

I have taken part in the planning for one of these ACOs, by leading the development and implementation of clinical strategies designed to make the ACO successful. The vehicle for the ACO is a large Independent Practice Association (IPA) known as Medical Professional Services (MPS).  The IPA includes more than 400 physicians in central Connecticut.   The purpose of this blog is to share the deliberations and planning as they relate to home care and to explore how others outside Connecticut are addressing the same issue.

During 2011, MPS explored multiple opportunities that were available as a result of the Affordable Care Act.  The CMS initiatives and health care delivery reform approaches that MPS considered were:

1. The Bundled Payments for Care Improvement Initiative;
2. Independence at Home; and
3. Accountable Care Organizations.

As part of our deliberations in regard to the Bundled Payments initiative, MPS convened a meeting with the leadership of five local home health organizations.  These included not for profit agencies, a hospital-owned agency and a for-profit agency.  In a short time, the group identified strategies to:

  1. Shift appropriate patients from facility based post-acute care to lower cost home based care;
  2. Improve operations of primary care practices to provide optimal support to home care;
  3. Improve operations of home care agencies to provide optimal support to primary care physicians; and
  4. Focus care on patient-centered goals.  This last strategy relates directly to the desire of many patients to avoid hospitalization and to focus instead on palliative care or hospice care.

These strategies in turn were accompanied by specific tactics.

  1. Share information.  This specifically means sharing discharge summaries and other key clinical documents with the home care agency.  (While the ACO anticipates health information exchange, a web portal or other high tech solutions, most agencies currently rely on faxes.)
  2. Support functional teams.  Every home care nurse would share his or her cell phone number with the physician who in turn would provide his or her cell phone number to the home care nurse.  Other providers will be added to the nurse-physician team as needed.
  3. Rapid cycle performance improvement.  MPS would host a weekly conference call to discuss every readmission from home care as well as every “near miss.”

In the end, MPS elected to become an Accountable Care Organization (CMS prohibits organizations from sharing in savings for more than one innovation project).  All the strategies and tactics developed to address bundled payments were adopted by the ACO when it began operation on July 1, 2012.

Other ACOs are also working to optimize post-acute care.  Detroit Medical Center includes eight acute care hospitals, multiple out-patient facilities and one post-acute care facility.  The health system has formed a virtual network of partnering post-acute providers and established a joint operating committee to oversee its operations.[1]  The focus is on improving clinical outcomes and efficiencies through collaboration on mutual goals.

HealthEast Care System in St. Paul, Minnesota is also relying on formalizing collaboration with selected post-acute providers to align the continuum of care to the maximum benefit of patients.[2]

Thus, while details vary from market to market, certain themes are emerging.  The most important one is collaboration among high performance organizations to achieve mutual goals.  Home health care organizations that understand this dynamic can strategically position their organizations in a rapidly evolving market place.

[1] Lauren Phillips, “Continuing Care Networks: Affiliating with Post-Acute Providers,” Health Care Financial Management Newsletter, (May 30, 2012), available online at–affiliating-with-post-acute-providers/.

[2] Ibid.