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News Roundup: March 4, 2013

Seniors Will Get Short End of the Stick From Sequester Cuts

Published by Home Health Care News
Alyssa Gerace
February 28, 2013

Home health care providers are expecting 2% reductions to their Medicare reimbursement from the upcoming sequester, but seniors may be disproportionately impacted from even more slashed funding to the Older Americans Act (OAA) and other non-defense discretionary (NDD) programs.

With Congress so far unable to reach a balanced budget deal to avert the sequester—which exempts Social Security, Medicaid, and the Supplemental Nutrition Assistance Program—other programs including Medicare and housing will see spending reduced by $85 billion.

Much of the reduced spending is on the budget’s discretionary side, says Amy Gotwals, senior director of public policy and advocacy at the National Association of Area Agencies on Aging (n4a), and it will affect senior-serving programs such as home-delivered meals, rides for doctors appointments or shopping trips, and in-home support for daily chores of getting dressed, cleaning, or cooking.

“All of those programs are at very grave risk,” she says. “Any ‘savings’ from the sequester would pale in comparison to the added costs from premature nursing home placement for seniors who can no longer remain in their homes and communities; poorer nutrition and health consequences; increased falls and other avoidable crises that put vulnerable seniors at risk.”

There’s been furor regarding the upcoming 2% cuts to Medicare provider reimbursements and defense spending, but the amount of funding slashed from other programs varies and will likely have a much deeper impact on the non-defense discretionary side. The OAA is looking at a 5.2% cut for the remaining seven months of fiscal year 2013, translating to an effective rate of 9% considering the funds that have already been expended in the first five months, according to Gotwals.

“This [disparate rate for cuts depending on mandatory, defense, or non-defense programs] is so arbitrary, and it’s going back to the part of the budget that’s already been whacked,” she says, referencing earlier cuts totaling $1.5 trillion over 10 years to discretionary spending included in fiscal year 2011 appropriations.

Under sequestration that takes effect March 1, Gotwals says, 18.6 million fewer congregate and home-delievered meals would be served, and 2.1 million fewer transportation rides would be available for seniors. Another 1.6 million people would not be able to get in-home personal care services, and more than 62,000 family caregivers would lose access to respite care, counseling, and other supportive services that help sustain their caregiving roles.

Older Americans receiving Social Security won’t see their benefits affected, AARP told its members in a statement on the sequestration, but they might see other areas of impact.

“The program’s administrative funding, however, will be further cut at a time when budget constraints have already hampered the agency’s ability to provide timely, efficient and accurate service to Americans,” said AARP. “We remain concerned about the potential negative impact of an increased backlog of claims, reduced hours and possible additional closures at the Social Security Administration’s field offices, which serve beneficiaries in communities throughout the nation.”

The Department of Housing and Urban Development’s various programs, such as Section 202 Housing for the Elderly and LIHEAP (low income housing energy assistance program) are expected to eventually see an impact from the across-the-board cuts.

“If the sequestration is a true, across-the-board cut—all subsidy and grant contracts would likely experience a 5.1%-5.3% cut, most likely to come off the end of the funding allocation year—leaving shortfalls that HUD will hope that Congress will finally step up to the plate to cover last minute or after-the-fact,” says LeadingAge, an association that represents nonprofit long-term care providers.

Ultimately, cuts will be “all over the map,” Gotwals says. “We don’t know what that’s going to look like. The cuts are unavoidable, but there are options in how they’re implemented.”

CMS Credits Obamacare for Slight Decrease in Hospital Readmissions

Published by Senior Housing News
Alyssa Gerace
February 28, 2013

The Affordable Care Act (ACA) was a key driver in reducing the national rate of hospital readmissions of Medicare beneficiaries within a month of discharge, according to a top Centers for Medicare & Medicaid Services (CMS) official.

As ACA implementation continues to take force, it has already made “significant progress,” CMS said in a Thursday update, noting better health outcomes for Medicare beneficiaries, provider interest in Accountable Care Organizations (ACOs), and slowed growth in healthcare spending.

The 30-day readmission rate has hovered at about 19% for the past five years, but CMS estimates it decreased slightly to 17.8% in the last half of 2012, translating to about 70,000 fewer rehospitalizations for any cause throughout last year.

That drop in readmissions, according to CMS official Jonathan Blum, is “largely the result of provisions of President Obama’s healthcare law,” reports The Washington Post, listing components of the ACA such as financial penalties for hospitals with Medicare readmissions above an accepted threshold, along with extra funding and incentives for hospitals and outpatient providers to coordinate more comprehensive post-acute care upon discharge.

The data doesn’t pinpoint why rehospitalizations went down, the Post points out, but CMS stressed the reduction resulted from hospitals putting larger focus on reducing readmissions—partially because of incentives under healthcare reform, and partially because of penalties for failure to do so.

Healthcare spending has been slowing down at a national level, growing by less than 4% in 2011 for the third straight year, said CMS citing the annual Report of National Health Expenditures, while Medicare spending per beneficiary only increased by 0.4%, down from the preceding three years’ 1.9% average growth.

CMS also pointed to the more than 250 organizations—which can include skilled nursing and home healthcare agencies—participating in ACOs, serving about 4 million Medicare beneficiaries. These organizations will save up to an estimated $940 million in their first four years of operation, CMS projects, and more are expected to form.

Reform Is Curbing Readmissions, CMS Says

Published by Modern Healthcare
February 28, 2013


The Obama administration says provisions of the healthcare reform law have led to fewer Medicare patients returning to hospitals within 30 days of discharge.

Readmission rates fell to 17.8% of Medicare hospitalizations in November 2012 after averaging 19% in the past five years, according to the CMS. The improvement meant 70,000 fewer readmissions last year, the agency said.

Jonathan Blum, director for the Center for Medicare at the CMS, highlighted the drop in testimony before the Senate Finance Committee on Thursday as an example of initiatives authorized by the Patient Protection and Affordable Act already helping to lower costs and improve care quality in the healthcare system.

“I believe that through the payment policies and the innovation models that are being created that there is some result,” Blum said about the drop in readmissions, which are widely considered a flag for lapses in care that may have caused their return.

In October the CMS initiated its first round of penalties for hospitals with higher-than-expected numbers of patients who return to the hospital within 30 days of a discharge by cutting their overall Medicare reimbursements from 0.01% to 1%. Those maximum penalties are scheduled to jump to 2% in 2014 and 3% in 2015.

That first round of penalties cost 2,217 hospitals an estimated $280 million, according to the agency, with the magnitude of the penalty determined by a calculation of an excess readmission ratio based on 30-day readmission rates for heart attack, heart failure and pneumonia.

Blum cautioned that the findings were based only on first-year results for program and that clearer results are expected in subsequent years as additional measures were added, including for cardiac bypass surgery, cardiac stenting, and other vascular procedures.

Hospital advocates have warned that the program could have a disproportionate impact on safety net hospitals who serve higher ratios of poor patients because those patients are less likely to follow post-discharge treatment directions.

The Premier healthcare alliance, which is coordinating the participation of 450 hospitals in HHS' Partnership for Patients, found its rural and critical access hospitals had larger readmissions improvements than its overall group of hospitals averaged. The rural hospitals had a 11.2% drop in readmissions in the period studied by CMS, compared to an average 10.2% drop in readmissions among Premier group hospitals.

“We know the critical access hospitals don't always keep or manage the more chronically difficult and sick patients, so they have actually fared better” said Monica Barrington, a vice president at Premier.

She credited a range of quality initiatives that Premier has implemented at its hospitals aimed at lowering their readmission rates. Their best performing hospitals adopted all of the procedural changes, such as the use of discharge screenings that ensure any needed referrals. “It's a slow and steady improvement, which tells you that these are sustainable processes,” Barrington said.

Hospitals also have worried that the program can penalize them for post-discharge developments with patients that are beyond the hospitals' control.

But supporters of the readmission penalty program said it appears to have encouraged a growing number of hospitals to partner with other providers in their communities to ensure continuing care for discharged patients. Provider consolidations have brought their own concerns about reduced patient choices and increased prices.

The CMS aims to further improve readmission rates through a focus on the large regional disparities that its data show persist among hospital readmission rates.

“There are some parts of the country that are much lower than 17.8%,” Blum said. “We know it is possible to drive the average down further.”

Sequester Plunges Senior Care Programs Into “Grave Danger”

Published by Senior Housing News
Alyssa Gerace
February 27, 2013

Senior care providers are bracing for the impending March 1 sequester, but seniors are expected to feel a much larger impact because of effective rate cuts to the Older Americans Act (OAA) and other non-defense discretionary (NDD) programs.

With Congress so far unable to reach a balanced budget deal to avert the sequester—which exempts Social Security, Medicaid, and the Supplemental Nutrition Assistance Program—other programs including Medicare and housing will see spending reduced by $85 billion.

Much of the reduced spending is on the budget’s discretionary side, says Amy Gotwals, senior director of public policy and advocacy at the National Association of Area Agencies on Aging (n4a), and it will affect senior-serving programs such as home-delivered meals, rides for doctors appointments or shopping trips, and in-home support for daily chores of getting dressed, cleaning, or cooking.

“All of those programs are at very grave risk,” she says. “Any ‘savings’ from the sequester would pale in comparison to the added costs from premature nursing home placement for seniors who can no longer remain in their homes and communities; poorer nutrition and health consequences; increased falls and other avoidable crises that put vulnerable seniors at risk.”

There’s been furor regarding the upcoming 2% cuts to Medicare provider reimbursements and defense spending, but the amount of funding slashed from other programs varies and will likely have a much deeper impact on the non-defense discretionary side. The OAA is looking at a 5.2% cut for the remaining seven months of fiscal year 2013, translating to an effective rate of 9% considering the funds that have already been expended in the first five months, according to Gotwals.

“This [disparate rate for cuts depending on mandatory, defense, or non-defense programs] is so arbitrary, and it’s going back to the part of the budget that’s already been whacked,” she says, referencing earlier cuts totaling $1.5 trillion over 10 years to discretionary spending included in fiscal year 2011 appropriations.

Under sequestration that takes effect March 1, Gotwals says, 18.6 million fewer congregate and home-delievered meals would be served, and 2.1 million fewer transportation rides would be available for seniors. Another 1.6 million people would not be able to get in-home personal care services, and more than 62,000 family caregivers would lose access to respite care, counseling, and other supportive services that help sustain their caregiving roles.

Older Americans receiving Social Security won’t see their benefits affected, AARP told its members in a statement on the sequestration, but they might see other areas of impact.

“The program’s administrative funding, however, will be further cut at a time when budget constraints have already hampered the agency’s ability to provide timely, efficient and accurate service to Americans,” said AARP. “We remain concerned about the potential negative impact of an increased backlog of claims, reduced hours and possible additional closures at the Social Security Administration’s field offices, which serve beneficiaries in communities throughout the nation.”

The Department of Housing and Urban Development’s various programs, such as Section 202 Housing for the Elderly and LIHEAP (low income housing energy assistance program) are expected to eventually see an impact from the across-the-board cuts.

“If the sequestration is a true, across-the-board cut—all subsidy and grant contracts would likely experience a 5.1%-5.3% cut, most likely to come off the end of the funding allocation year—leaving shortfalls that HUD will hope that Congress will finally step up to the plate to cover last minute or after-the-fact,” says LeadingAge, an association that represents nonprofit long-term care providers.

Ultimately, cuts will be “all over the map,” Gotwals says. “We don’t know what that’s going to look like. The cuts are unavoidable, but there are options in how they’re implemented.”

Home health care can help individuals avoid hospital stays, ER visits

Published by Billings Gazette
Sean Moore
February 26, 2013

When it’s feasible, most people would prefer to stay in their own home if they are ill or injured.

Home health care provides skilled medical care in a patient’s home to help individuals remain on their own if they can function independently. Those services include nursing care and can also include a combination of physical, occupational or speech therapy and the services of a social worker. Certified home health aides may also be available to help with daily needs such as bathing.

As your health status changes, the skilled medical care provided through home health care can help you remain at home and avoid unnecessary emergency department visits or hospitalizations.

By staying at home, a patient maintains a high degree of independence. At home, a patient usually plays a larger role in determining how health care will be provided than in a hospital setting. Home health care providers look at the unique conditions in a home that may influence a patient’s safety and well-being. Informal caregivers, such as family and friends, may only be able to offer limited oversight. A home’s design and layout may, or may not, meet a patient’s needs. Stairs may hinder mobility. Doorways may be too small to allow wheelchair access.

When it comes to choosing a home health care agency, the federal government has tried to take some of the guesswork out of the process. The government requires home health agencies to reveal information that can be used to compare the quality of care. Those indicators are described as “quality measures.” The measures include information on how often each home care agency uses best practices when caring for its patients and whether patients improved with home health care in certain important areas of care.

The Centers for Medicare and Medicaid Services require home health agencies to report their quality outcomes. It works like a report card. For example, if you had hip or knee surgery, you might want to look at the quality measures related to managing your daily activities, such as walking, bathing, getting dressed, getting in and out of bed and cooking. Another measure is managing pain. Treating pain helps keep patients comfortable and helps their recovery. Preventing harm, such as falls, and preventing unplanned hospital care is equally important to the patient’s recovery. All of those measures are publicly reported and available on the website Medicare.gov by entering the search terms “Home Care Compare.” You can compare a specific home health care agency with other local agencies or with home care agencies nationally.

The site also allows you to see the “patient experience of care survey,” which shows what other patients have said about their recent home health care experience. The purpose of the survey is to gather information from patients, or the patient’s family or friends, about their experiences with a home health agency. The survey asks patients about the care they received and if they would recommend the agency to someone else. The survey results also tell home health care agencies where to focus their quality improvement efforts.

Using Quality Measures to compare health care agencies can help you to choose the right agency for your loved one.

Home health care providers seek to offer high-quality, safe care in ways that honor a patient’s independence and accommodate the individual characteristics of each patient’s home and family. Patients can be referred to home care by their primary care provider or discharge planners after a hospitalization or inpatient stay. Family members, or the patient, can also request home care services.

If you are ill, or someone you love is ill, choosing a home health care agency can be a daunting task. But, like any decision, being informed can help you make the best choice.