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News Roundup: March 4, 2016

Remote Monitoring Slashes Readmissions 40% for UVA Health

Published by Home Health Care News
By Amy Baxter
March 4, 2016

As federal payors continue to push the national health system toward value-based purchasing with financial incentives for coordinated care, major hospital systems are partnering up with businesses that can improve patient outcomes after a discharge.

Locus Health is one of those companies that provides coordinated care with remote patient care management technology. The Virginia-based company provides programs that aim to reduce readmissions, improve health outcomes and optimize patient management and engagement. With a web-based technology, Locus Health’s clinicians work with other health providers.

The patient care management company has undergone another successful round of funding, raising $4 million at the beginning of the year. A significant investment came from University of Virginia Health System (UVA) in Charlottesville, Virginia. The hospital system has been a significant investor in the Locus Health and has participated in a study while utilizing the technology.

Over the two-year study, Locus Health enrolled more than 80% of the eligible patients in their program, and the initial results have revealed positive patient outcomes and cost savings.

The data revealed that readmissions for Medicare patients with select conditions fell by 40% over two years with the use of Locus Health’s program. This study target patients with five specific conditions: AMI, heart failure, pneumonia, COPD and joint replacements. For joint replacement patients, the results were even better, with a 64% reduction in readmission rates for UVA during the course of more than a year.

These conditions are currently being targeted by Medicare under bundled payment rules to reduce admissions and tie costs together or a single period of care, Andy Archer, co-founder and senior vice president of Locus Health, told Home Health Care News.

The program’s biggest emphasis is on reducing these hospital readmissions, which can result in costly penalties for health systems.

“From UVA’s perspective, the readmission penalties are real, and hospital systems all over the country have come to realize that Medicare means business with respect to the penalties,” Archer said. “There’s a really strong financial impact that accompanies what is a really great, very positive impact on patients and patient care.”

The results of the study were better than the targeted rate of reduction—originally 20%—and show the impact of coordinated care on both patients and costs.

One of the most important cornerstones of the program is getting patients involved in it. To coordinate care, providers need to have information about their patients. Patients that are participating in the program by engaging with the technology can help their clinicians keep track of their health and avoid readmission down the road, even without visits from a home health agency.

“It speaks volumes in terms of the outcomes when you look at the level of patient engagement that was achieved across the board,” Maggie Short of UVA told HHCN. “They committed to being active participants on a daily basis, sending in their metrics, taking calls from the clinician and responding to calls. It takes a patient to be pretty committed to be engaged in some level of activity around this self-management on a daily basis.’

Not only are the outcomes more cost effective, but UVA is seeing some positive changes within patients themselves.

“A number of these patients before the program were, to some degree, resigned to this revolving door of readmission,” Archer said.

With a high rate of engagement, 96% of patients said they were satisfied with he program in a survey.

Home Health to Relieve Overcrowded Hospitals When Disaster Strikes

Published by Home Health Care News
By Mary Kate Nelson
March 4, 2016

Home health and hospice care providers in the United States now have a resource to turn to in the event of a public health emergency, courtesy of the Centers for Disease Control and Prevention (CDC).

The Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies, published March 1, was developed by the CDC Healthcare Preparedness Activity (HPA), with guidance from stakeholders from long-term care facilities, home health agencies and hospice agencies.

Long-term, home health and hospice care agencies and facilities are expected to play a major role in helping to reduce the patient surge on hospital emergency departments and other health care sectors within their communities during a public health emergency, the planning guide states. For one, sick, but noncritical patients may have to be housed at a long-term care facility or treated in the community, as opposed to being sent to a hospital—as hospitals are already running at or near full capacity.

Because of this, the planning guide says, long-term care stakeholders must engage in public health emergency planning efforts within their communities.

Accordingly, the CDC identified the issues and gaps long-term care sectors face during a public health emergency—such as an influenza pandemic—and developed tools to assist them in addressing these gaps and issues.

The new resource revolves around six topic areas identified by relevant stakeholders. These topics, as written in the planning guide, are:

Situational awareness—maintaining awareness of the status of a public health emergency and the response to it
Continuity of operations—ensuring that your facility or agency continues to operate during a public health emergency
Facility/agency operations—ensuring that the appropriate personnel are in place to direct the operation of your facility or agency
Crisis standards of care—accommodating crisis standards of care
Staffing—ensuring that you have personnel who are available to respond to a public health emergency
Fatality management—managing fatalities in your facility

Every long-term care provider, home health care or hospice agency should assign one individual to serve as an emergency planning coordinator for their agency or facility, according to the planning guide. Ideally, this coordinator will have clinical and infection control experience and will be responsible for guaranteeing that all action plans in the planning guide are carried out. The emergency planning coordinator should be given the resources, time and authority to develop their facility’s or agency’s emergency preparedness and response plan, the planning guide states.

Prior to the publication of the Planning Guide, the Centers for Medicare & Medicaid Services issued a proposed rule that “would establish national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they adequately plan for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems.” Although there is no way to predict exactly what CMS will require in the final rule, the authors believe the Planning Guide, for the most part, is in alignment with CMS’s intentions, the National Association for Home Care & Hospice reported.

Lonely, Homebound Senior Could Be Just a Stereotype

Published by Home Health Care News
By Mary Kate Nelson
March 4, 2016

Think most seniors are lonely? Think again.

A whopping 76% of American seniors never or rarely feel lonely or isolated, according to a poll commissioned by Caring.com, a senior care resource for family caregivers seeking information and support as they care for aging loved ones. In fact, only 6% say they have feelings of loneliness or isolation on a frequent basis.

Meanwhile, 16% of seniors feel lonely sometimes, the poll found.

“You always hear that seniors are lonely, and the common belief is that loneliness is one of the big issues around senior citizens,” Andy Cohen, CEO of Caring.com, told Home Health Care News.

Cohen was “shocked to learn” otherwise.

The findings of the poll, conducted by Princeton Survey Research Associates International (PSRAI), could assuage the concerns of those who care for seniors outside of the senior housing setting.

“It will be welcome news to family caregivers, as there are other things they may want to worry about more,” Cohen said.

Seniors who live in close proximity to others aren’t necessarily better off, the poll revealed. Seniors living in urban areas are approximately twice as likely to feel lonely frequently, compared with those living in rural and suburban areas.

“Seniors are just not lonely,” Cohen said. “I think it’s just sort of a stereotype.”

PSRAI conducted interviews by phone with 628 adults age 65 or older living in the continental United States. The interviews were conducted between Jan. 7 and Jan. 10, and between Jan. 21 and Jan. 24.

LHC Group CEO: Why Home Health Needs a ‘Non-Acute’ Identity

Published by Home Health Care News
By Tim Mullaney
March 4, 2016

When it comes to preventing hospital readmissions and controlling costs after joint replacements and similar procedures, home health agencies and other post-acute providers play a crucial role. But agencies may gain an advantage if they also are involved before a patient even enters the hospital for treatment.

“We don’t like to use the word post-acute anymore,” says Keith Myers, CEO of LHC Group (NASDAQ: LCHG). “We say regularly now that we’re not post-acute, we’re non-acute. In many of our hospital joint ventures, we’re having just as big an impact on the pre-acute side.”

LHC Group is in a particularly good position to comment on the evolving relationship between home health providers and hospitals. Hospital joint ventures have long been a niche play for the Lafayette, Louisiana-based company, which employs more than 10,000 people and has a 25-state footprint. About 50% of LHC’s revenue comes from JV relationships with hospitals and health systems, Myers pointed out in a recent conversation with Home Health Care News.

Currently, LHC Group has partnered with more 60 hospitals and health systems, including a recently inked JV with Baton Rouge General Hospital. Preventing “costly and avoidable hospital readmissions” is one of the key objectives of that venture, Myers stated in a press release when the deal was announced earlier this month. And preventing readmissions is a goal that many home health providers now have—Affordable Care Act policies mean hospitals face Medicare reimbursement cuts if they readmit too many patients, incentivizing them to work more exclusively with home health agencies that can stop that from happening.

Since forging its first hospital joint venture in 1998, just four years after its founding, LHC has developed a time-tested approach to prevent rehospitalizations.

“The critical first step is to have the ability to risk-stratify your patient population and to update that on a regular basis,” Myers says. “If we have 500 patients on census at one of our JV locations, we have to know which 50 are highest risk and focus additional resources—which we don’t typically get reimbursed for in fee-for-service—to those patients, to bend the cost curve by avoiding unnecessary inpatient costs.”

A call center at the LHC home office takes calls from the field, and workers there follow scripts so that they can efficiently triage alerts and deploy caregivers to intervene before a hospital readmission is necessary, Myers says. Utilizing high-skilled clinicians such as nurse practitioners is another key part of the strategy.

“We’ve learned over 22 years, that’s how you avoid the rehospitalizations,” he says.

But a singular focus on rehospitalization may not be enough to be a stand-out hospital partner these days. Recent Medicare initiatives, such as a bundled payment program for hip and knee replacements, make it imperative for hospitals and their partners to keep quality high while making the episode of care as cost-efficient as possible. Here, a pre-acute focus is a differentiator, Myers says.

“We’re helping to drive value in the hospitals that are in those [hip and knee] bundles,” he says, “I don’t have the data readily available, but I’ll take a shot and say one-third or more of the value we’re creating is coming from our interaction with patients on a pre-acute basis. Planning the care path before surgery is resulting in reduction in length-of-stay by about 30% to 35% on those patients. So it’s not just reducing rehospitalization, but bringing down length-of-stay post-op. And, they’re moving out of the hospital to home health faster because of our interaction.”

LHC Group is not the only home health provider that sees itself occupying the “non-acute” category; the concept has been embraced by the Partnership for Quality Home Healthcare, a provider association that Myers currently chairs. LHC Group also certainly is not the only provider pursuing hospital partnerships—and the volume of potential transactions in its docket indicates just how avid hospitals are to find the right “non-acute” partners.

As of the third quarter of 2015, LHC Group had reviewed more than 264 acquisition or hospital JV opportunities, Myers said on an earnings call in November. While he did not share exact updated numbers in advance of this week’s upcoming earnings release, he indicated that the pipeline is not getting any smaller.

Easing the Burden of Illness with Palliative Care

Published by Santa Barbara Independent
By LÉNA GARCIA
March 4, 2016

Soon after her engagement, Santa Barbara native and first grade teacher at St. Raphael School Aana Rivlin began the difficult task of carrying for a parent with a cancer. Her mother, 63-year-old Terry Strickler — a software configuration manager at Raytheon — had been diagnosed with an advanced stage of cholangiocarcinoma, a rare bile duct cancer.

Following her mother’s death in June 2015, Rivlin spoke with The Santa Barbara independent about her experience with Visiting Nurse & Hospice Care (VNHC) and Sansum Clinic’s Community Palliative Care Program — an outpatient holistic treatment service for seriously ill individuals and their families — and a resource on the rise in S.B. county. Two services, the community care program and the in-patient Palliative Care Consult Team, are available to are residents.

A patient at the nonprofit outpatient program the Cancer Center of Santa Barbara, Strickler received both advanced medical care and around-the-clock familial support when Rivlin and her fiancée moved into their mother’s S.B home. The three were determined to fight the two tumors in Strickler’s liver, which started in the thin tubes carrying bile fluid to the organ.

When Strickler’s oncologist, Dr. Daniel Greenwald of the Cancer Center, referred the family to palliative care, Rivlin said the concept carried “a negative connotation,” similar to the hopelessness attached to hospice. But, “There’s this big gap,” she added, “What do you do when you can’t reach the doctor?”

Throughout the weeks to come, VNHC’s team of specially trained palliative care doctors, nurses, and social workers provided pain symptom management and emotional support to Stickler. Forming the link between the oncologist and his staff, the nurses would call and visit Rivlin and her mother at home. “They really just give the patient someone who listens to them…they would tell me what a good job I was doing taking care of her and hanging in there,” Rivlin said.

Consultation nurses like Julie Hirsch, a longtime VNHC staff member who has been with the palliative care program since its inception in 2006, were available by phone 24/7 to the family. Describing her career as “a lot of listening and talking [about] symptoms and issues,” Hirsch told The Independent in a phone interview, “We see people who are not quite ready for hospice but need support and symptom management.”

According to Dr. Michael Bordofsky, Medical Director of VNHC, palliative care typically serves “patients suffering from congestive heart failure, chronic obstructive pulmonary disease, and dementia. Many participants have [advanced] cancer.” From 2013-2014, VNHC saw a 20-percent jump (796-955) in the number of people using one of the two palliative care programs, read the organization’s press release. The same increase was predicted from 2014-2015.

“…Often described as a win for everyone,” Bordofsky said of the service, “…palliative care doctors, nurse practitioners, and home health nurses can bill insurance just like everyone else.” Organizations like VNHC and Cottage Health help fill the gap of what insurance doesn’t cover, he added. Citing the National Hospice and Palliative Care Organization’s (NHPCO) most recent report, Bordofsky said about a quarter of Medicare’s total costs finance the last year of a person’s life — but “80 percent” in the last month is spent on hospitalization. Neither program raises the overall cost of healthcare.

While providing support to patients and caregivers, Santa Barbara’s palliative care programs offer what Rivlin calls, “a creative solution to a difficult situation.”