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News Roundup: December 16, 2016

Senate Bill Would Extend Independence at Home Demonstration

Published by Home Health Care News
By Mary Kate Nelson
December 16, 2016

A pilot program that incentivizes the delivery of home-based health care for chronically ill patients may be extended if newly introduced legislation passes.

The Senate Finance Committee Chronic Care Working Group introduced the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016 (S. 3504) on Dec. 6. The bipartisan legislation, among other things, would extend the Independence at Home (IAH) demonstration for two additional years.

Specifically, the bill would allow IAH, which is set to expire in September 2017, to last until September 2019. The bill would also raise the maximum number of allowable beneficiaries to 15,000 from 10,000.

IAH, which began in 2012, enables doctors and nurse practitioners to deliver in-home primary care for applicable Medicare beneficiaries. The demonstration is intended to reduce unnecessary visits to the emergency room, avoidable hospitalizations and readmissions, and to lower Medicare costs overall.

In 2015, IAH saved Medicare more than $25 million, or an average of $3,070 per beneficiary, the Centers for Medicare & Medicaid Services (CMS) found. The demonstration saved Medicare more than $10 million in 2016.

The National Association for Home Care & Hospice (NAHC) praised the newly introduced S. 3504 legislation in a statement on its website, noting that IAH physicians often work with home health agencies to achieve Medicare spending efficiencies and optimal patient outcomes.

The Visiting Nurse Associations of America (VNAA) similarly supports the Committee’s decision to extend the IAH demonstration.

“VNAA would like to see IAH converted into a permanent program, as detailed in our June 2015 letter to the Chronic Care Working Group and in S.3130,” the organization said in a statement to Home Health Care News. “VNAA approves of extending the program through September 30, 2019 and increasing the cap on the total number of participating beneficiaries from 10,000 to 12,000 while allowing practices for up to three years to receive a shared savings payment before they are terminated from the demonstration.”

The Partnership for Quality Home Healthcare, in a statement to HHCN, also expressed pleasure that the Independence at Home Demonstration was included in the Chronic Care Act of 2016. PQHH is a Washington, D.C.-based coalition of home health providers that aims to improve the quality, efficiency and integrity of home health care.

S. 3504 was introduced by U.S. Sens. Orrin Hatch (R-UT), Johnny Isakson (R-GA), Mark Warner (D-VA) and Ron Wyden (D-OR).

Healthcare leaders want Trump to continue focus on value-based care

Published by Modern Healthcare
By Shannon Muchmore
December 16, 2016

A group of influential healthcare industry executives is asking President-elect Donald Trump and other incoming policymakers to keep and prioritize value-based care models, which have been championed under the Affordable Care Act.

“This is not the time for policymakers to waver or reverse course, which would send a negative message to the industry and chill ongoing transformation efforts,” reads the letter made public Wednesday by the Health Care Transformation Task Force.

The letter appeals to traditional Republican priorities like reducing Medicare and Medicaid spending, promoting public-private partnerships and encouraging new and existing businesses. It is addressed to Trump, Vice President-elect Mike Pence, House and Senate leaders of both parties, the nominee for HHS secretary, Tom Price, and nominee for CMS administrator, Seema Verma.

The Health Care Transformation Task Force is a group of 43 heavy-hitters including hospitals, doctors, health insurance companies and patient advocates and focuses on promoting value-based care instead of the current fee-for-service system.

Jeff Micklos, executive director of the task force, said key aspects of the letter are reminding the incoming administration that the movement toward value-based care—like accountable care organizations and other payment models that are tied to quality outcomes—has always been bipartisan and that it cannot be left on the back burner.

“Even inaction is really a concern,” he said.

Micklos said the task force wants to make sure other health policy issues like Trump's promise to repeal the Affordable Care Act don't push issues like implementing the Medicare Access and CHIP Reauthorization Act, or MACRA, off the agenda. If that happens, investments companies have made in new care models will be at risk, Micklos said.

“What doesn't necessarily get a lot of exposure and what we're bringing to light here is the level of innovation that is happening in the private landscape,” he said.

The letter calls for the continued use of the Center for Medicare and Medicaid Innovation, also known as the CMS Innovation Center, to test payment models. The center has received some criticism from Republicans, including Price, for implementing models with mandatory provider participation.

Micklos said a platform for studying new payment models is necessary, and Republicans could use the Innovation Center to test models using their own methods and priorities.

David Lansky, CEO of the Pacific Business Group on Health and task force member, said employers are concerned that not moving forward with value-based models would lead to higher, unsustainable costs and sicker employees.

“Competitiveness depends on control of healthcare costs and healthy workers,” Lansky said.

Task force member Dr. Angelo Sinopoli, vice president of clinical integration and chief medical officer of Greenville (S.C.) Health System, said a simple statement from new leaders that they will support alternative payment models would be a good start to open dialogue.

“Unless we get a signal from the new transition team that they are going to continue to focus on efficient and market-based solutions to taking care of patients, I think we could creep back to a model where the cost of care actually goes up rather than down,” he said.

Harvard Report: Home Care to Surge as Population Ages

Published by Home Health Care News
By Alana Stramowski
December 16, 2016

Within the next decade, the number of Americans 65 and older is going to surge. But as this happens, the demand for housing to accommodate those who wish to age in place will also increase drastically.

By 2035, more than one in five people in the country will be 65 or older, according to a report released today by the Harvard Joint Center for Housing Studies.

In the coming years, the number of people 65 and older will increase from 48 million to 79 million.

“Researchers have estimated that nearly 70% of older adults will need some form of long-term care in later life, the majority provided in the home but including some time in a skilled nursing facility,” the report said. “In the future the focus of more intensive care may shift more toward the home, the home is already a vital site of long-term care delivery.”

Home modifications are a must

Even though the majority of older adults want to live at home for as long as possible, by 2035, 8.6 million people will be paying more than half their income for housing, and those who qualify for federal rental subsidies will increase by 90% from 2013 to 2035, the report found.

To achieve the goal that many Americans want, both public and private entities will have to work to ensure that home modifications can easily be accomplished but also be affordable.

One requirement that older homeowners will demand to age in place will be universal design at an affordable price, the report says.

“There are a fair number of older adults who have the financial resources to keep up in retirement, but there are more adults with moderate to low funds,” Jen Molinsky, senior research associate at the Joint Center for Housing Studies and lead author of the report, told Home Health Care News.

In an effort to incentivize and even require universal design in homes, a number of state and local governments created visitability ordinances. These ordinances require all homes not just to be habitable, but also visitable by someone with a mobility device, the report said.

Creative financing options

Another opportunity the increase in older population will bring is the opportunity to reevaluate how and where care is delivered, Molinsky added.

And the reality for many Americans is that they want to stay put and get the care they may need in their home, but struggle to find the money to do so.

The problem may be especially tough for renters, while those who own their homes might have more options.

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The typical older homeowner has 42 times more wealth than that of the typical older renter, which brings the option of tapping into home equity to help make ends meet in retirement a viable option.

The median monthly cost for a home health aide is $3,813 and the number of months a homeowner would be able to afford the care before his or her wealth is spent down is 27 months, but if the homeowner taps into his or her home equity he or she could afford the care for 68 months, the report said.

Currently, the majority of older adults who receive for long-term care pay out of pocket, but as the aging population skyrockets in the next decade, many older homeowners will need to explore innovative alternatives to make ends meet to be able age in place.

The comprehensive 98-page report also brings up the following topics:

-How obesity, diabetes and arthritis could impact aging baby boomers

-The future of dementia for the aging population

-Trends in the numbers of households with disabilities

Woman grateful for help in returning ‘home’

Published by Dayton Daily News
December 16, 2016

The Ombudsman office is frequently involved in interesting cases. A very nice woman who resided at a local nursing home contacted our office requesting to move to an apartment in the community. The resident had lived in a nursing home for several years but recently completed a long period of rehabilitation and believed she was ready to move to an apartment and live as independently as possible.

However, the resident, who is wheelchair bound, needed assistance moving from the nursing home and did not know how to make her dream a reality. The Ombudsman met with the woman at the nursing home to determine what challenges they would face in moving the resident to an apartment. During their initial meeting the Ombudsman asked whether the woman needed assistance with any activities of daily living such as bathing, transferring into bed, transportation or exercising. The Ombudsman concluded the woman would need some assistance but certainly appeared more than capable of living on her own. In fact, the woman intended to return to the workforce after finding an apartment, which also meant she would need an apartment close to a bus line. The Ombudsman then obtained the resident’s consent to investigate her case and do everything possible to help her move to an apartment.

The Ombudsman then met with the nursing home’s director of nursing and learned what home-based nursing services the woman would need in order to ensure the transfer to an apartment was successful. The Ombudsman then contacted an individual connected with HOME Choice, a Medicaid funded program that helps transition eligible Ohioans from nursing home settings to home and community-based settings, where they receive services and supports in their home.

HOME Choice was established in 2008 with the goal of moving 2,000 Ohioans back “home.” The Ohio program currently ranks second nationally in transitioning individuals from nursing homes to independent living. Once the HOME Choice representative was contacted, the Ombudsman coordinated a meeting with the woman, the HOME Choice representative and the relevant nursing home staff. A plan was then put together by the “transition team” to have the resident moved to her apartment with 6-8 weeks. First, an apartment had to be located that was on a bus line and within our resident’s monthly budget.

Thankfully, the HOME Choice program is able to pay the initial deposit and first month’s rent because most residents transferring from nursing homes to the community don’t have the resources to meet this expense. Once the apartment is secured, the home health services are scheduled with a local home health agency. Finally, the HOME Choice representative took the woman shopping for home accessories she does not possess. Sometimes this includes a bed, dishes, towels, sheets, or a chair. Once the shopping is completed a final discharge meeting is scheduled and the woman knows her move-in date.

In this case, the woman had her final discharge meeting and learned she would be moving to her apartment in five days. She was so excited to regain her independence, despite not having a television in her apartment. A ground floor unit was located and the resident is approximately three minutes from the bus line. She will also have home healthcare services 15 hours a week, spread over five days, to assist with physical therapy and daily activities. The resident called the Ombudsman the day after moving in to her apartment and expressed her thanks for helping her regain her independence and dignity.