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News Roundup: March 18, 2013

OP-ED: Home Care Aides Can Help Care Coordination Efforts

Published by PHI
Matthew Ozga
March 13, 2013

An op-ed published in the Concord Monitor on February 28 argues that home care aides are well positioned to play a significant role in care coordination.

However, the op-ed -- written by Rebecca Crosby Hutchinson, the director of home care agency Lutheran Social Services In-Home Care in New Hampshire -- points out that the robust care coordination necessary to reduce hospitalizations is currently not paid for adequately by either Medicaid or Medicare.

"For older adults, the home-care aide can play a crucial role in providing information about the client when health status declines or changes," Hutchinson writes. "Experienced home-care aides are able to build a reliable and trusting relationship with their clients and family members and encourage healthy habits and safe living."

In March 2012, a Washington, DC, forum co-sponsored by PHI and SEIU explored the possibility of using advanced training to expand the roles of home care workers within multidisciplinary care teams.

"Home care workers in advanced positions have the potential to offer tremendous value to our health care system," said Steve Edelstein, PHI National Policy Director. "With the right training and support, these workers are uniquely qualified to improve consumers' care quality while lowering costs."

Home Health Care Providers “Unfairly Impacted” By Sequestration Cuts

Published by Home Health Care News
Alyssa Gerace
March 13, 2013

The upcoming sequestration, which cuts Medicare reimbursements to health care providers by 2%, could be the straw that breaks home health care agencies’ backs in an industry that has been experiencing rate cuts for years.

The impact of sequestration is expected to be particularly acute in the healthcare industry, according to public accounting and consulting firm CliftonLarsonAllen LLP, and even more so for home health agencies.

“It has a larger effect on home health agencies because they’ve been sustaining cuts to rates for the past few years,” says Gregg Hathorne, partner at CliftonLarsonAllen. “Given those cuts, that 2% could basically mean existence or not, for agencies that are treading a very thin margin.”

While the home health industry received something of a reprieve to its market basket adjustment for fiscal year 2013, he says, it wasn’t excluded from the across-the-board sequestration cuts, which are expected to have a “significant impact.”

A majority of home health agencies are small and either family-run, owned by smaller proprietary agencies or non-profits, or are governmental in nature, according to Hathorne. Sequestration could substantially affect their margins and whether or not they can hire more employees or sustain operations, he says.

Health care providers in general, including home health agencies, are facing a “monumental shift” in revenue cycles with sequestration about to take effect, says CliftonLarsonAllen.

Medicare reductions will total about $11.1 billion from April 1 to March 31, 2014, according to the U.S. Office of Management and Budget. Providers are expected to see a reduction in reimbursements for services provided starting April 1, if sequestration goes into effect as planned.

The impact on the home health industry is still unclear in some respects, Hathorne says, based on how providers are paid for episodes of care rather than providing a service in full and then filing a reimbursement claim.

Home health providers get paid in two parts: about half up front or within about 15 days of filing an initial claim, then the rest after filing a final claim once the full service has been performed. As of now, it’s unknown whether cuts will be applied retroactively to the full episode of care, or just the “settle-up” from the final claim, says Hathorne.

“There’s still a little bit of uncertainty for providers who are paid up-front for an episode that started prior to April 1,” he says. “It could be that that half won’t be subject to sequestration cuts, while the rest of it that occurs after April 1 will be.”

The home health care industry will sustain “a bit of an unfair share of sequestration’s impact” compared to other health care providers, but it’s expected to pull through.

“Home care’s future is going to drive health care’s improvement in the country,” Hathorne says. “It’s such a resilient [industry] and has sustained so many challenges in the past, and it will have to sustain more.”

CMS announces 20 new participants in program to improve transitions, reduce rehospitalizations

Published by McKnight's Long-Term Care News
Tim Mullaney
March 12, 2013

The Centers for Medicare & Medicaid Services recently announced 20 new organizations participating in the Community-based Care Transitions Program (CCTP), which is an initiative to cut down on hospital readmissions by facilitating better patient transitions between acute and post-acute providers.

With the latest round of participants, there are now 102 community-based organizations (CBOs) taking part in the program, CMS said March 7. The CBOs receive funding for two years to undertake efforts to cut down on readmissions, and the funds can be renewed for the duration of the five-year CCTP program based on performance. The CCTP program has $500 million in funding to distribute through 2015.

Sun Health, an Arizona-based philanthropic organization, is one of the new CCTP participants. It will partner with two nonprofit skilled nursing/rehabilitation facilities and two medical centers to improve transitions in Maricopa County, Arizona. Components of the transition program will include medication reconciliation, fall risk assessment and depression screening.

A full list of the new CCTP participants can be found here.

Progress 2013: Home health care programs help keep seniors in their own homes (with video)

Published by News Herald
Caitlin Fertal
March 11, 2013

Staying in her home is important to Willowick resident Dorothy Kantz.

After her heart surgery in 2009 she has been working with a nurse from Lake Health Hospitals to manage her congestive heart failure and diabetes.

She is on oxygen at all times and monitors her blood pressure and weight daily.

Her husband John used to be her primary caretaker until he himself needed heart surgery about a year ago.

For the two to stay in their home, both medical and non-medical home care services were necessary.

The couple, married 62 years, have lived in their current home for the past 14 years. They moved from a multi-level home after Dorothy broke her ankle because it became hard for her to get around, John Kantz said.

Susan Sharp, a registered nurse with Lake Health's Home Care program, has visited John and Dorothy at least once a week for the past three years.

The preventative care helps to keep Dorothy out of the hospital and in good health with her condition, Sharp said.

CNN: Home Care Aides Face Poor Wages, Despite Surging Demand

Published by Home Health Care News
Jason Olivia
March 11, 2013

The aging population of baby boomers looks to spark a surging demand in the number of home health aides by 2020, CNN Money reports.

On track to become the nation’s fastest growing job, the U.S. Labor Department projects that home health workers will experience a 70% increase between 2010 and 2020.

But even though the demand for home health aides is expected to increase to meet the demands of a massive boomer population, these workers still face roadblocks in wages and benefits that the country will need to address in the coming years.

CNN Money writes:

But even though there are plenty of job opportunities, many of these people make the same wage as teenagers flipping burgers or selling clothes at the mall. The average hourly wage is just $9.70 an hour, according to the Labor Department.

For those in the industry who work full-time, this amounts to roughly $20,000 a year. Many health care aides only work part-time though — and they do not receive benefits.

Under these conditions, it’s no surprise then that about 40% of home aides rely on public assistance, such as Medicaid and food stamps, just to get by.

Many home health care aides are exempt from federal minimum wage and overtime laws, due to a little-known provision in the Fair Labor Standards Act passed in 1974, which puts them in the same category as casual babysitters. The Obama administration has been trying to change that over the past two years, but its efforts have been met fiercely with lobbying from the industry.

If the industry is forced to pay minimum wage and overtime to home health aides, CNN notes, workers’ hours could be restricted to 40 hours a week or less, which could in turn lead to a reduction in pay for live-in workers.

The industry also disputes the government’s claim that it would only cost an extra $166 per worker a year to comply with federal minimum wage and overtime regulations, CNN writes.

Home care, tele-medicine cut health costs

Published by Sun Sentinel
William Gibson
March 11, 2013

To understand how the health-care system sometimes fails patients and often wastes money, consider the case of a South Florida nursing-home patient who developed a cough and slight fever.

"The nurse notifies the doctor, who doesn't get much information and says, 'Send her to the emergency room,'" recounts Joseph Ouslander, associate dean for geriatric programs at Florida Atlantic University. "She has tests in the emergency room, some of which are falsely positive, and is admitted unnecessarily to the hospital, where she gets acute confusion and breaks her hip.

"It happens every day: An episode that could have cost Medicare a couple hundred bucks turns into one that costs closer to $20,000. So you are creating human misery, and you're spending money."

Striving to avoid such calamities, Ouslander and other health-care leaders in Florida are developing innovative methods to care for many patients in the comfort of their homes or in nursing homes instead of sending them on costly and risky trips to the hospital.

An FAU program trains nurses and advises thousands of nursing homes across the country about ways to detect problems and treat patients without always resorting to the emergency room. Farther north, Orlando Health is using physician interventions, "tele-medicine" and even old-fashioned house calls to keep people out of hospitals.These Florida initiatives are tackling one of the biggest problems facing Congress and the nation: how to provide quality care at lower cost without raising taxes or cutting benefits.

They are unfolding just as Congress and the Obama administration are looking for ways to restrain health costs that threaten to overwhelm government programs such as Medicare and Medicaid during a time of huge deficits.

U.S. Sen. Bill Nelson, D-Fla., new chairman of the Senate Committee on Aging, points to more efficient methods such as these as an alternative to proposals in Congress that would cut costs by privatizing Medicare through a voucher-like insurance system.

"Reducing hospital readmissions will not only save the Medicare program billions, it will save beneficiaries from potential infection and further out-of-pocket expense," Nelson said at a recent committee hearing.

A long-running controversy over Medicare will heat up this week when House Budget Chairman Paul Ryan, R-Wis., unveils his latest budget framework. He is expected to revive a plan that would give Americans now 54 and younger fixed "premium support" money to buy private insurance once they become eligible for Medicare rather than provide open-ended coverage as now.

Ryan and fellow Republicans note that Medicare's Part A hospital coverage is projected to run short of money by 2024 unless Congress cuts costs.

Nelson's Aging Committee is exploring other options, including more reliance on home health care and moving away from the traditional fee-for-service system that rewards doctors for the number of procedures ordered.

More efficient delivery of health care would save $2 trillion over 10 years — $1 trillion of it spent by the federal government, including $761 billion by Medicare — according to The Commonwealth Fund, a respected research group, which presented its findings to the Aging Committee.

Nelson plans to raise these findings and point to a range of cost-cutting options in the coming budget debate while trying to fend off voucher-like proposals that would reduce Medicare benefits.

One example is a program developed by Ouslander at FAU called INTERACT, which already is used in nursing homes here and abroad and soon will be adapted for patients at home and in assisted-living communities.

"We have a great opportunity now to improve care for a growing number of people who are going to live until extreme age, prevent complications and unnecessary expenditures," Ouslander said. "We're saving billions of dollars and giving better care."

The program trains nurses to better detect health problems, communicate with doctors and treat patients in some cases without sending them to hospitals. Ouslander also encourages more end-of-life care at patient homes or hospice centers.

An INTERACT pilot project at 25 nursing homes in Florida, Massachusetts and New York cut the rate of hospital admissions by 17 percent, FAU reported.

Orlando Health, meanwhile, is exploring ways to keep patients from returning to the hospital, spurred in part by being penalized under the Affordable Care Act for a relatively high hospital-readmission rate.

Patients now leave Orlando Health hospitals with a 30-day supply of medicine and a follow-up doctor's appointment within five to seven days. Patients also get advice about diet and medication and are asked about financial needs.

"Somebody who doesn't have enough money may be taking a half dose of blood-pressure medicine that puts them back in the hospital," said David Sylvester, who oversees post-acute services at Orlando Health. "Or a patient may think a can of soup is a healthy meal but wakes up the next morning after gaining 3 pounds because of all the sodium in the soup and goes back into congestive heart failure."

An experimental program at Orlando Health allows patients to stay at home, push a button on a control box, stand on a scale and send information such as weight and blood pressure to a nursing station miles away to detect early signs of heart failure. And a House Calls program that sends doctors into homes is serving about 200 patents a year.

The result: a 15 percent reduction in hospital readmissions during the past two years, Sylvester said.

Starting in June, Orlando Health plans to add a "hospital at home" service in which home-health nurses and patients consult with doctors via videoconference to devise treatment plans without a trip to the hospital.

"People are more comfortable, their loved ones are around, and it's much less expensive because you don't have the capital costs of a hospital," Sylvester said.

"The demand will continue to grow," he predicted. "We as baby boomers have a little higher expectation for our health care, and I think we will continue to focus on having people treated in the least restrictive, most cost effective, safe environment."