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News Roundup: April 8, 2013

Obama’s 2014 Budget May Spell Changes for Home Health Providers

Published by Home Health Care News
Alyssa Gerace
April 3, 2013

The home health care industry could experience some changes in 2014 such as Medicare copayments for new beneficiaries or increased fraud prevention measures for agencies receiving federal reimbursements.

Some aspects of President Obama’s 2013 budget pertaining to home health care will likely remain for next year’s budget, expected to be released on April 10, according to the Medicare Newsgroup.

If the White House’s 2014 budget is similar to the previous year’s budget, its Medicare-related measures will stay focused on containing costs and reducing fraud and waste, says the article.

The president’s fiscal 2013 budget included measures that would introduce copayments for new Medicare beneficiaries receiving home health care starting in 2017. Implementing copayments would have pros and cons, according to supporters and detractors of the concept.

The budget cited research indicating that beneficiaries with Medigap plans providing first dollar or near-first dollar coverage “have less incentive to consider the costs of health care services, thus raising Medicare costs and Part B premiums for all beneficiaries.”

While requiring Medicare beneficiaries to pay part of the costs of their home healthcare could alleviate program costs, it could also end up costing Medicare more in the long run, according to an analysis by the Partnership for Quality Home Healthcare with Avalere Health.

In many cases, it’s cheaper for beneficiaries to receive at-home care as opposed to getting skilled nursing or rehabilitation care in an institutional setting, the analysis pointed out. If they were to instead seek institutionalized care because a Medicare copayment made home health care unaffordable on top of existing housing and basic living expenses, Medicare would end up paying for much of that care in a much more expensive setting.

“A co-payment could lead some low-income beneficiaries to forego needed home health services and end up in an institutional setting as a result, where the cost to Medicare and taxpayers would be higher,” the Partnership for Quality Home Healthcare said of the December 2012 analysis.

Another budgetary measure expected to carry over from fiscal year 2013 to 2014 is the President’s call for Medicaid to be a “last resort payer.”

Medicaid may continue efforts to reduce fraudulent reimbursement claims, says the Medicare Newsgroup, by rescreening 1.5 million home health agencies, medical equipment suppliers, doctors, hospitals and other providers for potential fraud.

Ed. note: A previous version of this article indicated that Medicaid may rescreen 1.5 million home health agencies, rather than 1.5 million various health care providers, including home health agencies.

Joint Effort Introduces College Students to Hospice Care

Published by Home Health Care News
Jason Olivia
April 3, 2013

Students at the University of Notre Dame have been given the opportunity to add a course on hospice care to their curriculums.

The University of Notre Dame and the Center for Hospice Care have teamed up to offer a unique course for ND students called, “Introduction to Hospice and Palliative Care.”

First offered on campus in the Fall Semester of 2011, class organizers were surprised to see even more students enroll this time around, with 95 students total compared to the 80 enrolled in 2011.

The class, which was designed to provide undergraduate students with an introductory understanding of hospice and palliative care, included students from a number of pre-professional studies program, the vast majority of them pursing careers in medicine.

“Educating future health care providers about the hospice concept and introducing them to the benefits hospice and palliative care provides those facing serious, life-limiting illnesses is at the core of the mission of The Hospice Foundation,” said Mike Wargo, COO of the organization.

The day-long course covered a variety of topics focusing on how hospice and palliative care is given in the current healthcare system. Students were also given an introduction in the compassionate interpersonal communication skills required in caring for those in need of palliative care or who are dying.

Teachers for the course were an interdisciplinary team including physicians, nurses, social workers and bereavement counselors, as well as other hospice and palliative care staff.

Local hospitals to provide home health coach to help Medicare patients

Published by Spartanburg Herald-Journal
Dustin Wyatt
March 30, 2013

Hospitals in Spartanburg, Union and Cherokee counties are changing the way they treat Medicare patients who exhibit high risk factors, such as heart and lung problems.

Starting in April, after patients are discharged and return home, a visitor, in the form of a home health coach, might arrive on their doorstep within 72 hours to offer education, support, and strive to ensure patients don't return to the hospital for a while.

The Upstate Care Transitions Coalition is a new joint effort by Spartanburg Regional Health Care System, Mary Black Health Center, Upstate Carolina Medical Center and Wallace Thomson Hospital to reduce the readmission rates of Medicare patients by 20 percent.

In the U.S., close to one in five Medicare patients — or about 2.6 million senior adults — are readmitted to the hospital within 30 days of discharge. That comes at a cost of more than $26 billion a year, the government estimates.

In October, the Center for Medicare and Medicaid services began issuing additional penalties to hospitals for every readmitted patient.

Dr. Rick Foster, senior vice president of quality and patient safety at the South Carolina Hospital Association, told the Herald-Journal at the time that a solution, to reduce readmissions, would be for health care providers to work together and collaborate.

"You're talking about better coordination of care once the patient leaves the hospital," he said. "Which includes getting that patient into a medical home, providing follow-up with home help services, and working with nursing homes to coordinate care."

The four hospitals in three counties got involved in the Center for Medicaid and Medicare Services Community-based Care Transitions program (CCTP), which was designed in 2011. Currently, 126 hospitals across the country receive funding from the program.

The Community-Based Care Transitions Program (CCTP) is a part of the Partnership for Patients, a public-private partnership aiming to cut preventable errors in hospitals by 40 percent and reduce preventable hospital readmissions by 20 percent over a three-year period. The hospitals involved in the CCTP will work with the Center for Medicaid and Medicare Services (CMS) to provide support for patients as they move from hospitals to new settings, such as home or skilled nursing facilities.

"We are very excited to have these sites join our efforts to improve opportunities for patients to continue to make gains after they leave the hospital," said Marilyn Tavenner, CMS acting administrator, in a statement "I've seen the very real difference that support from organizations like our partners in the Community-based Care Transitions Program can make to people's post-hospital care and their health."

Renee Romberger, vice president of Community Health Policy and Strategy at Spartanburg Regional Health Care System, said one reason why readmission rates are so high is that doctors and health care providers don't know what a Medicare patient's world is like once they leave the hospital.

Some might not have transportation to get to and from a doctor's office for a follow-up appointment. Some might not be able to afford needed medications. Some patients who live alone might be overwhelmed by information once they leave and not know how to take care of themselves. Others might not even have a primary care doctor.

All of the factors can lead to a patient being readmitted within 30 days of discharge.

"We have to care about what happens after somebody leaves the hospital and before somebody comes in," Romberger said. "There is so much that happens to people after they leave that really affects their health almost as much as what we do inside the hospital."

The home health coaches will go into a patient's home within 72 hours after discharge.

They will visit once, and then give the patient three follow-up phone calls over the next few weeks.

Angela Roberson, director of case management with Spartanburg Regional Health Care System, said the coaches' job is to motivate the patients and help them figure out how to take care of themselves better.

"It's about getting to know the patient and getting a feel for where they are going to be successful and where they might have barriers," she said.

Patients can choose whether or not they want to take part in the program, but Romberger expects most will.

"Who doesn't want to improve their quality of life?" she said.

My Turn: Reform health care? Start with home health care

Published by Concord Monitor
March 2, 2013

One of the important health care challenges we face is implementing the concept of “coordinated care” – a delivery model that forms the cornerstone of the Affordable Care Act of 2009.

The idea is to coordinate the care that individuals receive from providers so we can improve their experience, produce better health results and reduce Medicare and Medicaid costs.

A good place to start would be with the care staff who best know the patient. How would this work? Here’s one example:

A client of our agency, Lutheran Social Services In-Home Care, is an 84-year-old Concord retired teacher who has lived alone for 18 years with a half-mile dirt driveway separating her from her neighbors. Fiercely independent and with no children nearby, she, like most of us, wants to remain at home. Until recently her only regular help was a home-care aide for 10 hours per week who assisted with grocery shopping, some cooking and cleaning.

Last year, she fell while at home and was hospitalized for treatment of five broken ribs and dehydration. She spent four days in the hospital and then four months in rehabilitation. Medicare paid the majority of her hospitalization and rehabilitation.

This year, her care and health status is closely coordinated by a home-care RN. The RN reviews her health status and communicates with her physician when necessary. Upon the advice of the RN, she accepted six additional hours of home health care each week, sometimes twice per day.

Her nutritional status has improved; she has gained weight and now weighs 97 pounds. With additional monitoring by trained aides, who communicate with the RN who, in turn, communicates with her physician’s office, she has avoided hospital re-admission and additional Medicare costs.

This coordinated care and home care support is only possible because our client pays privately for her care. Currently, Medicare pays only for hospitalization and very short-term home care assistance following hospitalization. Medicare does not pay for her home assistance or the RN who supervises and coordinates her care. She is not Medicaid eligible, but even if she were, Medicaid only pays for limited home care and current reimbursement rates will not support RN oversight and coordination for persons receiving ongoing home-care assistance.

Effective care coordination will take place over time, and it will include the entire team of care providers. For older adults, the home-care aide can play a crucial role in providing information about the client when health status declines or changes.

No other paid member of the care system is present in the home on a regular basis and can implement the kind of proactive measures and monitoring of chronic conditions – congestive heart failure, diabetes, pulmonary disease and other conditions common in late maturity – that substantially reduce the cost to our public and private health coverage programs. 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.

New Hampshire currently has over 900 home-care aides providing thousands of hours of care in the homes of our Medicare and Medicaid recipients each year.

New Hampshire would be well served to mobilize our already-existing home care workforce and include them in pilot programs now being developed with funding from the Affordable Care Act as we move toward effective coordinated health care.

(Rebecca Crosby Hutchinson is director of LSS In-Home Care, which provides home-care services to more than 400 clients in New Hampshire.)