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News Roundup: December 4, 2015

Health Network Saves $5 Million Through Home Care Program

Published by Home Health Care News
By Kourtney Liepelt
December 4, 2015

Amid a significant push to reduce hospital readmission rates and as new reimbursement initiatives unfold, one Pennsylvania health network has ramped up its home care program to better streamline its services, saving millions of dollars in the process.

Pittsburgh-based Allegheny Health Network (AHN) launched its Healthcare@Home program last year. Since then, AHN boosted its service offerings and post-acute connections, resulting in approximately $5 million in savings from avoided hospital readmissions within a month of discharge, Bill Gammie, president of home health, hospice and palliative care at AHN, told the Pittsburgh Post-Gazette.

In 2015, Medicare penalized hospitals a total of $428 million, or 3% of their total reimbursement, for readmissions within a month of being sent home, the Post-Gazette reported. This figure is up from $227 million, or 2% of total reimbursement, in 2014. And with a change in Medicare payments for joint replacement surgeries at Pittsburgh-area hospitals coming in April 2016, collaboration is proving more crucial than ever.

“This is not just about getting them to walk again, but how can we get them to stay in the home they love,” Vicki Hoak, executive director of the trade group Pennsylvania Homecare Association, told the newspaper. “The bottom line is that it’s all about communicating.”

Indeed, new partnerships are driving the program’s success. Healthcare@Home first connected with Celtic Healthcare Inc., a home health and hospice provider serving Pennsylvania, Ohio and Maryland, effectively creating the second-largest such provider in the region. From there, it partnered with UPMC Home Nursing Agency, followed by Johns Hopkins Home Care Group to acquire a majority stake in Ford City-based Klingensmith HealthCare, along with its expertise in home care and medical equipment.

AHN’s acquisition of St. Vincent Health System in 2012, as well, bolstered the provider’s capability to administer medications intravenously at home, rounding out the program’s suite of home care services. The program also works with skilled nursing facilities to ensure patients receive specialized care they can’t receive at home.

The result—a decrease in hospital readmissions among AHN’s home care patients since the program’s launch, from 19% to 14%.

“This kind of stuff—it’s cutting-edge,” Brian Holzer, a physician who oversees AHN’s Healthcare@Home program as senior vice president of diversified businesses, told the Post-Gazette.

New health care jobs in Pennsylvania not at hospitals

Published by The Morning Call
By Sam Kennedy
December 4, 2015

Health care employment is booming in Pennsylvania, but not at hospitals.

Most of the hiring is taking placing at outpatient and elder care facilities, according to an analysis of state data by the Hospital & Healthsystem Association of Pennsylvania, or HAP.

The trend is driven by a combination of demographic changes, medical advances and the Affordable Care Act, HAP Vice President of Research Martin Ciccocioppo said.

While hospitals continue to be "a constant and major economic contributor," he said, "medicine has progressed to the extent that there are now new options."

In December 2007, months before a financial crisis triggered recession, Pennsylvania hospitals employed 270,200 workers. By October of this year, the most recent month for which state Department of Labor and Industry data is available, the figure was 271,700, representing an minuscule increase of less than 1 percent.

During the same time frame, the number of people employed in ambulatory health-care services, which include a variety of outpatient facilities, surged past that of hospitals, growing 18 percent to 312,700.

The rate of growth was even higher in home health care services: 53 percent, bringing the sector's employment to 50,600 people.

Health care industry employment is an important source of relatively high-paying and stable jobs. It also serves as an indicator of broader societal shifts.

Ciccocioppo noted that the U.S. population is skewing older and sicker as the baby-boom generation moves into its retirement years and people live longer, often with chronic health problems. This has fueled an expansion in services, such as nursing homes, geared toward such people.

Nursing and residential care facilities across the state employed 203,800 people in October — an 8 percent increase over December 2007.

In response to surging demand, the number of people employed at resident mental health facilities, which serve Alzheimer's and dementia patients among others, grew at an ever faster rate, increasing 18 percent to 54,300.

In contrast, hospital utilization as measured by inpatient admissions and length of stay has only declined, according to Ciccocioppo. He said the Affordable Care Act, which President Obama signed into law in 2010, has shifted the financial incentives: Whereas hospitals used to get more money for providing more care, now they can get more money by providing better results — that is, by getting patients back home and on their feet sooner.

At the same time, medical advances such as laparoscopic surgery have allowed many procedures, such as knee surgery, which once required lengthy hospital stays, to be performed on an outpatient basis. Such an approach has the benefit of keeping patients home, where the cost of care during post-operation recovery is significantly lower (as is the risk of infection).

Under the ACA, Ciccocioppo said, hospitals have embraced the so-called triple aim of improving patient care and public health while lowering costs. This, he concluded, "has led to a change in the way care is being delivered — in a good way."

More seniors opting for home health care options

Published by WP Observer
By Ciara Varone
December 4, 2015

In 2012, there were 43.1 million people – 13.7 percent of the population – who were 65 or older in the United States, according to the U.S. Census Bureau. By 2050, the Congressional Budget Office projects that this age group will rise to one-fifth of the total U.S. population. As this age group grows, an increased number of senior citizens are looking for care options, and many are turning away from institutionalized settings and embracing care options available in their own homes.

“I think home care’s the best-kept secret because unless you’ve had it, you don’t really know what it is,” said Craig Moore, executive director of Florida Hospital Home Care Services. “It’s always a surprise to patients or family members when they hear, ‘I can get this in my home.’”

When asked by The New York Times in 2012, 80 to 90 percent of older people said they wanted to remain in their homes, avoiding institutionalization for as long as possible. The 2010 Census found that 3.1 percent of the older population resided in skilled nursing facilities, down from 4.5 percent in 2000. For seniors wishing to hold on to their independence, home care may be the best option.

“We’re really in your home, immersed in your environment and helping you to understand, you know, what you can do to live healthy and well and recover,” Moore said. “We do a lot of education to help you get better. But the goal is to make you independent in your own environment and help you get back to a level of independence in your community as well.”

“I think as people are living well and longer… there’s an increase in that need,” he said.

Life expectancy is steadily growing, reaching a new high of 78.8 years for the U.S. population in 2012, up 0.1 percent from the year before, according to the Centers for Disease Control and Prevention.

Moore also mentioned the benefits home care offers to the “sandwich generation” of adults who are providing care to their own children, as well as to their parents. A 2013 survey by the Pew Research Center found that 47 percent of adults in their 40s and 50s fit this category. Home care can help reduce the workload on these adult children who are helping their aging parents, Moore said.

Personal emergency responders and automated medication dispensing machines are a few services offered by FHHCS that help seniors live independently while also assuring their loved ones of their safety, Moore said. The medication dispensers are prefilled by a nurse and locked so patients can’t overmedicate. If a patient misses a dose, the device is hooked up to a phone line, which alerts FHHCS, allowing them to call and check in.

“For some patients, that [service] has meant they’re able to live alone for a little bit longer,” Moore said.

Home care is about more than independence for some. For the 5.1 million Americans aged 60 and older who had Alzheimer’s disease in 2015, according to the Alzheimer’s Association, a change of setting can lead to catastrophe.

“It keeps them in the comforts of their homes, which is huge, especially for someone with Alzheimer’s or dementia,” said Britney Winston, community relations director for Home Instead Senior Care of Orlando.

Keeping patients in their homes can ease the distress caused by unfamiliar settings, she said. Home Instead Inc. has a network of franchises across around the world, including the office servicing Central Florida. It offers specialized services for patients affected by memory loss.

The majority of those receiving home care do so at no cost to themselves, as the services are covered by Medicare part A, Moore said. In this respect, home care not only reduces costs for individuals, but also for the government. A 2004 MetLife market survey of nursing home and home care costs found the average daily rate for a private room in a skilled nursing facility was $192 or $70,080 annually. In comparison, the hourly rate for a home health aide was $18.12.

In addition, the Census Bureau reported in 2014 that from 2005 to 2011, the cost of nursing home care and assisted living facilities rose by 4.4 percent annually, compared with 1.4 percent for home health aides.

“From a federal savings perspective, because we always hear congressmen and women talking about the Medicare program itself, it is a very low-cost way of providing really good care for patients,” Moore said.

Florida Hospital Home Care is a nonprofit founded in 1985, servicing about 600 patients on a daily basis throughout Orange, Seminole and Osceola counties, Moore said. The goal is really to extend Florida Hospital’s services into the community, he added.

“Home care allows our system to have relationships with patients that don’t just happen within an episode of care,” Moore said. “We’re really creating a relationship with our community and our patients that’s ongoing, that’s continuous. It’s not just when they’re ill.”

“Some want us to continue going on even after, you know, there’s no longer a need for us to be there,” he said with a laugh.