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News Roundup: February 26, 2016

Family caregivers need more support

Published by Boston Globe
February 26, 2016

DEALING WITH a chronic or degenerative medical condition can be isolating, as well as painful — and not just for patients. In millions of homes across the United States, family members are caring for a parent or older relative, with little or no coordinated help. It taxes them financially, physically, and psychologically. A new study of more than 1,700 family caregivers helps to quantify the price they are paying. It also highlights the crucial part they play in the way health care is delivered, and makes a convincing case for granting family caregivers equal access to medical data doctors share among themselves.

The study, conducted by researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore, and published by JAMA Internal Medicine, found that about 14.7 million unpaid caregivers assist 7.7 million — mostly older — adults, many of whom have dementia. Family caregivers can be overwhelmed and exhausted, so focused on tending to the needs of a loved one that they make decisions detrimental to their own well-being. Some eat poorly and stop exercising. Others give up social activities that reduce stress, or they struggle to stay focused on the job. For instance, the study found that people responsible for the in-home health care of an older adult were more than three times as likely to “experience work productivity loss” as someone who didn’t take on such duties.

The role of family caregivers will loom larger as providers are pressured to improve efficiency while cutting costs. Decreasing the number and frequency of hospitalizations is critical to such efforts, and it means more older patients are being sent home sooner than they might have been a few years ago. Once patients are discharged, their families usually are left to cope with issues like drug dosing, wound care, and the monitoring of vital signs. They might not know where to find assistance, simply don’t have the time to look for it, or worry that insurance won’t cover enough of any added costs.

“We have highly trained providers in a highly regulated environment, and we release patients into the care of their families, who often are left hanging,” says Jennifer Wolff, the study’s lead author and an associate professor at the Bloomberg School of Public Health. Those families are “invisible” to medical professionals, Wolff says, despite the essential care they provide around the clock. “They have less access to the information that they need to manage care.”

The study raises awareness of the work that family caregivers perform on a daily basis, but it also should prompt change. Patients suffering from dementia are not capable of retrieving and analyzing their own medical records. Meanwhile, doctors are reluctant to release patient records to someone else — even a daughter or son — because of privacy concerns. Giving family caregivers password credentials to access to their relatives’ electronic medical records would be a practical step toward connecting them with doctors, nurses, and hospitals to manage care.

“There’s a big opportunity for the system to better understand who is really providing care for patients at home,” says Wolff. That includes insurance companies, which must broaden their definition of health care “provider” by offering reimbursements for expenses like ramps and safety rails that make at-home care easier and safer.

Family caregivers deserve more recognition, and better treatment.

How to Thrive in Home Health’s New Era

Published by Home Health Care News
By Amy Baxter
February 26, 2016

With value-based purchasing (VBP) programs underway and new quality measures being considered, the home health industry is entering a new era, according to advisors from the Visiting Nurse Associations of America (VNAA).

As performance continues to be tied to reimbursements and financial incentives, home health agencies that are proactive about their quality improvement plans and can prove it with data will be better served in the VBP environment, industry experts said during a webinar by VNAA and the Alliance for Home Health Quality and Innovation.

“All of these things come together to create what I believe holds the possibility of a new era for what we are doing in home health care,” Barbara Muntz, RN, BSN, MTS, and senior advisor to Community Health Accreditation Partner (CHAP), said during the webinar.

CHAP is an organization that offers an accreditation process for home health, home care and other community-based organizations and service providers.

A New World Order at Home

Home health agencies in nine states are just getting used to the first VBP pilot program from the Centers for Medicare & Medicaid (CMS), which took effect on January 1, 2016. The program requires home health agencies to report quality measures and compete for increased Medicare payments for higher quality performance.

For the rest of the industry, the pilot program is an opportunity to observe performance improvement models.

“The guy who putts second goes to school on the guy who putts first,” Muntz said during the webinar. “Those of you who are in one of these nine states to launch the VBP pilot, the rest of us are able to watch and learn.”

However, VBP is not the only programming shift home health agencies are dealing with. Additional quality assurance and performance improvements measures proposed by CMS, as well as more services being tied to bundled payments, are part of a “great convergence” of how the delivery of home health care is changing, according to Muntz.

These delivery changes and reporting measures are stemming from CMS’s triple aim—improving the quality of care, improving health outcomes and reducing health care costs—and the national quality strategies that are being implemented.

Data-Driven Decision Making

There is no doubt that data is the crux of thriving in this system. And for home health agencies, reporting the right data and tracking performance can have a huge financial impact.

“Data are the tools we use to evaluate and improve care, make decisions, provide evidence of value,” Muntz said. “With VBP, now data are tied to your financial wellbeing.”

With new programs coming to pass, home health must report new measures and determine data strategies that can reflect performance improvement in innovative ways.

“In the world of health care, the use of medians or averages can really be a problem,” Muntz explained. “Averages don’t show variances, but patients don’t feel averages. They feel variances. Having a performance improvement program and choosing measurements that reduce negative variations is critical for patient outcomes and your success.”

CMS has focused some of its initiatives on specific patient groups, such as the bundled payment program for those who have undergone hip and knee replacement surgery. CMS is expected to roll out additional programs related to specific procedures and patient groups. Focusing on improving quality and reducing costs among the groups with the highest costs of care, or ‘hot spotters’, can have a positive effect overall, and could be a good strategy for home health agencies, according to Muntz.

“As we move into this value of health care arena, there is a lot of focus on the hot spotters in hospital care,” Muntz said. “If we focus on the patients that are really high risk, we are overall going to improve the value proposition, the value and cost, and lower our risk. …Focusing on that hot spotter group is a good approach.”

Translating Data to Agency Success

Another important arm of maintaining a successful home health agency amid the “great convergence” is keeping employees engaged in a changing environment. Implementing new performance models can take a toll on home health employees, who are often contracted workers.

“Employee engagement is tough when you have contracted employees,” Muntz said.

The role of quality assurance may once have been able to be conducted by a single nurse, but home health companies may need to increase their resources to ensure all the new quality measures are appropriated, Muntz said.

However, Muntz believes that data can also be leveraged to show the human conditions of quality improvements by bringing data points into a translatable story. She referred to a hospital initiative that aimed to save 100,000 lives through the direct actions of employees.

“They were able to translate actions taken in the hospital to how many lives were saved, and translate out for the staff member that those kinds of humanizing of the data to make it tell a story—that’s a real story of the impact of these activities—is one way to help engage them.”

Make Family Caregivers Matter More: Measure Them

Published by Huffington Post
Steve Landers MD,MPH
February 26, 2016

Early in my medical training a sage family physician, Jack Medalie, reminded us students that there's often a "hidden patient whose suffering goes unnoticed." Medalie was referring to family members who may be struggling as much or even more than the person that is being directly cared for by the doctor. Medalie was a pioneer in the medical specialty of Family Medicine, a specialty that didn't exist until 1969, but today represents 80,000 American physicians. I think he was on to something!

In addition to traditional medical diagnosis and treatment, the pioneers of Family Medicine recognized that to truly help people live better lives doctors needed to understand and address family and community dynamics. I loved the holistic thinking and was inspired to become a part of this specialty; I later graduated from the same Family Medicine program that Medalie launched at Case Western Reserve University.

While medical issues at all ages and all stages of life profoundly impact families--the common medical issues of aging exact an enormous toll on families. Family caregivers are daily working in the shadows of our health care system, helping their loved ones that suffer from Alzheimer's disease and other neurological conditions, heart disease, severe arthritis, cancer, and various other diseases and combinations of diseases. The efforts, effectiveness, and strength of family caregivers are major factors in the success or failure of health care for older people. Family caregivers also have other personal and workplace responsibilities that are heavily impacted by their caregiver role.

With the aging of the Baby Boomer generation there will be over 80 million people insured by Medicare; by 2022 Medicare is expected to cost the country over $1 trillion per year. The economic and societal importance of how we navigate the demographic shift cannot be underestimated, and family caregivers are at the heart of these issues.

When family caregivers succeed their loved ones are less likely to be unnecessarily hospitalized on Medicare's dime, the caregivers remain more productive in the workforce, they are better parents and partners, and their own health is better. There's a lot at stake. This is more than a health care concern; it's a business issue, economic issue, and family issue.

In spite of the central importance of family caregivers to their loved ones, to the health care system, and to the future of our country, they remain as Medalie noted decades ago "hidden." The best step to get caregivers out of the shadows of American health care is to routinely measure and report on their experience and their outcomes. While such measurement would require substantial forethought and expense, it will lead to real action and improvements.

In recent years we have seen hospitals, physicians, insurers, nursing facilities, and home health agencies develop incredible efforts to improve patient experience. Health care leaders are studying hospitality industry behemoths like Disney and Ritz Carlton, hospitals are appointing "Chief Experience Officers," and the strategic plans of health care providers around the country include improving the patient care experience.

These efforts are directly related to Medicare's mandatory measurement and reporting on the patient experience at the provider level. But, family caregiver experience is not routinely tracked.

Medicare also benchmarks providers on various quality measures and outcomes, and many types of organizations that work with Medicare beneficiaries have "stars rating" systems. However, these measurement systems don't routinely track outcomes for family caregivers. Why not?

Imagine if such outcomes and experience measures were in place for family caregivers how much energy, creativity, innovation and competitive spirit would be unleashed to try and change health care services to better meet the needs of family caregivers? It would be of particular importance to measure aspects of caregivers that contribute to their ability or inability to keep their loved ones at home and in the community. There would be more focus of doctors and others to do all we can to help people get needed home care supports to buttress the efforts of family caregivers.

Efforts to increase provider level caregiver experience could be coupled with a new focus on family caregivers in the high level research and reporting done by the Surgeon General, Institute of Medicine, National Institutes of Health, Centers for Disease Control, and Agency for Health Care Research and Quality. Make family caregivers matter more to Medicare--measure them.

Connecticut Report Claims Major Savings Possible Through Home Care

Published by Home Care Daily
By Valerie VanBooven, RN BSN
February 26, 2016

There have been numerous reports and studies conducted through the years regarding the cost of short and long-term care for the elderly. When a senior is being cared for in a nursing home, it’s one of the most expensive options and can be cost-prohibitive to many. For those seniors who live in poverty, have exhausted their life savings and other assets, they may end up being cared for by the state, which for Connecticut often means moving into a nursing home.

A new report conducted by a nonprofit organization has determined that the state could potentially save hundreds of millions of dollars by providing opportunities for seniors to remain within the comfort of their home and receive in home care instead of being transferred to a nursing home.

At the moment, Connecticut’s budget and deficits have been causing a great deal of frustration, anxiety, and challenges for its leaders as well as taxpayers. At the moment, about 60 percent of the residents of the state who require any type of long-term care are receiving it at home.

The goal for Connecticut’s leaders is to increase that percentage to about 75 percent, which would save an estimated $657 million. The main reason for this is that in home care is the most cost-effective (affordable) option available for seniors and other adults who may require some type of long-term care.

In the Hartford Journal news article, Report: Connecticut Could Save $657 Million By Caring For Elderly In Their Homes, written by Russel Blair:

“This new study shows that in the current budget environment, it is essential for Connecticut to stay on its current path in terms of the reform of long term care practices,” Jim Torgerson, chairman of the CT 21 Steering Committee, said in a statement. “This policy has already improved the quality of life for many residents, while reducing costs to taxpayers, and it is certain to improve the quality of life for thousands of others as the baby boom generation ages.”
At the moment, a nursing home care room costs more than $12,000 per month, and that number is expected to increase by 73 percent by 2027. A home care aide costs about $3,600 per month full-time and a home health aide costs about $4,000 per month and those costs are expected to remain consistent for the most part through 2027.

For any senior who would have the ability to remain home as opposed to moving into a nursing home, the cost savings can be tremendous.