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News Roundup: June 3, 2016

Health System Data Proves Palliative Care Pays Off

Published by Home Health Care News
By Amy Baxter
June 3, 2016

Palliative care has been gaining steam as a crucial service over the last few years, but increasing its accessibility is largely dependent on figuring out how to pay for it. Without much in the way of reimbursements from federal payers, palliative care providers have traditionally been few and far between. However, some health systems are working on improving access and increasing awareness of these services within home settings, and harnessing data to prove the value.

UnityPoint Health (UPH), an integrated health system that operates in Iowa, Illinois and Wisconsin, has been improving its palliative care at home and hospice services across the health system for more than a decade. Since 2005, UPH has implemented metrics to measure the effectiveness of its growing reach with palliative care.

As the fourth largest non-denominational health system in the county, clinical executives hope their palliative care program successes can impact policy down the line for more reimbursement measures.

Overnight Success

The UnityPoint at Home program has grown from 55 patients to more than 8,000 as of 2014.

While the program has been around for more than a decade, it started picking up steam and increasing its patient base once the data metrics were implemented. The metrics were based on research from what already existed nationally as well as additional information and definitions the health system considered, according to Lori Bishop, vice president of clinical services at UPH’s home division, UnityPoint at Home. UPH measures clinical, financial, operational and customer satisfaction metrics for palliative care across its inpatient, community and clinic settings.

“We’re an overnight sensation—if you think that it’s been 10 years in the making,” Bishop joked. “I do believe that we can see a direct correlation between the growth of our programs and the investment in these programs with our ability to measure.”

Once the health system integrated data across all settings, the value of palliative care gained firmer footing and the scope of the services expanded, according to Bishop.

“There’s a great uptick in the patients that we’ve been able able to serve that correlates with our ability to report out to our systems and to our regions the value of what we bring to the population for the seriously ill population,” Bishop said. “That growth started around 2011 and 2012 when we were able to start reporting out measures.”

Reaching more patients has had a big impact on hospital utilization and overall cost savings, by reducing readmissions by 50% for inpatient settings and 70% for outpatient settings between 2012 and 2015. UnityPoint measured six months before and after an initial consult, which mostly took place in an inpatient settings. The data revealed that there was a significant drop in hospital utilization following a consult.

Part of the success is also due to an increase in care coordination and referrals between home health care and hospice, according to Bishop. In the same three-year span, the percentage of palliative care patients referred to home health jumped from 4% to 30.7% following a discharge.

“There’s a relationship there that’s between that reduction in utilization of the hospital and the connection to those community-based providers,” Bishop said.

Metrics on a National Scale

Attributing the broad reach of UnityPoint’s palliative services to more data and refined metrics, Bishop is hopeful that this type of data can be brought to a national scale and eventually influence policy to expand palliative care services.

However, a real pathway toward policy that includes palliative care would likely result in increased regulation for these services that are similar to home care and hospice requirements, according to Bishop.

“There isn’t a lot of reimbursement for palliative care,” Bishop said. “We hope to improve that over time, but you also have to be careful what you wish for, because that would mean additional regulatory burdens for palliative care that don’t exist today. So, we have to be cautious.”

Expanding palliative care services nationally would also require an influx of health care workers to provide care.

“The biggest challenge is there aren’t enough palliative care-trained individuals to go around,” Bishop said. “Providers that are certified in palliative care and hospice are a hot commodity right now. There are not enough of them.”

Lawmakers Urge CMS to Kill Home Health Care Demo

Published by Morning Consult
June 3, 2016

Over 100 House members are urging the Obama administration to withdraw a demonstration program that would require prior authorization before processing claims for home healthcare in an effort to prevent fraud.

The lawmakers say the proposal would interfere with the patient-doctor relationship and would undermine efforts to move towards patient-centered care. The bipartisan letter was led by Reps. Tom Price (R-Ga.) and Jim McGovern (D-Mass.), and was signed by 116 lawmakers.

“Stated simply, prior authorization of home healthcare imposes a requirement that prevents a patient from receiving home health services after the physician orders home healthcare unless and until an intermediary has reviewed and approved the order,” they write.

The demo occur in Florida, Texas, Illinois, Michigan and Massachusetts. CMS hopes the program will stop the improper payment rate for Home Health Agency to stop increasing.

The lawmakers say the demo would limit access to home care, increasing the length and cost of hospital stays for patients, and raised concerns that the demo could cost taxpayers more than a quarter of a billion dollars. They also say that CMS is overstepping its authority by testing a “method of screening and utilization management, not a method for investigation or prosecution of fraud.”

“This demonstration project imposes costs on patients, providers and taxpayers,” they write. “Delaying patient care while waiting for CMS to approve home health services may put patient health in jeopardy and cause patients to stay in the hospital for longer than necessary.”

Lawmakers Take Stand Against Home Health Prior Authorization

Published by Home Health Care News
By Mary Kate Nelson
June 3, 2016

Mounting backlash against the Centers for Medicare & Medicaid Services’ (CMS) proposed home health preauthorization rule is coming from a fresh source—lawmakers on both sides of the aisle.

A bipartisan group of 116 lawmakers in the U.S. House of Representatives penned a letter to CMS Acting Administrator Andrew Slavitt and Department of Health and Human Services (HHS) Secretary Sylvia Burwell requesting the withdrawal of the proposed demonstration for prior authorization of Medicare home health services.

The proposal, made by CMS in February with the aim of cracking down on Medicare fraud and abuse, would require home health agencies to receive prior authorization before caring for patients.

Delaying patient care while waiting for CMS to approve home health services would jeopardize patient health and result in patients remaining in the hospital longer than necessary, the lawmakers said in the letter.

“Many patients find themselves in the most clinically fragile condition during the week following a hospital discharge,” the lawmakers wrote. “It is vitally important that we continue to meet the care needs of Medicare patients during this critical transition time post-hospital discharge.”

Additionally, the proposal would not target bad actors as planned, the lawmakers argued. Instead, the proposal would do little to identify abusive and fraudulent behavior, while increasing the administrative burden on all home health agencies—even those that do not have a history of fraud.

The lawmakers also attacked the legality of the preauthorization rule, saying the government has no legal authority to impose prior authorization for Medicare home health.

The Partnership for Quality Home Healthcare, a Washington, D.C.-based coalition of home health providers whose mission is to improve the integrity, efficiency and quality of home health care for seniors nationwide, commended the lawmakers for their letter.

“We ask that CMS work with us to develop program integrity solutions that are patient centered and eliminate bad actors without disrupting access to care and increasing healthcare costs,” Partnership for Quality Home Healthcare Chairman Keith Myers said in a prepared statement.

Update Public Policies to Recognize the Value of Nurses

Published by Morning Consult
June 3, 2016

Health care is a complicated system involving many players. Most often, a discussion on health care centers around physicians, payers and patients, so it’s all too easy to overlook those on the front lines of care: dedicated nurses. Nurses play a personal, hands-on role in the lives of their patients.

Since the early days of house calls, nurses have traveled wherever people called home. As healthcare technology has evolved, nurses have led the migration of patient care out of hospitals and institutions and into homes and communities. It is through their dedication to person-centered care, commitment to support the entire family and ability to find solutions to empower patients that more and more therapies are delivered in the comfort of home.

But as far as home health and hospice care has come, there is much progress to be made – especially when it comes to ensuring our healthcare system has enough providers to adequately care for the rising number of people who will need home health and community based care in the coming years.

This is of particular concern for those who rely on Medicare-certified home health. As 10,000 baby boomers become Medicare-eligible every day, the need for home-based services grows exponentially.

The current policy landscape allows nurse practitioners (NPs), nurse anesthetists and certified nurse midwives to perform many services for Medicare beneficiaries autonomously, including admitting patients to hospitals and ordering nursing home care and prescribing medications. But when it comes to home health care, these clinicians are barred from ordering the delivery of clinically effective and low-cost care in the home. This creates a tremendous access barrier for vulnerable patients and drives up spending to the Medicare program.

In fact, the Future of Nursing report issued by the independent, objective Institute of Medicine strongly recommends that advanced practice nurses be able to practice to the full extent of their training by changing the Medicare program to allow these skilled clinicians to perform admissions assessments and certify patients for home healthcare services.

Fortunately, Senators Susan Collins (R-Maine) and Chuck Schumer (D-N.Y.) and Representative Greg Walden (R-Ore.) have introduced the bipartisan Home Health Care Planning Improvement Act in both houses of Congress. The bills would allow NPs, clinical nurse specialists, certified nurse-midwives and physician assistants to certify patient eligibility for home healthcare services under Medicare.

Home health and community care are poised to play a bigger and bigger role as Americans live longer and increasingly desire to avoid institutional settings by aging in their own homes. It is imperative that we recognize the value and training nurses bring to the overall health care continuum with updated policies supportive of consumer needs and professional practice.

The changes proposed in the Home Health Care Planning Improvement Act would improve access to important home healthcare services and potentially prevent additional hospital, sub-acute care facility and nursing home admissions–all of which are costly to the consumer, the taxpayer and Medicare -while empowering nurses to practice to the full extent of their license and partner with physicians and other professionals in redesigning health care, as called for by the Institute of Medicine’s Future of Nursing report.

Tracey Moorhead is the President and CEO of the Visiting Nurse Associations of America.