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News Roundup: July 22, 2016

Hospital care transitions are key for those with Alzheimer's or other dementias

Published by Long Term Living
By Pamela Tabar
July 22, 2016

People with dementia have a higher chance of being hospitalized than those who have no cognitive decline, and the way transitions between care settings are handled can make a big difference in outcomes and re-hospitalizations, said a panel of speakers today in a care transitions webinar.

The event, “Care Transitions to and from the Hospital for Individuals with Alzheimer’s and Related Dementias,” discussed the programs hospitals should use to inform families and caregivers in the challenges of admitting a person with cognitive decline to a hospital and discharging him or her either back home or to a nursing home.

Making a hospital visit can be one of the most confusing upheavals for people with dementia. Unfamiliar surroundings, unfamiliar staff, interrupted routines, different foods and other things can upset their internal balance and cause outbursts, behaviors and even increased cognitive decline, explained Alan Stevens, PhD, the director of the Center for Applied Health Research. “Families often say, ‘Things were going very well until,’ and that ‘until’ is most often a hospitalization.” Dementia also is a key factor in hospital length of stay, he added. “Even good hospitals that watch length of stay very carefully will still see a higher length of stay for those with dementia.”

The panelists discussed some of the things that caregivers can do to reduce anxiety before, during and after hospital visits:

Be conscious of the day/night cycle and avoid night interruptions if possible.
Get them up and out of bed when possible, even just for a short walk across the room. “Mobility should be viewed as a vital sign,” said Kathryn Agarwal, MD, assistant professor of medicine at Baylor College of Medicine.
Be proactive about medication reviews, obtaining detailed documentation of any medications prescribed at the hospital as well as how long they should be taken.
Serve as a coach to families and help them learn about the facts of the disease and the supportive services available to them.
Be willing to serve as interpreter for families in terms of managing their expectations, especially after discharge. That includes the involvement of home healthcare services, added Karen Rose, PhD, RN, FGSA, FAAN, University of Virginia School of Medicine. “Many families don’t understand what home health is, and what it is not,” she said. “Many think that home health is going to come in and take care of everything.”
Take every opportunity to educate families of the difference between palliative and curative care, including the importance of POLST and MOLST documentation.

Skilled nursing facilities should be proactive about finding out what education their acute care partners are providing for patients and families at discharge and as follow up afterward, Agarwal added. “It may be of value for skilled nursing facilities to ask their local hospitals to help them understand what programs they have, Nursing homes may decide that hospital A is going to give better geriatric care than hospital B. Interview them on how well equipped they are to care for their patients.”

Home Care as a Key Population Health Investment

Published by Health Leaders Media
By Christopher Cheney
July 22, 2016

Home health is playing a significant role in reducing hospital readmissions and total cost of care at Florida's Lee Memorial Health System.

Investing in home health capabilities has become a cost-effective element of the population health strategy at Fort Myers, FL-based Lee Memorial Health System.

"Having home health capabilities allows patients to be discharged from the hospital sooner and receive a higher level of care without having to go to a post-acute facility all of the time," says Joby Kolsun, DO, clinical integration medical director at Lee Physician Hospital Organization.

"Owning the home health resource reduces unnecessary testing by allowing the complete record to be available to the nurses, as they share the same electronic record system."

Lee Memorial has a total of 1,423 licensed beds distributed across four acute-care hospitals, a rehabilitation hospital, and a children's hospital. In 2015, the health system posted patient service revenue of $1.4 billion.

Thomas "TJ" Pennsy, MBA, RRT, is executive director of home health services at Lee Memorial. He says there are several elements to investing resources in home health and achieving a return on investment.

"The major investment is clinical expertise in the form of nursing, nurses' aides, medical social work, and physical, occupational, and speech therapy, at a minimum."

"As more clinically complex patients are sent home," he says, "the level and cost of clinical expertise will rise. Additionally, the growth of in-home technologies has led to a greater use of telehealth and telemedicine to connect physicians to the clinicians and the patient in the home. The investment can be quite expensive, but may be offset by reduced readmissions back to the hospital and the corresponding costs incurred in that setting by addressing and treating possible emergent situations at home," Pennsy says.

Significant Cost Impact

The potential for home health programs to reduce total cost of care at Lee Memorial is significant.

"The average variable—labor and supplies—cost for a heart failure patient readmission within 30 days is $4,700," he says. "The total readmission cost is $9,800 and is more than $1,100 higher than the first admission.

"Taking into consideration the cost of readmissions and readmission penalties, hospitals may find it is cost-effective to use home health resources as a component to reduce readmissions in coordination with the patient's primary care physician."

Lee Memorial's home health program has made an impact in reducing hospital readmissions, Pennsy says. "Our overall return-to-acute for all home health admissions dropped from 15.9% in fiscal year 2015 to the current 14.9% in fiscal year 2016."

Readmission rates are a key financial metric for the home health program at Lee Memorial and other nonprofit healthcare providers.

Home Health Care Industry Is Growing, Research Supports

Published by Home Care Daily
By Valerie VanBooven
July 22, 2016

Following passage of the Affordable Care Act in 2010, it was expected that the home health care industry would be the number one job provider throughout the country. A new research study conducted by Grand View Research has estimated that the growth of this industry is expected to reach 7.8 percent between 2014 and 2020.

That means it will reach $355.3 billion by 2020. With regard to this report, it was noted that this total involves home healthcare products and services that are specifically designed for use within the home environment by caregiver, patients, and even family members who are supporting their loved ones.

Nasdaq Global Newswire provided information regarding a recent report released by Grand View Research, and it was noted in the blog, Home Healthcare Market Size Is Projected To Reach $355.3 Billion By 2020: Grand View Research, Inc.:

“Increasing adoption of telehealth and other emerging healthcare technologies are expected to drive market growth over the forecast period. Home healthcare is rapidly getting adopted as a cost effective alternative to healthcare establishment based therapy and therefore, growing geriatric population base and prevalence of chronic conditions requiring long term care is also expected to have a positive impact on growth. Presence of untapped potential in emerging markets such as India, Brazil and China and increasing health awareness are expected to serve this market as future growth opportunities.”
With regard to the market as a home, home healthcare dominated, accounting for over 85% of global revenue in 2013. Infusion therapy is expected to be the fastest growing aspect of the market, and China and other nations in the Pacific are expected to drive a significant portion of the growth within this industry.

Technology is a driving force behind this significant growth, with telehealth and other technological innovations being designed to help improve delivery of service and support for those who require support at home.

Home care agencies, under increased financial pressure from continued cuts to Medicaid reimbursement rates, have turned to adopting various technologies to improve communication and efficiency, not just among home care aides and other providers, but also with doctors, nurses, and even family members.

As the in home care industry continues to experience growth, it has also faced growing pressure from numerous fronts, including with regard to wages, overtime pay protections for these workers, and the aforementioned cuts to reimbursement rates. It has been expected that technology could play a more integral role in the home health care market and this research study appears to support that notion.

How Home Care Can Win a Role With ACOs

Published by Home Health Care News
By Amy Baxter
July 22, 2016

Home care is rapidly changing, opening doors for the industry to become a valuable partner in accountable care organizations (ACOs). While home care isn’t necessarily invited to the ACO table as a matter of course, many companies are positioning themselves for the future by marketing themselves as a driver of cost savings and better health outcomes.

ACOs are typically made up of physician groups or other acute-care providers that earn Medicare payment incentives for collaboratively managing the health of their patient population. While home care may not be Medicare-reimbursed, it can prove its value in keeping patients healthier for lower costs and become a crucial part of the equation.

“Home care can no longer remain as it is in the status quo,” Barbara Knott, executive director of SCAL Home Care and Kaiser Permanente, said at Post Acute Link Care Continuum conference in Chicago in June. “If you still look how you did five years ago, you’re already behind.”

To become more involved in ACOs and become a valuable and attractive partner to other types of health care providers, there are a few things home care agencies can do, according to a panel of experts who spoke on the topic:

Understand your business. Knowing what type of ACO to be a part of is only a piece of the puzzle. A home care owner should know their business inside and out and be able to assess how much risk to take on.
Leverage services with data. Data is especially important to leverage high performing services to other health care providers. Being able to back up lower readmission rates and other important metrics can help an agency stand out as a preferred partner and be a partner ACOs are looking for.
Don’t be everything to everyone. While health care sectors continue to merge, home care agencies don’t necessarily have to the end-all solution to its ACOs and other partners. Instead, having success in one area or service line can be more valuable. ACOs are built of several different providers, which means not all partners need to offer the same programs. Home care companies should stick to a limited area to perform well and offer data underscoring that success.
Build a network. While experts say to keep a limited number of programs to do them well, diversifying through a network of other providers can still be advantageous when it comes to getting involved with ACOs.
Collaborations are Key

To become a part of an ACO, home care can step up through collaborations and network partnerships. By being part of a greater network, even home care companies with relatively few service lines can remain attractive as an ACO partner through collaboration. Rather than viewing other companies as competitors, home care owners should look at potential partnerships instead.

“We don’t consider it to be a competitive environment,” Scott Herman, CEO of Jordan Health Services, said. “We look at the baby boomer curve. Speaking together we are going to make our industry better.” Jordan Health Services provides in-home care to patients in Texas, Oklahoma, Louisiana and Arkansas and takes both private pay and Medicare/Medicaid patients.

However, being a part of a network also requires different health care providers to have the same mindset in their goals.

“You have to make sure everyone is thinking in the same vein of thought when trying to build something,” said Knott. “No home care agency can manage a community itself.”

Additionally, the value of home care must be fully understood and realized before they will be recognized as a partner in ACOs, experts agreed. The best method to prove value is data. Over the long term, home care will be recognized as a central point of care along the health care continuum, experts hope.

New Models Show How Home Health Can Improve Care & Reduce Costs

Published by Morning Consult
By Teresa Lee
July 22, 2016

Although surgeons have been performing total joint replacements for at least a hundred years, many of the most remarkable advances have emerged in just the past decade. New artificial joint materials, surgical techniques, and treatment protocols have transformed what was once a brutal surgery with significant recovery time into a far more manageable procedure and recovery.

Innovation is also thriving for new payment models, including the Centers for Medicare & Medicaid Services’ newly introduced Comprehensive Care for Joint Replacement (CJR) model. Implemented in April, the CJR model requires that Medicare make a single payment for all services provided during a 90-day episode of care. With that singular payment in mind, providers must work to maximize outcomes, minimize complications and avoid expensive hospital readmissions.

Data released last month show that post-acute care provided in the home setting has the potential to successfully reduce costly hospital readmissions for patients following joint replacement surgery.

The recently released analysis by Dobson DaVanzo & Associates examined how patients fared in various post-acute settings, following their lower extremity joint replacement (LEJR) and hospital discharge. The results were positive both for Medicare, and for patients – who widely prefer home health to other post-acute settings.

Across all post-acute care settings and areas of the country, Medicare paid approximately $5,000 less when patients were first discharged to home health care compared to other post-acute settings. Additionally, while readmission rates for a select group of patients (those with a major joint replacement without major complication or comorbidity) typically average eight percent, patients receiving home health care immediately after an acute stay saw a readmission rate of just five percent compared to 12 to 15 percent for patients receiving rehabilitation in facility-based settings.

It’s good news, but not a tremendous surprise for home health care providers. For years, skilled home health providers have paved the way for today’s model of clinically advanced, cost-effective, patient-preferred care. More than 3.5 million Medicare beneficiaries depend on home health care as they recover from injury or illness, including many who have difficulty accessing outpatient care or who need intensive assistance with an acute or chronic health problem.

The trend towards providing more cost effective care in the most appropriate setting is catching on across the healthcare system, and Dobson DaVanzo’s analysis underscores how game changing it can be – especially when combined with new payment models such as CJR.

With CJR being tested in 67 metropolitan statistical areas, home health providers have shown themselves to be valuable partners and effective providers, and with more than 400,000 LEJR procedures performed on Medicare beneficiaries annually in the U.S., costing Medicare more than $7 billion for the hospitalizations alone, the need for cost-effective care options couldn’t be more timely.

Given the remarkable advances we’ve seen over the past century when it comes to joint replacement surgeries, the future is anyone’s guess. One thing is certain: controlling costs for a growing number of Medicare beneficiaries who require LEJR will depend a great deal upon smart partnerships, innovative treatment models, and thoughtful care transitions. Skilled home health providers are excited to be an important player in the next generation of care.