Payment, Reimbursement and Quality Lead the Home Care Trends Illuminated at the Northeast Home Health Leadership Summit
Each year, for the past 13 years, home health agency leaders gather in Boston for three days at the Northeast Home Health Leadership Summit. Aren’t we glad this summit was last week and not this week as Boston braces for the blizzard of 2015?
Traditionally at this leadership conference, speakers share their insight on the industry and home care executives, administrators, and nurses fill the seats seeking understanding of the latest trends—all with the same goal of gaining some insight into how to allocate time and resources for best practices. This year more than ever, there is a need for increased creativity and adaptability in the agency, the workplace and the industry.
The changes that are pending in providing Medicare in-home care as a post-acute service have just been escalated with the latest announcement on January 26th by the Obama administration. By the end of 2016 they want 30% of payments for traditional Medicare benefits to be tied to alternative payment models such as accountable care organizations, bundling, value based reporting, the Independence at Home model or medical homes, with a goal of hitting 50% by the end of 2018.
This is not a surprise, but, it is happening quicker than most predictions.
Sparking the leadership light was the focus of this conference, and after a few days of taking it all in, here are a few standout speakers who helped to spark my leadership light.
Dana Sheer, ACNP and director of clinical programs for Partners HealthCare at Home, in eastern Massachusetts, spoke about the importance of homecare pre- and post-hospital discharge.
She offered some interesting solutions on how to capitalize on post-acute opportunities through technologies, chronic care management, development of a mobile observation unit and integration with medical homes. She had a great report and case study on the Emergency Room diversion program that they have implemented that is sort of an urgent care clinic that goes to the patient’s home. This is a service that works for those with a mix of clinical complexity, who are frail with possibly some home safety concerns. Her enthusiasm and the ideas that are coming out of a need to change how home health works in tandem with the hospital show that we can solve some of our problems, and are creating ways to do just that.
Dr. Steven Landers, MD, and president of Visiting Nurse Association Health Group, Inc. stressed that home health agencies should promote value instead of volume in achieving person?centered care. He has coined the moniker “home centered care” to describe how he foresees the future of care for our aging population, and, he is always full of insights and ideas. Listen to him if you really want to see what the vision for care in America should be. He brings a physician’s perspective but also a home centered care perspective to the discussion.
Mark Graban, author and healthcare consultant, opened up those linear management minds with thoughts on organizational improvements (meaning happier employees and better patient care) through Kaizen, a Japanese concept that means “change for the better.” Although this management concept has been around a long time, starting in manufacturing, it was artfully applied to the home care setting, and it bears repeating.
In terms of change, he said, start small. “Moving from the mindset of a judge to a coach is critical,” Graban says. “You have to be careful how you react to a bad idea and treat each idea as a gift.” In light of the recent announcement moving the dates for payment change closer to the present, it is only through thoughtful processes focused on change that agencies will make the deadline and change how they operate.
Kaizen requires a baseline of trust, he notes that if there is fear and lack of trust people will not participate. It also requires that leaders want to improve and that they believe that the team is capable of doing more. Leaders also should remember that it’s ok if they don’t have all of the answers. An open line of communication is the better approach, and reminding oneself that there’s no need to cover up any problems.
Robert E. Mechanic, M.B.A, Brandeis University and Executive Director of the Health Industry Forum addressed the important data surrounding expenses for Medicare and examined new approaches to manage, coordinate and utilize post-acute services, including home care and implications for patients, providers and policy.
The numbers are staggering: Medicare spending on post?acute care now exceeds $62 billion annually. We are incurring a $500 billion annual deficit and that is on top of the $13 trillion overall deficit. His pronouncement? “Payment models are going to change!” )And boy was HRE right on the money!)
Since we have already been seeing and participating in some changes, it is worthy to note that 15% of Fee For Service Medicare beneficiaries (5.7 mil) are already participating in ACOs. Currently there are 17.7 million participating in Medicare Advantage, but their reimbursement has to decrease 15% in the near future, so that program will change as well. Bundled payments are happening throughout the healthcare settings. Value based payments are a hot topic of discussion, and the industry is struggling to find common grounds to measure quality.
We now have some data from the effects of the ACA: 8 million people signed up for health exchange, and guess what? They picked lower cost plans! This is forcing insurance companies to lower prices and find ways to keep costs down.
With the establishment of new payment models, strong incentives have been created for coordination of post?acute care. Health systems, ACOs and Medicare Advantage plans are beginning to establish preferred networks of providers to deliver care more effectively and reduce hospital re?admissions. Again, this movement will only escalate as home care agencies become more of a provider of choice for those who are leaving hospitals and want to recuperate faster, have a better quality to their life, and feel safer at home.
After a few days with some of the leaders in home health, that spark has been lit inside of many. There’s a need to think of the person behind the care, the person who is part of the care team, and the influx of people to come. There’s a flame calling to burst with creativity and a readiness for change. And that flame will only grow. Together we can make a difference, and we can provide better care to our citizens.
Thanks again to AXXESS for sponsoring my travels and industry involvement. Their software provides efficiencies at an affordable price, and they are on target with measuring quality that makes reporting easier, and revenue cycle management that will assist agencies in figuring out how to price services so they are participating in the changes in reimbursement as they are implemented.
“Data are just summaries of thousands of stories—tell a few of those stories to help make the data meaningful,” say authors Chip and Dan Heath.
On February 1, you can share your stories with the most comprehensive national study on the private duty home care industry, and you can do it all online. The 2015 Private Duty Benchmarking Study is one of the most important half hours you can spend all month. It happens annually, and for the past 6 years, Home Care Pulse has teamed up with the Home Care Association of America (HCAOA), crafting a thorough survey with the goal to help seniors across North America receive the very best care possible.
This year, the study has been shorted by 25 percent (now, it typically takes less than a half hour to complete), but boasts that it will provide even more data and benchmarks than years previous. That means less time filling it out, and more data provided.
This year, once you complete the survey, you’re thanked with more data. You’re able to download a regional report with the data on top referral sources, median number of caregiver employed/quit/terminated, net promoter score and caregiver engagement—all by your region.
The survey covers a range of topics including: specific figures about your business, direct care expenses (from caregiver wages to insurance to mileage to meals), sales and marketing expenses, operating expenses, legislative issues including Obamacare, caregiver shortages and growth opportunities.
My experience with the survey is that some questions are easier to answer than others. The trickier, more specific numbers questions may require a little research beforehand. You can also download a prep worksheet to help you prep your answers for the actual survey. Fill it out and refer to it the day you complete the online survey.
Any day in February, you can visit http://benchmarking.homecarepulse.com to take the online survey, which opens on February 1st and closes midnight, February 28th.
Share your story—your participation helps support the largest national study on the private duty home care industry. And once the survey results are out, you’ll get to sift through the data and discover new analytics that will help you expand your sturdy foundation and grow.
Prepare. Participate. Reap rewards from the data.
Yesterday in the case of the Home Care Association of America, et al v. David Weil, et al, Judge Richard J. Leon ruled for home care by vacating a remaining key component of the U.S. Department of Labor’s regulations that would have effectively eliminated the longstanding companion care exemption under the Fair Labor Standards Act (FLSA). The Department of Labor’s, modifying the FLSA, was set to take effect on January 1, 2015. This important decision vacates the remaining key components of the final regulation, resolving both concerns with the Department of Labor’s updated definition of companion care and the exemption’s application to third party employers.
On December 22, you will remember that the Court ruled in home care’s favor as well, and this decision reinforces that December 22 decision resulting in a clear victory for clients of home care providers, including seniors and individuals with disabilities, who depend on these essential services to remain independent, and at home, where they want to be.
Home Care Association of America (HCAOA), the National Association for Home Care (NAHC) and the International Franchise Association (IFA) and many others who operate in the home centered care space have long held the Labor Department’s regulatory actions in this area to be outside the bounds of the the law. Yesterday’s decision provides hope to many who had feared they would no longer be able to afford home care services due to the Labor Department’s overreach. This is an incredible victory for the home care industry and for those who seek to have care at home!
When it comes to home care, we should all be familiar now with the Triple Aim: improving patient outcomes, reducing cost of care and improving the health of our population. Accommodating this lofty goal, with the influence of federal policies (including the Medicare home health benefit), along with the sea of seniors —and the home health boat is rocking. It’s only a matter of time (we’re talking 10,000 new Medicare eligible adults each day) until something breaks.
The Future of Home Health Care Project, organized by the Alliance for Home Health Quality and Innovation, has been focusing the past year on these very issues—addressing how home health care is currently used, and how it will be used in the future for older adults. In another step along the way to finding answers, the ‘Future of Home Health Symposium: Tackling Critical Issues for the Future of Home and Community Based Care’ took place yesterday in Washington, D.C.
The day-long event was filled with panelists and speakers addressing issues in the industry—discussions ranged from optimizing home health interdisciplinary teams, to improving efficiency with technology, to key payment and policy reforms, to diverse interests and services funded in silos (which result in fragmented care based on what Medicare pays for, not necessarily what patients need), to the home health workforce. Much was covered, but the main unanswered question is, “What is the solution?”
Dr. Steven Landers chairs the Alliance and started the day with a Tom Peters quote: “If you are not confused, you are not paying attention”. And, anyone who has interfaced with the health care delivery system knows that is the case: confusion reigns supreme.
Technology is one possible answer for some of the issues. And, technology has been a game changer in the home health field; yet the Medicare home health benefit does not currently support these innovative approaches to care. Some states are starting to reimburse for telehealth in some home settings, but we have a long way to go.
As for the future of home health, there are many times when we feel like we’re are stuck in the ocean without an oar, and the waves are just bouncing us around. But with projects like the Alliance’s Future of Home Health Care Project and some of the new innovation projects sponsored by CMS, a collection of some of the top minds in home health care, the shore IS in sight—we just have to continue to communicate and encourage change.
At the end of the symposium, Steven Landers, MD, MPH, President and CEO of the Visiting Nurse Association Health Group, Inc. addressed the group and said we need to “work toward moving from our introspection and sharing to identifying basic tenets and themes to tell the world.”
And I agree. We need a better story up front, we (home care, home health care, home centered care) need to address who we are and what we need.
What are the core themes that are interdisciplinary? We need to identify those and agree upon a common set of themes and beliefs that we can tell the outside world to move forward. Key themes, common goals and critical next steps need to be identified for a future of home centered care that will meet the needs of an aging society.
From my perspective we could start with these core themes:
>Moving from disease states to functionality and frailty as keys to determining what level of care is needed and who is at greatest risk for rehospitalization
>Moving from post-acute care to a focus on wellness and preventing hospitalizations or falls in the first place
>Creating standardization in a) quality measures across the board, and b) interoperability of the EMR-HMR and home care/hospital/physician communication methods
>Developing a workforce that understands geriatrics and embraces patient centered care with the caregiver essential to the plan of care
>Developing specific interventions and protocols for those 5% of beneficiaries who absorb 50% of the cost of care
>Working as care teams with all looking at the patient with the patient’s goals in mind: social workers, physicians, nurses, therapists and family/caregivers
What core themes do you see?
We have a long way to go, the sea is endless and the water’s rough, but we are the leaders of our own vessels and I’m optimistic that we can steer home health care in the right direction.
AXXESS Technology Solutions needs to be applauded for their sponsorship of the Alliance and the Future of Home Health Care Project, along with their scholarships awarded for attendance to this symposium for state home care association directors, nursing doctoral students and industry consultants. It is businesses like AXXESS, stepping up to the plate and working to make the Triple Aim a reality, that will help make the home centered care dream for the future a reality.
There’s something so interesting about the power of music. We can be busy with our day, traveling in our car to another meeting, and on comes Etta James’s At Last, and for a moment we’re not sitting in our car; we are back at our high school dance waiting for Randy Herlocker to ask for a slow dance. We associate music with long-term memories, and it’s a powerful, emotionally moving and downright quick experience.
And there’s a reason so many of us describe music as “moving.” It’s because it stimulates more parts of the brain than any other human function, according to Elena Mannes, who wrote The Power of Music, a book about how music can play a bigger role in health care. Because of this fact, Mannes sees the potential of music’s power to change the brain and affect the way it works.
She’s not the only one. Social worker Dan Cohen has also been hard at work in this field, specifically related to improving care outcomes for patients with dementia in long-term-care homes. He believes music could be an ideal tool in health care to help animate and bring a sense of identity to someone living with advanced dementia. Cohen is the founder of Music & Memory, a nonprofit program that promotes the use of digital music players with individualized playlists to improve the quality of life for elders. The program has seen success because even though Alzheimer’s damages the ability to recall facts and details, it does not destroy the connections between a favorite song and an important memory, no matter how long ago.
Cohen has found that these personalized playlists can decrease reliance on anti-psychotic and anti-anxiety medications, enhance engagement and socialization and actually be a boost for caregivers, due to the reduced agitation and decreased resistance to care.
For a closer look at Cohen’s approach, check out the documentary that follows him called Alive Inside. The documentary chronicles people with dementia, caregivers, and experts in the field. The film shows us the effect listening to personal music favorites can have on a person with a disease that damages brain chemistry—they can reconnect, sometimes in a matter of seconds. Check out this moving documentary excerpt of Henry listening to his personalized playlist.
Much has been done in the area of incorporating music into care in the assisted living facility front. In fact, so far 489 long-term care settings in 42 states and 8 countries are Music & Memory Certified. The program is spreading to other areas of healthcare, including hospice, home care and hospitals.
There are 16,000 long-term care facilities in the U.S., which serve as home for 1.6 million individuals. In regards to home care, there are approximately 33,000 providers in the U.S. that provide home health care for about 12 million individuals, according to NAHC, the National Association for Home Care & Hospice. This means there are millions of opportunities for music to be introduced to home care, too. Thankfully, an iPod or digital music player is a simple technology that most caregivers own. The trickiest part of the process (and some would argue the most fun) is compiling the personalized playlist.
If interested, the Music & Memory program trains professional caregivers to create playlists on iPods that are personally meaningful to each resident. Or you can do it on your own, too.
As a home health care provider or caregiver, you can leave the personalized playlist on an iPod or digital audio device at the patient’s home and interact with him/her and the music on your visit. It’s rewarding for not only the patient, but for family members and the caregiver or health care professional, too.
If you were making your own playlist, something that would light a fire within you, what would it include?
Here are a few of my personal favorites:
In a mind that battles with recollecting, it’s an amazing gift to rouse someone’s memories and identity, all with the powerful starting spark of music. And, if you were born close to the era of music that moves me, you are also going to have to move to that music. But that is a blog for another time.