Merrily Orsini's Thought Leadership

Payment, Reimbursement and Quality Lead the Home Care Trends Illuminated at the Northeast Home Health Leadership Summit

Leadership Summit Lights Fire with Attendees

A Survival Kit may be needed for health care payment reform

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.