OASIS D-Day: Assess Once, Score Twice

December 11, 2018

In less than three weeks, home health agencies will be transitioning from OASIS-C-2 to the new OASIS D assessment.   Given all the regulatory changes this year and with the holiday season upon us, it has really been a sprint to get staff trained.

HCA of MA recently held three training sessions for members and not surprisingly there is concern with staff being ready, especially around the nuanced degrees of functional assessments and specifically related to the new items related to mobility and self-care.  While OASIS-D comes advertised as “dropping 28 previous M-Items” from OASIS-C-2, the additional assessments will require lots of creative patient engagement on the part of the admitting nurse or therapist, according to HCA Director of Regulatory and Clinical Affairs Colleen Bayard.

“OASIS-D is intended to begin to standardize patient assessment and quality measures across all post-acute providers,” said Bayard.   “But for us in home care some of the new items ask for very nuanced responses. For example, the mobility item (GG0170) has 17 mobility activities that  the clinician must  ‘code’ with a  6-point scale from independent to dependent or  ‘code’ with 4 possible responses related to ‘activity not attempted.’  The admitting clinician is responsible for assessing a patient’s ability to stair climb, pick up an object from the floor and even make a car transfer.

During the Alliance’s trainings, Bayard warned agencies to expect some productivity issues related to the learning curve,  but stressed that the training message across the industry should be: “assess once, score twice.”   In other words, be aware of OASIS M assessment questions which track to newly added  GG assessments and use the same assessment to respond to multiple OASIS items in the same category.  Bayard also recommends close auditing or self-monitoring in the initial months, especially related to the responses “patient refused” or “dash” (not attempted).    (Ask:  could the clinician interview a family member as a way to get a response?)

Bayard recommends using the “Expansion of the one Clinician Rule” to your advantage because CMS is encouraging an interdisciplinary team approach with OASIS-D. Bayard’s final advice: “As you focus on your training be aware that your nurses are going to need to have a strong intersection of observational skills with interview skills.”

HCA has several places members can come to share and learn as they move past Jan 1.   Our Clinical Directors and Quality Improvement list serves and networking groups will be highly focused on OASIS-D as winter turns to spring.  The Clinical Directors next meet Thursday, January 10 and the QI Managers will next meet on January 9th.  Meeting information is here.  Our email groups are here.

If you haven’t already studied it – here is a list of more than 100 answers to OASIS questions received by CMS from the industry during recent CMS in-person trainings and webinars.


Talking Home Care: NAHC’s Calvin McDaniel on the 2018 Midterm Elections

November 19, 2018

Kelleher and McDaniel

On this week’s edition of Talking Home Care, we are joined by Calvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC). Calvin oversees NAHC’s legislative priorities on Capitol Hill, and collaborates with the Alliance and other state associations on shared, industry-wide priorities.

Our discussion recaps the 2018 Midterm Elections and what to expect in the 116th Congress, which will be seated in January 2019. Enjoy!


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 29 minutes; Size: 23.2 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

GuestCalvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC).

2018 Midterm Elections Recap (Updated Monday, 11/19):

  • Democrats regained control of the US House of Representatives, gaining 37 seats so far and holding a majority of 233 seats to Republicans’ 198 seats.
  • Republicans held control of the US Senate picking up two seat as and expanding their Senate Majority to 52 seats to Democrats’ 47 seats. The Mississippi senate seat is heading toward a run-off election on November 27th.
  • On the state level: Democrats flipped nearly 400 state legislative seats nationwide, flipped seven Republican-held governor seats, and took full control of the legislature and Governors’ mansion in seven states.
  • Lastly, three states: Idaho, Nebraska and Utah voted to expand Medicaid. And a fourth state, Maine, elected a democratic governor, who will likely do the same.
  • Overall, nearly 116 million voters cast ballots, representing over 40% of eligible voters and represents the largest midterm voter turnout in 104 years.
  • It is expected that Representative Richard Neal (D-MA) will become the Chairman of House Ways & Means, and Representative Jim McGovern (D-MA) will become the new Chairman of the Rules Committee. This greatly increases the Massachusetts’ Congressional Delegation influence on Capitol Hill.

The most important takeaway from our conversation with Calvin is that HCA members should prepare for an incredibly active two years of advocacy. Take hold of your responsibility to engage your elected officials on behalf of your organization and join us in the fight on the many issues facing our industry. Be it an email to a legislator, inviting them to your offices for a tour or on a home visit, or taking time to join us in D.C. for one of the many fly-in events, it takes an army of voices to accomplish a common goal. To get involved, email Jake Krilovich.

Return to www.thinkhomecare.org.


Home Care Month 2018: Building a Workforce for the Future

November 2, 2018

Today marks the start of Home Care Month. This is the first of several blogs post reflecting on the current issues impacting the industry.

Every day in this country, 10,000 baby boomers turns 65. This new generation of “elders” are unlike any other to come before it. Economists suggest that these baby boomers control 70% of all US disposable income, yet a large percentage are not well prepared financially for retirement, with savings far below what they are projected to need to “sustain their quality of life.” Thanks to medical advances, these aging boomers should have a longer life expectancy than even the generation before them. They are more educated. They are accustomed to speaking up about their health care needs and they are technologically savvy. And without a doubt, they will be looking for a long-term care delivery system that meets their needs, allows them to age in place with some degree of financial security and with little dependence on their children (whom many boomers are still supporting!).

In short, they will want a high-quality, cost-effective, technologically-advanced home care delivery system. As we celebrate home health care month in Massachusetts and around the country, let’s look at some of what we need to do to make sure we have that in place.

Starting with Workforce Issues

This chart from a recent report from global health care consulting firm, Mercer, depicts what many have written about: There is a huge gap between the availability of a home health aide/personal care workforce and patient need. Massachusetts is among the states expected to feel it the most, and the graphic speaks to how much has to be done in this area.

Home health agencies – dependent on heavily regulated Medicare and Medicaid funding for most of their services – are increasingly unable to offer wage and benefit packages that allow them to compete within the health-care or service-delivery sectors. Added business costs such as the state’s EMAC assessment and mandated paid sick leave make it harder for private home care companies to keep costs affordable and attract workers. Already, many report more demand than they have the workforce to meet.

To ensure an available, productive, and healthy workforce we support:

  • Repealing the onerous EMAC assessment on agencies whose workers access public insurance (Medicaid);
  • Providing premium assistance or pooled purchasing of health insurance for direct care workers;
  • Adequately adjusting Medicaid reimbursements to cover living wages and benefits; and
  • Investing now in the creation of a meaningful, long-term care workforce training, with nurse and aide training funds.

Looking at Technology

There are many who think some of the workforce demand can be offset with the new technologies emerging to support aging at home. These include sensor devices that can detect a multiplicity of conditions and situations including missed meals or medications, a problematic change in weight or blood pressure, or a fall. According to a recent report by the MA state Auditor’s office:

The potential for technological change to impact the labor requirements for home health/direct care workers is considerable. As low cost technologically-based products become available it is likely that these emerging products and services will serve as both substitutes for and complements to home health/direct care occupations.

Most of these technological devices require a receiver to get and act on the collected data. While in some cases this may be a family member, it should also be noted that home care agencies are appropriately poised to be the monitor of remotely transmitted systems, sending a nurse or aide to visit only as indicated. As workforce issues intensify, we would like to see and support:

  • More insurance coverage, including Medicare and Medicaid for remote monitoring devices
  • More modeling of partnerships between private home care companies and technology vendors to test the market for, and price, care extender technologies as part of a private home care plan of care.

Home Care Month is a time to honor the contributions of home health workers who are the lifeline to health care for some many home-bound elders, for isolated and struggling families and for the disabled. Let’s also use this opportunity to listen to and respond to their needs.

Return to www.thinkhomecare.org.


Talking Home Care: Amanda Oberlies on “No on MA Ballot Question 1”

October 31, 2018

The Alliance’s Pat Kelleher &
ONL’s Amanda Oberlies

Should health care facilities have their nurse-to-patient ratios defined by law? That’s the question put to Massachusetts voters this coming Tuesday. Amanda Oberlies of the Organization of Nurse Leaders joins us to discuss why her organization (and the Alliance) oppose Massachusetts Ballot Question #1. Their conversation covers:

  • Who’s behind the ballot question and why?
  • What is the intersection of staffing-ratios and quality?
  • How does California’s experience with a similar law correlate to the MA proposal?


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 30 minutes; Size: 24 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

Guest: Amanda Stefancyk Oberlies, PhD, MBA, RN, CENP, is the Chief Executive Officer of the Organization of Nurse Leaders (ONL).

Resources:


Talking Home Care LogoDon’t want to miss the next episode of Talking Home Care? Subscribe through iTunes, Google Play, or accessing its feed directly.

Return to www.thinkhomecare.org.


Talking Home Care: Pat Ahern on Palliative Care 101

October 19, 2018
Pat Ahern of Care Dimensions

Pat Ahern

Pat Ahern of Care Dimensions joins us for the eighth episode of the Talking Home Care Podcast. As the CEO of the largest and most experienced palliative care agency in the region, Pat’s an authority on palliative care, hospice, and related issues. In a conversation with Alliance Executive Director Pat Kelleher, Ahern discusses:

  • Palliative care’s role as a “midwife at the other end of life”;
  • Dementia care;
  • Payment reform;
  • Referral sources;
  • Nurse recruitment and training; and
  • Physician involvement.


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 26 minutes; Size: 12 MB). If you enjoy it, please give us a five-star review so others can find it as well.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

GuestPatricia Ahern, joined Care Dimensions in 2017 as president and CEO. With more than 30 years of leadership in healthcare and an MBA, she has the clinical and strategic business skills, and a true passion for the mission, that enables her to provide Care Dimensions’s vision and leadership.

Resources: More information about Care Dimensions.


Talking Home Care LogoDon’t want to miss the next episode of Talking Home Care? Subscribe through iTunes, Google Play, or accessing its feed directly.

Return to www.thinkhomecare.org.


Statement on Boston Globe Article: A Stranger in the House

September 21, 2018

Boston, MA – The Home Care Alliance of Massachusetts issued the following statement in response to the two-part Boston Globe article titled “A Stranger in the House” printed September 16th and 17th:

The Home Care Alliance and its members have a zero-tolerance policy when it comes to patient abuse. Over many years we have worked with the Department of Public Health, Elder Affairs and Health and Human services to address issues of elder abuse and billing fraud. Our members take very seriously the responsibility of ensuring the safety and quality of care being delivered to their clients.

These Boston Globe articles confusingly lump three different classes of workers together: personal care attendants employed directly by consumers in the PCA program, aides hired through a home care agency, and workers hired directly by consumers in the underground marketplace.

While the article cites 20 cases of agency-hired workers committing abhorrent crimes in ‘recent years,’ it fails to contextualize the fact that home care agencies have employed over 75,000 workers and delivered care to more than 600,000 elders in the past five years.

We have long advocated for the Commonwealth to develop a licensure process and we support state legislation (H.344) which we believe would enact baseline consumer protection standards for private pay home care agencies. We also advocated for recently enacted legislation to license certified home health agencies.

In failing to adequately explain the structure of the home care system in Massachusetts, readers are left confused and scared. At a time when aging-in-place is a statewide priority, we should be working on solutions that expand access to these services and protects consumers in the setting that they prefer: home.

About the Home Care Alliance of Massachusetts:

With a mission to unite people and organizations to advance community health through care and services in the home, the Home Care Alliance of Massachusetts is a non-profit trade association and advocacy group providing representation, education, communication, advocacy and – ultimately – a voice for the state’s home health industry. Founded in 1969, the Alliance has grown to represent more than 160 home care and home health agencies across the state. For more information, visit www.thinkhomecare.org.


HCA Submits Comment on Medicare Changes; Submit Your Comments Now!

August 30, 2018

On July 1st, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule which includes several changes to the home health benefit for 2019 and beyond. The public comment period closes this Friday August 31, 2018, at 11:59 p.m. As of this blog posting, 760 comments have been submitted to CMS which is encouraging, but far from the more than 1,300 comments submitted last year in response to the HHGM proposal which was ultimately withdrawn.

You can view the HCA’s written comments here and can download the word document here.

You may submit your own comments to CMS here.

Here are some of the key changes proposed, and an overview of HCA’s response:

Home Health Wage Index Changes

  • The 2019 proposed payment rates increase by 2.1% which represents a $400 million increase.
  • HCA of MA has long expressed concerns to CMS over inequities in how the wage index is calculated for home health agencies compared to hospitals. HCA urges CMS to adjust the 2019 home health agency wage index to reflect a policy to limit the wage index disparity between provider types within a given CBSA.

Proposed Patient Driven Groupings Model (PDGM) for CY 2020

  • Implementation: As the proposed PDGM would mark a major change in the way home health agencies will be reimbursed, the HCA urges CMS to delay implementation by one year to ensure that there is no disruption in access to services for beneficiaries and evaluate the accuracy of the model and its effect.

  • LUPA Thresholds: CMS proposes to set the LUPA visit threshold at the 10th percentile for each payment group. HCA believes this is complex and will complicate the care planning process for home health agencies. HCA urges CMS to retain the current LUPA thresholds and revisit them in future years.

  • Behavioral Assumptions: CMS proposed three ‘behavioral assumptions’ in the PDGM totaling -6.42%. However, these assumptions are not based in data or evidence. HCA believes that two of the three assumptions already exist in the current PPS methodology including; that agencies are already incentivized to both report the highest playing diagnosis codes and to develop and deliver plans of care that exceed the LUPA threshold. This could result in an over estimated impact of behavioral assumptions and the HCA urges CMS to eliminate the Clinical Group Coding and LUPA threshold assumptions.

  • Split percentage payment approach: HCA believes that changing from a 60 to 30 day billing period will be very disruptive to agencies’ operations and increase back-office costs. Therefore, HCA urges CMS to continue the split payment approach at the current 60/40 and 50/50 splits for early and late periods, respectively, to give agencies cash flow breathing room.

  • Certification and Re-certification of Patient Eligibility: HCA has long advocated for regulatory language to align with sub-regulatory guidance as it relates to documentation of the patient’s eligibility. HCA is encouraged by CMS’ proposal to eliminate the requirement that the physician provide an estimate of how much longer skilled services are required and we request that CMS consider revisions to the physician’s burden of the F2F encounter as a condition of payment. 
  • Remote Patient Monitoring: HCA strongly supports the proposal to recognize remote patient monitoring costs as an administrative cost on the HHA cost report. HCA does recommend however that CMS remove the regulation that does not allow remote patient monitoring to be used as a substitute for in-person home health services. 
  • Home Health Value Based Purchasing Model: HCA has long supported the HHVBP model aiming to improve quality by giving HHAs incentives to provide better quality care. However, HCA urges CMS to modify the HHVBP to recognize stabilization in the scoring because in many cases, stabilization (instead of improvement) is an appropriate goal for some patients.

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