HCA and Northeastern University Partner on Nurse Symposium in June

March 21, 2019

These days, it seems like every week a new report is published sounding the alarm of a rapidly aging population across the United States and a shortage of workers prepared to care for this barreling silver tsunami. So much of the media coverage and research is focused on the paraprofessional workforce.

See for example, these reports/publications:

However, the Home Care Alliance member surveys indicate that the problem is broader than just a shortage of home health aides. The availability of a trained nursing workforce to meet a growing home-based health care delivery system is also emerging as an issue. Compounding challenges are impacting our ability as an industry to attract nursing students into home and community-based settings after nursing school.  That is why, on June 7th the Home Care Alliance of Massachusetts and Northeastern’s School of Nursing are hosting a symposium on the very topic of building a home care nursing workforce at Northeastern University from 9AM – 3PM.

The event, titled: Nursing Call to Action: Building a Nursing Workforce to Deliver Complex Care at Home, will bring together more than 25 nursing schools and 25 home health providers for a day-long session. The program will kick-start a dialogue brainstorming new approaches for preparing and exposing Massachusetts nursing students for an increasingly intensive health delivery system in the home.

This event will look past the issue of reimbursement rates or ever-changing reforms at CMS, and instead will focus on four key areas:

  1. Identifying knowledge and skills gaps for LPN/RN new-grads and what changes can be made to address the gaps and develop competencies in executing highly complex services
  2. Elevating the visibility to nursing schools of the growing demand for home-based services and the need to expose students to possible careers in home care nursing
  3. Identifying strategies on recruitment as new-grads and experienced nurses prepare for possible careers in home care nursing
  4. Identifying barriers and strategies to get home health agencies more involved in clinical placements for nursing students

If you would like more information on this event, please reach out to Jake Krilovich. Please note: There is limited space for this event!


Full Brochure for 2019 NEHCC Now Available

March 8, 2019

The full conference program and schedule for the 2019 New England Home Care and Hospice Conference & Trade Show is now available for download.

View this document on Scribd

The NEHCC is the region’s premier event for home care and hospice agencies. It’s hosted by the six New England state home care associations, which collectively represent nearly 400 organizations. The 2019 NEHCC will be held June 5-7, 2019 at the Sea Crest Beach Hotel in Falmouth, MA.

For more information about the conference, or to register to attend, visit www.nehcc.com.

Return to www.thinkhomecare.org.


Home Health, EHRs and Data Interoperability

February 27, 2019

In 2011, the Centers for Medicare and Medicaid Services launched the “Meaningful Use (MU) initiative to incentivize certain sectors in the US health care system to move toward electronic health records (EHR) that would be used in a meaningful manner that allows for the electronic exchange of information to improve continuity and quality of care. Significant financial incentives were provided to “eligible providers” – essentially defined as hospitals and physician practices. More than $20 billion was spent and more that 600,000 eligible providers were enrolled. Home health, behavioral health and skilled nursing facilities were not eligible.

Now, it seems there is some limited acknowledgement that it may be time to rethink that. In a proposed rule relative to interoperability just published in the Federal Register, CMS is including – as a Request for Information – an ask for any feedback as to how to improve data interoperability for providers that have as yet received any incentives for using electronic health records.

“Transitions across care settings have been characterized as common, complicated, costly, and potentially hazardous for individuals with complex health needs. Yet despite the need for functionality to support better care coordination, discharge planning, and timely transfer of essential health information, interoperability by certain health care providers such as long term and PAC, behavioral health, and home and community-based services continues to lag behind acute care providers,” the proposed rule says.

CMS acknowledges that a contributing factor to the lag in Interoperability among post-acute care providers was that they were not eligible for incentives under the program formally known as meaningful use. CMS asks for input on specific ways it could financially help these sectors adopt and use technology.

CMS also asks for feedback on measurement concepts and quality improvement steps that could feasibly be applied to post-acute care, behavioral health and home and community based-services providers. Given that mandate in the IMPACT ACT that certain patient assessment data should be standardized and CMS is interested in feedback as to what parts of that data set — or the whole IMPACT Act data set — would be appropriate to include.

Adding some fuel to what may be an obvious fire (no incentive = limited movement) is a just published study in the Journal of the American Medical Directors Association that examined gaps in communication between hospital and home health care staff, concluding that some could have serious medical consequences.

The authors surveyed nurses and staff at 56 home health agencies throughout Colorado. Participants were sent a 48-question survey covering communication between hospitals and agencies, patient safety, pending tests, medication schedules, clinician contact and other areas. Although almost all (96 percent) respondents indicated that Internet-based access to a patient’s hospital record would be at least somewhat useful, fewer than half reported having access to EHRs for referring hospitals or clinics. No surprise: getting medication doses right due to conflicting information was identified as a major problem.

Their conclusion: Future interventions to improve communication between the hospital and HHC should aim to improve preparation of patients and caregivers to ensure they know what to expect from HHC and to provide access to EHR information for HHC agencies.

Comments to CMS will be due in April. Date not yet announced.

Return to www.thinkhomecare.org.


PDGM Fix Introduced, Advocacy Needed

February 21, 2019

Last week, a bipartisan group of senators, led by Sen Susan Collins (R-ME)  introduced what will be a most important legislative priority for HCA of MA this year.  Senate bill (S.433) will curtail the so-called $1 billion “behavioral adjustment” cut under the Patient Driven Groupings Model (PDGM) to which all of home health is transitioning in 2020.  Among, many other changes, PDGM will move home health from a 60 to a 30 day payment unit. This is the most significant change to home health payment since the Prospective Payment System was introduced in 2000.

The Congressional action that called for a home health payment overhaul required that the new payment model be budget neutral against current spending levels. However,  the legislation also allowed that CMS to consider “behavioral  adjustments” defined as industry actions that would be taken to increase payment under the new model, unrelated to patient case mix changes. CMS has used this authority very broadly to institute a payment adjustment in the first year of PDGM based on “assumptions” of behavioral changes, and that adjustment calls for a 6.42% base rate reduction, or a possible $1b reduction in payments.

S 433 would prohibit CMS from making any pre-rate change reductions based on assumptions and instead to phase in any adjustments (either up or down) based on observed evidence (i.e., data supported) changes in provider behavior. The objective would be to achieve budget neutrality by 2029. This later piece addresses concerns the Congressional Budget Office (CBO) expressed regarding whether a similar bill introduced last session was truly budget neutral. S.433 also would allow Medicare advantage plans and Center for Medicare and Medicaid Innovations (CMMI) to waive the “confined to home”  provision when in the best interest of a Medicare beneficiary.

Regardless of the “behavioral adjustments,” the PDGM model is expected to have a tremendously varied impact state by state and agency by agency.  A significant amount of this impact is related to a Congressional  requirement that the payment model no longer use the volume of therapy as a payment level determinant.  (Something MEDPAC has been calling on CMS to do for years.)   The state of Florida, where therapy visits average 10.45 per episode of care is set to “lose” the most – projected at $141 million.  California on the other hand, where the average therapy utilization per episode was 5.76,  will be the largest gainer.  MA (need numbers from Tim)  Note: S 433 does not seek to make changes to the structure of the payment model that produces these changes.

It is important to reflect on CMS’ proposal in 2017, Home Health Groupings Model (HHGM) and how we arrived to where we are today. At the time, HHGM represented similar changes to the payment model, without soliciting industry feedback and some estimates predicting a 15% reduction in payments. As a result, the industry unified itself behind one message: that CMS withdraw its proposal and engage stakeholders to come up with an alternative. Upwards of 13,000 emails were sent to Congress from the industry, 49 members of the U.S. Senate and almost 160 members of the U.S. House of Representatives signed onto letters to CMS echoing the request to withdraw HHGM. This was a remarkable show of mobilization by the industry and we’ll need it again to make modifications to PDGM.

At present there is no bill in the House, but it is expected that one will be forthcoming.  Strong early sign on support is critical to keeping this bill moving and HCA of MA will be urging members to contact the MA delegation to support S.433 and the companion house legislation to be introduced. Stay tuned for these advocacy alerts in our weekly newsletter and advocacy messages in the coming weeks.

HCA will also be hosting a number of member events to prepare for the payment transition.  While the full day PDGM programs in March in Northampton are sold out, there will be a high concentration of sessions on PDGM at the New England Home Care Conference and Trade Show in on June 5 -7 inn Falmouth. Watch here for more details.

In the meantime, send a message here to Senators Warren and Markey about the need for their support on this issue. 

Let’s do this home care – we cannot sustain $1 billion in cuts based on assumptions, not facts!


The “Agency Advantage,” Explained

February 20, 2019

Many families ask why they should work with a home care agency rather than hiring a nurse or aide themselves. Re-designed to better answer that question, The Agency Advantage is a one-page flier that describes the benefits of contracting with an agency compared to a direct hire. Best of all, blocks of up to 50 are available at no charge to members.

In addition to describing the benefits of working with an agency, it also shows the advantages as a checklist:

Return to www.thinkhomecare.org.


The New ThinkHomeCare.org

January 21, 2019

The Alliance is extremely pleased to announce the first re-launch of its website in nearly five years.

Screenshot of the new design.

Design & Home Page Changes

  • A clean, responsive design that works both for desktop and mobile platforms;
  • Member sign-on available directly on the home page and many sub-pages; and
  • New red button highlights and a simplified navigation menu to direct members & non-members alike to topics of interest.

Function & Enhancements

  • A new Education Page with categories that that filter for the events you’re looking for;
  • An overhauled Association Store with better categories and clearer organization;
  • A brand-new Library of Recorded Webinars, some available for purchase (at reduced rates for members), some available at no charge;
  • A redesigned Find-an-Agency search helps families find services that meets their needs; and
  • A new, members-only page listing money-saving Group Purchase Programs available through the Alliance.

As with all websites, we’ll continue to make changes and enhancements over the coming weeks and months. If you have any problems or suggestions, please contact me at tmeyer@thinkhomecare.org.

Return to www.thinkhomecare.org.


Education Doesn’t Stop for Winter: It’s Webinar Season!

January 9, 2019

The Home Care Alliance of MA is proud to top education to our members on important and relevant topics. There are roughly 5-8 programs held a month and during the winter, they mostly belong to webinar education! Webinars are a cost effective way of educating your staff – you pay an affordable price for one line and have staff gather in a room to listen together, or access the recording for a later date training.

Below you will find some of our current webinars being offered which range in topics from Coding to CASPER reports to Aide education.

There are continuously new programs offered including on-site education, trainings, and conferences. Check out our calendar on our website to stay the most informed!

Contact Megan Fournier at mfournier@thinkhomecare.org or 617-482-8830 for any questions!


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