Thursday, December 15, 2011

Not Going to the Doctor after Hospital Discharge is a major cause of Readmissions

Home Health Care Leaders across the country are looking for opportunities to serve more patients by working with hospitals to reduce unanticipated re-admissions. Beginning in 2013, Medicare will begin penalizing hospitals that have excess risk-adjusted rates for health attack, heart failure, and pneumonia.

A recent research study published by the National Institute for Health Care Reform suggests that one of the major causes of re-admissions is failure of the patient to see their doctor within 30 days of being discharged.

More than a quarter (26.1%) of all readmissions in the 30 days after discharge were for conditions unrelated to any conditions identified in the initial or index admission. At one year post-discharge, more than a third (37.4%) of all readmissions or rehospitalizations was unrelated to the initial admission (findings not shown). Reasons for the unrelated rehospitalizations included such conditions as hypertension, congestive heart failure and stroke, which frequently present as comorbidities. For example, a patient with both diabetes and congestive heart failure might be hospitalized for an acute diabetic episode, treated and released, then rehospitalized three months later for congestive heart failure.

F ollow-up care from a physician or other medical provider after a hospital discharge is important to monitor the condition that led to the hospitalization and for preventing readmissions. One-third of adults discharged from a hospital did not see a physician, nurse practitioner (NP) or physician assistant (PA) in the 30 days following discharge, excluding physicians seen in emergency departments . Even 90 days after discharge, 17.6 percent still had not seen a physician, NP or PA.

It's clear that there are opportunities for home health agencies and private duty companies to help reduce hospital re-admissions by encouraging patients and clients to see their physician after being discharged from the hospital.

What are you doing to reduce hospital re-admissions?

Monday, November 14, 2011

U S Supreme Court to Hear Health Care Reform Case

The United States Supreme Court is to hear a challenge to The Patient Protection and Affordable Care Act and deliver its ruling at the height of next year's presidential election campaign.

In an order released on Monday morning(11-14-11), the Supreme Court announced that it will hear more than five hours of oral argument in the challenges to the Affordable Care Act brought by 26 states and several private parties.

The order indicates the gravity with which the justices view the health care cases, as the Court rarely allots more than an hour to for argument in each case it hears.

Within those five-plus hours, the justices divided the time into four separate arguments to address the various questions raised in petitions from the Department of Justice, the 26 states and the National Federation of Independent Business.

Wednesday, October 12, 2011

Senator Amy Klobucher on Home Health & Hospice

Another of the featured speakers at the 2011 National Association for Home Care & Hospice annual convention in Las Vegas was Senator Amy Klobucher (D-MN). Senator Klobucher touched on several important issues that will affect home health and hospice.

Focus on the Delivery System

While health care reform as written in the Patient Protection and Affordable Care Act is important, we need to focus on the delivery system. We need to reduce the cost of delivering health care while improving the quality of care outcomes. We need to follow the model of Mayo Clinic in Rochester, MN, and we could save billions.

Reduce the Debt

We have to do something about the national debt. The current trend is unsustainable. The solution is a combination of revenue growth and spending cuts.

The Silver Tsunami

The number of seniors over the age of 65 is doubling by 2030. As a country we need to prepare for this coming wave of seniors who will consume significantly more health care services.

Clarifying Long Term Care Insurance

The senator discussed new legislation to clarify long term care insurance. "People don't buy insurance because they don't understand it."

NAHC Washington Update

At the opening general session of the 2011 NAHC annual convention in Las Vegas, Val Halamandaris and his team of staff and volunteer leaders gave us an update on what's happening in Washington that will affect home health care, hospice, and private duty home care.

The conversation focused on the debt reduction process, and the impact of cuts in Medicare reimbursement to fund the Patient Protection and Accountable Care Act (Health Care Reform).

The three big issues are:

1. The activities of the Super Committee, and the potential for more cuts to Medicare.

Washington's last-minute deal to raise the U.S. debt limit in August also created a powerful "super committee" of 12 legislators charged with finding $1.5 trillion in deficit reductions by this fall. If they fail, automatic across-the-board spending cuts kick in.

2. Co-pays for home health and hospice

President Obama proposes Home Health Care co-payments. Under the President's plan, starting in 2017:

o Upper-income beneficiaries would pay higher monthly premiums for outpatient and prescription coverage. Eventually about a quarter of all Medicare beneficiaries would be hit with the higher income-related premiums that only a small share of seniors now pay.

o Newly signed-up beneficiaries would pay a penalty if they also purchase private insurance that covers all or most of Medicare's copayments and deductibles. Administration officials say such insurance encourages over-treatment.

o New beneficiaries would pay a $100 copayment for home health services.

o New beneficiaries would pay a higher annual deductible for outpatient services. The so-called Part B deductible, currently $162, is indexed for inflation. It would go up by $25 for new enrollees in 2017, 2019 and 2021.

3. Medicaid

According to Mark Heaney, CEO of Addus Health Care, and chair of NAHC's National Council on Medicaid Home Care, we are looking at "techtonic shifts" in state Medicaid programs around the country.

The Accountable Care Act places much more responsibility on the state Medicaid programs to provide health care coverage for the uninsured, and provides for significant expansion beginning in 2014. According to Heaney, "45% of long term care spending is Medicaid Home Care."

Other topics covered by the panel included:

  • Cuts to home health and hospice of $10 to $12 billion over ten years
  • 3% reduction in Hospice payments for routine care in a skilled nursing facility
  • More states going to managed care for Medicaid
  • The rethinking of the CLASS ACT, which was Senator Ted Kennedy's last wish, as the federal actuaries take a closer look at the economics of this voluntary long term care insurance program.
  • The key role that hospital based home health agencies can play in the success of Accountable Care Organizations
At this time of huge legislative and regulatory change that affects home health and hospice, leaders need to be aware of these changes. One of the best ways is to be actively involved in your state or national home care and hospice association.

What do you think?

NAHC Annual Conference Update

There were about 250 people in the breakout session 0n Tuesday, October 4, 2011, at the National Association for Home Care and Hospice conference where I spoke on the topic, "Selling Home Health Care to Physicians." My colleague, friend, and fellow professional Speaker, Dr. M. Tray Dunaway, and I put the program together and have presented it a number of times over the past three years. More on that in a later post.

While at NAHC, I made a point to catch a number of the general sessions and breakout sessions that I thought would be most interesting to readers of Home Health Care Today and the Home Health Care Leadership Minute.

Here are some of the presentations that we'll be covering.

  • The opening general session with NAHC staff giving a Washington Update
  • Senator Amy Klobucher (D-MN) on health care reform
  • Former Senator and Senate Majority Leader Tom Daeschle
  • Val Halamandaris on the State of The Union in Home Care & Hospice
  • Hospice Marketing with Richard Chesney and Stan Massey
We'll upload a separate blog post for each of these reports.

Wednesday, October 05, 2011

New Research on Post Acute Care for Medicare Beneficiaries

On September 28, 2011, The Dartmouth Institute for Health Policy and Clinical Practice released a new research report on patterns of post-acute care for Medicare Beneficiaries. The report reveals striking variations in 30-day readmission rates and little progress in reducing readmissions and improving care coordination between 2004 and 2009.

This report will hold much valuable information for home health leaders who are looking at new opportunities created by the Affordable Care Act with regard to partnering with hospitals to reduce readmissions.

We just downloaded the report and have not had the opportunity to uncover all of the details. You can download the report, or wait a few days until we've had the opportunity to pull out the information that is most valuable for home health and hospice executives.

Senate Panel says three largest home health companies bilked Medicare.

The nation's three largest home-health companies bilked Medicare out of potentially millions of dollars by tailoring medical care to get the highest payments, the Senate Finance Committee said in a 664-page report released Monday.

"The home health therapy practices identified at Amedisys, LHC Group, and Gentiva at best represent abuses of the Medicare home health program," the report concludes. "At worst, they may be examples of for-profit companies defrauding the Medicare home health program at the expense of taxpayers."

The panel's investigation began last year after The Wall Street Journal raised concerns about home-health payments. The new report says the home-health agencies ordered unnecessary therapy visits in order to benefit from Medicare bonuses for reaching certain thresholds.

What impact will this report, and the subsequent news coverage, have on the public's perception of home health care?

Tuesday, July 26, 2011

Home Health Care's Role in ACOs

This week, I had the opportunity to participate in a community event put on by the Health Enterprise Network of Louisville. One of the featured speakers was Dr. Bruce Harmony, MD, FACP, former Chief Medical Officer at Geisinger Medical Center in Danville, PA. Dr. Harmony is now the Managing Partner of Geisinger Consulting Services.

Growing up in central Pennsylvania, and spending many hours delivering patients to Geisinger as a volunteer fire fighter and ambulance driver during college, I am very familiar with the fabulous work that has been done at Geisinger over the last five decades. It is clearly one of the premier health care systems in the country. It is also one of the models for the Accountable Care Organizations defined in section 302 of the Patient Protection and Affordable Care Act of 2010.

According to the panel at the Health Enterprise Network event, an Accountable Care Organization (ACO) is “an integrated provider system that is accountable for a patient population.”

Unlike the concept of capitation that was promoted in the mid 1990’s, ACOs will receive payment on a fee for service basis, and will be eligible for additional payments if they achieve cost savings and meet performance standards for quality.

According to Dr. Harmony, the concept of ACOs has been around for 15 years, but it has only been in the last 5 years that specific language and descriptions have more clearly defined them. As one panelist put it, “A ACO is like a Unicorn. It’s a fascinating animal, but no one has ever seen one.”

What will Home Health Care’s Role be in the ACO?

In listening to the expert panel on ACOs, and in reading the elements of the Affordable Care Act, it is pretty clear that there will be an important role for home health care. We have specialized expertise and capabilities to aid the ACO in

o Care Transitions – moving patients from hospital to home

o Care Coordination – linking together various providers

o Chronic Diseases Management – patients with five or more chronic conditions consume huge amounts of health care resources

o Wellness and Prevention – reducing cost by improving health and avoiding disease

It’s clear that we will have an important role to play in the success of ACOs. There are two looming questions:

  1. How will ACOs pick their home health care partners?
  2. Will home health care partners share in the savings, or will we be treated as sub-contractors to the ACO?

The answers to these questions lie in the value that we bring to the ACO and it’s principles. It pretty clear that successful ACOs will be physician driven, and will partner with hospitals and other acute and post-acute providers. Will the leaders of the ACO see home health care as bringing significant value to the equation?

Ed Haislmaier, Senior Fellow at the Center for Health Policy Studies at the Heritage Foundation focused on the rise on chronic conditions due to pollution, stress, and obesity. He said that 20 million people with five or more chronic conditions represent 6% of the population but use 30% of the health care resources.

John Holahan, PhD, Director of the Health Policy Research Center at the Urban Institute was another panelist at the Health Enterprise Network event. He said, “Price is what you pay. Benefit is what you get. Value is the relationship between the two.”

The group generally agreed that health care in America is the most expensive in the world, and the benefits are uneven depending on geography and social economic status. In essence they said, “We’re spending to much for what we get, or we’re getting too little for what we spend.” We need to have a better value proposition.

I think we can all agree that home health care can add to that value proposition by providing higher quality health outcomes at lower cost to the consumer and the payer. How, then, do we convince the principles of ACOs that we can make a difference for them in cost savings and quality performance measures?

Get Ready for the Future - and Your Role in ACOs.

Over the past 25 years, we have worked with over 500 different home health agencies, hospice, and private duty home care companies strategic planning, business development, and leadership. If you are in a situation where you may have the opportunity to become part of an ACO, now is the time to begin planning for it.

For your next Executive Strategy Retreat, or annual Strategic Planning Process, you need an experienced facilitator who can guide your leadership team through a focused, interactive process of strategy development.

Using the storyboarding technique from the Walt Disney organization, Stephen Tweed will guide your team through assessment, direction, competitive advantage, and measurement. You’ll come away with a strategy that you can implement. And we’ll guide you along the way.

No other home health care professional brings the unique combination of practical experience and proven facilitation skills to your next strategic planning process. To explore the opportunity, call Julie Raque at 502-339-0653 to set up a preliminary telephone conversation.

Saturday, July 09, 2011

Transforming the environment of a Hospice House with Healing Images

Do you know a hospital administrator or health care facility CEO who would like to magically transform the environment of their facility? Do you know someone who works in senior living who would like to create a more healing environment for seniors? Do you know someone who would like to transform the end-of-life experience for hospice patients?

I was on Face Book yesterday, and saw an amazing new post by my friend and fellow professional speaker, Dewitt Jones. Dewitt is an award winning photographer who once traveled the world for National Geographic. I have a fabulous photo he shot hanging on my office wall of fishermen in the fog on the River Tweed in Scotland. Having fished that river, the photo brings back wonderful memories. This beautifully frames image was a gift to me as I completed my term as President of the National Speakers Association in 2003.

Dewitt and several of his photographer friends have created an amazing new web site called Healing Images. They are making available at cost hundreds of their award winning photographs so that hospitals, senior living communities, and hospice houses can transform drab hallways into magnificent art galleries. The images they are making available are often breathtaking, and other times bring back wonderful memories and create peace of mind and quality of life.

Please take a few minutes to visit this web site. Then pass this information on to any health care facility administrators that you feel might be interested in transforming their buildings into a place of peace, harmony, and beauty.

I'd love your feedback. What do you think of this idea? Is this something that hospitals, skilled nursing facilities, and hospice residences would like to use to create a more healing environment? Give us your comments below or send me an email.

Best regards,
Stephen Tweed

Thursday, June 30, 2011

Visioneering Home Health & Hospice

By Stephen Tweed, CSP

Several weeks ago, I was re-reading Andy Stanley’s wonderful book, Visioneering. Andy is the pastor of North Point Community Church, a three campus church community in the northern suburbs of Atlanta. I picked up his Visioneering book some time ago when I saw the cover and was immediately drawn to the title.

As you know, we’ve been big on vision as part of the process of growing your home care business. Our four corner stones: Assessment, Direction, Competitive Advantage and Measurement rely on vision as part of setting direction. Perhaps you’ve heard me speak and tell the story of the young man in the audience in California who said to the group, “Vision without action is hallucination.” Then in another program, a participant responded to that, “Yes, and action without vision is confusion.”

We want neither hallucination nor confusion when it comes to seeing the future of our home health or hospice businesses.

I define vision as "a consciously created fantasy of what could be, fueled by the conviction that it should be".

Andy Stanley says about vision:

"Visions are born in the soul of a man or a woman who is consumed with the tension between what is and what could be."

"Visions are formed in the hearts of those who are dissatisfied with the status quo."

How do you feel about the status quo in your home health agency or hospice? How does the tension play out between what is and what could be?

What is your vision for the future of your home health care business? What actions will you take to turn that vision into reality?

I’m in full agreement with Andy Stanley’s definition of “Visioneering.” It is “the course one takes to turn vision into reality".

The 'visioneering process', as we practice it at Leading Home Care, has seven steps:

1. Assessment – Where are you now?

2. Visioning – Where do you want to be? What does your ideal future look like?

3. Force Field Analysis - Define the driving forces pushing you toward your vision, and the restraining forces that are blocking your path.

4. Competitive Advantage – Define what makes your home health agency or hospice different from your competitors. Home Care & Hospice are more competitive now than ever before in history.

5. “Strategic Plan at a Glance” – your one-page plan for achieving your vision.

6. High Value Activities and High Value Contacts - initiatives that will move you toward your ideal future.

7. Measurement - Setting up a strategic scorecard to measure and manage your progress.

Another aspect of this process is “vision casting”. That’s the process of painting a word picture of a possible and desirable future. Visionary leaders of home care companies are “Vision Casters” who continually paint word pictures for their team members about where the company is going, and what the future will look like. They paint a positive picture of hope and change, and then develop strategies for Visioneering . . . turning those word pictures into reality.

Whether you are developing a new strategy to grow your business, or concentrating your next ACHC accreditation survey with flying colors, you can use the Visioneering process to develop focused initiatives to get the outcomes you seek.

About the Author: Stephen Tweed is Chairman and CEO of Leading Home Care ... a Tweed Jeffries company. He works with CEOs and senior exectives of home health agencies and hospices who want to grow their business and get ready for the future. He can be reached at or at 502-339-0653.