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?