Monday, December 16, 2013

New Study Affirms Effectiveness of Home and Community Based Services

The University of Minnesota’s National Residential Information Systems Project (RISP) recently released a study titled Residential Services for Persons with Intellectual or Developmental Disabilities: Status and Trends Through 2011 (the Study)The Study’s major findings as they apply to home and community-based services (HCBS) and rebalancing are below.

HCBS Waivers: The number of people with intellectual and developmental disabilities (IDD) that are recipients of HCBS waivers increased dramatically, from 1,381 in 1982, to 62,429 in 1992, to 373,946 in 2002, and to 616,491 in 2011.  Total IDD HCBS waiver expenditures increased from $10.9 billion in 2001 to $26.3 billion in 2010 to $27.9 billion in 2011. From 2001 to 2011, the degree of expenditure increase varied significantly across states, with Illinois, Mississippi, New York and Ohio experiencing increases above 500%, while California, Michigan, New Hampshire, Oklahoma, and Rhode Island seeing increases from 25% to 73%.  HCBS waiver recipients accounted for 69.0% of the national IDD population in 2010. 

Rebalancing: The Study provided several statistics demonstrating the success of rebalancing of the IDD population.  The average daily population living in either psychiatric or large state-operated IDD facilities decreased from 187,305 nationally in 1965 to 103,629 in 1985 and to 29,809 in 2011.  Relative to the general population, the institutionalized IDD population declined as well.   The proportion of those with IDD living in either psychiatric or large state-operated IDD facilities as compared to the general population fell from 115.8 per 100,000 nationally in 1965 to 49.3 per 100,000 in 1985 and to 9.6 per 100,000 in 2011.

Further evidence of rebalancing is demonstrated when comparing the proportion of IDD population residing in Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IDs) (27.2 out of 100,000), versus those receiving HCBS (197.9 out of 100,000) in 2011.  The utilization levels of HCBS relative to the population varied significantly among states.  Eight states had over 350 out of 100,000 receiving HCBS (Arizona, Iowa, Minnesota, New York, North Dakota, South Dakota, Vermont, and Wyoming), while five state had fewer than 100 per 100,000 receiving HCBS (Delaware, Michigan, Mississippi, Nevada, and Texas).

Cost-Effectiveness of Rebalancing: The Study confirmed the cost-effectiveness of HCBS compared to institutional care.  In 2011, annual Medicaid expenditures per person in ICF-IDs was $148,146, versus only $45,294 per person for IDD HCBS.

For the full Study, click here.

Friday, December 06, 2013

Final Home Health PPS Rule published in Federal Register

The US Department of Health and Human Services published the 2014 Home Health Perspective Payment Rule in the Federal Register on Monday, December 2, 2013. 

The CY 2014 national standardized 60-day episode payment will be $2,869.27 as compared to an average payment per episode of $2,952.03 per episode on calendar year 2013.  The new rate for agencies that do not submit quality data is reduced by 2% to $2,813.18.

The CY 2014 national per-visit rates will be:

Home Health Aide - $54.84
Medical Social Services - $194.12
Occupational Therapy - $133.30
Physical Therapy - $132.40
Skilled Nursing - $121.10
Speech-Language Pathology - $143.88

What impact will these new rates have on your home health agency?

What impact will they have on the industry?

Thursday, December 05, 2013

Free Hospital Readmission Report

One of the significant areas of opportunity for home health agencies is working closely with hospitals
to reeducate unnecessary readmissions.  In order to open up that opportunity for a meaningful discussion with hospital leaders, you need to have some facts and data about that hospital and their readmission rates.
Now, you can get a free sample report for any hospital in your market area.  If you like the sample, you can order reports for the other hospitals you serve. 

The Hospital Readmission Report is the first step in preparing your sales strategy for your key hospital accounts.  Knowing whether your hospital is in trouble on readmission penalties or if it is in the "safe zone" for now is critical in positioning your agency.

And, since the post-acute world is becoming divided between networked and non-networked providers, the Hospital Readmission Report is crucial in presenting your agency as part of the post-acute solution.  

Please contact me (Rich Chesney) by email or phone for your FREE Hospital Readmission Report.  There is absolutely no obligation and no reading between the lines.  Just send the hospital name, city and state and HMR will send you the report.  

Rich Chesney
Healthcare Market Resources, Inc. 

At Leading Home Care, we have worked with Rich for many years, and we can highly recommend that data that he provides.

Tuesday, November 19, 2013

OIG Permits Hospitals to Pay for Care Transition Services

 By Elizabeth E. Hogue, Esq.

Hospitals are increasingly aware of the need to prevent readmissions.  Although there is limited data regarding what works and what does not, it appears that certain types of care transition services; such as follow-up regarding prescription medications, appointments with physicians following discharge, etc.; may be helpful.  The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services addressed the issue of the provision of these services to hospitals in Advisory Opinion No. 13-10, issued on August 9, 2013.  The Opinion addresses the issue of whether a wholly-owned subsidiary of a major pharmaceutical manufacturer can assist hospitals to better coordinate care, help patients adhere to their hospital discharge plans, and avoid preventable hospital readmissions. 

Specifically, the vendor will sell hospitals a package of services designed to help them avoid payment reductions associated with excess hospital readmissions.  The services will be marketed to hospitals directly and through group purchasing organizations authorized to act as purchasing agents for hospitals.  Agreements to purchase the services will be in writing, signed by both the vendor and hospitals, and have a term of not less than one year.  The Agreement will also spell out all of the services that the vendor will provide to hospitals.  The vendor will charge hospitals standard fees at fair market value. In other words, agreements between the vendor and hospitals will meet the requirements of the personal services and management contracts safe harbor or exception under the federal anti-kickback statute. 

Hospitals will be able to purchase services from the vendor on a patient-by-patient basis that they expect will help reduce preventable readmission rates.  Discharge planners/case managers will identify patients who may benefit from services offered by the vendor.  If patients elect to receive the services, discharge planners/case managers will enter their discharge plans into the vendor’s software system.

Participating patients will have access for a twelve-hour period each day to a patient liaison who will help them understand and follow their discharge plans.  For the remaining twelve-hour period each day then patient liaisons are unavailable, participating patients will be automatically transferred to a twenty-four-hour nurse hotline.  Patient liaisons, who are not necessarily clinicians, will contact participating patients within forty-eight hours of discharge to ensure that they understand and will follow discharge plans. 

Thereafter, patient liaisons will contact participating patients daily or at intervals selected by contracting hospitals to administer questionnaires about participating patients’ health and compliance with discharge plans.  Participating patients may also answer questionnaires on the internet or through telephone interactive voice response systems.  Patient liaisons will ask participating patients about medication compliance, remind them about refills, and add newly-prescribed medication to their electronic health records.  Patient liaisons may also assist participating patients with various tasks, such as scheduling follow-up appointments, reminding them about scheduled appointments or helping them obtain transportation at participating patients’ own cost, providing participating patients with unbranded educational materials intended for general audiences, and providing updates to participating patients’ caregivers and primary care providers.  Reports will be provided to hospitals regarding patients’ medication adherence, post-discharge physician appointment completion, readmission rates, demographics, readmitting hospitals, and secondary diagnoses.

Fees charged by the vendor for these services will include an initial flat fee for implementation services.  The vendor will also charge a per-patient annual fee.  Hospitals may also request additional services for which the vendor would charge separate or additional fees, based on an hourly basis plus expenses and a reasonable profit margin.

The OIG reviewed the above and concluded that the proposed arrangement is unlikely to violate the federal anti-kickback statute or to trigger the imposition of civil money penalties for the following reasons:

-          The arrangement is unlikely to lead to increased costs or overutilization of federal reimbursable services.
-          The proposed arrangement is unlikely to interfere with clinical decision making.
-          The vendor will implement a number of safeguards to prevent the proposed arrangement from being used to increase drug sales by the parent pharmaceutical company.
-          The proposed arrangement is unlikely to result in inappropriate patient steering.
-          Participating patients will designate providers, practitioners, and suppliers that he/she wishes to receive information associated with the services provided by vendor. 
-          The proposed arrangements will not involve providing any rewards or incentives to participating patients that would likely influence their selection of providers, practitioners, or suppliers.

Based upon this Advisory Opinion, it appears that hospitals may pay outside vendors for services related to care transitions so long as the criteria described above are met.  As long as the same safeguards are in place, hospitals may pay post-acute providers for the same types of services.

Readmission rates must be reduced and controlled.  Hospitals must engage in activities to accomplish this goal and clearly need capable partners.

Elizabeth E. Hogue, Esq.
Office: (877) 871-4062
Fax: (877) 871-9739
Twitter: @HogueHomecare

©2013 Elizabeth E. Hogue, Esq.  All rights reserved. 
No portion of this material may be reproduced in any form without the advance written permission of the author.

Saturday, November 09, 2013

Impact of the Homecare and Hospice Industry on your state's economy economy know that home care and hospice is a huge industry sector, and has a major economic impact on our country.  There are over 11,500 certified home health agencies, over 4,500 hospices, and over 19,000 private duty home care companies in our country. What economic impact do they have?

The Pennsylvania Homecare Association commissioned a study to examine the economic impact of homecare and hospice on the commonwealth of PA.  Here are some interesting data that was reported in the study:

  • The industry contributed $11.2 billion in direct economic impact, and $10.5 billion in indirect impact 
  • The economic impact of homecare and hospice was just slightly lower than the nursing home industry - $21.7 billion versus $23.5 billion
  • Homecare and hospice provided 25% more jobs that nursing homes
  • Homecare aide and personal care aide jobs are expected to grow by 70% in the next seven years - the fsatest growing job sector in the country
  • Homecare and hospice generated more than $925 million in state and local taxes in PA in 2012.  
Each of us can be proud of what homecare and hospice contributes to our local and state economies, and the positive impact we have on the individuals, the families, and the communities in which we live.

For a complete look at the results of this study, see Impact of Homecare and Hospice Industry on Pennsylvania's Economy.  

Thursday, September 12, 2013

The Coming Chaos - Lessons from Massachusetts

By Stephen Tweed

This morning, I attended a program sponsored by our local Healtcare Enterprise Network here in Louisville.  The speaker was Thomas H. Lee, MD, the former President of Partners Healthcare System in Boston.  Dr. Lee was one of the people who had significant input into the creation of the health care law in Massachusetts that first required universal health care coverage.  Dr. Lee is now with Press Ganey.  

Some highlights from Dr. Lee's presentation will be of interest to CEOs and leaders in home health, hospice, and private duty home care.

Health Care Reform will unfold in three phases:

  1. Insurance reform - who gets covered and where the money comes from
  2. Payment reform - how the money gets paid to providers
  3. Delivery system reform - how the care is delivered
The Affordable Care Act was Phase 1.  Phases 2 and 3 are getting under way and causing great turmoil and stress.    As these phases unfold, there will be "some things that are unpleasant for all parties, and some things that are positive for all parties."

The most contentious issue is employer penalties, and we can expect new legislation every two years to address the problems with the implementation of the law.

The key elements of reforming the system are:

  1. Coverage for (almost) all
  2. Payment covering full costs of care (to reduce cost shifting)
  3. Meaningful efforts to control costs.
The challenge is that when the economy gets tight, Medicare and Medicaid want to pull back on paying the full cost of providing care, so providers shift the cost to commercial payers.  In Massachusetts, the payers rebelled against the cost shifting and that let to the crafting of the reform law.

Dr. Lee also discussed the "overarching goal" of "Improving Value", and set out six elements of a strategy to improve value.  He defined value as...

"The outcomes that matter to patients versus the costs required to deliver those outcomes."

  1. Build real teams
  2. Measure outcomes and costs
  3. Provide episode-based incentives for value
  4. integrate care across delivery systems (the tough one)
  5. Grow excellent integrated practice units
  6. Enable information technology
 There components are interdependent, and not a menu where you can pick two.

Some Questions for you:

  • What are you doing in your home health agency or hospice to get ready for phase 2 and phase 3 of health care reform?  
  • What have you done to address the implementation of the Accountable Care Act?   
  • How is it affecting your agency?

Tuesday, July 09, 2013

More Medicare Cuts will drive Home Health Agencies to Seek Other Sources of Revenue

The Centers for Medicare and Medicaid Services (CMS) published the proposed 2014 PPS rule on June 27, 2013 which includes another 1.5% reduction in payments.  Add on to this the 2% sequestration cut and agencies will see an average 3.5% decrease in Medicare payments.

As we wrote some months ago, these changes in Medicare reimbursement for home health could be the most significant threat to the industry since the Interim Payment System that was part of the Balanced Budget Act of 1997 caused over 25% of Medicare Certified Home Health Agencies to go out of business. 

Some industry experts are suggesting that this 3.5% cut could be repeated in future years under the Affordable Care Act's home health rebasing provision.

Over the past three years, we have seen more home health agencies looking for other streams of revenue to reduce their dependence on Medicare and Medicaid.  Of course, one of those potential streams of revenue is Private Duty Home Care.  For more information on how your home health agency can grow it's private pay revenue, here are several other resources for you to consider:

The Academy for Private Duty Home Care

Private Duty Today

Caregiver Quality Assurance

Tuesday, May 28, 2013

What impact will the Accountable Care Act have on Physician Shortages?

A recent report by Deloitte Consulting suggests that the Commonwealth of Kentucky will be short nearly 3800 physicians as a result of expanding the state Medicaid program to meet the demands of the Patient Protection and Affordable Care Act.  The state is about to add 300,000 new Medicaid beneficiaries to the 800,000 already covered.  Already, there is a shortage of physicians willing to care for Medicaid patients.

What are you seeing in other areas of the country?  What impact will the ACA have on physician availability in your state or local area?

This should be of significant concern for home health agencies who serve Medicaid patients, as it will be more difficult to find physicians willing to certify patients, conduct face to face encounters, and provide care plan oversight.

What's your take on this issue? 

Thursday, May 23, 2013

Safety in Home Health Care

By Steve Bills

When people talk about safety in the health care field, many people
immediately think about hospital safety, but there is another facet of health care to consider—home health care. Home health workers provide hands-on, long-term care and personal assistance to people with disabilities or other chronic conditions in the clients’ homes.

These health professionals include personal aides, nursing assistants or home health nurses, who either work directly for their clients or for an agency or business that sets up appointments and visits. Because of the varied work environments in clients’ homes, there are multiple workplace hazards to which home health care workers may be exposed.

As the number of home health workers increases, the chances of injury also increase. In November 2011, the U.S. Department of Labor's Bureau of Labor Statistics released data showing that nonfatal occupational injuries and illnesses for health care support workers increased 6 percent, which is almost two and a half times the rate for all private and public sector workers.

Exposure to Unsafe Conditions
Because these health care professionals work in their clients’ homes, their work environments will vary. Home health workers may encounter homes without water or with extreme temperatures, as well as unsanitary conditions and hostile pets, which are all unsafe conditions.

Unsanitary conditions may cause the presence of rodents or other pests. Those conditions may also cause the contamination of medical supplies and help spread disease and infection. Hostile pets carry the risk of a home health care worker being bitten, feeling threatened or otherwise injured.

It’s important for home health workers to understand what conditions are acceptable for a work environment, as well as when they should remove themselves from such conditions. Home health care workers should be encouraged to talk with supervisors about any unsafe conditions in their clients’ homes, and they should be educated on the process to report such conditions.

Bloodborne Pathogens
The hazard of bloodborne pathogens is not unique to the health care industry, but the potential for a more serious injury is greater. Home health care workers provide support for their clients who are disabled or ill. Those clients often require some medication, which may be in the form of injection. The key is to reduce an employee’s risk of exposure.

Hepatitis B, Hepatitis C and HIV are just some of the more common bloodborne pathogens that home health workers can be exposed to. Exposure may occur through needles, sharp injuries, mucus membranes and skin exposures.

Personal protective equipment, such as gloves or goggles, can help reduce the risk, and should be worn at all times. When home health care workers handle blood or other body fluids, certain protocols should be followed to ensure there is no direct exposure to them. Containers should be completely sealed, and proper medical procedures should be followed.

The Occupational Safety and Health Administration (OSHA) recommends that health care workers are educated on an exposure control plan with details on employee protection measures.

Violence on the Job
A home health care fact card created by the Centers for Disease Control and Prevention notes that these workers are vulnerable because they face changing and unpredictable environments when they go into someone’s home each time. The violence can range from verbal abuse, threats of violence, physical abuse to homicide.

It is important to maintain a zero-tolerance policy for any instance of workplace violence. Any such cases should also be reported immediately.

Home health care workers should know how to identify a potentially dangerous situation, and they should be trained in how to manage hostile and violent situations. If they feel uncomfortable at any time, they should remove themselves from the environment.

Client Lifting and Moving
Due to client lifting and moving, home health care workers may experience work-related musculoskeletal disorders, such as low back pain or rotator cuff injuries. These can be caused by excessive force to the back when lifting a client, the repetition of the movement if it is repeated on a regular basis, or assuming an awkward position when performing these tasks and placing stress on the body.  

When moving or assisting clients in movement, several factors should be considered to help determine the proper method in moving the patient:
·      The level of assistance the patient requires
·      The size and weight of the patient
·      The ability of the patient to understand and cooperate
·      Any medical conditions that the patient may have

The ultimate solution is to minimize or eliminate the manual lifting of patients when possible.

Motor Vehicle Accidents
An often-overlooked hazard that home health care workers face every day is the travel to and from various patient locations. With most jobs, driving is limited to getting to and from work once a day. For home health care workers, driving can be the most frequent activity they perform each day. Every worker that is required to drive on the job needs to be alert and drive defensively. Vehicles need to be maintained and serviced regularly. Weather and traffic patterns can greatly impact driving safety, and driving practices should be adjusted to the conditions of the roadways.

The more home health care workers are prepared to protect themselves against these hazards, the more productive and safe the environment will be for them and their clients.

About the Author: Steve Bills is Senior Manager of Loss Prevention for Texas Mutual Insurance Company. Austin-based Texas Mutual Insurance Company is the leading provider of workers’ compensation insurance in Texas. 

Wednesday, March 20, 2013

Who do recommend for Insurance for our Home Health Agency??

Over the past few years we have received countless requests from our readers asking for recommendations for an insurance company that specializes in the home health industry.
Here is one of those requests:

"We are a small Home Health Care business in Maryland.  We are state licensed and just recently received ACHC accreditation.  Are you aware of any Insurance Companies that specialize in HHC Business Insurance? We're getting raked over the coals with a 20% increase from our local insurance company and that with 0 claims ever made!


Beth H., Operations Manager"

We responded with a suggestion that she contact David Dickie at The Solutions Group.  We have received tremendous feedback over the years from individuals who have purchased insurance through The Solutions Group, so we invited them to become a Resource Associate for The Academy for Private Duty Home Care and Selling Home Health Care to Physicians programs.

Resource Associates are companies that we highly recommend to our readers and our workshop participants because we have great confidence in their products, and we know that the owners of these companies are high integrity people who provide exceptional value to their customers. 

Several months later, we received this note back from Beth.

"Thank you so much for recommending David Dickie for our insurance needs.  We will save 62% this year on our liability policy and we have more coverage than our original policy!

Thank you again!


It is customer feedback like this that makes us very comfortable in recommending companies like The Solutions Group and David Dickie.  If you are interested in saving money and increasing profits for your home care company, click on the link below and check out the information on The Solutions Group.  

Tuesday, March 19, 2013

US Senators Support Home Health and Hospice

By Stephen Tweed

When  was the last time you visited Washington DC and the US Capitol?  When was the last time you walked into the office of your US Senator?  When was the last time you sat in a Senate conference room to hear eight members of the Senate speak about home care and hospice?

I'm writing to you today from the Russell Senate Office Building in Washington DC where the National Association for Home Care and Hospice has gathered for their March on Washington and Private Duty Home Care Association meeting.  We just heard eight US Senators speak to the group, and each one of them described their own experience with home care or hospice with a family member or constituent, and their support for the services we provide. 

Today, we heard from:

Senator Kay Hagan (D-NC)
Senator Mary Landrieu (D-LA)
Senator Jerry Moran (R-KS)
Senator Pat Roberts (R-KS)
Senator Susan Collins (R-ME)
Senator Mark Warner (D-VA)
Senator Ben Cardin (D-MD)

Each one of them thanked us for what we do in caring for patients and saving money for the government.

And yet, as Senator Pat Roberts from Kansas said, "And how do we thank you?  With cuts in Medicare reimbursement."  Go figure.

After our opportunity to hear from these Senators, I went down the hall to the office of the senior Senator from Kentucky, Senate Majority Leader Mitch McConnell.  While I was not able to meet with the Senator, I spent some significant time with my friend, Karl Magnuson, who is an intern in the Senator's office.  Karl talked with me about the workings of the office and his role in preparing daily press briefings for the senator and his staff.  Then we had lunch in the small take out grill in the underbelly of the US Capitol, and Karl showed me some of his own secret spots as we toured the Capitol building.

In a bit of serendipity, we also bumped into Kentucky Senator Rand Paul on the tram that runs under ground from the Russell Senate Office Building over to the Capitol.  We had an opportunity to listen in as Senator Paul talked with some constituents about immigration reform. 

NAHC Legislative and Regulatory Priorities

By Stephen Tweed

What's most important to you in terms of legislation and regulation regarding home health care and hospice?  What's the impact of new laws and regulations be on your home health agency or hospice?
What do you need to do to get ready for the future?

As I visited with agency owners, CEOs, and senior leaders during the NAHC March on Washington and Private Duty Home Care meeting this past week, the biggest issue I was hearing was the impact of The Accountable Care Act on the business operations and finances of home health, hospice, and private duty home care.  Monday evening I participated in a series of stand-up round table conversations about the biggest strategic issues in Private Duty.

On Tuesday, we went over to the Russell Senate Office Building to hear from eight senators who support home care and hospice (See previous post).  Then we spent some time reviewing the legislative and regulatory priorities from the National Association for Home Care and Hospice.

Here's what's on top of the list for NAHC:
  • Ensure home care and hospice participation in transitions of care, Accountable Care Organizations, Chronic Care Management, Heath Information Exchanges, and other health care delivery reforms.
  • Allow Nurse Practitioners and Physician Assistance to sign home health plans of care.
  • Recognize Telehomecare interactions as bona fide Medicare and Medicaid services.
  • Enact a comprehensive home and community based long term care program for all age groups
  • Ensure the availability of home care and hospice personnel to meet the growing needs of the baby boom generation.
  • Ensure appropriate and adequate reimbursement for and access to Medicare home health services.
  • Oppose a "sick tax" - a fee paid by patients to access Medicare Home Health services.
  • Establish reasonable standards for rebasing Medicare home health service payment rates.
  • Reform the home health face-to-face encounter requirement.
  • Require Medicare Advantage plans to provide a home health benefit fully equivalent to original Medicare
  • Ensure full market basket updates to Medicare home health.
  • Establish transparent and accurate processes for modification of PPS payment rates and case-mix adjustments
  • Ensure full market basket updates for the Medicare hospice benefit.
  • Revise the requirements for Hospice face-to-face encounters.
  • Oppose expansion of co-payments for Medicare hospice benefit.
  • Ensure access to hospice care for rural patients.
  • Protect and expand access to home and community based care under Medicaid.
  • Protect access to home care and hospice services, including care paid for directly by individuals.
This is an ambitious agenda, and we encourage you to get involved in your state home care association, and to actively support the legislative and regulatory agenda of your state and the National Association.

Tuesday, February 19, 2013

New HIPAA Rules Issued by US Dept of HHS

Part I
Elizabeth E. Hogue, Esq.
Office: (877) 871-4062
Fax: (877) 871-9739
Twitter: @HogueHomecare

The U.S. Department of Health and Human Services (HHS) has issued final rules to:

-        Modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Enforcement Rules to implement statutory amendments under the Health Information Technology Economic and Clinical Health Act (HITECH Act) to strengthen the privacy and security protection for individuals’ health information;

-        Modify the rule for Breach Notification for Unsecured Protected Health Information (Breach Notification Rule) under the HITECH Act to address public comments received on the interim final rule;

-        Modify the HIPAA Privacy Rule to strengthen the privacy protections for genetic information by implementing section 105 of Title 1 of the Genetic Information Nondiscrimination Act of 2008 (GINA); and

-        Make other modifications to the HIPAA Privacy, Security, Breach Notification and Enforcement Rules to improve their workability and effectiveness and to increase flexibility and to decrease burden on regulated entities.

The final rules will be published in the Federal Register on January 25, 2013, and will be effective on March 26, 2013.  Covered entities and business associates must comply with the final rules by September 23, 2013.

This is the first in a series of articles that will address key provisions of the rules, their impact on post-acute providers, and practical solutions for compliance.

Major provisions in the form of four final rules include the following:

1.       Final modifications to the HIPAA Privacy, Security and Enforcement Rules mandated by the HITECH Act and certain other modifications to improve the Rules that were issued as a proposed rule on July 14, 2010.  The modifications include:

-        Make business associates of covered entities directly liable for compliance with certain requirements of the HIPAA Privacy and Security Rules.

-        Strengthen the limitations on the use and disclosure of protected health information for marketing and fundraising purposes, and prohibit the sale of protected health information without individual authorization.

-        Expand individuals’ rights to receive electronic copies of their health information and to restrict disclosures to health plans concerning treatment for which individuals have paid out of pocket in full.

-        Require modifications to and redistribution of covered entities’ notice of privacy practices.

-        Modify the individual authorization and other requirements to facilitate research and disclosure of child immunization proof to schools and to enable access to decedent information by family members or others.

-        Adopt the additional HITECH Act enhancements to the Enforcement Rules not previously adopted in the October 30, 2009, interim final, such as the provisions addressing enforcement of noncompliance with the HIPAA Rules due to willful neglect.

2.       Final rule adopting changes to the HIPAA Enforcement Rules to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act originally published as an interim final on October 30, 2009.

3.       Final rule on Breach Notification for Unsecured Protected Health Information under the HITECH Act that replaces the breach notification rule’s “harm” threshold with a more objective standard and supplants an interim final rule published on August 24, 2009.

4.       Final rule modifying the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes that was published as a proposed rule on October 7, 2009.

Part 2 – New HIPAA Rules Issued: Business Associates

The U.S. Department of Health and Human Services (HHS) has issued final rules to:

-        Modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Enforcement Rules to implement statutory amendments under the Health Information Technology Economic and Clinical Health Act (HITECH Act) to strengthen the privacy and security protection for individuals’ health information;

-        Modify the rule for Breach Notification for Unsecured Protected Health Information (Breach Notification Rule) under the HITECH Act to address public comments received on the interim final rule;

-        Modify the HIPAA Privacy Rule to strengthen the privacy protections for genetic information by implementing section 105 of Title 1 of the Genetic Information Nondiscrimination Act of 2008 (GINA); and

-        Make other modifications to the HIPAA Privacy, Security, Breach Notification and Enforcement Rules to improve their workability and effectiveness, and to increase flexibility and decrease burden on regulated entities.

The final rules were published in the Federal Register on January 25, 2013, and will be effective on March 26, 2013.  Covered entities and business associates must comply with the final rules by September 23, 2013.  This is the second in a series of articles that will address key provisions of the rules, their impact on post-acute providers, and practical solutions for compliance.

First, with regard to Business Associates, the new final rules clarify whether “conduits” of protected information are Business Associates.  Specifically, entities that provide transmission services only, including any temporary storage of protected health information (PHI) incidental to transmission services, are not Business Associates.  Entities that provide storage are considered to be Business Associates, even if the agreement with the covered entity does not contemplate any access, or access on a random or incidental basis only.  In short, the “test” under the new final rules is length of custody; not access.

The new final rules also address the issue of whether “downstream contractors” are directly responsible for compliance with the Business Associate requirements of both the Security Rule and the Privacy Rule.  According to the final rules, all entities are directly responsible for compliance even if the parties do not enter into a written Business Associate Agreement.  Providers are not required to enter into Business Associate Agreement with all downstream contractors.  They must sign a Business Associate Agreement with the entity with which they do business directly.  Providers’ Business Associates are then required to get written “satisfactory assurances” from each of their immediate subcontractors.  In the event of a breach, all “downstream contractors” are required to report up the chain to providers.

An example of the above requirements is a provider who contracts with a shredding company to dispose of records that include PHI.  The provider must enter into a Business Associate Agreement with the shredding company.  The shredding company, in turn, contracts with a trucking company to pick up the records and deliver them to the shredding company.  The shredding company is required to get “satisfactory assurances” of compliance from the trucking company.

The new final rule also clarifies that Business Associates are directly responsible under the Privacy Rule for:

-        Limiting uses and disclosure of PHI to requirements of Business Associate Agreements in the Privacy Rule,

-        Disclosing PHI to HHS for investigation of business associates’ compliance with HIPAA,

-        Disclosing PHI to covered entities or individuals in response to requests for electronic copies of PHI,

-        Compliance with the minimum necessary requirements of the Privacy Rule, and

-        Entering into Business Associates Agreements with subcontractors.

Monday, February 11, 2013

Hospice Use Increasing

According to a recent article in USA Today, twice as many people died in hospice care as in a hospital or nursing home compared to a decade ago.  Quoting a study in The Journal of the American Medical Association, they found that in 2000, 22% of seniors died in hospice care, and by 2009 that number had increased to 42%.

While more and more people are receiving the benefits of hospice care, the length of stay is still very short.  More than 25% of hospice use in 2009 was for three days or less, and 40% of those late referrals followed a period of intensive care.  For many patients, hospice is an add-on to a very aggressive pattern of care during the last days of life.

An accompanying article calls for an end to aggressive treatment at end of life by improving communication between patients, family members, and physicians regarding the benefit and likely expectancy of this last minute intensive care.

The study shows that people dying of cancer are more likely than those with dementia or COPD to use hospice, and the percent of people with dementia who spent time in intensive care in the last month of life rose from 18.6% in 2000 to 21.8% in 2009. 

While more and more consumers are aware of the benefits of hospice care, our society still clings to life dearly and insists on intensive treatment right up to the last minute.

What do you think about the growth in the use of hospice care?

What do you think about using content marketing to tell the full story of hospice and its benefits?

Monday, January 28, 2013

Linking up with Provider Sponsored Medicare Advantage Plans

By Stephen Tweed

One of the things you may want to consider in growing your home health agency is linking up with provider sponsored Medicare Advantage plans in your local marketplace.  While most home health agencies much prefer traditional Medicare fee for service patients, there are times when it makes sense to develop strategic alliances with Medicare Advantage plans, also know as Medicare Part C.

Medicare Advantage started in 1997 as part of the Balanced  Budget Act, and was known as Medicare+Choice.  The name was changed to Medicare Advantage by the 2003 Medicare Prescription Drug, Improvement and Modernization Act.  Here are some facts about MA plans:
  • In 2012, Medicare Advantage plans covered 13.7 million enrollees, or 27%  of all Medicare beneficiaries.
  • Medicare Advantage plans account for 22% of Medicare Spending.
  • MedPAC estimates that MA plans were paid 7 to 14% more that traditional fee for service. 
  • The Patient Protection and Affordable Care Act will cut $200 billion from MA plans between 2010 and 2020. 
  • The average MA enrollee paid $35 per month in 2012. 
  • 65% of MA plan beneficiaries are covered by the six largest insurers. 
The Centers for Medicare and Medicaid services (CMS) rates Medicare Advantage plans on a 1 to 5 star ranking system (sort of like hotels).  The top ranked plans receive bonuses based on quality.  The top ranked plans were awarded $3.1 billion in 2012. 

Five-star plans receive up to 5% of Medicare payments as bonuses and are permitted to recruit and enroll beneficiaries year round.  Other plans have limited enrollment periods.  CMS contacts beneficiaries enrolled in lower performing plans and encourages them to switch to four and five star plans. 

The 2013 star ratings, released in October of 2012 based on 2011 data showed that 10 of the 11 five star rated plans were owned by hospitals, health systems, or physician groups.

sources: CMS, American Hospital Association

What does this mean for Home Health and Hospice?

If you are a provider based home health agency, and your health system has it's own Medicare Advantage plan, you really want to get to know the leaders of the health plan and understand their issues and priorities.  The more you understand their business, the more you can help them achieve their goals, and the more they will want you to care for their patients.

If you are a free standing agency, and your local health system has a provider owned MA plan, you will want to do some networking to get to know the leaders of the plan.  If the local hospital based agencies are not doing a good job of connecting with the MA plan, there may be an opportunity to make inroads and generate some new patient admissions. 

While many of these provider owned MA plans have not yet formed Accountable Care Organizations, there are some similarities.  The more you understand how these plans are reimbursed by Medicare, and how they are rewarded for top performance, you more you can help them achieve there goals. 

As one health system executive said, "one of the most vexing issues we face is medication reconciliation.  When a senior with five or ten drugs is hospitalized, I guarantee those medications will change post-discharge."  If your home health nurse or case manager can help that patient adjust to the new combination of prescriptions and make sure they take their meds, the chances of an avoidable readmission go down. 

A study in the February 2012 issue of the American Journal of Managed Care showed that between 2006 and 2008, 30-day hospital readmission rates for Part C plans were 22% lower than for traditional Medicare fee for service. 

Take some time to get to know your local Medicare Advantage plans, and particularly the provider owned plans.  Then use your networking connections to get to know the leaders, and develop strategic alliances to help them meet their goals. 

As our dear friend and professional speaking colleague Zig Ziglar always said, "You can have everything you want in life, if you just help enough other people get what they want."

Friday, January 18, 2013

New Online Tool Helps You See Readmission Rates for your Local Hospitals

By Stephen Tweed

We recently found a web site that allows you to enter in the name of a local hospital, and get a graphic display of their readmission rates for heart failure, heart attack, and pneumonia.  These are the three diagnoses that are used to calculate the penalties in the Hospital Readmission Reduction Program in the Accountable Care Act.  Beginning in October 2012, hospitals are being assessed penalties if their readmission rates for these three conditions exceed established standards.

Health Recovery Resources, a consulting firm that helps hospitals and patients reduce congestive heart failure re-admissions through a research based platform that constructively guides patient's behavior, has set up the page on their web site.  The Resources page says ...

Unplanned readmissions generate substantial medical and financial burdens that cost Medicare $17 billion a year. With Heart Failure the most frequent reason for re-hospitalization, there is an urgent need for reform. As of October 1, 2012, Medicare will be reducing overall Medicare payment to hospitals with high readmission numbers. Through an analysis of hospitals projected to be penalized for their high readmission rates, Health Recovery Solutions has been able to identify potential clients, and plan strategically for their business. By addressing this issue, Health Recovery Solutions is emerging as market leaders for providers and patients as readmissions becomes more of a focal point of better care.

I went to the web site, put in my name and email address, and the name of a local hospital in Louisville.  The results came back almost immediately.  Here's a look at what came back.

This can be a valuable tool for you to use in planning your sales presentations to local hospitals on how your home health agency can help them reduce avoidable readmissions.  We're finding that many hospital and health system executives respond positively to sales presentations that contain facts and data, and especially when the data are about their own organization.

The more you know about your customers, the more you can create a compelling value proposition by describing problems they have that you can solve through your home health and hospice services.  If you have questions or would like to discuss how you can use this information and the Four P's of Powerful Persuasive Presentations, don't hesitate to email or give me a call at 502-339-0653.


Congress Looks to Home Health Industry for Spending Cuts

In January, after months of Congress considering ways to reduce federal spending in light of the so-called "fiscal cliff," the home health care industry was spared. Copays, additional cuts and accelerated rebasing were on the docket, but Congress opted to cut hospitals, imaging and renal care providers instead. 
But, we're not out of the woods yet. To avoid going over the fiscal cliff, Congress extended the new year deadline for sequestration, which would reduce Medicare provider payments by 2%, to the end of February. Now that the newly-elected Congress has been sworn-in and is ready to get to work, home health is back on their radar, and the likelihood is very low that our industry will dodge copays, more cuts and accelerated rebasing for a second time. 
Copay proposals range from $100 to $600, and accelerated rebasing could effectively cut provider reimbursement by anywhere from 3.5% to 10% per year for two years (2014 and 2015, instead of the four-year phase in from 2014 to 2017, as required by health care reform). Simply put, after $40 billion in cuts from the Patient Protection and Affordable Care Act, our industry cannot sustain a copay or any additional cuts!
Industry leaders in Washington believe that home care was spared last month because of strong advocacy efforts by industry professionals (like you!) who weighed in across the nation. Together we sent thousands of emails to congressional delegations letting them know the value of our industry, and how that value will only increase with 10,000 Baby Boomers retiring every day. With Congress set to begin these discussions in the coming weeks, it's time to take action again!
Contact your state home care association to find out the most effective way to reach out to your Members of Congress and Senators

Thursday, January 17, 2013

Delays in Medicaid Pay Create Problems for Hospitals

by Stephen Tweed

An article in Today's Wall Street Journal (1-16-13) describes how hospitals in Maine are concerned that further deficit talks in Washington may erode funding for Medicaid.  A coalition of 39 Maine hospitals is demanding $484 million in back payments from Medicaid going back to 2009.

The Maine hospitals have launched radio and newspaper ad campaigns to press state legislators for payment.

"When the State doesn't pay its bills,
Hospitals can't pay theirs."

While Maine's delay is highly unusual, other states are showing months-long delays in making payments for services provided to Medicaid beneficiaries.

What Impact on Home Health Care?

What impact are these Medicaid payment delays having on home health agencies?  What % of your home health agency or hospice revenues come from Medicaid?

As we have talked with leaders across the country, we see a wide range of payer mix depending on how well Medicaid reimburses home health services.

I was facilitating an online sales meeting yesterday morning with three offices of one company in two different states.  One state reimburses home care quite well and pays on a timely basis.  The other state pays very poorly and is often late.  This company is forced to have different strategies in different offices because of the different payment rates in these two states. 

One of the major factors causing this delayed payment is that the state of Maine expanded eligibility for Medicaid during better economic times and the sate now has one of the highest percentages of residents covered by the program.  This is potential threat in the future for all of us, as the Accountable Care Act increases the numbers of people who will be enrolled in Medicaid programs.  While the Feds will pay most of the bill at the beginning, in later years a bigger portion of the tab will fall to the states.

With Medicaid making up 7% of the federal budget, it's a prime target for lawmakers looking for long-term cuts in government spending.

What do you think?  What's happening in your state?

Thursday, January 03, 2013

What's Your "Magnificent Obsession"?

By Stephen Tweed

What's the one major life experience that you have always wanted to have?  What's the one thing that you lay awake nights dreaming about?

Each of us needs a "Magnificent Obsession". Something significant to dream about doing or experiencing. I'm not just talking about a bucket list.  We all need one of those too.

I've come to learn that not everyone has their own Magnificent Obsession.  For my sister-in-law, Patricia Nardi, it was do an around-the-world-cruise.  For my wife, Elizabeth, it was to live for an extended period of time in Italy. Both of these wonderful women have had the opportunity to fulfill their magnificent obsessions.

For Elizabeth, her chance to live in Italy for an extended period came this past summer and fall. She spent almost three months living in Tuscany, with a couple of weeks in a cottage in Chianti and 10 weeks in an amazing palazzo in the city of Florence.  Elizabeth's dream was not to go over there and do all of the typical tourist things.  We've done that.  Here dream was to go there and live as the locals live.  She wanted to experience the culture, the people, and the lifestyle of Italy in the 21st century.

What's your Dream?

There's a wonderful saying that says to lead a fulfilling life, everyone needs something to do, someone to love, and something to hope for.  As a leader in home health care or hospice, you have plenty to do.  Hopefully, you have a rich life with someone you love to share it with.

The real question is, What are  you hoping for or dreaming of in your life?  Get clear about it and that becomes your "Magnificent Obsession".

Here's a Sample

While having the experience of living in Tuscany, Elizabeth took time almost every day to write about her adventure.  First, she posted it as a blog and sent links to friends and family.  However, as the blog progressed, she realized that people from all around the world were finding the blog on the internet and reading her story.   The fact that so many people were finding and reading the blog encouraged her to give it more of a life of its own. When she got back to the states and decompressed from her life in Italy, she explored the idea of transforming the blog into a book.  Her friends and family encouraged her to do that, and several of our professional speaker and author friends gave her guidance in how to transform her writing into an eBook format.

The result is a brand new eBook that is now available on Amazon for the Kindle.  It has been an amazing adventure not only to share with Elizabeth her adventure in Italy, but to share the adventure of turning it into a book. 

To learn more about the concept of creating your own "Magnificent Obsession", take a few minutes and download 90 Days in Florence: Diary of an Italian Adventure in Tuscany.  Read through this intimate memoir of one person's personal experience living out their dream.

Then set aside some quiet time to think about your life, and the one passion you have that can be molded into your once in a life time adventure.  Enjoy the Journey.