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.