In The News

Proposed HCBS Rule Could Diminish Service Access, Hamper Provider Retention Efforts, 11 Senators Tell CMS

McKnight’s Senior Living | By Lois Bowers
A proposed federal rule that would require providers of home- and community-based services to spend at least 80% of the Medicaid payments they receive for personal care, homemaker and home health aide services on compensation for direct care workers could diminish older adult access to services and hamper providers’ workforce retention efforts, 11 Republican senators told the administrator of the Centers for Medicare & Medicaid Services on Thursday.
“We have significant concerns that the proposal could and will likely harm access for seniors and people with disabilities, particularly in rural regions of the country, as well as harm workforce retention and provider networks,” the senators wrote CMS Administrator Chiquita Brooks-LaSure in a letter.
The missive was signed by Sens. Marsha Blackburn of Tennessee, Ted Budd of North Carolina, Shelley Moore Capito of West Virginia, Steve Daines of Montana, James Lankford of Oklahoma, Markwayne Mullin of Oklahoma, Tim Scott of South Carolina, Dan Sullivan of Alaska, John Thune of South Dakota, Thom Tillis of North Carolina and Roger Wicker of Mississippi.
CMS proposed the “Medicaid Program; Ensuring Access to Medicaid Services” rule in April. The proposal, which also would mandate quality measures and make other changes to the HCBS program, was sent to the White House Office of Management and Budget in January, and CMS has indicated that it plans to issue a final rule by April.
The 11 lawmakers recommended that CMS assess Medicaid data through collaborations with states and other stakeholders, as well as federal resources such as the Medicaid and CHIP Payment and Access Commission, and then work with MACPAC “to create a stakeholder and interagency evaluation of the impacts on payment, data and other outcomes of defining the direct care workforce.”…

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The Bottom Line: Top Billing, Financial Mistakes Responsible for Home Health Agency Struggles

Home Health Care News | By Joyce Famakinwa
Home health providers often make mistakes that leave money on the table at best, and at 
worst, lead to financial ruin. 
However, providers that learn to avoid these stumbling blocks will be better positioned to achieve longevity and financial stability. 
In general, the home health consulting firm SimiTree has noticed an increase in the amount of providers that have been struggling with things like unbilled claims, inaccurate primary payer selection and more, according to Lynn Labarta, vice president of post-acute revenue cycle management at SimiTree. 
In fact, Labarta recently wrote about this very topic for SimiTree. 
“SimiTree has thousands of customers in the home health and hospice space all over the country, and we have been seeing an uptick in these issues and agencies struggling or feeling that they may not survive,” she told Home Health Care News. 
Labarta believes that not staying on top of unbilled claims is the No. 1 issue that providers are currently struggling with. It’s an issue that pops up at companies of all sizes.
“We see this unbilled claims issue with all sorts of agencies — all the way from startups to mid-size agencies, even some of the largest agencies in the country struggle with this for different reasons,” she said.
Broadly, most providers’ EMR has a section in the software where all of the unbilled claims are housed. These are claims that can’t be billed because there is some type of hold on them. Typically it’s a clinical hold, or regulatory issue that prevents the claim from being billed. 
For many providers, this is where most of the revenue lives. 
“We’ve seen agencies that have thousands of claims sitting in the unbilled claims list,” Labarta said. “When you translate the thousands of claims sitting in that bucket, depending on the size of the agency, you’re talking about hundreds of thousands of dollars. Of course, if you’re dealing with a smaller agency it could be smaller dollars, but it still impacts cash flow. This makes agencies feel like they’re seeing patients and working very hard, but not seeing the money coming through the door.”…

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‘Not About A Shiny New Toy’: How Home Health Providers Are Succeeding With More Complex Patients

Home Health Care News | By Patrick Filbin
As home health patients become sicker and more complex, providers have been forced to find ways to keep their care models financially viable.
In order to combat some of those “acuity creep” challenges, industry leaders are leaning on technology, data-driven decision making and more value-based care.
“We continue to navigate through a very regulated industry,” Janice Riggins, chief clinical officer at VitalCaring, told Home Health Care News. “That continues to pose issues for us, in addition to expenses for training and education. The recruitment and retention of qualified staff that have that clinical expertise is a financial implication. All of these aspects are at a very heightened level. Now more so than ever.”
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
Staffing costs and physician engagement
When taking care of the sickest and most complicated patients, it’s imperative that clinicians and caregivers are properly trained and that staff resources are optimized.
“Training and education is an investment that needs to be considered,” Riggins said. “It’s really important for our staff to have continuous training in order to handle these complexities of the sicker patients, which add to that overall operational cost.”
In this care environment, clinicians must be operating at the top of their licenses, McBee Associates President Mike Dordick told HHCN.
“Unlike going in and changing a wound or basic injections, you’re going to the sicker patients where there’s a lot more that clinicians have to be able to to deal with,” Dordick said. “Your resource allocation and your staffing strategy has to be at a higher level than if it was a lower-acuity patient.”
McBee Associates is a consulting firm that works with hospitals and post-acute care providers.
Maintaining an adequate staffing level will always be a struggle for providers. The same goes for covering the costs that are necessary to take care of new-age patients.

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Medicare Home Care Eligibility Standards Unfairly Burden Family Caregivers, Think Tank Argues

McKnight’s Home Care |  By Adam Healy
Researchers called on the Centers for Medicare & Medicaid Services to act now to integrate more kinds of home care benefits for Medicare beneficiaries to help patients and their caregivers grappling with strict eligibility criteria and inadequate support systems.
“Millions of unpaid family caregivers are providing a broad range of assistance to beneficiaries as they recover from illness, move through rehabilitation or deal with chronic health challenges,” experts from the non-profit research group Aspen Institute wrote in a recent report. “Without more medical and social support from a reconfigured Medicare system, the overwhelming burden on family caregivers will only grow heavier.”
Medicare’s criteria for a beneficiary to be eligible for home care is too high, they argued, and unpaid family caregivers bear the greatest responsibilities caring for those that do not make the cut. Oftentimes these caregivers are forced to “spend down” to become eligible for Medicaid, whereby long-term services and supports, including home- and community-based services, are more easily accessible. 
By expanding Medicare’s eligibility pool and offering home care services to a greater share of the Medicare population, beneficiaries can enjoy better health outcomes, the researchers said.
“Current criteria for receiving home health Medicare services, especially the requirement that a recipient be homebound, greatly shrinks the eligible population,” they wrote. “A number of alternative eligibility guardrails, such as functional status or level of risk for potentially avoidable nursing home care, could be considered if the homebound requirement were eliminated.”
New systems to coordinate care between healthcare and nonmedical personal care providers should be considered by CMS, they added. Things like reimbursement for navigation services, better training opportunities for caregivers, and effective use of new technology are especially important and can make it easier for providers and caregivers to help older adults in need of home care.
While a one-size-fits-all solution may not be possible, current support for Medicare-funded home care is simply not enough, Aspen Institute wrote.
“Medicare needs to change. An aging population and the opportunities introduced by technology add to the sense of urgency,” they said. “Coupling immediate steps with longer-term strategies to respond to the needs of a changing healthcare environment can strengthen family caregiving and allow Medicare beneficiaries to remain in the safe and familiar environment of home.”


Hospice Experts Advocate for Early Admission to Hospice

The Herald-Mail (Story from Hospice of Washington County)

“Former President Jimmy Carter’s months-long time in hospice has helped tens of millions of Americans realize that hospice isn’t a brink-of-death service, that it helps patients and families focus on quality of life and not just length of life,” observed Hospice of Washington County CEO Sara McKay.

With a physician, nurse practitioner, nurse, certified nursing assistant, social worker, chaplain, bereavement specialist and hospice-trained volunteers, “the hospice team is structured to manage the patient’s physical, emotional and spiritual needs and support the patient’s loved ones while helping them care for their loved one,” McKay added.

According to Lee-Anne West, MD, physician executive and chief consultant for Hospice of Washington County, one of the biggest hurdles to overcoming resistance to a timely hospice admission is the misnomer that signing up for hospice means that a patient is giving up and that care stops with a hospice admission. “Nothing could be further from the reality of what hospice care entails,” West explained. A major difference, she noted, “is that before a patient enters hospice, the focus isn’t on the patient but rather is on fighting the disease—even when those treatments aren’t helping. After a patient enters hospice, the focus is solely on the patient’s comfort and dignity, managing pain and other symptoms, thus allowing the patient to enjoy being at home, in a comfortable setting, surrounded by family and friends.”

Instead of endless trips to a hospital emergency room for a patient with a limited time left to live, “the care comes to the patient in hospice,” she explained.

Having worked in hospice and palliative care for more than 18 years, West has seen numerous studies over the years that have demonstrated that patients who enroll in hospice live longer than patients with a similar diagnosis and similar demographics who continue aggressive curative treatments up until they are near death. “For many patients who come on hospice earlier, life expectancy can increase by as much as one to three months,” West stated. “When you step back from doing everything to treat the disease, the patient is allowed to live in the moment. The psychological pressure often melts. Hospice patients tend to live longer when they elect the hospice benefit earlier.”…

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