Most Americans Would Welcome Hospital Care at Home, Survey Shows

US News | By Carole Tanzer Miller
 
WEDNESDAY, July 10, 2024 (HealthDay News) -- Many Americans like the idea of receiving hospital-level care at home, believing they'd recover from their ills faster and without safety risks. 
 
"Patients of course want the best-quality care, but often prefer to be at home, especially if technology allows them to work closely with their physician toward recovery," said study leader Melissa Frasco, a research scientist at the University of Southern California (USC) Schaeffer Center.
 
The new study -- published July 8 in the Journal of the American Medical Association -- is an outgrowth of a pandemic-era trend. 
 
As COVID-19 packed hospitals across the country, the U.S. Centers for Medicare & Medicaid Services temporarily authorized at-home care under a waiver that Congress extended through the end of this year. The extension included a requirement that CMS study the quality of at-home care. Congress is considering whether to approve reimbursements for hospital-at-home care over the long haul.
 
In all, 322 hospitals in 37 states are approved to provide at-home care.
For the study, researchers surveyed 1,100 participants in the university's online Understanding America Study about their preferences. 
 
In all, 47% called hospital-at-home care an acceptable alternative to inpatient care. Fewer than 1 in 5 had a negative view of it, while 36% were neutral.
 
Fifty-six percent of respondents agreed that people recover faster at home than in the hospital -- and 21% strongly agreed.
 
Acceptability of at-home care was consistent across economic groups, health status, insurance coverage, prior hospitalizations or use of telehealth services, the study found.
"Our findings offer valuable information for policymakers and health systems as they navigate a new landscape of post-pandemic patient care," said study co-author Erin Duffy, director of research training at the Schaeffer Center, said in a USC news release.
There's more about the benefits of telemedicine at Johns Hopkins Medicine.

The Hospice Care Accountability, Reform, and Enforcement Act of 2024 Would Eliminate Payment for Certain Aide and Homemaker Services

The Health Group

The Hospice Care Accountability, Reform, and Enforcement Act of 2024 (“Hospice CARE Act of 2024”), currently in draft form, would eliminate coverage of certain aide and homemaker services.  The draft legislation would make the following changes (changes in bold) effective on or after October 1, 2026, to existing regulations.

42 U.S. Code § 1395x - Definitions

“The term “hospice care” means the following items and services provided to a terminally ill individual by, or by others under arrangements made by, a hospice program under a written plan (for providing such care to such individual) established and periodically reviewed by the individual’s attending physician and by the medical director (and by the interdisciplinary group secured in paragraph (2) (b) of the program –

(D) (i) in the case such individual is not residing in a skilled nursing facility or a nursing facility, services of a home health aide who has successfully completed a training program approved by the Secretary and in the case such individual is not residing in a skilled nursing facility or a nursing facility, homemaker services,”

This provision of the draft legislation goes directly at the assumption that Medicare payments for patients residing in nursing home settings are too high and that a duplication of payment occurs when considering payments to the nursing home and to the hospice.  The provision would remove the requirement of the hospice to provide aide and homemaker services to hospice patients residing in a nursing home setting.

Implementation of this provision would trigger a reduction in payments to the hospice for a routine home care day when the patient resides in a nursing home setting.  The draft legislation provides no indication as to how any payment reduction would be initially determined (the draft legislation includes provisions for rebasing hospice payments in the future).  Additionally, hospices would be expected to segregate aide and homemaker services provided to patients residing in a nursing home on the Medicare cost report as such services would not be considered a covered hospice service.

Such a change would seem to indicate that the nursing homes have the financial responsibility for the provision of all aide and homemaker services; however, such services would not appear to be under the direct control and supervision of the hospice.  Any aide and homemaker services for these nursing home residents provided directly by the hospice would be non-reimbursable as a noncovered service.

Forthcoming Additions and Modifications to Employment Laws in Colorado

Littler | By Tom Carroll, Matt Freemann, David Gartenberg, and Billie Jo Risheim

Modest Changes to Colorado’s Noncompete Law

Though not as impactful as the 2022 amendments, the General Assembly also modified one of the exceptions to the Colorado’s noncompete statute. C.R.S. § 8-2-113(2)(a) bars any covenant not to compete that restricts any person’s right to receive compensation for labor performed for an employer. But the statute also delineates several exceptions to this rule, including subsection 3(a), which allows employers to contract with employees to recover the expense of training and educating the employee, where the training is different from typical, on-the-job training. Section 3(a) limits an employer’s recovery to the “reasonable costs of the training.” The employer’s recovery must decrease over the two years following the training, proportionately based on how many months have passed since the completion of the training, and any recovery must be in compliance with the Fair Labor Standards Act.

Recently enacted HB 24-1324 adds language to section 3(a) that allows the Colorado Attorney General to establish rules regarding the training’s transferability or the credentialing that is available to the employee because of the training. The act also adds enforcement language to section 8(b), which now allows the attorney general to recover three times the amount of any employer recovery or attempted recovery when an employer’s training-repayment provision is void under section 3(a) specifically, in addition to the penalties already provided for.

The significance of these changes lies in the potential for the attorney general to promulgate rules regarding transferability and credentialing. Employers will likely now have to weigh those characteristics in determining whether to include training-repayment provisions in employment contracts.

Changes in AI, Privacy, and Health Benefits Coverage

Important changes in the red-hot area of AI were enacted into law with the passage of Senate Bill (SB) 24-205. The act creates statutory tort liability for AI algorithmic discrimination in employment. With its passage, employers using “high-risk” AI tools must implement risk management policies, conduct impact assessments, and provide detailed notices by February 1, 2026. An in-depth discussion of SB 24-205 can be found here.

Additionally, HB 24-1058 and HB 24-1130 amended Colorado’s Privacy Act (CPA), which is generally applicable to entities that conduct business in Colorado or target Colorado consumers. HB 24-1058 act expanded the definition of sensitive data. Sensitive data now includes biological data and neural data, which are both collected from an individual’s body or brain functions. The CPA imposes various duties on companies that process sensitive data; hence, employee training on the newly expanded sensitive data may be appropriate. HB 24-1130 imposed new requirements on companies that collect and use biometric information. A more detailed discussion of HB-1130’s amendments can be found here.

Besides AI and privacy, the 2024 legislative session also produced changes in health-benefits coverage. SB 24-73 amended several statutes to reflect that employers must employ no more than 50 employees (down from the pre-amendment ceiling of 100) to qualify as a small employer for health-insurance purposes.

HIPAA Violation: Mom Needs More Fiber?

Elizabeth E. Hogue, Esq.

Imagine that a celebrity receives care where you work and curiosity gets the better of you, or someone you know is admitted and you would love to know the details. It’s oh so very tempting! So, you access records of care provided to patients that you have no legitimate need to view. The HIPAA police are on it! Because let’s not forget that the HIPAA Privacy Rule is a criminal statute.

An emergency room physician, for example, pled guilty to illegally obtaining the personal health information of multiple individuals. He was convicted of one count of wrongfully obtaining individually identifiable health information under false pretenses. The physician received a resident physician license and participated in an emergency medicine residency program at a university hospital. He worked in the emergency room of two hospitals in the university system.

The doctor used his access as a resident physician to the hospitals’ electronic health record to access the records of two patients without their knowledge or consent. He was never the patients’ physician. The patients were not receiving care in the emergency rooms where the doctor worked at the time he accessed the records.

The doctor also admitted that he sent a photograph to someone else of one of the patients wearing a hospital gown in which the patient’s rectum was hanging out of the patient’s body. And now for the “best” part: the doctor also admitted that he falsely wrote in a letter that he sent the picture of the patient with a prolapsed rectum to his mother to remind her of the importance of fiber intake!

Do you remember the comedian, Flip Wilson, who repeatedly claimed that the devil made him do it? When it comes to accessing patients’ medical records in violation of HIPAA, you must “put the devil behind you!” Protecting patients’ private health information is serious business - serious criminal business. Be vigilant!

By the same token, providers must also always remember that the HIPAA Privacy Rule isn’t just about protecting health information; it’s also about giving appropriate access to it. In the zeal to protect information, it anecdotally seems that practitioners have lost sight of the fact that access to information is at least as important as protection of information. In fact, the Office for Civil Rights, the federal enforcer of HIPAA violations, has focused on denial of access in enforcement actions for the past several years.

Remember that, however tempting the information you would like to have may be, temptation pales in comparison to jail time!

©2024 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.