In The News

Contradictory Policymaking Has Led To Costlier Care: The Future of Health Care Is In The Home

Home Health Care News | By Guest Contributor
The following is an op-ed submitted by: Ken Albert, CEO, Andwell Health Partners; David Causby, CEO, Gentiva; Marcylle Combs, CEO, MAC Legacy; Brent Korte, CEO, Frontpoint Health; John Olajide, CEO, Axxess; Billy Simione, Managing Principal, SimiTree; Jennifer Sheets, the former CEO of Interim HealthCare; Susan Ponder-Stansel, CEO, Alivia Care; David Totaro, Chief Government Affairs Officer, BAYADA; Sara Wilson, President & CEO, Home Assist Health; and Bryan Wolfe, the former CEO of Traditions Health

As the nation faces a debt ceiling of $34 trillion and climbing, it’s no surprise that the federal government is under pressure to find ways to cut program costs and crack down on overspending. 
What is surprising is that the program they continually target in budget cutbacks has an impressive record of saving the government billions: Medicare-certified home health care. 

Though home health care helps nearly 36 million 65+ and permanently disabled Americans recover at home and avoid costlier placements in institutions, the Centers for Medicare & Medicaid Services (CMS) has initiated deep cuts to the Medicare home health industry, totaling $25 billion in cuts over the next decade

Government-funded health care programs like Medicare, Medicaid and Medicare Advantage (MA) home health are closely connected in how they are financed. 
This is because Medicaid and Medicare Advantage have such insufficient funding to begin with, forcing providers to rely on Medicare to cover the shortfall to offset the costs incurred in treating patients under Medicaid and Medicare Advantage – a decade-old system that is severely flawed and requires all three programs to ride on the backs of one another for financial stability. 
The solution is two-fold: First, CMS must stop cutting Medicare home health care funding. Cutting funding year after year has only created turmoil in the very industry that is essential in providing stable, in-home care for vulnerable Americans. 
Second, CMS and the Medicare Payment Advisory Council (MedPAC) must seek to develop new policy approaches that account for Medicare’s cost-savings and support a sustainable funding model for Medicare, Medicaid and MA. This two-fold solution will ensure that purported federal efforts to save money and cut programs are not done so to the detriment of millions of seniors and adults with permanent disabilities. 
As funding cuts continue, the costs of business and operations increase, leaving home health providers forced to either cut wages, services and coverage areas or shut their doors altogether. This ultimately costs Medicare more money by pushing patients into costlier institutional settings while simultaneously risking health outcomes. 
Medicare home health patients have better health outcomes and are at less riskfor rehospitalization. Since COVID, we have seen a substantial shift in America’s future of health care as more evidence has shown home to be the safer and more comfortable setting. Without fixing the flawed system, vulnerable Americans won’t be able to access this option of care and our government will be forced to spend even more money. 
To put it into perspective:
It costs $2,010 per month to care for a patient at home for 30 days under home health care.
skilled nursing facility costs an astronomical $16,500 for that same care.
That’s a cost savings of approximately 88% for every patient diverted from a skilled nursing facility and cared for at home. Put another way, we can care for eight people at home for the cost of caring for one person in an institution…

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Nursing Home Groups File Lawsuit to Block CMS' Staffing Mandate

Fierce Healthcare | By Dave Muoio
Nursing home associations have filed a lawsuit in federal court seeking to block a controversial staffing policy the Biden administration says is necessary to protect facility residents.
The American Health Care Association, the Texas Health Care Association and the operators of three nursing facilities in Texas filed their complaint Thursday in the Northern District of Texas. It seeks to block a final rule, published in the federal registrar on May 10, that they argue exceeds the administration’s statutory authority.
“We had hoped it would not come to this; we repeatedly sought to work with the Administration on more productive ways to boost the nursing home workforce,” Mark Parkinson, President and CEO of AHCA, said in a release announcing the lawsuit. 
“Unfortunately, federal officials rushed this flawed policy through, ignoring the credible concerns of stakeholders and showing little regard for the negative impact it will have on our nursing home residents, staff and the larger healthcare system.”
The Centers for Medicare and Medicaid Services’ (CMS’) final rule requires facilities receiving Medicare and Medicaid funding to have a total nurse staffing standard of 3.48 hours per resident per day. It also outlines ratio requirements for registered nurses (0.55 hours per resident per day) and nurse aides (2.45 hours per resident per day), and a requirement for at least one registered nurse to be onsite 24 hours a day.
These and other requirements are set to be phased in over the coming years, with certain facilities like those in rural communities getting extra leeway.
AHCA and other industry groups have been against the requirements since they were proposed last year. They warned that the final rule would in effect reduce access to care due to nursing homes’ widespread workforce shortages and tight finances.
In an analysis released earlier this month AHCA and the National Center for Assisted Living, for instance, the groups wrote that the nursing home industry would need to hire an additional 102,000 nurses and nurse aids to come into compliance, a collective $6.5 billion per year added expense. They also warned that over 290,000 current residents of nursing homes could be displaced due to census reductions or full closures.
“Hundreds of thousands of seniors could be displaced from their nursing home; someone has to stand up for them, and that’s what we’re here to do,” Parkinson said…

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‘Time To Claim The Future’: The Hospital-At-Home Model’s Chance To Decentralize US Health Care

Home Health Care News | By Andrew Donlan

Hospital-at-home care has a chance to become a mainstay in the larger home-based care ecosystem. As its stakeholders aim to get it there, there are a few factors that need to be considered. 
Firstly, without payment, there is no hospital-at-home model. Early pioneers of the model in the U.S. know that all too well. 
But Medicare providing adequate payment for hospital-at-home care during the public health emergency (PHE) was a major first step to get other payers to follow. The Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver has already been extended through 2024 – it was initially supposed to expire at the end of the PHE – and now is up for another extension. 
Earlier this month, Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.) introduced a bill that would push back the expiration date of the waiver program by five years. An extension bill was also introduced in the House
That would make for an obvious tailwind for hospital-at-home stakeholders. It not only would keep the payment valve open for current hospital-at-home programs, but also give health systems interested in the model the assurance that investment will be worth their time. 
Additionally, earlier this year, Sens. Marco Rubio (R-Fla.) and Tom Carper (D-Del.) introduced the At Home Observation and Medical Evaluation (HOME) Services Act, which would allow providers to admit patients into hospital at home prior to being admitted in the brick-and-mortar hospital
The Acute Hospital Care at Home waiver taking on a wider scope, more payers following Medicare’s lead and more home-based care providers becoming involved isn’t just good news for the hospital-at-home model, though. 
It pushes forward the idea that the home can eventually be the epicenter of health care in the U.S., which is an idea that many home-based care stakeholders are behind, but also a major departure from the current system. 
“One may ask why a five year extension, as opposed to something made permanent,” Medically Home CEO Rami Karjian recently told me. “We think Medicare wants to go the bundled route for making this permanent. We think they have this vision, like with BPCI-A, acute and post-acute care integrated and paid for together. That’s where we think this is 
ultimately going to go.” …

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More Than a Third of Healthcare Organizations Aren’t Prepared for Cyberattacks: Report

Healthcare Dive | By Sydney Halleman

Thirty-seven percent of healthcare organizations did not have a cyberattack contingency plan in place, despite half having experienced an attack, according to a new survey from Software Advice.

Dive Brief:

  • More than one in four ransomware attacks in healthcare impact patient care, according to a new survey out this week from advisory firm Software Advice.
  • About half of healthcare organizations that experienced a ransomware attack said the breach impacted patient data — and 34% said they failed to recover the data after the attack.
  • Cyberattacks can result in pricey downtime and delay critical procedures, the report said, but only 63% of companies report having a cybersecurity response plan in place.

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Uber Reveals New Product to Help Caregivers and Home Health Agencies

McKnight’s Senior Living | By Adam Healy
Rideshare technology firm Uber recently announced a new service aimed at addressing the logistical challenges faced by family members and home care agencies when providing care for older adults aging in place.
Uber Caregiver, revealed last week, will allow users to designate a primary caregiver who can request transportation and deliveries on the user’s behalf. The service aims to alleviate some of the logistical burdens of caregiving, like coordinating rides to appointments or arranging grocery deliveries.
“The notion here is to be able to engage a caregiver in a loved one’s care journey,” Zachary Clark, chief growth officer of Uber Health, told McKnight’s Home Care Daily Pulse in an interview. “We’re really kind of cognizant and aware of the 50 million Americans across the United States that identify themselves as caregivers.”
He added, “If the care receiver isn’t an Uber user today, but Mom and Dad or a sibling is, this is a way to kind of help an individual navigate [their care].”
The service will begin rolling out by late July or early August, Clark said. By the end of 2024, Uber Health plans to add tools like over-the-counter medicine delivery capabilities to the Uber Caregiver platform. The company has already ventured into health product delivery services; Uber recently partnered with Reperio, a technology startup, allowing drivers to deliver health screening kits to and from patients’ homes.
Users will also be able to use healthcare benefits to pay for Uber Caregiver services. Uber Health is working with Medicare Advantage, Medicaid and commercial payers to allow their members to use their plan’s benefits to order rides or deliveries. This feature also gives consumers better visibility into their health plan’s offerings, which can often be confusing to navigate, Clark noted.
“You might be accessing an Uber, but that benefit might be managed through a third party broker. We want to be able to tell you that you have 22 out of your 24 rides left,” he explained. “Today all of that information resides in disparate places. And so combining that in a way that helps engage the member around what they have access to, we think, can be really powerful to create the right kinds of utilization that really we should see of these benefits. “
Home care and home health providers are uniquely positioned to use Uber Caregiver to their advantage, Clark said. The platform can make it easier for patients to engage with care services, he noted. It also allows family members to take a more active role in their loved one’s care, thereby reducing providers’ time spent on tasks like coordinating rides and deliveries, and increasing their opportunities for face-to-face interaction.
“Over time, it reduces the administrative burden for a home health or home care agency carries with them,” Clark said. “So by inviting the caregiver into that experience … it requires less of that home health or personal care coordinator over time, which helps them be more efficient and spend more time with the patient.”

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