The Case for Integrating Social Determinants Into Palliative Care

Hospice News / By Jim Parker

Individually, palliative care and social determinants programs both have the potential to improve quality of life and reduce costs — but that potential may be greater when the two are combined.

Social determinants are non-medical needs that can have a significant impact on the trajectory of patients’ health, such as nutrition, transportation, social or caregiver support, and housing, among others. Social and economic factors like these drive 40% of health outcomes, according to the Better Medicare Alliance.

With the care model’s focus on patients’ goals and quality of life, palliative care providers may be uniquely suited to assess those needs, according to Terri Maxwell, general manager, chief clinical officer, and co-founder of Turn-Key Health, a CareCentrix company.

“The interdisciplinary nature of palliative care, especially the inclusion of social workers, positions palliative care nicely to help to address the myriad needs that people have,” Maxwell told Hospice News. “Palliative care is well positioned to be able to positively close gaps related to social determinants of health — if a program is structured to uncover what those gaps are.” 

Integrating social determinants of health into community-based palliative care improves patient outcomes and can reduce higher-acuity care, which can help providers demonstrate their value to payers.

Home-based palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch indicated in a 2019 report…

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The Uncertain Future of Hospice Certificates of Need

Hospice News / By Holly Vessel

While their merits are hotly debated, the substance of certificate of need laws often exist in a state of flux.

Certificate of need (CON) laws have a huge influence on hospices’ ability to expand patients’ access to care, as well as impact the competitive landscape and quality of care in a given market.  

A myriad of factors play into states’ decisions to keep these laws on the books, according to Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization (NHPCO). 

“It really depends on the current culture of the state,” Lund Person told Hospice News. “It’s the atmosphere, beliefs about free-market economy and all those bigger things that play a role in whether a state even remotely considers a CON or not.”

As of December, 35 states and the District of Columbia had some type of CON program in place, reported the National Conference of State Legislatures (NCSL).

Wide variation exists in these laws from state to state in terms of requirements and applicability. Currently, 14 states have CON laws that include hospices.

Though New York enacted the first of these laws in 1964, they began to pick up steam due to federal requirements implemented during the 1970s. These federal rules were eventually repealed, and since then states have been left to make up their own minds about CON.

Will CON laws last?

To date, 12 states have rescinded their CON laws or allowed them to expire, according to NCSL. New Hampshire, which scrapped CON in 2016, was the most recent.

According to some, the prevalence of these laws may continue to dwindle.

“In this day and age, we’ll see how long CONs last,” Freeman Smith, north region president for Traditions Health told Hospice News at the VALUE Conference in Chicago. “There’s a real push to get rid of the CON state. It was a process to control the cost 20 years ago, but right now the market place determines that.”

Regulators and legislators in at least 18 states began reassessing their CON laws during the past three years.

Lawmakers introduced bills to remove all or most CON requirements in Alabama, Alaska, Kentucky, Maine, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina and West Virginia.

Several states also enacted or considered CON reform bills, some of which removed requirements for certain settings, including Michigan, Tennessee, Washington, Montana and Virginia. Montana removed CONs for all settings except nursing homes as of last October.

Additionally, three states — Connecticut, Delaware and Massachusetts —appointed commissions to study the issue…

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Colorado Health Facilities Interaction

From CDPHE

Last week Colorado Department of Public Health and Environment (CDPHE) announced that it, “does not intend to seek another set of emergency rules, nor does it intend to seek to make the current Chapter 2 regulations permanent. As such, the Chapter 2 COVID-19 Vaccine Requirements shall expire July 14, 2022.”

The Board of Health indicated that they have decided to change the policy due to the following:

First, the vaccination rate, as well as medical and religious exemption numbers, have remained steady for the past 3+ months.

“Second, HB22-1401 was signed into law by Governor Polis on May 18, 2022. While the bulk of this bill pertains to licensed Hospitals, there is language directing the Department to enact requirements for all licensed facilities and agencies related to infection prevention and control. While the Department has not yet determined what these requirements will be, the statute requires that they include provisions related to testing, vaccination, and treatment for COVID-19 in accordance with applicable recommendations and guidance. While the specifics will be worked out with stakeholders in the future, the Department envisions COVID-19 vaccination will be part of this conversation.

“Third, while the Department intends to let its state licensure vaccination requirement expire in July, it is important to note that the federal requirement for staff to be vaccinated or obtain a valid medical or religious exemption, through the Centers for Medicare and Medicaid Services (CMS), will still apply to any licensed facility that is certified by CMS to receive federal reimbursement. Approximately one-third of all licensed facilities are certified by CMS, and therefore their staff will still be subject to a vaccination requirement.

“Key takeaways for licensed facilities and agencies:

• Effective July 14, 2022, current obligations under Part 12 of 6 CCR 1011-1, Chapter 2 related to COVID-19 vaccination expire. 
• This includes the associated obligation to report into Colorado Health Facilities Interactive (COHFI) on a twice-monthly basis. 
• The requirements of Part 11 of Chapter 2 regarding vaccination against influenza are still in effect and not impacted by the expiration of these emergency rules. 
• Despite the expiration of these rules, facilities and agencies may maintain any mandatory vaccination policies they have adopted to date. 
• Long-term and residential care facilities (Skilled Nursing Facilities, Assisted Living Residences, Intermediate Care Facilities, and Group Homes) are still subject to the requirements of Public Health Order 20-20 and the Comprehensive Mitigation Guidance document. 
• Facilities certified by CMS are still subject to the federal government’s vaccine mandate. 

• CDPHE’s Health Facilities and EMS divisions will engage in conversations with stakeholders later regarding the implementation of HB22-1401, which will likely include some requirements around vaccination and vaccination policies."

Home Health Industry Pushes Back on CMS Budget-Neutrality Methodology for PDGM

Home Health Care News

Since the release of the U.S. Centers for Medicare & Medicaid Services’ (CMS) proposed payment rule, home health stakeholders have been sitting in their respective “war rooms” trying to navigate the proposal.

As providers geared up for the unveiling of the proposal, many knew that CMS’ analysis of whether the Patient-Driven Groupings Model (PDGM) led to higher, lower or equal spending compared to the old payment model would be a major factor, according to William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC).

Many are pushing back against CMS’ methodology for assessing budget neutrality, with organizations such as NAHC expressing their concerns even prior to the release of the proposed rule.

“When we found out on Friday that CMS chose to use the same methodology which had been roundly condemned by anybody who had evaluated it, we had to conclude the CMS had effectively declared war against home health,” Dombi said. “I don’t mean that in an emotional sense, but in a practical sense, where the outcome of this proposal could be extraordinarily — not just disruptive — but devastating to the home health care community.”

He made these comments during NAHC’s latest webinar on Thursday.

Overall, the proposed rule comes with a decrease to payment rates by 4.2%, or $810 million less compared to 2022 rates.

“CMS only gets to that [$810 million] by adding in the inflation update, so the inflation update for 2023 is a meager 2.9%,” Dombi said.

The proposed rule also includes a 7.69% PDGM budget-neutrality adjustment.

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