Monthly Archives: August 2015

Reinventing Home Health?

“(T)he Affordable Care Act directs CMS to develop a plan to implement value-based purchasing…encouraging home health agencies for some time to partner with ACOs (Accountable Care Organizations) and become part of the value stream.

Yet beyond dabbling in a handful of bundled payment experiments, few home health care companies have made an effort to be part of the discussion about value-based care. Not a single one has taken the lead.

One reason for their reticence is an issue of comfort: like most other established businesses, they resist change.

Another, perhaps less emotional reason, is the way that CMS issued its final rule on ACOs. Home health providers can be part of a Medicare ACO at its inception as long as a physician group or hospital is the primary owner. Beyond that, any other arrangement by another Medicare provider or supplier must be approved at the discretion of the Secretary.

Further, since agreements and contracts must be executed before an ACO submits its application, it isn’t clear whether that new agreement would be allowed at the beginning of a new performance period.

What the VBR (Value-Based Reimbursement) initiative means for home health agencies is clear and is part of CMS’ stated objectives: weaker providers without the technology and other means to keep costs in line and quality under control will go out of business. There are more than 12,000 Medicare-certified home health agencies today. Perhaps less than half will survive in the form we know it by 2018, with the fastest decline in pilot states.

Innovations In Home Care

Some providers are looking beyond traditional service models and expanding their services to enhance the patient experience, improve the quality of care, and lower costs:

  • Hospice of Michigan last year expanded its At Home Support program to partner with Ohio-based Western Reserve, after a pilot showed a 34 percent cost reduction—about $3,400/month—by reducing hospitalization, re-hospitalizations, and emergency room (ER) utilization.
  • Moorestown, New Jersey-based BAYADA Home Health Care has launched a physician house call service that it expects will enhance the continuum of care offerings the company already provides. The company made news with a substantial technology investment in April 2013, when it equipped 4,000 caregivers with Samsung Galaxy tablets. BAYADA says it improved patient care, allowed for faster reimbursement, and reduced after-hours paperwork.
  • CMS recently announced results from the first performance year of its Independence at Home project, calling the demonstration “positive and promising.” Evaluators found that participants saved over $25 million — on average, about $3,070 per beneficiary. CMS said all 17 participating practices improved quality in at least three of six quality measures and four practices improved quality on all six. One of the program participants, the Visiting Physicians Association, netted $7.8 million in practice incentive payments out of the $11.7 million bonus that CMS paid out.” – Reinventing Home Health?

Both for-profit and not-for-profit hospitals spend on their operating expenses for uncompensated care – “In response to the findings, California Hospital Association spokesperson Jan Emerson-Shea said, ‘Charity care is important, but it is only a fraction of the total picture of how [not-for-profit] hospitals reinvest back into their local communities.’ She added, ‘In addition to charity care, [not-for-profit] hospitals fund research, education, wellness services and a myriad of other programs that are determined based on the needs of local communities’ (“To Your Health,” Washington Post, 8/4)…While not-for-profit hospitals in California spend slightly more on charity care than their for-profit counterparts, they spend the same amount on uncompensated care, according to a study published in Health Affairs, the Washington Post’s “To Your Health” reports…charity care accounted for about 1.9% of operating expenses among not-for-profit hospitals in California. In comparison, charity care amounted to 1.4% of operating expenses among for-profit hospitals in the state. However, both for-profit and not-for-profit hospitals spent an average of 4.4% of their operating expenses on uncompensated care, according to the study (“To Your Health,” Washington Post, 8/4)…Takeaways: The researcher wrote that the findings suggest a need for more accountability under the Affordable Care Act, which requires all not-for-profit hospitals to have charity care policies. They noted that the ACA ‘lacks specific details, including which patients qualify and what charges should be waived’ (Brino, Healthcare Finance, 8/4). They added, ‘The takeaway is not that we should not be giving tax breaks, but that there should be a little more accountability’.”

(Re)Designing Healthier Capitalism

“So the real debate is about the new version of capitalism: do we ‘design this,’ or pretend that everything will be okay as the tech elite get richer and people who lose their jobs get poorer?” – (Re)Designing Healthier Capitalism