Biden to DOL: Workers Have ‘Guaranteed Right to Refuse Employment’ If They Feel Unsafe

In President Joe Biden’s first few days of office, he has signed a slew of executive orders, some of which may have an immediate effect on home health and home care agencies.

One executive order, for example, laid the groundwork for a $15 minimum wage. The “Fight for $15” has long been a complicated issue for America’s home-based care operators, many of whom want to pay their workers more but struggle with stagnating reimbursement rates.

In addition, Biden also plans to increase the unemployment benefits add-on by $100 to $400 per week once the current spending package expires in March.

Anecdotally, providers haven’t been too concerned about the additional benefits. But there’s another aspect of Biden’s plan that could make it into a larger issue.

A fact sheet released by the Biden administration on Jan. 22 says that “workers have a federally guaranteed right to refuse employment that will jeopardize their health, and if they do so, they will still qualify for unemployment insurance.”

That is a part of the “new executive actions” to “deliver economic relief for American families and businesses amid the COVID-19 crises,” according to the fact sheet.

Specifically, Biden is asking the U.S. Department of Labor (DOL) to consider clarifying that workers do have the right to opt out of work if they fear it is unsafe for them or their families. Further guidance on which types of workers would apply has not yet been provided.

“The Biden package could certainly create some incremental headwinds for home-based care staffing, as we saw in the summer months last year after the first iteration of the CARES Act implemented the $600-per-week unemployment assistance,” Scott Fidel, an analyst for the financial services firm Stephens Inc., told Home Health Care News in an email last week. “However, we would not expect the staffing challenges to not be as significant as what we saw last year following the CARES Act.”

But with that potential DOL provision, things could get tricky for both home health and home care providers.

Theoretically, if the DOL did clarify that workers can stay home and collect unemployment if they feel unsafe, that could put thousands of home-based care workers in the position to opt out of their jobs for the time being.

Home care agencies have used hazard pay from Paycheck Protection Programs (PPP) loans in an attempt to mitigate some of these issues in the first place. Likewise, hazard pay from the government was supposed to fill holes on the home health side.

Particularly when it comes to Medicaid reimbursement, however, hazard pay has come late and been subject to high taxes. That’s at least the case in Virginia, where checks came in up to three months late and with a 35% chunk taken out for taxes, according to the Richmond Times-Dispatch.

Hazard pay can encourage workers to stay on the job and risk their own well-being, but it’s often not enough to overcome concerns about potentially exposing high-risk family members back home.

In 2019, 43% of American households reported having at least one member with pre-existing conditions.

“President Biden believes that workers should have the right to safe work environments and that no one should have to choose between their livelihoods and their own or their families’ health,” the fact sheet states.

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What President Joe Biden’s ‘American Rescue Plan’ Means for Home Care Operators

Before President Joe Biden was sworn in on Wednesday, he had already unveiled plans for another massive stimulus package, one that could help home-based care providers in some ways — and hurt them in others.

Under the new president’s “American Rescue Plan,” for instance, there would be $400 billion put forth to increase COVID-19 testing and the speed at which vaccines are distributed. That, along with $350 billion for state and local governments, would be generally helpful for home-based care providers.

At the same time, unemployment benefit add-ons and a federal minimum wage hike could potentially bring even more trouble to a historically tumultuous staffing environment. Many home-based care operators support paying their workers more, but most can’t afford to do so without a corresponding reimbursement increase.

At the beginning of the public health emergency, the $600 unemployment benefit add-on placed a massive burden on agencies trying to keep their staff at work during an especially trying time. Home health aides and caregivers saw an opportunity to avoid risk and stay home with their families — and maybe even make more money than usual while doing so.

The last spending bill, instituted a few weeks ago, has put a $300-per-week add-on in place. That is set to expire in March, but it could be replaced with the higher $400-per-week provision in Biden’s plan.

“It depends on how quickly Congress can get a bill drafted and then to the floor for a vote,” Scott Fidel, an analyst for the financial services firm Stephens Inc., told Home Health Care News in an email. “[But] we could envision these provisions relating to unemployment in Biden’s COVID plan targeted to kick in as the prior enhanced benefits are set to expire in March.”

After the initial $600-per-week add-on was in place, it took a while for many agencies to get enough workers back that had left. Another boost to unemployment benefits could jeopardize retention again.

“We’ve been trying to rebound ever since May,” Mitch Markowitz, the VP of business development at Family & Nursing Care, told HHCN in December. “And it’s been very, very slow incremental growth. That’s mostly because those caregivers, once they’re gone, they’re gone.”

Silver Spring, Maryland-based Family & Nursing Care is a private-pay home care company.

In spring, some caregivers opted for unemployment to earn money without exposing themselves or their families to the virus.

But the environment is far different now. Thanks to more widely available personal protective equipment (PPE), better screening protocols and early access to COVID-19 vaccines, there is less uncertainty surrounding the virus in the home-based care world.

“The Biden package could certainly create some incremental headwinds for home-based care staffing, as we saw in the summer months last year after the first iteration of the CARES Act implemented the $600-per-week unemployment assistance,” Fidel said. “However, we would not expect the staffing challenges to not be as significant as what we saw last year following the CARES Act.”

When it comes to vaccines, Biden’s team is hoping to inoculate 100 million Americans in the administration’s first 100 days.

The American Rescue Plan’s concerted effort to increase vaccine distribution and testing could further reduce uncertainty and concern.

“If the vaccine program is able to accelerate from its initial rocky implementation and the economy also continues to recover, we think workers will be more inclined to join the labor pool as compared to taking the unemployment benefits,” Fidel said.

Minimum wage hike

Another Biden proposal that could affect home care and home health agencies is a mandated $15-per-hour minimum wage.

According to the U.S. Bureau of Labor Statistics, the 2019 median pay for home health and personal care aides was $12.15 an hour.

In general, Biden’s transition team has emphasized the importance of helping direct-care workers earn higher wages. The administration’s health care plan, which is included on its official website, explicitly sites home care.

“The Biden Administration will partner with health care workers and accelerate the testing and deployment of innovative solutions that improve quality of care and increase wages for low-wage health care workers, like home care workers,” the plan reads.

The minimum wage increase, however, is one of the aspects of the plan that still has a long way to go until implementation.

“While the $15 minimum wage hike at the federal level would likely present additional wage and margin pressures for home-based care providers — especially in lower-wage personal care — this proposal will be a tougher sell from a bipartisan perspective and will still likely face a rocky legislative pathway for approval, even with the Democrats nominally in control of both the House and Senate,” Fidel said.

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HHS Delays Provider Relief Fund Reporting Requirements in Response to Updated Utilization Guidelines

The U.S. Department of Health and Human Services (HHS) on Friday announced it will amend the reporting timeline for the Provider Relief Fund, giving home health agencies and others more time to prepare required information. The news comes shortly after Congress clarified financial dos and don’ts of the program.

Originally, the opening date for HHS’s Provider Relief Fund reporting portal was slated for Jan. 15, with the first deadline set at Feb. 15.

The formal delay is the result of Congress passing the Federal Appropriations Act at the end of December, which authorized HHS to distribute an additional $3 billion in relief funds to health care services providers.

As of now, no new official compliance deadline has been set.

“HHS has been working to update the [Provider Relief Fund] reporting requirements to be consistent with this new law,” the health department said in a statement. “That said, as HHS has done in the past, the department wanted to give recipients ample time to familiarize themselves with the updated reporting requirements well in advance of required submission deadlines.”

For now, HHS has still opened its online reporting portal for providers starting on Friday. Providers that have received relief fund payments exceeding $10,000 should establish accounts and begin the reporting process, officials suggest.

Aside from authorizing a fresh tranche of funds, the Federal Appropriations Act included new provisions that made changes to the scope of Provider Relief Fund payments. For home health providers, especially larger ones with multiple business segments or entities, this means new flexibilities around how the funds can be utilized.

Under the new law, providers are able to transfer relief funds between their corporate parents and subsidiaries.

“Some of the prior HHS guidance had suggested that [relief funds] earned from some of the targeted distributions — which are distributions that went out to specific provider types, such as nursing facilities or hospitals — had to remain with the entity that received it,” Anil Shankar, a partner at law firm Foley & Lardner LLP, told Home Health Care News. “Congress kind of overrode that, declaring that the funds can be transferred within the corporate family.”

The recently passed appropriations legislation also reverts guidelines around calculating lost revenues back to what was previously in place as of June 2020. Updates guidelines require providers to calculate lost revenues using any “reasonable method of estimating the revenue” compared to the same period in the absence of COVID-19.

“It allows providers to run a comparison of the difference between their budgeted revenue versus their actual revenue, which is significant because the October-November guidance would not have permitted that,” Shankar said. “[It] instead required a year-over-year comparison, which in some cases, may not have been a very accurate comparison.”

Shankar noted that the previous guidance in place was a point of contention among health care organizations. Providers, generally, viewed the requirements as overly restrictive.

Still, some uncertainty around how providers should calculate budgeted versus actual revenue remains.

“Now, you can use budgeted versus actual as your comparison to identify the amount of lost revenues,” Shankar said. “But there are still questions about what counts as a budget discretion and what counts as actual.”

There are also questions around the time period, he added.

“It’s not clear to me now, with a new legal change, if they’re going back to something different or more flexible, where you can do it on a quarter-by-quarter basis, or if it’s still a full year at a time,” Shankar said.

Shankar said he believes the HHS Provider Relief Fund reporting portal being open may provide the answers to some of these lingering questions.

Provider Relief Fund distribution first began in April of last year with an initial tranche of $30 billion to Medicare-reimbursed health care providers. The federal government has since added to that with several more general and targeted relief rounds, with the latest being a $24 billion infusion in December.

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Certificate of Need Markets Can Mean Big Business for Home Health Buyers, But Opportunities Are Growing Scarce

Home health mergers and acquisitions got off to a slow start in 2020, then picked up considerably by year’s end. Home health insiders are now predicting a big year for M&A activity in 2021, especially after COVID-19 relief vanishes and economic realities become clearer.

The Patient-Driven Groupings Model (PDGM) will likewise play a part in the M&A landscape, as will other payment-related changes.

But another major factor will be Certificate of Need (CON) laws in some states and regions. Whether buyers want to enter into those precious territories — and whether prospective sellers are willing to give up their valuable position — will be an intriguing storyline in coming years for home health dealmaking.

A CON program is a state regulatory tool that controls the number of health care resources in a given area. It requires home health operators looking to enter a CON state to prove that there is an indisputable need for more home health services in an area.

In other words, an agency cannot exist in a CON state unless it holds a certificate.

The CON concept began with hospitals. The government wanted to make sure it wasn’t funding too many brick-and-mortar institutions in small geographic clusters.

Since then, the same logic has come to home health.

There are currently 18 Certificate of Need states, plus Washington, D.C. Entering these states organically, and not by way of M&A, may be harder than ever, Mark Kulik, the managing director of M&A advisory firm The Braff Group, told Home Health Care News.

“Today, in 2021, it’s extraordinarily difficult to get a certificate,” Kulik said. “They’re not issuing many, if at all. And when there is an application for a new CON, a home health agency has to go through a process that includes a public hearing.”

At that public hearing, other agencies in the area can argue against a new home health operator’s case that it should be allowed to open up shop. And it’s worth it to keep others out, for agencies already established in a CON state. Keeping supply lower as demand remains high is good for business.

In effect, CON-state providers have an artificial moat built around them in the marketplace. With regulation, there may be four or five providers in an entire county. Without it, there’s more likely to be dozens — or more.

“Agencies in those respective states have been contacted numerous times by myself, my competitors and by other agencies on a direct basis because they are so valuable,” Kulik said. “And I think that the demand is going to spike again for those agencies. It’s just a question of how the owners feel about exiting at that point in time.”

If an operator wants to enter into a CON state that has deemed itself “full” in 2021, it will have to buy in — and that won’t come cheap.

Hypothetically speaking, if there are two identical agencies — one in a CON state and the other in a non-CON state — the one in the CON state will garner a 30% to 75% higher selling price, Kulik said.

But that price hike may not be enticing enough for owners to sell. CON-state agencies are typically larger and healthier. They have a stable competitive landscape and are not forced to worry about new competitors coming into town year after year.

“Theoretically, if you’re in a CON state, you’ve got the same competitors — two, three, four, five years from now,” Kulik said. “If you’re in a non-CON state or area, that’s always top of mind. ‘Who’s moving into my service area? Who’s going out of business? Am I growing or shrinking?’ You have all sorts of other issues at play.”

Once the second phase of PDGM is more firmly underway, Kulik expects M&A activity to pick up considerably after the first quarter. When it does, the CON-state jockeying should be in full force.

Into the weeds of CONs

Buying options in Certificate of Need states are scarcer than they used to be.

Encompass Health Corp. (NYSE: EHC) is now the fourth-largest home health provider in the U.S., according to LexisNexis data. But it wasn’t always a large player.

As it added scale, other large home health players were buying up agencies where in CON states. As a result, there are fewer acquisition options for Encompass Health to go after now.

“I think we find ourselves, if anything, a little behind,” Luke James, the president of Encompass Health’s home health and hospice arm, told HHCN. “That’s somewhat intentional. But in terms of what’s left in some of these states that we’d like to be in, it’s certainly scarcer than it used to be.”

Birmingham, Alabama-based Encompass Health announced recently it is “exploring strategic alternatives” for its home health and hospice business, which brought in a total segment revenue of $1.09 billion in all of 2019, according to company financial filings.

Organic growth and non-CON state acquisitions were enough to get Encompass into the top-five of the home health world.

“We felt like, at the time, that was a better solution — for us to spend less and get a similar outcome, or at least an acceptable outcome,” James said.

But now Encompass Health is a home health behemoth, which gives it the ability to enter into CON states, even if they’re scarce. But the math and logistics look a lot different than they did five to 10 years ago.

Other home health competitors have a stranglehold in some CON regions and can opt to outbid everyone else for any agencies that come up for sale.

Still, if Encompass Health feels an acquisition is feasible and in line with its national strategy, it won’t be afraid to throw a lot of money at a seller to enter into an area it desires.

“Maybe the return metrics [on a CON acquisition] don’t look so good on paper compared to other opportunities we have, but we may think it’s the right long-term decision for our organization to go ahead and do it anyway,” James said.

Encompass Health’s main growth strategy continues to be prioritizing the overlapping of its businesses in areas where it is already present. For instance, if the company has hospitals or other facilities in an area, the home health and hospice arm would like to join them.

Some of those areas are in CON states, and some aren’t.

But James doesn’t entirely agree with the notion that it’s always better to be in a less competitive CON state or area. Encompass Health’s largest footprints are in Texas and Florida, for instance, where CONs are not required.

“In some cases, we enjoy the increased competition, because it allows us to really stand out,” James said. “And whenever there’s tough years — [like with] PDGM or RAPs going away, for instance — I think that what we’ll see is that more concentrated states have a lot more smaller providers trying to get out. With more disruption comes more opportunity for the larger, more sophisticated and better prepared providers in those states.”

Fulton County, Georgia, has about 35 home health providers, whereas Dallas County, Texas, has closer to 700. Encompass Health is located in both of those counties.

“Is it a lot more competitive in Dallas? Absolutely,” James said. “Is it harder to recruit and retain? Yeah, it is. … But in times of uncertainty and disruption, I think there’s more opportunity for a fallout in some of the lower-quality, less prepared providers in Dallas County than in Fulton County.”

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$1.4 Trillion Spending Package Extends Sequestration Holiday, Grants Home Health OTs More Authority

As different health care stakeholders combed through the new $1.4 trillion spending package approved by Congress on Monday, many likely felt a mix of excitement and disappointment.

Included in the nearly 6,000-page spending package was a $900 billion COVID-19 relief bill, changes to home health therapy rules, certain hospice provisions and more. That’s really just the tip of the iceberg, too, as it’s unlikely that even the lawmakers who voted on the package read it in its entirety.

Home-based care insiders are in the process of doing so. So far, there’s reason to be happy about the relief package, which now awaits President Donald Trump’s signature.

“We are grateful that Congress recognized the need to support home care and hospice during the pandemic,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News in an email.

In addition to the previously noted items, Dombi called attention to the package extending the Medicare sequestration holiday, which was initially set to expire at the end of this month. More CARES Act grants, an extension of the Medicaid Follows the Person (MFP) program and extra spousal impoverishment relief are likewise victories for home health and hospice operators, NAHC’s president said.

“[There is also] the expanded SBA Paycheck Protection Program (PPP) and more that will help keep [home health] and hospice operational,” Dombi added.

Specifically, $284.5 billion more has been added for a second round of PPP loans for businesses with less than 300 employees and a demonstrated revenue loss greater than 25%.

The extended sequestration suspension is a major win for all Medicare-reimbursed health care providers, which have faced a 2% cut since 2014. Providers across the country continue to deal with new, previously unexpected expenses and erratic revenue patterns.

The new pause on sequestration runs through March 31.

Additionally, the spending package and COVID-19 relief includes nearly $70 billion to purchase and distribute vaccines, plus funds to help states conduct testing. About $20 billion of that funding will be dedicated to making the vaccine available at no cost for certain individuals.

Other COVID-19 specifics include $22.4 billion for testing, contact tracing and other prevention practices necessary for combatting the virus. Another $3 billion was included for additional grants for health care providers to be reimbursed for expenses or lost revenues tied to COVID-19.

For Medicare-funded home health businesses, $175 billion more has been put into the Provider Relief Fund, which could grant them a lifeline until the pandemic subsides.

Therapy changes

Similar to NAHC, the American Occupational Therapy Association (AOTA) celebrated certain provisions on the $1.4 trillion spending package.

In what AOTA called a “historic home health victory,” the package includes language from the Medicare Home Health Flexibility Act that enables occupational therapists (OTs) to open home health therapy cases. The U.S. Centers for Medicare & Medicaid Services (CMS) will have one year to implement a rule allowing for that change.

“Today we celebrate hard-fought victories for occupational therapy scope of practice and payment, following extensive AOTA-led advocacy initiatives,” the advocacy organization wrote in a statement.

OTs were granted the flexibility to open up home health cases during the public health emergency, but this bill will allow them to do so moving forward. AOTA said it has worked for “decades” on this measure.

The bill also made COVID-19-related telehealth flexibilities permanent.

Funding for hospice providers, small businesses

The “Rural Access to Hospice Act” and the “Helping our Senior Populations in Comfort Environments (HOSPICE) Act” were also included in the spending package.

Rural health clinics and federally qualified health centers cannot currently bill under Medicare Part B for hospice, which often becomes a barrier to caring for remote populations. With the Rural Access to Hospice Act in place, providers will be able to receive payment for services to patients in hospice, which will help those populations.

The National Hospice and Palliative Care Organization’s (NHPCO) was happy with the hospice provisions.

“NHPCO appreciates this bi-partisan, bi-cameral agreement,” NHPCO President and CEO Edo Banach said in a statement. “Hospice patients and families will benefit from improved access in rural and underserved communities as well as needed relief during this public health emergency. This legislation will enable hospice providers to continue providing uninterrupted care during this unprecedented time.”

Adult day providers weren’t as lucky. There were no specific provisions aimed at helping those operators during the public health emergency.

Katie Smith Sloan, the president and CEO of the aging-focused organization LeadingAge, previously discussed how Congress has fallen short in its efforts when it comes to helping adult day centers around the country.

What may help these providers, as well as other home care organizations, is the new round of PPP money that’s included in the package. If they are able to qualify, which most should be able to, that will at least ease some of the payroll burden that they’ve faced amid the public health emergency.

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Surprise! Congress Takes Steps to Curb Unexpected Medical Bills

Most Americans tell pollsters they’re worried about being able to afford an unexpected medical bill.

Late Monday, Congress passed a bill to allay some of those fears. The measure is included in a nearly 5,600-page package providing coronavirus economic relief and government funding for the rest of the fiscal year.

Specifically, the legislation addresses those charges that result from a long-running practice in which out-of-network medical providers — from doctors to air ambulance companies — send insured Americans “surprise bills,” sometimes for tens of thousands of dollars.

The legislation itself was a bit of a surprise, coming after two years of debate that featured high-stakes lobbying by all who stood to gain or lose: hospitals, insurers, patient advocacy groups, physicians, air ambulance companies and private equity firms, which own a growing number of doctor practices. A similar effort failed at the last minute a year ago after intense pressure from a range of interests, including those private equity groups.

This time around, no group got everything it wanted. Lawmakers compromised — mainly over how to determine how much providers will ultimately be paid for their services.

“No law is perfect,” said Zack Cooper, an associate professor of public health and economics at Yale who studies health care pricing. “But it fundamentally protects patients from being balance-billed,” he said, referring to out-of-network medical providers billing patients for amounts their insurer did not cover. “That’s a remarkable achievement.”

The bottom line: Patients may still be surprised by the high cost of health care overall. But they will now be protected against unexpected bills from out-of-network providers.

Here’s a rundown on what this legislation means for consumers:

Fewer Surprise Bills

Starting in 2022, when the law goes into effect, consumers won’t get balance bills when they seek emergency care, when they are transported by an air ambulance, or when they receive nonemergency care at an in-network hospital but are unknowingly treated by an out-of-network physician or laboratory.

Patients will pay only the deductibles and copayment amounts that they would under the in-network terms of their insurance plans.

Medical providers won’t be allowed to hold patients responsible for the difference between those amounts and the higher fees they might like to charge. Instead, those providers will have to work out with insurers acceptable payments. For the uninsured, for whom everything is out of network, the bill requires the secretary of Health and Human Services to create a provider-patient bill dispute resolution process.

The measure takes aim at situations in which patients have little choice about whether they are in network, including emergencies. A recent survey found 18% of emergency room visits, on average, resulted in at least one surprise bill. (A growing number of emergency rooms are staffed by private equity-owned agencies that sign few in-network agreements.)

The legislative agreement also applies to nonemergency care provided at in-network facilities, where patients receive care and services from out-of-network providers, such as anesthesiologists and laboratories.

Also included in the bar on balance billing is air ambulance transportation, which is among the most expensive medical services, often costing tens of thousands of dollars.

Still, the bill does not extend its consumer protections to the far more commonly used ground ambulance services. But it does call for an advisory committee to recommend how to take this step.

An Option for Consumers to Agree to Balance Billing

In some cases, physicians can balance-bill their patients, but they must get consent in advance.

This part of the bill is aimed at patients who want to see an out-of-network physician, perhaps a surgeon or obstetrician recommended by a friend.

In those cases, physicians must provide a cost estimate and get patient consent at least 72 hours before treatment. For shorter-turnaround situations, the bill requires that patients receive the consent information the day the appointment is made.

In a sense, though, this provision allows consumers to forfeit protection.

Health providers “have to give you a good-faith cost estimate. If you sign that, then you can be billed whatever that physician wants to bill you,” said Jack Hoadley, research professor emeritus in the Health Policy Institute at Georgetown University.

The legislation allows this only in nonemergency circumstances and bars many types of physicians from the practice. Anesthesiologists, for example, can’t seek consent to balance-bill for their services, nor can radiologists, pathologists, neonatologists, assistant surgeons or laboratories.

Payment Will Be Sorted Out in Negotiations

While lawmakers agreed that patients will be held harmless, the real fight was over how to decide what amounts providers would be paid by insurers.

Some groups — including hospitals and physicians — opposed any kind of benchmark or standard to which all bills would be held. On the other side, insurers, employers and consumer groups argued for a benchmark, warning that, without one, providers would angle for much higher payments.

The legislation carves out some middle ground.

It gives insurers and providers 30 days to try to negotiate payment of out-of-network bills. If that fails, the claims would go through an independent dispute resolution process with an arbitrator, who would have the final say.

The bill does not specify a benchmark, but it bars physicians and hospitals from using their “billed charges” during arbitration. Such charges are generally far higher than negotiated rates and bear little or no relation to the actual cost of providing the care.

That was considered a win for insurers, employers and consumer advocates, who argued that allowing billed charges would mean higher prices — potentially driving up premiums — in cases sent to arbitration.

Billed charges “are totally made up” by providers, said Cooper, at Yale. “So, the big deal is that arbitrators are not considering charges.”

But hospitals and doctors won a limit they sought, too.

In last-minute changes over the weekend, they succeeded in barring consideration of Medicare or Medicaid prices during arbitration. Those government payments are often far lower than the negotiated rates paid by insurers and self-insured employers.

Instead, the bill says negotiators can consider the median in-network prices paid by each insurer for the services in dispute. Other factors, too, can come into play, including whether the medical provider tried to join the insurers’ network, and how sick the patient was compared with others. It also allows consideration of network rates a provider may have agreed to during the previous four years, which might help some high-priced services, such as air ambulances, remain costly even in arbitration.

Overall, the legislation “did include some wins for provider groups,” said Loren Adler, associate director at the USC-Brookings Schaeffer Initiative for Health Policy.

Even so, he expects the legislation will help insurers contain some prices and provide “some downward pressure on premiums, even if relatively minor at the end of the day.”

State Laws May Change

More than 30 states have enacted some type of surprise billing protections, but only 17 are considered comprehensive, according to the Commonwealth Fund.

Comprehensive states — California, New York and New Mexico, for example — extend protections to cover nonemergency situations at in-network hospitals, but that isn’t the case in less comprehensive states, the fund noted.

And state laws have another limitation: They apply only to certain types of insurance, and often do not cover Americans who get their health insurance through self-insured employers, which tend to be midsize to large companies because they fall under federal rules.

But the new federal rules will cover most types of insurance plans, including those offered by self-insured employers.

“States can’t fully deal with these situations, but this covers it,” said Hoadley, at Georgetown.

Still, some provisions in state law, such as how to determine a payment, differ from the federal law. In such cases, the federal law defers to states.

Statehouse lawmakers may eventually alter their legislation or adopt new proposals to avoid confusion, said policy experts. If they don’t, they could be left with rules that affect people differently depending on whether their insurance comes through a large self-insured employer or directly from an insurance plan subject to state law. “I would be surprised if, over time, states don’t just glom onto the federal law,” said Adler.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


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No Funding, Closures and Limited Capacity: Adult Day Providers in Dire Need of Help

In late November, the aging-focused advocacy organization LeadingAge wrote a note to Congress, calling for relief on behalf of the 5,500 adult day service providers across the country and the vulnerable patients they serve.

“Adult day services providers across the country urgently need dedicated federal funding to ensure they are able to continue providing services during and after the COVID-19 pandemic ends,” the letter read.

It was signed by LeadingAge President and CEO Katie Smith Sloan and Donna Sizemore Hale, the executive director of the National Adult Day Services Association.

Unlike other health care providers across the care continuum, adult day providers haven’t been the benefactors of any major funding from the federal government. Meanwhile, state mandates have kept adult day operators completely closed, or opened at just 30% or 50% capacity.

A lack of government relief and a major loss in revenue due to limited capacity or complete closures has left the adult day world in deep trouble.

“I think we definitely do need to appreciate that operating at 30% to 50% capacity — or whatever the capacity limit is — is going to have a huge financial impact on any organization over a long period of time, whether they are adult day operators or a business in any other industry,” Brendan Flinn, the director of home- and community-based services at LeadingAge, told Home Health Care News.

Operators are prioritizing safety as they open. That frequently means reopening at reduced capacity, which means a reduced bottom line as well — and sometimes an unsustainable one.

It also means additional expenses, even with a greatly reduced number of members. For smaller adult day operators, those expenses consist of purchasing safety equipment such as PPE and plexiglass in lower quantities — and, thus, at higher prices.

LeadingAge’s letter to Congress included an asking price of $422.5 million to support providers and the over 260,000 individuals they serve.

Worst of all, a lack of support means that the vulnerable individuals that frequent adult day centers are left behind. Reduced capacity squeezes out members in need of care and socialization.

“I was on a call with some of my providers last week that had recently reopened, … and they were talking about their members, and how they had lost a ton of weight, how they’ve declined cognitively,” Flinn said. “Whatever health conditions they had, they had been exacerbated.”

Those providers had also reported that once they had reopened and welcomed members back, all of those aspects had begun improving.

But that’s for the ones lucky enough to return to adult day centers amid the ongoing public health crisis. For the ones that haven’t, those conditions are likely to continue worsening, bringing stress to them and their families.

Adult day centers are a great resource for lower- and middle-income families. They offer care and socialization to seniors at an often lower, more feasible price.

According to Genworth Financial, the 2020 national median cost of adult day services was $1,603 per month. Comparatively, the assisted living cost was over $4,300 per month, while nursing home care was about $7,750.

“It’s similar to anything else we’ve learned from data, research or anecdotal reporting … we’re seeing the effects to a greater degree for lower-income families and communities,” Flinn said. “We know that adult day services are a great way for [these] families and individuals to receive some type of services if they are not eligible for Medicaid and can’t afford something like a nursing home, but need some sort of care.”

The distribution of funds

It’s not that the Provider Relief Fund, for instance, cut out adult day providers. Instead, it’s that once those funds were released to the U.S. Department of Health and Human Services (HHS), the agency did not include them among the providers who would receive relief.

Phase Two of the Provider Relief Fund — for the most part — was the only phase that adult day providers were able to access. Even then, it was designated for providers that had billed Medicaid, and resources were extremely limited.

“These funds were turned over to HHS, and it made the decision about where those funds went,” Flinn said. “So [HHS] were the ones who decided that Phase One would include Medicare Part A, they were the one that decided what providers would get what type of relief.”

So, if there is another relief package coming down the pike, it’s likely to be distributed the same way. And that would still likely leave adult day providers behind. Some states have been better than others when it comes to adult day relief funding, but it has not been enough to make up for the lost ground from a federal standpoint.

To make matters worse, in the recent and initial federal recommendations for vaccines, adult day providers and their members were not included in the highest priority group.

Stunted growth

Elder-Well, a non-medical social model for adult day care, had high hopes in January of this year.

The Framingham, Massachusetts-based company was founded in 2014 by home health veterans Kara and Ken Harvey.

The Harveys were set to begin growing their business by franchising locations in Massachusetts and Florida, offering discounts for potential franchisees. The couple hoped to add 10 in 2020.

“Adult Day is — and is going to be — a very preferred long-term care option,” Kara Harvey told HHCN. “And so before the pandemic hit, we had many people throughout the country interested in joining the franchise system, and then that halted.”

The Harveys have noticed the recession sparking more interest from entrepreneurs of late, but have held back on opening up a slew of new locations given the uncertain regulatory climates in the two states. While they recently opened a new Elder-Well location, they’ve fallen short of their aspirations for obvious reasons.

Adult day centers were also labeled non-essential in both Florida and Massachusetts.

“That was painful,” Harvey said.

In Florida, however, they were allowed to open back up in May. In Massachusetts, adult days weren’t allowed to reopen through the summer.

Elder-Well wasn’t eligible for larger Paycheck Protection Program (PPP) loans. And because it is a social model that does not receive money from Medicare and Medicaid, the only way they were able to recoup some revenue during the public health emergency was to offer virtual solutions.

“It was difficult, I think, for all service providers in the senior care industry, but particularly for adult day,” Harvey said. “Those that weren’t able to pivot instantly and set up a virtual option really took a hit.”

Elder-Well has leveraged a partnership with the cognitive assistance company MapHabit, as well as Zoom and Facebook Portal, to stay in touch with its members.

After keeping its head above water virtually in 2020, the company has tempered its expectations. Now, it hopes to open six locations in 2021.

“Whether it be a social or a medical model, adult day centers are key in order for seniors to continue living at home in each community,” Harvey said. “There needs to be more insight provided for the lawmakers to understand that, and to appropriate funding and support for programs.”

The post No Funding, Closures and Limited Capacity: Adult Day Providers in Dire Need of Help appeared first on Home Health Care News.

House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others

U.S. Representatives Brad Schneider (D-Ill.) and David McKinley (R-W.Va.) introduced the Medicare Sequester COVID Moratorium Act last week.

If passed, the bill would extend the temporary suspension of Medicare sequestration payment reductions, giving home health agencies and other providers more financial flexibility headed into an uncertain 2021.

Since 2014, the U.S. Centers for Medicare & Medicaid Services (CMS) has been cutting Medicare reimbursements to home health providers by 2%, as directly by Congress. Under the law, payments that exceed Medicare’s cap must be returned to CMS.

As part of a larger COVID-19 relief effort, home health providers received a reprieve from sequestration when the CARES Act passed in March. CMS suspended the 2% Medicare sequestration, effectively boosting reimbursement rates during a period some health care experts referred to as a “holiday.”

The provision is soon set to expire at the end of December, but the newly introduced legislation would extend the temporary suspension of Medicare sequestration to an undetermined date.

The aim of the bill is to help providers focus on responding to the COVID-19 emergency instead of financial challenges that may arise during this time.

“At a time when health care workers are on the front lines battling the COVID-19 pandemic, Congress should be doing everything within their power to ease their burden,” Rep. McKinley said in a statement. “America’s health care providers continue to be stretched thin and face serious financial challenges as a result of the economic and public health crisis.”

For many home health agencies, CMS pressing pause on Medicare sequestration payment reductions has ensured that they have the resources to provide care during the public health emergency while staying afloat financially.

If the legislation doesn’t pass, this could mean trouble for providers, Matt Wolfe, a partner at law firm Parker Poe, told Home Health Care News.

“The CARES Act’s temporary suspension of Medicare sequestration payment reductions has allowed home health providers to purchase PPE, train staff, and otherwise invest in keeping patients and staff safe during the pandemic,” Wolfe said. “If this bill does not become law and the sequestration is reinstated, it will be a devastating blow for home health providers at a terrible time.”

With this in mind, the bill has also drawn support from organizations such as the Partnership for Quality Home Healthcare (PQHH).

“The Partnership, alongside the broader home health community and every other provider sector, is supportive of extending the suspension of the 2% sequestration cut for Medicare providers,” Joanne Cunningham, executive director of PQHH, told HHCN. “With COVID cases on the rise, the entire health care system continues to be challenged.”

Suspending the 2% reduction beyond 2020 is “a prudent step” that will provide much-needed support to the entire Medicare provider community and patients, she added.

PQHH is a home health care advocacy organization based in Washington, D.C.

Additionally, the bill has garnered support from organizations including the American Association for Homecare, LeadingAge, the Visiting Nurse Associations of America and the National Association for Home Care & Hospice (NAHC).

“We see an extension of the sequestration moratorium as a high priority for all Medicare providers in order to preserve our very fragile health care system,” NAHC President William A. Dombi told HHCN. “Reducing payments to health care providers, already stressed to a breaking point during the height of the pandemic, will add unnecessary risks to care.”

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Legislation Aimed at Expanding Advance Care Planning Introduced in Senate

On Wednesday, Sen. Richard Blumenthal (D-Conn.) introduced the Compassionate Care Act, a bill that would support advance care planning and end-of-life care.

For home health providers with existing hospice service lines or ambitions for expanding into palliative care, the news is encouraging. If passed, the Compassionate Care Act places more resources behind public awareness campaigns for these services.

Specifically, the legislation would throw federal support behind a public education campaign that promotes the importance of advance care planning, something that often goes overlooked. This would include grants and pilot initiatives aimed at educating medical, nursing and social work students.

Additionally, the Compassionate Care Act focuses on the development of end-of-life quality measures and expanding access to advance care planning through telehealth.

“This bill will help Americans have the difficult but necessary conversations about end-of-life care,” Blumenthal said in a statement. “The COVID-19 pandemic has reminded Americans of all ages of the importance to have a plan in place in case of severe illness or death. By promoting end-of-life care through public awareness, expanding telehealth services and working with physicians, we can ensure that not one more person is robbed of making critical life or death decisions for themselves during this pandemic and beyond.”

If enacted, the Compassionate Care Act would also, among other things, establish guidelines for advance care planning and develop continuing education criteria for health care providers in the arena. It would further allow physicians to recertify hospice stays through telehealth, which could reduce paperwork and administrative burdens.

It’s become increasingly common for home health providers — with hospice, palliative care and other services in place — to function as an almost one-stop-shop for aging services.

Companies such as LHC Group Inc. (Nasdaq: LHCG), Amedisys Inc. (Nasdaq: AMED), Addus HomeCare Corporation (Nasdaq: ADUS) and several others have viewed hospice care as part of a larger strategy to encompass multiple care capabilities.

On the palliative care front, reimbursement remains a challenge, however.

So far, the legislation has garnered support from a number of health care advocacy organizations including LeadingAge, the Coalition to Transform Advanced Care (C-TAC), National Partnership for Healthcare & Hospice Innovation (NPHI), the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC).

“Consumer awareness of the importance of advance care planning, as well as an understanding of the array of care options at the end of life, is critical, a truth we have only seen magnified by the COVID-19 pandemic,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement, “This important legislation provides much-needed resources to develop educational programs, initiatives and strategies for both consumers and providers that will ensure greater access to and understanding of advance care planning and end-of-life care.”

In addition to her role at LeadingAge, Sloan also serves as acting president and CEO of Visiting Nurse Associations of America and ElevatingHOME.

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CMS Launches ‘Unprecedented’ Hospital-at-Home Strategy to Manage Latest COVID-19 Surge

In an effort to increase hospital capacity amid the current COVID-19 surge, the U.S. Centers for Medicare & Medicaid Services (CMS) on Wednesday announced “unprecedented” flexibilities around providing hospital-level care for patients in their homes.

Similar to CMS’s recent allowances surrounding telehealth, the agency’s latest efforts are focused on lifting barriers that could potentially hinder care during the public health emergency, CMS Administrator Seema Verma said in a statement.

Wednesday’s flexibilities aren’t coming out of thin air. Instead, they build off the success and learnings of the nation’s existing hospital-at-home models, pioneered by organizations like Johns Hopkins and Mount Sinai.

“With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond,” Verma said.

Through CMS’s “Acute Hospital Care At Home program,” eligible hospitals will be granted “unprecedented” and “comprehensive” regulatory flexibilities to treat certain patients in their homes. The agency clarified the new flexibilities are aimed at acute care in the home and very different from “traditional home health services.”

In addition to building new capacity, CMS’s program is also a means to support established hospital-at-home programs, which have mostly had to rely on payment mechanisms outside of the Medicare fee-for-service world. CMS believes that with proper monitoring and treatment, acute conditions such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) can be treated in the home setting.

Wednesday’s move received praise from Dr. Bruce Leff, a hospital-at-home expert and the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine.

“CMS made a terrific decision in recognizing the value of hospital-at-home care for the public health emergency,” Leff told Home Health Care News in an email. “Hospital-at-home is well proven to provide high-quality hospital-level care in patients’ homes for many acute conditions — and patients and their families love it.”

Similarly, the move drew applause from Contessa, a company that helps organizations provide hospital-level care in the home through its Home Recovery Care model.

“Given the tremendous strain COVID-19 is putting on our health care system, access to home hospital care has never been more important,” Travis Messina, CEO of the company, said in an email. “The teams at CMS and CMMI expertly executed this hospital-driven model. Hospital-level care requires appropriate clinical oversight from hospital leaders.”

Messina added that his team is “thrilled” Mount Sinai Health System, one of Contessa’s partners, was already approved for CMS’s new model due to its extensive experience with the hospital-at-home concept.

Under the program, participating hospitals will be required to implement screening protocols prior to delivering care in the home. Participants will need to screen for both medical and non-medical factors, including working utilities, assessment of physical barriers and screenings for domestic-violence concerns.

Participating hospitals will also need to provide in-person physician evaluation before starting care in the home.

Additionally, a registered nurse is required to perform evaluations on each patient — in person or remotely — daily.

“Acute Hospital Care at Home is for beneficiaries who require acute in-patient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis,” CMS noted.

Wednesday’s announcement from CMS has roots in its Hospitals Without Walls program, which was first established in March. CMS’s Hospitals Without Walls program loosened regulatory restrictions in order to enable hospitals to provide services in other settings.

Over the years, the hospital-at-home model has gained a reputation for providing better outcomes at a lower cost. Despite this, the model has still mostly existed as a niche service line for providers in the U.S.

Recently, the COVID-19 emergency has served as a catalyst for renewed interest in the model.

Currently, Brigham and Women’s Hospital, Huntsman Cancer Institute, Massachusetts General Hospital, Mount Sinai Health System, Presbyterian Healthcare Services and UnityPoint Health are being approved for CMS’s new program.

“We’re at a new level of crisis response with COVID-19, and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need,” Verma’s statement continued.

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California Law Banning Toxic Chemicals in Cosmetics Will Transform Industry

A toxic chemical ban signed into law in California will change the composition of cosmetics, shampoos, hair straighteners and other personal care products used by consumers across the country, industry officials and activists say.

The ban, signed by Gov. Gavin Newsom at the end of September, covers 24 chemicals, including mercury, formaldehyde and several types of per- and polyfluoroalkyl substances, known as PFAS. All the chemicals are carcinogenic or otherwise toxic — and advocates argue they have no place in beauty products.

When the law takes effect in 2025, it will mark the first major action to remove toxic substances from beauty products in almost a century. Federal regulation of cosmetics has not been updated meaningfully since 1938, and only 11 ingredients in personal care products are regulated by the Food and Drug Administration. By contrast, the European Union bans more than 1,600 cosmetic substances and ingredients from cosmetics.

The California law, passed by wide margins in both houses of the legislature, “is a milestone for cosmetic safety in the United States,” said Emily Rusch, executive director of the California Public Interest Research Group, which was heavily involved in shaping the bill.

The Personal Care Products Council, which represents big companies like Amway and Chanel, was hesitant but eventually supported the bill and worked directly with legislators on its final form. The industry’s buy-in will help give the California law national repercussions.

“If you’re doing business in the United States, you’re doing business in California,” said Mike Thompson, senior vice president for government affairs at the council. “I would assume that this would really, in many ways, set up a new standard.”

Breast Cancer Prevention Partners, another activist group, advocated strongly for the measure because many of the banned chemicals have been linked to breast cancer, said Janet Nudelman, the group’s director of program and policy.

For salon workers like Kristi Ramsburg, the bill could offer the peace of mind that comes from knowing her workplace is freer of toxics. Over the 20 years she’s worked as a hairdresser in Wilmington, North Carolina, Ramsburg has done hundreds of straightening jobs on her clients’ naturally frizzy hair. Performing the procedure known as a Brazilian Blowout three to four times a week exposed her to harsh and dangerous/toxic products including formaldehyde and phthalates.

She experienced “sore throats, dizziness. My vision changed, definitely,” she said. “You’d be almost crying at first.”

Studies dating to the early 1900s show that inhaling even small quantities of formaldehyde can lead to pneumonia or swelling of the liver. It’s been classified as a carcinogen, according to the FDA.

Ramsburg believes her exposure severely damaged her health. Over six years, she had surgeries to remove her gallbladder, ovaries and appendix. After her liver swelled dangerously, she suspected, based on medical consults and studies she read, that the formaldehyde she had been breathing for decades was to blame.

“I was just inundated with toxins constantly. I literally almost died,” she said.

Horror stories like Ramsburg’s are what motivated legislators, as well as the cosmetic industry, to support the California law.

Federal legislation that would have given the FDA more power to control or recall products containing the 11 federally regulated ingredients failed to gain traction in either chamber in recent sessions, despite the support of celebrities like Kourtney Kardashian.

Advocates say the inadequacies in federal regulation have been apparent for years. Current law does not require cosmetics to be reviewed and approved by the FDA before being sold to consumers. And the agency can take post-marketing action only if a cosmetic’s ingredients were found to be tampered with or its labeling is wrong or misleading.

The FDA couldn’t even intervene when asbestos was found in cosmetics sold at the youth-oriented Claire’s and Justice stores. In a 2019 letter, then-FDA Commissioner Scott Gottlieb wrote that his hands were tied because “there are currently no legal requirements for any cosmetic manufacturer marketing products to American consumers to test their products for safety.” No action was taken.

FDA scientists moved to ban formaldehyde from hair straighteners as early as 2016, according to internal agency emails, but weren’t successful. A 2019 study by government investigators found that using hair straighteners was linked with a higher risk of breast cancer, which rose with increased use. The study also found that using permanent hair dye was linked with an increased breast cancer risk.

After the federal legislation stalled, advocates changed their focus to California. The Golden State’s liberal leanings made it a likely place to pass a bill, while its status as the world’s fifth-largest economy meant any new law would have national impact. That has previously been the case, as when California set its own limits on car emissions or demanded nutrition labels for restaurant menus.

“It plays that pivotal role nationwide and has such a large economy, and so much of the cosmetic industry has a huge base here,” said Rusch, of the California Public Interest Research Group. “This type of landmark legislation has the effect essentially of setting a national standard. That was our intent.”

The Personal Care Products Council was open to the ban since the chemicals on the list — after some pruning during negotiations on the bill — include only those already prohibited in the European Union.

“You don’t want a patchwork of rules, either around the country or around the world. You want consistency,” Thompson said. “A lot of our companies may be already there, because they’re designing products for the European Union. … It’s just simpler for them to put out one product versus two.”

In recent years, growing consumer demand for transparency in beauty products has led to the development of a “clean cosmetics industry” whose products make up about 13% of high-end sales, double the percentage four years ago, according to the market research company NPD Group.

Drug and department stores have also increasingly moved toward “clean” products. CVS in 2019 removed parabens, phthalates and chemicals that contain or can give off formaldehyde from its store-brand products.

Advocates argue that the state law will force all companies to provide transparency and consistency about what, exactly, is in the products consumers put on their hair and faces.

“In order to ensure and give assurance to the public that the worst of the worst stuff is out of cosmetics, we felt we really needed to standardize and to put that into statute,” Rusch said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


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LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity

Keith Myers has seen his fair share of change in Washington, D.C.

Since co-founding the business with his wife, Ginger, in 1994, Myers has helped lead LHC Group Inc. (Nasdaq: LHCG) through parts of five presidencies as chairman and CEO. A new administration with Joe Biden in the White House would make that six.

Although President Donald Trump has yet to formally concede due to his team’s ongoing legal challenges to the 2020 election, Myers’ roles at LHC Group and the Partnership for Quality Home Healthcare mean he must plan ahead for all outcomes. Since last year, he’s been working to make sure home health care maintains its rising position, regardless of the political landscape.

Home Health Care News sat down with Myers for an inside look at those policy efforts. In addition to the 2020 election, LHC Group’s top executive also touched on recent COVID-19 vaccine news, emerging post-acute care trends, the future of the Center for Medicare & Medicaid Innovation (CMMI) and more.

Highlights from HHCN’s conversation with Myers are below, edited for length and clarity.

HHCN: Looking back, what have the past four years meant for in-home care?

Myers: I think the data speaks for itself. Pre-COVID, we had a significant, measurable tailwind. Policy has been moving in our direction. I think that was influenced heavily by all the investments we’ve made in data-driven policy work in D.C., especially over the last decade.

When COVID happened, it took those tailwinds and put them on steroids.

We’re already going in the direction of shifting more care into the home. We’ve been able to bring that shift about thanks to the industry’s work, paired with the insights from Dobson DaVanzo & Associates and the others we’ve brought in as objective third parties. These groups have looked at the claims data, proving beyond a shadow of a doubt the efficacy of the home health benefit and our ability to create favorable outcomes at much lower costs.

Apart from demonstrating the value of home health care over the years, the industry has also been able to improve its standing with the U.S. Centers for Medicare & Medicaid Services (CMS). Providers have drastically lowered improper payments, for example.

I think back to the late 90s. There was a group of us — some of the original home health pioneers — who got together and decided to invest in data. We had the courage to invest in data to not only show where the opportunity was, but how we could improve. We looked at who the bad actors were.

Rather than the whole industry being viewed as problematic, we started holding those bad actors accountable. I think we gained a lot of credibility from that.

Those efforts helped CMS hone their skills on what to look at. They’re much more targeted now in their approaches, and I think that’s good for everyone.

Looking ahead, what are some of the things that might change? What could a potential Joe Biden administration mean for LHC Group and other in-home care providers?

Well, historically, Democrats have been more favorable to health care, generally. I think that is still true today. If we’re positioned with reliable data to give us a seat at the table going in, I think that’s important.

At the Partnership for Quality Home Healthcare, we started preparing for this potential outcome last year. LHC Group is represented by former U.S. Senator John Breaux, who is a former board member of ours. He’s still very active. I talk to Senator Breaux every other day.

We reached out and brought in former Senator Blanche Lincoln during the summer. We started orienting her specifically for this potential outcome. She’s at Lincoln Policy Group, as is Tom Scully, a former CMS administrator who also represents the Partnership. Another name is former U.S. Representative Joe Crowley. We’re working with him as well.

We have the right story. We have the right messengers, people who know President-Elect Biden and all the likely players who will be in his administration. I think we’ve positioned ourselves very well.

And we weren’t just planning for this outcome. We had strategies for both potential outcomes.

One of the things Biden has talked about is “Medicare at 60.” What would that mean for the home health industry?

The obvious impact is volume. Volume would be increased.

But I do believe we’re going to have a divided government, so I don’t expect to see anything too big happen. I don’t think we’re going to see anything transformative.

You’ve been in this business a long time. You and your wife, Ginger, started the business from your kitchen table. How disruptive is it when there’s an administration change?

It’s a great feeling to be able to say what I’m about to say — and mean it 100%. Today, I don’t think it’s that big of a deal. That’s because the data and the policy momentum are already on our side.

Back in the 1990s, we didn’t have much of a position. We just had, you know, some people who would support us. For me, that was folks like Senator Breaux and others. We were cobbling together data and support for home-based care, but we didn’t have overwhelming evidence gathered by independent, third-party experts like we do today.

This is going to be my sixth president. I’ve seen all the different political landscapes. I’ve seen a White House controlled by Democrats. I’ve seen Republicans having both the House and Senate. I’ve seen all the different combinations.

In our experience, the highest risk has been when one party controls both the House and Senate, never mind who’s in the White House. But listen, I think we have a favorable landscape right now. Yes, we have some Senate races that still make things very tight. But Democrats in the House are seeing their numbers go the wrong way, so it’s unlikely they’ll do anything way out there.

And Biden is largely considered a moderate, someone who works across the aisle, much like Senator Breaux did.

CMMI has tested out a number of alternative payment models over the past four years. Overall, it has launched 54 since its formation, with officials often citing the Home Health Value-Based Purchasing Model as one of the most successful. How has LHC Group performed under that?

We’ve performed well in the nine initial states where we’ve had the opportunity.

There’s also the Comprehensive Care for Joint Replacement (CJR) model. We’ve done significant work there with Ochsner and had great success. That has informed a lot of our strategies around skilled nursing facility (SNF) diversion and other efforts to move patients downstream. 

I would also point to our broader and deeper experience with accountable care organizations (ACOs). We’re very proud of that. We’ve really come a long way with ACOs. I’d say the two biggest levers we’re pulling in that regard are preventative measures and care management on the front end, then, when patients do need care, leveraging home health care to the greatest extent possible.

Would you support a nationwide expansion of the Home Health Value-Based Purchasing Model?

Yes. The details are always important, but given a choice between strict fee-for-service versus some sort of value-based purchasing, we’re always going to take the value-based option.

What do you think a Biden administration would mean for value-based care? Would it be more of the same — or would there be a drastic difference?

I haven’t seen any evidence or indicators where I’d say “drastically different.” I think Democrats tend to lean into provider-based care. They’re not as much in favor of Medicare Advantage as Republican administrations, in my view.

I’m a big believer that providers should have — if not full control — a more meaningful stake in the risk pool. I think some of the CMMI demonstrations support that. You get the best of both worlds when providers have that seat at the table. You get lower costs and quality outcomes.

Earlier this week, Biden’s transition team unveiled members of its COVID-19 task force. It includes Atul Gawande, a former FDA commissioner and several others, but no in-home care experts. What are your thoughts on that?

I think we’ve learned over the years that there are a lot of ways to influence the process without having somebody officially named to a particular position. We know this through our experience with the Medicare Payment Advisory Commission (MedPAC).

I think there are more people favorable to home-based care policy than one might think. But, sure, we’d love to have somebody on the task force who’s directly involved with the home health industry.

If you had to look in your crystal ball right now, what’s one prediction for home health, hospice and personal care moving forward?

I think care in the home, across the board, is going to be the “ask” of patients. It’s also going to be the very first inclination of referral sources.

In the past, home-based care hasn’t been an afterthought, but it wasn’t always at the top of the list. Let’s take SNFs, for example. In the past, if a patient qualified for SNF, then they would typically get referred to SNF. Referral sources would automatically think it was the safest route for them, from a risk perspective.

But now, they see the risks associated with going to an in-patient setting. I’ve seen patients, families and referral sources acknowledging that risk more than ever. They’re saying, “You can be cared for at home, if that’s what you want to do.”

That conversation is happening with discharge planners and referral sources everywhere. It’s happening at a level that we weren’t seeing pre-COVID. I don’t think we’re going to go backwards on that. It’s a new normal.

Pfizer and Moderna came out and said they’re very close on COVID-19 vaccines. Once those are ready to distribute, what role should home health providers play?

Well, it’s almost not fair for me to answer that. Of course I think home health workers should play a role. And we’re all familiar with the phrase “social distancing” now. What better place to bring the vaccine to people than in their homes? Why would you bring everyone to a centralized location for a vaccine?

I think our front-line workers and the people they care for, including the elderly, should also be among the first to receive a vaccine. I’d like to hear arguments against that.

What has you excited about 2021?

There’s a lot to be excited about. Having been in the industry as long as I have been, I don’t know if 20 years ago I really believed I would see the day with this much opportunity.

I couldn’t see it from where we were back then. We were just fighting for survival. To see this opportunity intersect with our preparation as an industry and our ability as individual providers to care for patients downstream, it’s incredible. It’s what dreams are made of.

I couldn’t be more excited for or proud of our industry. It puts some pep in my step and makes me want to keep doing this for a really long time.

The post LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity appeared first on Home Health Care News.

Perspectives: Home Health Insiders Sound Off on the 2020 Election

The ongoing expansion of Medicare Advantage (MA), a federal minimum-wage hike and additional support for front-line health care workers during the COVID-19 public health emergency.

These are just a few of the industry-shaping topics that home health insiders are following going into Election Day this Tuesday. While each presidential election is important, 2020 will help set the trajectory of U.S. health care policy for years to come.

No matter who wins between President Donald Trump and former Vice President Joe Biden, one thing is clear: In-home care gained a larger role in the overall continuum of care this year — and that momentum isn’t going away.

To get a deeper understanding of the 2020 election and what it means for home-based care operators, Home Health Care News reached out to several stakeholders for their perspective. Their responses are provided below, edited for length and clarity.

* * *

Regardless of who wins, the fundamentals for home health care remain the same. There is a growing need for more care and higher levels of care in the home. The pandemic has only accelerated this trend as family members eschew institutional care settings. Meanwhile, telemedicine and virtual care will play the dual role of supporting quality care in the home — particularly for patients who need fewer services — and blurring the lines of what is considered traditional home care.

As state Medicaid budgets tighten, care for dually eligible individuals who have chronic and long-term care needs will need to be addressed. These individuals account for 20% of Medicare and 15% of Medicaid enrollment, yet account for about a third of spending for each. In-home care and care management can play a critical role in improving outcomes while reducing the overall cost of care. However, the U.S. Centers for Medicare & Medicaid Services (CMS), Congress and state Medicaid programs will need to figure out the right models to integrate this care while figuring out who pays for what and who gets the savings.

Ensuring that home health agencies can fully participate in virtual care initiatives — including reimbursement for such services — and ensuring that dual eligible integrated care efforts fully value the impact of care in the home are two of our top priorities.

Marki Flannery, president & CEO of the Visiting Nurse Service of New York (VNSNY)

* * *

The health care industry experienced unprecedented strains this year, but we also made strides in many areas. At the highest level, we saw bipartisan cooperation in the time of crisis that led to solutions for those acutely impacted by the pandemic, from telehealth coverage to Paycheck Protection Program (PPP) loans.

Regardless of the 2020 election outcome, in 2021, we’re turning our focus to a few key areas based on lessons learned from the public health emergency. Further elevating home health care as a viable care alternative is crucial. Whether it was helping to divert the surge on hospitals or sending patients home to recuperate from the effects of the virus in order to free up ICU beds, home care really rose to the occasion.

While there has been an increased appreciation and awareness of the power of home health care, there is still an opportunity to elevate understanding around the need for better home care reimbursement rates, fueled by an authentic understanding of the tireless value skilled and direct care workers provide. We are also working towards ways to secure and drive more competitive pay so that the home health care industry can more effectively fill the labor demand needed to support Americans who want to heal and thrive safely at home. We are continuing to see how cost-effective and truly preferred the home setting is for seniors who desire to age in place safely and securely. We want to do everything in our power to make this option more accessible.

— Jennifer Sheets, president & CEO, Interim HealthCare

* * *

Regardless of the outcome of the election, the prospects for positive legislation impacting the home health sector in 2021 are promising. The new Congress will be interested in making policy changes to strengthen the Medicare program, examining the needs of the Medicare population and building off of lessons learned because of COVID-19. One of these lessons is that access to home health care for vulnerable populations can and should be optimized, particularly at times when the Medicare patient population is uniquely vulnerable. The home health community has developed policy solutions that offer Medicare beneficiaries a wider array of post-acute care options, including those that expand the availability of care at home.

Being able to “choose home” for more Medicare patients who need care, as an alternative to other institutional care, can not only ensure that high-quality clinical care is available to a wider Medicare population, but can also ensure safety and increased patient choice.

We have also seen that care in the home should be optimized through increased use of technology. The availability of telehealth should be expanded upon for Medicare home health patients, particularly in times when infection risk is high, as was the case during COVID-19. The Partnership believes that telehealth opportunities should be optimized to ensure continuity of care for our nation’s most vulnerable patients.

— Joanne Cunningham, executive director, Partnership for Quality Home Healthcare (PQHH)

* * *

​I’m hopeful that the current election will have a very positive impact on the home health industry going forward. That is because our industry has done a wonderful job over the years of advocating for our interests with a paramount emphasis on bipartisanship that is clearly evidenced in the recently introduced federal legislation calling for home health telehealth reimbursement during national emergencies.

In both the House and the Senate, these bills are being sponsored and supported by both Democrats and Republicans. That is extraordinarily significant. And coupled with the magnificent work our industry has done treating those in need during the current pandemic, the message has been communicated far and wide that our industry’s support spans the partisan political divide and is here to simply treat patients, clients and families with the health care services they need, when they need them, in the comfort, safety, security and familiarity of their homes.

— Dean Chalios, president & CEO, California Association for Health Services at Home (CAHSAH)

* * *

Home care and hospice have the advantage of being supported by both parties. As such, whatever the outcome of the election, we expect any health care reforms to embrace health care at home as the awareness of its value has grown significantly during the pandemic. Once the dust settles after the election, we are prepared to work with the incoming Congress and administration to further advance home care and hospice.

— William A. Dombi, president of the National Association for Home Care & Hospice (NAHC)

* * *

The outcome of the 2020 presidential election could greatly impact legislation, support, attention and funding for home health care workers and agencies. Additionally, if the non-chronic illness Medicare-eligibility age is reduced to age 60 vs. 65, that will be a tremendous game-changer for payers, providers, patients and the entire health care ecosystem.

— Cleamon Moorer, Jr., president & CEO, American Advantage Home Care Inc.

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Lack of Stimulus Bill Could Lead to Rise in COVID-Related Lawsuits

Throughout 2020, there have been a number of new laws and legal trends that could have major impacts on the in-home care industry. In order for providers to be successful in the long run, it’s important to remain abreast of the latest developments.

That was the message delivered by Angelo Spinola, an attorney and shareholder at Littler Mendelson, during this year’s National Association for Home Care & Hospice (NAHC) annual conference.

Among key legal developments, Spinola touched on the Families First Coronavirus Response Act (FFCRA), which creates paid leave — both sick leave and family medical leave — for employees who satisfy certain conditions.

When it comes to the FFCRA, the status of the health care provider exemption should be an area of interest to providers, according to Spinola.

When the law originally went into effect in April, the U.S. Department of Labor (DOL) created a broad exemption for health care providers.

“It certainly covered home health providers … and arguably covered most of the non-medical home care providers as well,” Spinola said. “What the [DOL] allowed companies to do, if you did meet the exemption, is exempt everybody within the entity, meaning it wasn’t specific to the employee. It’s whether the employer would qualify as a health care provider.”

Under the law, providers who qualified for the exemption could elect to not offer coverage to any of their employees, or they could offer partial coverage, such as paid sick leave, but not paid family medical leave.

“There were many home care agencies that were doing just that; they were offering the paid sick leave, but not the paid family medical leave,” Spinola said. “The reason for that decision is that companies were really concerned about losing caregivers for an extended period, for 12 weeks of time, because their children were out of school. [They were concerned about] not having anyone available to care for their clients.”

Recent rumblings in New York have caused confusion around what companies qualify for the exemption, however.

The state of New York issued a legal challenge to DOL regulations, effectively saying that the department exceeded its authority in making the health care provider exemption so broad.

Generally, the state of New York challenged four elements of the FFCRA regulations including the work availability requirement, the definition of health care provider, intermittent leave and the documentation requirement.

The state won on all grounds.

“What does this mean for you?” he said. “It means that if you were relying on a health care provider exemption to exclude coverage under the FFCRA, … there’s some risk to you for having relied on that exemption. You were relying on a broader exemption that has now been struck down.”

The DOL has since revised regulations, and providers need to determine whether their agency is subject to the FFCRA.

As far as other steps providers should take, it’s crucial to determine whether it’s in the company’s best interest to provide full or partial FFCRA benefits to all employees. Providers should also communicate with employees, as well as implement an arbitration program, according to Spinola.

Stimulus package, qualified immunity

The next coronavirus-related stimulus package remains top of mind for providers.

When it comes to advocacy initiatives, most providers had five key areas of focus.

These areas include increased pay for front-line workers to discourage many from going on unemployment, child care support for caregivers, priority access to personal protective equipment (PPE), qualified immunity and the creation of an “HCBS Direct Care Worker Fund.”

In May, House Democrats unveiled the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, a COVID-19 stimulus bill. The bill included most of the five industry initiatives except for qualified immunity.

Ultimately, the bill passed out of the house, but couldn’t pass in the Senate.

Another stimulus package, the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act, was introduced in July. Out of five industry initiatives, the bill only included paid child care and qualified immunity. The legislation failed to pass out of the Senate.

“The problem that we are seeing is there’s no movement right now,” Spinola said. “They’re $2.5 trillion apart. There are significant differences between the two acts.”

While it’s impossible to say what will happen, Spinola pointed to the state of the economy as an indicator of the future.

“I think that what might happen is directly tied to the state of the economy,” he said. “We saw the economy really tank. We saw record unemployment claims. …I think we are seeing now because the economy is starting to rebound, there’s less pressure on Congress to create this stimulus package.”

As the election draws closer, there will be less focus on the stimulus bill.

“That’s concerning because that means a lot of the things that we were hoping to accomplish, … we might not get,” Spinola added.

In particular, if qualified immunity doesn’t pass, it puts the industry in a very vulnerable spot for litigation.

Overall, there have been at least 792 COVID‐related labor and employment lawsuits filed against employers, and more than 2,000 general COVID‐related lawsuits. More than 10% of these cases include class-action claims.

“Not surprising that since COVID hit, we’ve seen an increase in related cases,” Spinola said. “Each month, the number gets higher and higher, and we’re going to continue to see this. Unfortunately, we are seeing it specifically in the health care space.”

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[Updated] Lawmakers Introduce New Bill Paving the Way for Home Health Telehealth Reimbursement

Home health providers are one step closer to getting the No. 1 thing they’ve been asking for since the COVID-19 pandemic began: reimbursement for telehealth-driven visits.

On Friday, U.S. Senators Susan Collins (R-Maine) and Ben Cardin (D-Md.) introduced the Home Health Emergency Access to Telehealth (HEAT) Act, a bipartisan bill to provide Medicare reimbursement for audio and video telehealth services furnished by home health agencies during the COVID-19 emergency.

U.S. Representatives Roger Marshall (R-Kan.), Terri Sewell (D-Ala.), Jodey Arrington (R-Texas) and Mike Thompson (D-Calif.) introduced similar legislation in the House.

“Home health serves a vital role in helping our nation’s seniors avoid more costly hospital visits and nursing home stays,” Sen. Collins, chairman of the Senate Aging Committee, said in a statement. “The COVID-19 emergency has further underscored the critical importance of home health services and highlighted how these agencies are able to use telehealth to provide skilled care to their patients.”

If finalized, the HEAT Act would pave the wave for home health telehealth reimbursement during the current pandemic as well as future public health emergencies, when appropriate. The newly introduced legislation outlines that services would not be reimbursed unless the beneficiary consents to receiving services via telehealth, however.

To ensure that the Medicare home health benefit does not become a telehealth-only benefit, Medicare reimbursement would only be provided if the telehealth services account for no more than half of the billable visits made during a 30-day payment period.

“I know firsthand the benefits of home health care,” Rep. Sewell said in a statement. “When my dad was left wheelchair-bound after a series of strokes, we were fortunate enough to find home health care from highly skilled and caring health care professionals right where he wanted to be — at home in Selma. As a passionate supporter of protecting home health services, I’m proud to introduce the bicameral and bipartisan [HEAT Act], which will ensure that home health providers have the resources necessary to protect patients in their homes and health care professionals during the duration of the COVID-19 pandemic.”

Overall, the utilization of telehealth services has exploded since the middle of March.

In fact, more than 34.5 million telehealth services were delivered in Medicare and other government programs from March through June, according to recently released data from the U.S. Centers for Medicare & Medicaid Services (CMS). That’s a more than 2,500% increased compared to the same period in 2019.

While home health providers have certainly been a part of that boom in Medicare, they’ve typically had to provide telehealth services out of their own pocket. As currently structured, the home health benefit does not include a pathway for paying for any types of visits not furnished directly in person.

Industry advocacy organizations LeadingAge, the National Association for Home Care & Hospice (NAHC), the Partnership for Quality Home Healthcare (PQHH) and others have been working toward the HEAT Act for months, often pushing for telehealth payment during the discussions before each of the COVID-19 relief measures that have been passed.

“Many of our home health members have been providing critical services without reimbursement during the pandemic,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “The HEAT Act would resolve this inequity and put our home health members on par with all other providers with regards to flexibility during this and future public health emergencies.”

In addition to her role at LeadingAge, Smith Sloan also serves as acting president and CEO of the Visiting Nurse Associations of America and ElevatingHOME.

William A. Dombi, president of NAHC, also applauded the newly introduced bill.

“From the early onset of the COVID-19 pandemic, it has been well known that limiting person-to-person contact is key in reducing transmission and infection rates,” Dombi said in a statement. “Enabling home health agencies to incorporate telehealth visits into the plan of care, with reimbursement, will unlock new means of safe care delivery bringing peace of mind to Medicare beneficiaries.”

This is a developing story. Please check back later for additional updates.

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NAHC Pushing for Palliative Care, SNF-at-Home Medicare Benefits

As home health and home care operators move toward the ninth month of the COVID-19 pandemic, it’s important to take stock of what has been accomplished from a policy perspective. Many of 2020’s regulatory changes will be fleeting, but others will shape the future of post-acute care for years to come.

That was the message delivered Monday by National Association for Home Care & Hospice (NAHC) President William A. Dombi during the nonprofit advocacy organization’s annual conference. In addition to providing a regulatory recap, Dombi hinted at new Medicare benefits on the horizon and explained how the value of home-based care is at an all-time high.

“There has been an increased awareness of the breadth and depth of care at home, and this will have a long-standing impact on policy and politics as well,” he said. “There has been an absolute, exponential increase in respect for what you do in the home care setting. We took the stresses of the pandemic head-on and proved that care in the home is not only essential but [the best option].”

During Monday’s Washington update, Dombi revealed that 67% of in-home care providers are serving COVID-19-positive patients.

To support them in delivering that care, providers have been able to lean on a variety of lifelines, including funds from the CARES Act Provider Relief Fund and the Paycheck Protection Program (PPP). Providers have also received essential-worker classification and greater telehealth flexibilities.

Additionally, the U.S. Centers for Medicare & Medicaid Services (CMS) has recognized that virtually the entire Medicare population meets homebound status requirements.

“When you’re Medicare eligible, over the age of 65 or on disability, and you need health care services, you have a compromised condition to put you at even greater risk of fatality,” Dombi said. “CMS agreed with our position on this and issued interpretive guidance indicating that individuals who need to leave the home for services, it is medically contraindicated, thereby meeting the homebound standard.”

During the public health emergency, CMS also paused claims audits and the Review Choice Demonstration (RCD), a regulatory initiative designed to reduce improper billing in home health care. That has since been restarted, with temporary administrative flexibilities.

COVID-19 testing, non-physician certification

At the end of September, the U.S. Department of Health & Human Services (HHS) announced that home health and hospice agencies would receive 10 million rapid COVID-19 tests from a federal inventory of about 150 million. Dombi likewise touted that as a win.

In the first week of distribution alone, he noted, about 160,000 tests were distributed to home health and hospice agencies.

“The fact that HHS recognized that home care was an essential part of health care services and made us part of that allocation in itself is a notable success,” Dombi said. “Just being recognized, not being considered some stepchild in health care.”

Among the other topics he touched on during his Washington update, NAHC’s president highlighted excitement around non-physician certification, something the home health industry had been working toward for years.

Senator Susan Collins (R-Maine) first introduced legislation that pushed for this change in 2007.

“We found ourselves in the middle of discussions, negotiations and advocacy with the CARES Act, and Senator Collins said, ‘I think this is our chance to get it done.’ [She] was able to convince the Senate that now is the time to allow non-physician practitioners to have equal status with physicians, to the extent that the state law allows it within the Medicare home health benefit,” Dombi said.

New Medicare benefits

Despite making major inroads across various fronts, there are still a number of measures that need to be taken.

For one, providers are still on the lookout for the next coronavirus-related stimulus package, which was originally expected before the July 4th Congressional recess, then again before the August recess.

“This is a back and forth that’s happening between the House and the Senate, between Republicans and Democrats,” Dombi said. “We’re still looking to see if we can have something before they go on recess in October, but we’re planning also for a lame-duck session on it.”

As far as what providers hoped to see in the next package, the list includes continued funding for the Provider Relief Fund, plus expanded funding for Medicaid home- and community-based services. The list also includes premium pay for front-line workers and litigation immunity.

Another area of focus for NAHC is palliative care. The organization is moving to get revisions in the Medicare coverage manual under home health care to fully recognize palliative care as one of the services provided as part of the existing benefit.

“We don’t think we need Congressional action to get there,” Dombi said. “Some of you — maybe many of you — are already doing things that would qualify as skilled palliative care under the benefit and getting Medicare to pay for it.”

Home health providers can also expect to see the 2021 payment rule finalized before the end of October or during the first few days of November. NAHC is calling on CMS to roll back the 4.36% behavioral adjustment in the Patient Driven Groupings Model (PDGM) ahead of the announcement of the final rule.

“It’s not just because we are in this unprecedented year of COVID-19,” Dombi said. “CMS projected a decrease in [Low Utilization Payment Adjustments], as they thought home health agencies would try to maximize 30-day episodic reimbursement. We have seen just the opposite of that, partially influenced, of course, by COVID-19.”

Additionally, NAHC is pushing for the creation of a new benefit that will allow for a skilled nursing facility (SNF) level of care at home.

“We have designed a [SNF-at-home] benefit to give individuals on the Medicare program the option of going home with expanded services,” Dombi said. “We think the design will work to be a win for the Medicare program as well. It’s been proven that you can provide less costly and high-quality care at home.”

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CMS Announces New, More Provider-Friendly Rules for Advanced and Accelerated Loan Repayment

The U.S. Centers for Medicare & Medicaid Services (CMS) announced amended terms Thursday for accelerated and advanced payments granted to Medicare-certified health care providers — including home health agencies — during the public health emergency.

Under the new “Continuing Appropriations Act” of 2021 and “Other Extensions Act,” repayment for providers will now begin one year after the advanced or accelerated payments were received.

The accelerated and advanced payment program was expanded in late March, meaning that providers would have been required to make payments starting in August, but when August came around, providers were not forced to begin paying back the money distributed to them.

Now, repayment will officially be delayed until one year after the payments were issued.

“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” CMS Administrator Seema Verma said in a press release. “CMS’s advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal.”

In total, CMS has issued over $106 billion in payments to providers dealing with financial hardship and cash flow issues tied to COVID-19. CMS’s advanced and accelerated payment programs are generally granted to providers that, for example, are in an areas experiencing a natural disaster.

The distribution this time around, however, was one of the broadest — if not the broadest — distributions of upfront cash in the history of the program.

After the first year, there will be a tiered approach to a reimbursement cut-off, depending on how long providers take to pay back the money. That cut-off will range from just 25% of a provider’s reimbursement being cut off to 50%.

For instance, Medicare will automatically recoup 25% of Medicare payments that would usually be distributed to the provider for eleven months. Once that eleven-month period passes, recoupment will increase to 50% for the following six months.

If the home health provider is still unable to repay the total amount of the accelerated or advanced payments they received during that 29-month time period, CMS will issue letters requiring repayment of any outstanding balance, which will be subject to a 4% interest rate.

This means that providers will not only be gaining significantly more time to pay CMS back, but they will also be subject to a far lower interest rate if they are unable to repay in the designated time period. Usually, the interest rate would be closer to 10%. 

“This makes real accommodations for providers,” Judy Waltz, a partner at Milwaukee, Wisconsin-based law firm Foley & Lardner LLP, told Home Health Care News in September when the now-official CMS changes became a possibility. “Overall, the burden on providers is much, much more bearable.”

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HHS Adds $20B to Provider Relief Fund for Home Health Agencies, Others

The federal government announced Thursday that the Provider Relief Fund will be replenished with a tranche of $20 billion.

Unlike some of the previous rounds of relief, home health providers and others will have to apply for funding. The U.S. Department of Health and Human Services (HHS) will begin accepting applications from providers on Oct. 5, marking the start of the third phase of the fund.

The Provider Relief Fund has sent out over $100 billion to health care providers during the COVID-19 crisis. In addition to home health providers, the fund has helped support skilled nursing facilities (SNFs), hospitals, assisted living operators and even some behavioral health organizations.

“HHS has worked to ensure that all American health care providers receive support from the Provider Relief Fund in a fast and fair way, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus,” HHS Secretary Alex Azar said in a statement. “We’ve worked with all of the resources we have across HHS to ensure that America’s heroic health care providers know they can apply for support.”

Under the Phase 3 stage, providers that have already received funding and those that have denied it in the past are able to apply to help cover losses tied to the COVID-19 virus. Unlike previous rounds based on past years’ financial data, home health providers that began operating in 2020 — from January to March of this year — are eligible to apply for relief.

“We are very pleased that HHS has established a new distribution to support those health care providers that have been especially impacted by COVID-19,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News in an email.

Although more funding for home health providers is helpful, Dombi also added that he believed it was time for non-Medicare-certified home care providers to receive some sort of relief. To date, those providers have not received any official federal funding outside of the Paycheck Protection Program (PPP).

Policymakers don’t have to search too far to find a precedent for supporting non-medical, private-pay home care businesses. HHS announced in September that private-pay assisted living operators were eligible for funding under the Provider Relief Fund Phase 2 General Distribution.

“It would also be essential that HHS open a distribution to the crucial home care providers that do not provide Medicare or Medicaid services,” Dombi said. “Those home care providers serve highly vulnerable populations of the elderly and persons with disabilities. We have made repeated requests to include those home care providers in the distributions.”

The application window for the latest tranche of funding closes on Nov. 6 — and the money is likely to go fast. That’s why the government is urging needy providers to apply as soon as possible.

“We know providers want to receive payments shortly after submitting their information. However, this distribution requires cooperation on the part of all applicants,” HHS wrote in an online announcement. “Again, HHS is urging all eligible providers to apply early; do not wait until the last day or week of the application period. Applying early will help to expedite HHS’s review process and payment calculations, and ultimately accelerate the distribution of all payments.”

NAHC has also expressed concerns about the standards by which providers can apply for funding. Some of the unclear qualifications for federal funding have scared off providers or hindered their ability to get assistance in the first place.

“HHS must address the problems created by its recent change to the standards for what ‘lost revenues’ are covered by the fund,” Dombi said. “We have been partnering with HHS on this important relief for months, but still need these remaining areas to be resolved soon.”

HHS also began sending COVID-19 tests from Abbott to home health agencies this week. Over 10 million tests have been allotted for home health and hospice agencies, and providers have reportedly begun receiving them.

Over 258,000 tests are scheduled to go out between home health and hospice providers this week, a HHS spokesperson told HHCN.

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Congressman Vern Buchanan Urges CMS to Scrap PDGM’s 4.36% Behavioral Adjustment

In August, the Partnership for Quality Home Healthcare (PQHH) unveiled a first-of-its kind, comprehensive analysis of the Patient-Driven Groupings Model (PDGM).

Among its findings, the analysis — conducted by health economics and policy consulting firm Dobson DaVanzo & Associates — highlighted how government spending on home health care is 21.6% lower than what the U.S. Centers for Medicare & Medicaid Services (CMS) projected going into 2020. The cause of that discrepancy: PDGM’s behavioral adjustment, which the home health industry has largely opposed since early drafts of the payment overhaul. 

It appears the analysis has done its job in attracting attention to PDGM’s potential flaws.

U.S. Representative Vern Buchanan, a Republican from Florida, has sent a letter to CMS Administrator Seema Verma voicing his concerns about PDGM. Buchanan had previously co-sponsored legislation that, if passed, would have restricted CMS from making assumption-based rate reductions rooted in what it believes providers may or may not do.

The Dobson DaVanzo & Associates analysis showing a drop in home health spending was based on Medicare claims data from the first four months of PDGM. In his letter, Buchanan notes that many of the factors contributing to the spending decrease have continued since.

The Bipartisan Budget Act of 2018 requires PDGM to be budget neutral.

“With these current trends continuing, Medicare home health spending will be well short of the required budget-neutral level, as outlined by Congress,” Buchanan stated.

Specifically, home health spending is down because at least two of the three PDGM assumptions made by CMS have not played out.

According to the Dobson DaVanzo & Associates analysis, home health agencies aren’t “upcoding” by choosing the primary-diagnosis code tied to the most reimbursement dollars. 

Additionally, agencies have been hit with far more Low Utilization Payment Adjustments (LUPAs) than CMS projected.

In the first four months of the year when home health agencies were adjusting to PDGM, the national LUPA rate was 24.4% — with an all-time high of 28.7% in March.

Citing the uncertainty of the COVID-19 pandemic, CMS released its 2021 proposed home health payment rule in June with basically no changes to PDGM’s framework. The agency normally releases its final payment rule for the upcoming year at the end of October.

“I urge CMS to carefully consider the data submitted by commenters and to re-evaluate the assumptions used as the basis of the 4.36% rate reduction made in last year’s rule and proposed again for 2021,” Rep. Buchanan added. “CMS should take a data-based approach to its 2021 rulemaking responsibilities and move away from earlier theoretical assumptions and projections in favor of relying on actual provider experience.”

Senators Susan Collins (R-Maine) and Debbie Stabenow (D-Mich.) have also previously taken aim at PDGM’s built-in behavioral adjustment. Rep. Terri Sewell (D-Ala.) has joined Buchanan on the House side.

A Washington, D.C.-based home health advocacy organization, PQHH was quick to praise Buchanan for his continued support of the industry.

“The Partnership thanks Congressman Buchanan for his leadership on this issue and continued support of issues impacting the delivery of Medicare home health to American seniors,” Joanne Cunningham, the organization’s executive director, said in a statement. “Congressman Buchanan is a long-standing supporter of the home health community, and we echo his request that CMS discard any previous theoretical assumptions and projections of providers’ behavioral response to PDGM, and remove the -4.36% behavioral adjustment for CY 2021.”

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Senior Care Stakeholders: Latest COVID-19 Relief Proposal Is ‘Shameful,’ ‘Anemic’

Senate Republicans are close to unveiling their latest version of another coronavirus relief bill, with reports suggesting party leaders may do so Wednesday or soon thereafter.

The proposal — first obtained by Washington, D.C.-based newsroom Roll Call — is viewed as a “skinny” version of the previously released HEALS Act from July. Among its provisions, the Republican plan seeks to provide $300 in weekly unemployment insurance, additional money for coronavirus testing and another $158 billion for the Paycheck Protection Program (PPP), which closed for applications on Aug. 8.

Of note for home health providers and other organizations operating in the long-term and post-acute care spaces, the skinny bill appears to do little to alleviate financial and workforce hardships triggered by the public health emergency. In turn, it offers “no real relief” to the older Americans such providers serve, according to Katie Smith Sloan, president and CEO of the national aging services advocacy group LeadingAge.

“When eight out of 10 COVID deaths are among people 65 and older, and infections in nursing homes are breaking new records, it’s shameful to largely ignore the continued deaths and escalating danger to older adults,” Sloan said in a statement Wednesday.

To some extent, a drop in federal unemployment from $600 to $300 per week could lessen the number of in-home care workers opting out of their jobs during the ongoing crisis due to safety concerns. Those anxieties have contributed to some home health and home care agencies losing several workers over the past few months, despite the fact unemployment rates remain high.

Additionally, a reopening of PPP — with the program stocked with fresh funding on top of leftover funds — would likely go a long way in supporting small and mid-sized home-based care businesses.

Overall, more than 15,000 home-based care entities received PPP loans of less than $150,000 under PPP, according to a review of federal data conducted by Home Health Care News. More than 7,400 entities have received loans at or above $150,000, with dozens receiving loans in the $5 million-to-$10 million range.

“For those Interim HealthCare owners who applied and received funding, the PPP loan allowed them to ensure their teams of home health aides, nurses and other staff members could continue to serve their patients, safely in the comfort of their own homes by front-line staff who had access to the right resources, including proper personal protective equipment (PPE),” Jennifer Sheets, president and CEO of Interim HealthCare Inc., told HHCN in an email.

The Republic plan would also allow for a “second draw” on PPP for eligible businesses that have suffered a 35% revenue loss over a designated period, Roll Call reported.

Beyond those provisions, the plan would allocate a total of $16 billion to support COVID-19 testing and contract tracing. But aging services providers alone need at least $10 billion in testing aid, according to LeadingAge.

That’s especially true for long-term care hospitals (LTCHs), in-patient rehabilitation facilities (IRFs) and others, as testing is directly tied to Medicare payments. New guidance from the U.S. Centers for Medicare & Medicaid Services (CMS) says that such providers who want to get paid for treating COVID-19 patients must include a positive test in that patient’s medical record.

“This isn’t just skinny,” Sloan said. “It’s anemic.”

Moving forward, LeadingAge argues, the “continuum of aging services providers” — home health and home care agencies included — need more PPE, testing supplies and funding to cover “hero pay” for front-line workers, among other measures.

Gary Anderson, CEO of Lutheran Senior Services, echoed that call to action. St. Louis, Missouri-based Lutheran Senior Services is a provider of retirement communities, home- and community-based services and affordable housing.

“COVID has made this the most difficult year in our 160-year history,” Anderson said in a statement. “In the early days of the crisis, we lacked the necessary PPE and vendors did not have the inventory to supply us. It’s still hard to locate PPE — and we are spending tenfold on what we can afford.”

Across the organization, Lutheran Senior Services is on track to spend over $1.5 million on testing alone.

Assisted living communities have been hit particularly hard by the COVID-19 emergency and a lack of federal action.

In a survey of 193 U.S. assisted living providers conducted this month by the National Center for Assisted Living (NCAL), half said they were currently operating at a loss. Another 64% of assisted living providers said they won’t be able to sustain operations another year at the current pace of increased costs and revenue loss.

LeadingAge is not the only aging services advocacy organization to call for more federal support.

The Partnership for Medicaid Home-Based Care (PMHC), for example, is urging Congress to create a fund to help pay direct care workers higher wages during the public health emergency. The National Association for Home Care & Hospice (NAHC) has likewise called for more telehealth assistance, while the Partnership for Quality Home Healthcare (PQHH) is seeking an immediate pause to the Review Choice Demonstration (RCD).

The new “skinny” proposal is expected to cost about half as much as the previous $1 trillion COVID-19 relief legislation, according to The Wall Street Journal. Still, that price tag may be too high for some Republicans.

Meanwhile, House Democrats initially floated a $3.5 trillion plan of their own, though they signaled they’d be open to shaving that by about $1 trillion.

Roll Call noted the proposal text it obtained is subject to change.

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Dozens of Home-Based Care Businesses Have Received PPP Loans of $5M+

Since funds became available, in-home care businesses across the U.S. have received more than $666.36 million in loans of under $150,000 via the Paycheck Protection Program (PPP), a July Home Health Care News review of federal data found.

They have received hundreds of millions of dollars in large PPP loans at or above $150,000 as well, a new follow-up analysis reveals.

Created by the CARES Act, PPP is a potentially forgivable loan program designed to keep small and mid-sized businesses afloat during the economic fallout triggered by the COVID-19 virus. As of Aug. 3, more than 5 million PPP loans have been approved, adding up to more than $521 billion, according to the Small Business Administration (SBA).

Home health and home care providers have, in some instances, turned to PPP to overcome sudden dips in business due to patients and clients refusing service.

Some providers have additionally used PPP funds to better retain workers by financing bonuses, hazard pay and other compensation initiatives.

“With the help of PPP and other smart financial readiness and resources, Interim HealthCare operators have been able to continue paying [their] essential employees on the front lines,” Jennifer Sheets, president and CEO of Interim HealthCare Inc., told HHCN in an email. “It has allowed owners to expand their reach so home care continues to be a vital resource and strategic weapon to battle this public health emergency and to support more people in their local communities across the 41 states we collectively serve.”

Sunrise, Florida-based Interim HealthCare is a diverse home-based care franchise company with hundreds of locations across the U.S.

Combined, businesses delivering some form of in-home care have received more than 7,400 individual PPP loans at or above $150,000, HHCN’s follow-up analysis found. Those loans range from a minimum of $150,000 to a maximum of $10 million.

The amount any small business is eligible to borrow is 250% of its average monthly payroll expenses, up to a total of $10 million.

Congress mainly designed PPP as a way for companies to keep workers on payroll, but it has also been a valuable tool for paying for costly medical supplies during the COVID-19 crisis.

“We continue to see the need for full loan forgiveness for franchise owners, as other expenses during COVID-19, such as PPE, have been very challenging,” Sheets said.

While the bulk of PPP recipients are part of standalone corporations or independent businesses, many individual franchise locations also received support.

More than a dozen Interim HealthCare locations received PPP support to help with the operational challenges of COVID-19, for example.

“As COVID-19 cases began to rise across the country and hospitals experienced a surge in patients, the need for home health care became more important than ever,” Sheets said. “For those Interim HealthCare owners who applied and received funding, the PPP loan allowed them to ensure their teams of home health aides, nurses and other staff members could continue to serve their patients, safely in the comfort of their own homes by front-line staff who had access to the right resources, including proper personal protective equipment (PPE).”

Franchise locations from Right at Home, Senior Helpers, ComForCare and several other major home care franchisers also received PPP support, federal data shows.

The different ranges

To analyze PPP data, HHCN used NAICS code 621610, which includes “establishments primarily engaged in providing skilled nursing services in the home” and a range of other in-home care entities.

In addition to home health and home care agencies, the code includes hospice providers, companies that deliver in-home therapy services and others.

In the PPP loan category of “at or above $150,000,” most in-home care businesses applied for loans in the range of $150,000 to $350,000. In fact, of the more than 7,400 large PPP loans issued to in-home care businesses, more than half were within that range.

About one-third of in-home care businesses that applied for large PPP loans were in the $350,000-to-$1 million range, HHCN’s analysis shows. Slightly more than 12% applied for loans that checked in somewhere between $1 million and $5 million.

A total of 63 in-home care businesses linked to NAICS code 621610 were issued PPP loans in the $5 million-to-$10 million range.

Examples include Nizhoni Health, a Massachusetts-based home health provider that specializes in patients with acute mental illnesses, along with California-based Mission Healthcare, which recently launched an innovative palliative care program meant to keep vulnerable populations “out of no man’s land.”

The data analyzed by HHCN did not provide specific amounts secured by each PPP recipient.

Geographic breakdown

Current law dictated that the Paycheck Protection Program close at the end of Aug. 8. As such, SBA is no longer accepting PPP applications from participating lenders.

When PPP did close, it did so with more than $130 billion in unused funds left on the table. Depending on what Congress does in terms of passing another federal stimulus package, it’s entirely possible that more PPP support is on the way, however.

Overall, about 51 million jobs were saved due to PPP, according to government statistics. S&P Global estimates that number is actually closer to 13.6 million.

When it comes to where PPP funding is going, in-home care companies in Texas received the highest number of large loans, followed by in-home care entities in California and Pennsylvania.

General corporations, limited liability companies and Subchapter S corporations received more than 90% of all large PPP loans that went to in-home care companies. Nonprofit organizations received about 5% of large PPP loans, with sole proprietorships receiving less than 2%.

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Assisted Living Facilities Still Restricting Home Health Providers

Home health providers have been on the front lines of the COVID-19 crisis since its outset, yet a primary concern remains being left behind by legislators, whether that’s on a state or federal level.

Reimbursement for telehealth services is still on the forefront of everyone’s minds. But there are less-covered issues that haunt providers as they continue to deal with the ongoing public health emergency, too.

There are still severe restrictions on access to patients in facilities, for example. Additionally, the existing nursing shortage has only grown worse.

The main concerns moving forward will continue to be taking care of patients and dealing with the challenges of COVID-19 and the Patient Driven Groupings Model (PDGM). But advocating on behalf of the home health industry cannot stop in the meantime, Dr. Steve Landers, the president and CEO of Visiting Nurse Association Health Group Inc., said on a Wednesday webinar hosted by Blacktree Healthcare Consulting

“I think we’ve got to stay really front and center on [telehealth] and not get left behind,” Landers said. “Because other people are going to be providing telehealth into the home and into the community. That’s going to be a part of the delivery system going forward. And I think we in [home health] should be the leaders.”

VNA Health Group is one of the largest independent, nonprofit providers of home-based health services in New Jersey, northeast Ohio and southeast Florida. Headquartered in New Jersey — a part of an area the virus wreaked havoc on early — the provider had already cared for nearly 650 COVID-19 patients by the end of May, Landers told Home Health Care News.

Amid the pandemic, hospitals have been granted the ability to bill for outpatient remote services in the home, yet home health providers are still not able to do so.

There is also a mounting concern over new, restrictive immigration laws that could affect the nursing workforce in home health, Landers said.

“It’s not been a hot topic, but I’d love to see more done for the nursing workforce,” Landers said. “Our nursing schools are turning away tens of thousands of qualified applicants every year because they don’t have capacity to take them on. And on the other end, we’re losing more nurses every year than we’re putting in, … and now we’ve restricted immigration. We’ve got a big nursing challenge, and I personally would like to see some government intervention on expanding training for nurses.”

An additional hurdle in the past has been that nursing programs had prioritized institutional settings, which led students to believe that hospitals and specifically emergency rooms were the be-all and end-all.

Industry insiders are hoping that stigma changes with care moving further into the home during COVID-19 and better home health education becoming more ubiquitous.

“[There was always] this mindset that you had to have all this acute care experience before you can be successful in the home,” Mary Gibbons Myers, president and CEO of Johns Hopkins Home Care Group and president of Home & Community-Based Services for Johns Hopkins Health System, told HHCN in May. “But what we’ve been thinking over the last couple years is that we really need to go upstream and look at the institutional or the educational setting, making sure that the curriculum is changed so that instead of focusing people on critical care and hospital settings, [we’re looking] at the entire continuum of care … .”

One measure that was applauded at the beginning of COVID-19 in some circles, but has since become problematic, is the isolation of home health workers from institutional settings over the last five months.

That’s put the patients at an even further risk at times, Brent Korte, chief home care officer at EvergreenHealth, also said on the webinar.

“[We’ve been trying to] fight back to make sure that we have access to assisted living facilities and skilled nursing facilities,” Korte said.

EvergreenHealth was one of the first providers in the entire country to be hit by COVID-19 in the U.S., way back in February. Based just outside of Seattle, it is one of the largest home health and hospice providers in the Pacific Northwest.

The not-for-profit provides about 250,000 visits per year and is affiliated with a local hospital system.

A few months ago, when EvergreenHealth was blocked from seeing a patient to check on wounds, she eventually developed a stage-4 tunneling cubitus ulcer that led to her death.

“There can obviously be a very negative impact from not being able to see patients,” Korte said.

The cutoff from facilities has also had other negative impacts as well, such as staggering declines in mental health for isolated seniors unable to see their families.

New legislation decisions — or lack thereof — are bound to be a topic throughout the COVID-19 crisis, including whenever a new stimulus package is agreed upon. For home health providers, each one could mean the world.

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Amid COVID Chaos, California Legislators Fight for Major Health Care Bills

California lawmakers are barreling toward an end-of-month deadline to pass or kill bills amid the biggest public health crisis the state has faced in a century.

Yet even in a year consumed by sickness, they’re considering significant — sometimes controversial — health policy measures that aren’t directly related to COVID-19.

Much of this legislation predates the pandemic, having lacked the support to win approval in previous years. Now, the bills are making significant progress because they underwent rigorous vetting in the past. That puts them steps ahead in a year with little time for deliberation or debate.

They include bills to ban the sale of flavored tobacco products, such as menthol cigarettes and vaping liquids; allow California to develop its own brand of generic drugs; enhance the state attorney general’s power to reject hospital mergers; and allow nurse practitioners to practice independently.

“Some of these bills, which have pretty far-reaching effects, may just sweep through because [lawmakers are] trying to get out of here by the end of August,” said Garry South, a Democratic political strategist.

The California legislature has had a bizarre year. Lawmakers left town abruptly in March to comply with lockdown orders and then again in July when some Assembly members tested positive for COVID-19, cutting the legislative session short.

The reduced time means most policy committees scheduled fewer hearings in the last weeks of the session to debate bills. Because of COVID-19 restrictions, most witnesses are giving testimony over the phone and in video conferences, lawmakers are unable to have informal meetings in the hallways, and advocates have less opportunity to lobby officials.

Lawmakers face an Aug. 31 deadline to send bills to Gov. Gavin Newsom, who has until the end of September to sign or veto them.

Given the shortened time frame for voting and deliberation, legislative leaders repeatedly asked committee chairs and members of their houses to reduce their legislative load, focusing on the most pressing challenges, like COVID-19 and wildfires. Despite those directives, most officials acknowledge a need to address more than those issues this year.

“We have the capacity to do many different things, and there are many things we must tend to in this state,” Newsom said at a press conference in late July. “I look forward to signing many bills that the legislature sends down.”

Passage is not guaranteed in the last three chaotic weeks of the legislative session, but the following major health care bills have made it through one house of the legislature and are working their way through committees in the second chamber.

  • SB-977 would give the attorney general new authority to regulate and potentially deny mergers between large for-profit hospitals, private equity firms and physicians’ groups. Attorney General Xavier Becerra has been working on this legislation for years in the face of strong opposition from hospitals.
  • SB-793 is an enormously controversial bill that would go beyond the recent federal ban on flavors in vape cartridges, which excludes menthol and tobacco flavors. This measure would ban the sale of most flavored tobacco products statewide, including menthol cigarettes, an idea that has died and been resurrected in many forms in both the Senate and Assembly.
  • AB-890 represents another long-standing Capitol feud, with the powerful doctor lobby opposing. The measure would allow nurse practitioners — nurses with advanced degrees and training — to practice medicine in some cases without oversight from a physician.
  • SB-852 would establish a state office that would contract with drug manufacturers to produce or distribute low-cost generic drugs in California. Newsom floated the idea in January.

It’s not an accident that such weighty bills are the ones left standing after legislators were asked to slash their portfolio of bills this year, said Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee.

When Pan culled the bills his committee would consider, he eliminated measures with unresolved questions, he said, because administration officials dealing with the pandemic were less available to testify as witnesses and lawmakers were unable to work closely with one another in the Capitol.

“Is this something that needs to be done this year?” Pan said he asked himself.

That means many of the bills moving through his committee and other policy committees are largely the ones that have been scrutinized in previous years, Pan said.

“We spent a lot of time working through those issues and trying to get those all resolved for the committee,” Pan added.

But South warned that even legislation that has been heard in the past deserves the full debate and deliberation that would take place in a typical year.

“I don’t think the process is set up this year to be passing major legislation that affects major sections of society without adequate input from stakeholders and the general public,” he said.

Some lawmakers are keeping other measures alive by using the pandemic to sharpen pitches for their pre-COVID bills, with the refrain “Now more than ever.” Sure, the bill was important when it was introduced in February, they argue, but “now more than ever” it really has to pass.

“You’ve got legislators not used to having so many of their bills threatened,” said Rob Stutzman, a Republican political consultant. “It’s not surprising they’d be trying to adapt their proposals to the narrowed purview of this session, which is obviously COVID-related.”

Sen. Jerry Hill (D-San Mateo), author of the tobacco flavor bill, is employing this tactic.

“I know we’ve all had to reassess our priorities,” Hill said at an Assembly committee hearing. “Yet emerging evidence about smoking and COVID-19 suggests smoking can put people at greater risk.”

Another example of the “Now more than ever” trend is SB-855, a “mental health parity” bill that would strengthen requirements for private health insurance to cover medically necessary treatment for mental illnesses.

“Even before COVID, mental health and addiction were major crises in this country,” but the pandemic is making the crises worse, the bill’s author, Sen. Scott Wiener (D-San Francisco), said at a press conference last week. “People who were stable with their mental health are now losing stability.”

That’s not to say using COVID-19 as justification to pass a bill is just a gimmick; some problems really have gotten worse since the start of the pandemic, said Larry Levitt, executive vice president of health policy at KFF. (KHN, which produces California Healthline, is an editorially independent program of the Kaiser Family Foundation.)

“Mental health is a perfect example of the pandemic exacerbating problems that were already there,” he said.

Wiener’s measure has survived the Senate and several committees, but other lawmakers haven’t seen the same success.

Assembly member Adrin Nazarian (D-Van Nuys) lobbied hard for AB-2203, which would have capped out-of-pocket payments for insulin. Nazarian pointed to a study from the Centers for Disease Control and Prevention that showed 40% of people who died of COVID-19 had diabetes.

His bill sailed through the Assembly but wasn’t given a hearing in the Senate. He said he followed directions from leadership to reduce the number of bills he was carrying, paring them down from about 25 to fewer than 10.

“Without a pandemic, this was a straightforward bill that would protect consumers and curb health care costs,” Nazarian said. “I’m extremely upset and frustrated about this.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


This story can be republished for free (details).

New Court Ruling Creating ‘Tremendous Amount of Confusion’ Over Paid Leave in Home Care

After a Monday ruling regarding the Families First Coronavirus Response Act (FFCRA), many home-based care agencies are no longer considered health care providers, meaning they’ll now be forced to abide by robust federal paid-time-off mandates.

“There’s a tremendous amount of confusion [over this], and I think that a lot of providers do not understand what the impact of this decision is — and what it means,” Angelo Spinola, an attorney and shareholder at law firm Littler Mendelson, said on an emergency webinar addressing the ruling Thursday.

The ruling, which was made by the Southern District of New York, found that the U.S. Department of Labor (DOL) was too broad in its original definition of “health care providers” and, therefore, exempted too many businesses from FFCRA’s rules.

Home-based care providers had lobbied hard for exempt status, citing their essential role keeping people safely at home and out of hospitals.

FFCRA rules order any company with under 500 employees to allow paid sick leave and paid family leave to an employee who has been struck by COVID-19 or has a family member fallen ill. Rules also apply to those who have a child out of school due to the virus.

That required paid time off can reach up to as much as 12 weeks. Home-based care providers — formerly exempt — may now have to not only abide by FFCRA moving forward, but also pay for not doing so in the past.

Now that the DOL’s definition has been voided, the new definition has officially been law since March 1.

“[A great deal of providers] will no longer be able to utilize — at least as of today — the health care provider exemption,” Spinola said. “That’s irrespective of what kind of employees — caregivers or office staff. That’s the major takeaway.”

Right now, it would appear that this ruling would only affect New York and potentially Connecticut, but Spinola says that’s not necessarily the case.

“[Will it affect providers] outside of New York? The answer to that is not crystal clear,” Spinola said. “It’s not 100% certain, but I will tell you that it is most likely that it does. And from our perspective, you should take the position that it does apply to you.”

The current exemption list for businesses includes: doctors, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, nurse practitioners, midwives, clinical social workers and physician assistants. Additionally, individuals who can certify the existence of a serious health condition under the Family and Medical Leave Act (FMLA).

“Those are the people that would now be defined as health care providers, so that’s not home health. For the most part, that’s not non-medical home care,” Spinola said. “That’s not home health aides, personal attendants, CNAs — none of those positions would qualify as a health care provider. What does that mean? That means that if you as an organization would qualify for FFCRA coverage, you can’t exempt yourself anymore.”

What can be done

The question moving forward is whether anything can be done to rectify the decision in New York.

The two best chances would be an appeal from the U.S. Department of Justice (DOJ) or a revised definition to come about, possibly from the state of New York.

Waiting on an appeal is risky, Spinola said.

A revised definition is more likely, but that would require some help from the DOL.

“Hopefully the DOL will do this, but they’ve got a lot of fish to fry right now, including dealing with unemployment and all these other issues,” Spinola said. “It’s going to take an effort to make that happen. But it is a possibility.”

A revised definition to include more home-based care providers would help, but there would still need to be additional legwork put in to retroactively change the definition so providers wouldn’t be punished from the time from March to August.

If providers don’t abide by the FFCRA and are no longer deemed a health care provider, that could be ruled a minimum wage violation. An employee could file a private suit for back pay and a civil monetary penalty of over $2,000 could be applied, among other fines.

An employee could also file a suit if an agency fails or failed to provide proper family leave.

What providers can do

There’s a lot that providers can do for themselves, William Vail, special counsel at Littler, said on the webinar.

“First off, put a poster in place. Second off, get a policy in place. Third off, have some forms in place,” Vail said. “And most importantly, arbitration agreements — have those in place. Those are great ways to limit any sort of liability that you may have because you didn’t quite exactly do everything right.”

Providers can also tell their employees the situation and explain that they reserve the right to take away the benefits from the FFCRA if something changes.

“Explain that you know that the health care provider exemption may apply, but that you’re choosing to provide benefits,” Spinola said. “And that if the law changes at a later point in time, you reserve the right to revoke the benefits.”

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With Stimulus Deadline Nearing, Home-Based Care Industry Scrambles to Secure Additional Relief

Friday is the deadline set by House Democrats and Senate Republicans for agreeing to a new coronavirus stimulus package. Home-based care stakeholders have had ample time to review the publicly released details from both parties’ plans — and they have a wishlist of additional provisions they’re still hoping to see.

One of the central pain points sparking disagreement between Democrats and Republicans in the next stimulus package is unemployment benefits.

Previously, individuals who lost their jobs during the public health emergency could receive $600 per week from the federal government, in addition to any state-level benefits.

In many cases, those benefits outpace what home-based care agencies are able to pay their workers.

“The unemployment accelerated benefits definitely have been a challenge,” Jennifer Sheets, the CEO of Interim HealthCare Inc., told HHCN in June. “Early on, we had struggled even with some front-line workers asking to be laid off or let go, which makes you scratch your head and say, ‘How does this make sense?’”

Sunrise, Florida-based Interim HealthCare offers a wide variety of in-home care services, with nearly 300 locations across the U.S.

Part of the Republicans’ proposed HEALS Act has been re-employment bonuses for those who willingly go back to work. Republicans also pitched tax credits for businesses that employ those people.

Additionally, the Republicans’ proposed HEALS Act would cap federal unemployment benefits to $200 weekly until at least October, or cap payouts to 70% of an individual’s previous income.

July 31 marked the end of the CARES Act’s $600 weekly benefit.

In a recent SEIU tele-town hall, more than 80% of the 21,000 home care workers that convened said they felt the federal government had not “done enough to ensure home care workers have what [they] need” during the COVID-19 crisis.

Apart from unemployment-related provisions, home-based care advocates are hoping for more money in the Provider Relief Fund, which previously distributed over $175 billion to health care providers from the CARES Act.

The Democrat-led House of Representatives proposed $100 billion more for the fund. Meanwhile, Republicans suggested a $25 billion infusion in their HEALS Act proposal.

Some believe the latter figure is not even close to where it needs to be. That includes LeadingAge President and CEO Katie Smith Sloan.

“The legislation treats older lives as expendable,” Sloan said in a statement. “The resources provided are woefully insufficient. The package offers only a fraction of the $100 billion that will be needed to help aging services providers protect older adults and offers no specific funds for aging services providers.”

Additionally, multiple organizations have expressed that there needs to be more support for Medicaid home- and community-based services.

The Partnership for Medicaid Home-Based Care (PMHC) specifically did so in a statement on Thursday.

“The financial viability of Medicaid home- and community-based providers is critical to the national health care infrastructure, and the direct care workforce needs financial support to ensure the continuation of these essential services,” PMHC Chairman David Totaro said.

PMHC previously developed a proposal for Congress that included an HCBS Direct Care Workers Fund.

On his end, National Association for Home Care & Hospice (NAHC) President William A. Dombi hopes there may be an extension of the payback timetable and the level of interest under the Centers for Medicare & Medicaid Services (CMS) advanced and accelerated Payment programs.

CMS distributed more than $100 billion in advanced and accelerated payments to all Medicare providers in spring. Home health providers received $1.7 billion.

NAHC is also hoping that the telehealth waivers granted during the public health emergency will become permanent, such as the one that allows the face-to-face requirement to be settled with telehealth technology.

However, for the big domino to fall in telehealth — reimbursement for remote visits — home health providers will need to wait for Congressional action.

“Absence of reimbursement for telehealth [in the bill is a concern],” Dombi told HHCN. “We have significant Congressional support, but the measure may not make it into this stimulus package, and we may need to wait for the next opportunity.”

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Fearing Brexit chaos, UK asks pharma to build six-week drug stockpile

The UK government has asked pharma companies to build a six-week stockpile of drugs and find alternative shipping routes to the congested Dover-Calais crossing as the country heads for Brexit at the end of the year.

In a letter, Steve Oldfield, chief commercial officer at the Department of Health and Social Care, said the government is focused on preventing potential disruption to any categories of medical supplies.

Urging pharma companies to keep buffer stocks of medical supplies, Oldfield notes that global supply chains are “under significant pressure” because of the COVID-19 pandemic.

But in the letter published on the department’s website he asked companies to stockpile six weeks’ worth of stock on UK soil, adding that the department is ready to support companies with their plans if required.

One of the main issues is a pinch-point for supplies at the busy Dover-Calais shipping route, and Oldfield asked companies to look for other shipping routes amid continued speculation that Brexit could cause delays at borders with France.

David Watson, interim executive director for commercial policy at the Association of the British Pharmaceutical Industry (ABPI) said medicines companies had “worked around the clock” to ensure supply chains have been maintained during the pandemic.

He added: “With this pressure likely to continue over the coming months, it is imperative that the government works closely with (pharma companies) to provide the support they need to plan for the end of the transition period.

“While today’s letter means that preparations can proceed, detailed guidance is still urgently required from Government on issues like freight capacity, ferry routes and the Northern Ireland Protocol.”

The pharmaceutical industry has called for negotiators to seek a Mutual Recognition Agreement (MRA) – which would see both sides accept each other’s drug safety testing and inspections before export.

It is also asking for an agreement in order to avoid unnecessary duplication, disruption to supply chains or delays to patient access to medicine.

“Coronavirus has only strengthened our belief that the best possible outcome is for both sides to reach a deal that includes an MRA to protect patients and public health,” said Watson.


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HHS Delays Provider Relief Fund Spending Reports Until 2021

Home health providers that received more than $10,000 from the COVID-19-inspired Provider Relief Fund will need to account for all of the grant funds they spent by Feb. 15 at the latest, the U.S. Department of Health and Human Services (HHS) announced earlier this week.

When the Provider Relief Fund was established, health care providers were originally going to have to submit quarterly reports beginning in July. HHS delayed that deadline and then told providers to hold tight for further guidance.

Now, home health providers have until early 2021, but can begin reporting on how they used their relief funds as early as Oct. 1 of this year. Broadly, relief funds are designed to help cover monetary losses directly tied to the COVID-19 crisis and its economic impact.

Through the CARES Act, $175 billion was distributed to health care providers across the country from the Provider Relief Fund.

“I think there’s a growing recognition by HHS of the complexity of what providers are being asked to do in utilizing these provider relief funds, documenting usage of them and then reporting that out,” Matt Wolfe, a partner at law firm Parker Poe, told Home Health Care News. “I think HHS is trying to develop a little bit more consensus within its walls before they start demanding that providers report information.”

HHS will be releasing more detailed instructions on how to report by Aug. 17.

Without further clarification, reporting will likely be sloppier and inconsistent across the board, which could draw the process out even further, Wolfe said.

“I think this was a recognition of HHS needing additional time to be able to really refine the reporting requirements,” he added.

The $10,000 threshold takes into account the total amount of relief each provider received. So if a provider received two smaller amounts that added up to more than $10,000, it wouldd still be on the hook for reporting by February of next year.

“This announcement was really clarifying to providers when HHS intends to release additional information about the reporting requirements. It was also notifying providers when they’re going to release a reporting system that will allow recipients to be able to make these reports,” Wolfe said. “HHS was fielding a lot of questions from providers thinking that they had to make reports now. So that was the purpose of the announcement, [to clarify that].”

The next stimulus package, meanwhile, could make way for an expansion of that Provider Relief Fund, which would mean even more relief for providers in the future.

HHS began distributing provider relief payments to Medicare-certified home health agencies on April 10.

Initially, U.S. health care officials described the payments as having “no strings attached.” As time moved on, however, providers started to realize that wasn’t entirely the case, with some even declining the CARES Act money that had been allocated to them.

Encompass Health Corporation (NYSE: EHC) is one example.

“At the end of the day, we just felt, as a well-capitalized company, we had access to a variety of funding resources,” Encompass Health CEO Mark Tarr said during a May investor presentation. “We just thought it was the best decision for Encompass Health to return the funds.”

As for what further details could come out of the next announcement, that remains to be seen. While some speculated that the quarterly-report style could be done away with completely, Wolfe isn’t so sure.

“We’re still having to wait and see what the detailed instructions are going to be that they release later in August, but I don’t read this announcement to say that the quarterly requirements are necessarily going to go away,” Wolfe said.

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PDGM Data Shows Reality-Versus-Expectations Mismatch for Case-Mix Components

The Centers for Medicare & Medicaid Services (CMS) was a little bit off with some of its predictions related to the Patient-Driven Groupings Model (PDGM). 

At least, that’s true when it comes to the first four months of 2020, according to Strategic Healthcare Programs (SHP) data unveiled on a recent BlackTree Healthcare Consulting webinar.

The webinar covered data and trends related to the impact of PDGM and COVID-19 on home health agencies. As part of the presentation, experts compared SHP data to CMS projections on the various components of PDGM.

CMS detailed those projections in its 2020 final rule, using 2018 claims data paid through July 31, 2019, to inform its calculations. When put up against SHP data from January through April, it appears some of CMS’s predictions have yet to align with reality.

Take comorbidity adjustment, for example. It’s one of the five levers used to determine which of the 432 case-mix groups a case falls into under PDGM — and in turn, the reimbursement level that goes with it.

Under the new framework, there are three different comorbidity buckets: no adjustment, a “low” adjustment” or a “high” adjustment.

According to its models, CMS expected 56.4% of home health cases would have no adjustment; 35.5% would have a low adjustment; and only 8.1% would have a high adjustment.

In reality, 14.1% of cases had a high adjustment in the first four months of the year, according to SHP data. Those high adjustment cases are associated with a combination of secondary diagnoses that are tied to higher resource use when reported together — thus yield higher reimbursement.

“Some of that might be we’re doing a better job at secondary diagnosis coding, we’re paying more attention to that [or] we’re seeing more codes on the claim versus maybe what was just put on the OASIS,” Chris Attaya, vice president of product strategy at Strategic Healthcare Programs (SHP), said during the webinar.

Meanwhile, the expectations-versus-reality mismatch in functional impairment lever came as the biggest shock, according to BlackTree Managing Principal Nick Seabrook.

“The one area that surprised me the most is just the disparity in terms of the functional impairment scores,” Seabrook said during the webinar.

Like comorbidity adjustment, PDGM’s functional impairment lever is broken into three categories — low, medium and high — each of which comes with varying degrees of reimbursement. A higher impairment generally means higher reimbursement.

While CMS anticipated a fairly even split between all three functional categories, nearly 44% of cases have fallen into the high category. That’s over 12% more than what CMS expected, according to the data.

Source and timing trends are also slightly different from CMS’s expectations. Generally, the SHP data suggests that the industry is seeing far more “institutional early” cases and far fewer “community late” than CMS expected.

Specifically, CMS projected 61.4% of cases would be community late, while SHP found that only 54.4% were. Additionally, CMS estimated that 18.5% of cases would be institutional early, compared to 27.4% in reality.

Attaya wasn’t surprised by that mismatch, however.

“We’re seeing a higher [percentage] of early because … we’re still new with PDGM,” Attaya said. “Community late — we haven’t quite caught up yet, but I think we’ll see numbers continue to get closer to CMS [projections] as we go forward through the year when we have more opportunities for recerts that would continue to grow that ‘community late’ period.”

Other subcategories under the source and timing lever include “institutional late” and “community early,” which were on par with CMS’s expectations.

While the data provides a lens into the first four months of PDGM, it only tells part of the story. Home health providers were grappling with the COVID-19 emergency for the last several weeks of that four month period.

“As we kind of look at some of the trends, you’ve got to remember that [COVID-19] is included in there,” Attaya said. “That’s going to have some impact as you look at your overall numbers.”

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In-Home Care Providers on the Lookout for Next Stimulus Package

Although concrete details are largely unknown, in-home care providers remain on the lookout for the next coronavirus-related stimulus package.

Specifics on a possible fifth stimulus package could be released as early as this week, policy experts believe. 

“I think that’s the question, whether or not a package comes together that everyone agrees to before the August recess — or potentially after it,” Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare (PQHH), told Home Health Care News. “We’re seeing new spikes in different parts of the country, which has added renewed pressure.”

PQHH is a home health care advocacy organization based in Washington, D.C.

Senate Majority Leader Mitch McConnell (R-Ky.) and Treasury Secretary Steven Mnuchin have reportedly been working on a draft of the legislation for the past several weeks, with Mnuchin saying the next phase of relief should go toward industries hardest hit by the coronavirus.

“We are monitoring economic conditions closely,” Mnuchin testified on Friday in front of the House Committee on Small Business. “Certain industries, such as construction, are recovering quickly, while others, such as retail and travel, are facing longer-term impacts and will require additional relief.”

Broadly, a fifth stimulus package will likely focus on a number of topics, including funding for school reopenings, litigation immunity for certain industries and continued unemployment benefits, according to reports from The Hill.

“One thing the majority leader in the Senate has said is that there needs to be some form of business immunity from potential liability related to COVID-19,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told HHCN. “The other forces that are in play range from an extension of the federal unemployment insurance to further expansion of the Paycheck Protection Program (PPP).”

NAHC is also a D.C.-based trade organization. Its provider members span the full spectrum of home-based care.

So far, more than 15,000 home-based care companies have received more than $666 million in PPP loans of under $150,000, an HHCN analysis found.

Additionally, the next potential stimulus package could pave the way for an expansion of the Provider Relief Fund. It could also provide added federal support for state and local governments.  

One question that looms large is the total amount of the next stimulus package, according to Dombi.

“I think we’ve moved from whether there would be one, to how much it will be and what will be in it,” Dombi said. “Is it going to be a $1 trillion program, a $2 trillion program or a $3 trillion program? This seems to be somewhat fluid. The bill that came out of the House earlier — the HEROES Act — was over $3 trillion.”

The White House has, informally, indicated that a $2 trillion package is a possibility. Meanwhile, McConnell’s office reportedly wants the next stimulus bill to be around $1 trillion. 

In-home care providers may benefit from another stimulus bill in several different ways.

One is an additional injection of cash into the Provider Relief Fund. There are parts of in-home care that haven’t received funding, including private-duty home care and private-pay services, for example.

Some providers have only received 2% of their total revenue in terms of financial support, but are experiencing a cost increase that is close to 10%, according to Dombi.

Another measure that would help providers is special funding for front-line workers, who are facing additional risk due to the public health emergency.

“It goes by many different labels: premium pay, hazard pay, combat pay,” Dombi said. “There needs to be something to encourage people to come into doing that work, particularly at the lower end of the wage scale.”

Dombi also called for child care support for essential front-line workers.

“If the schools will not be uniformly open five days a week for all students, somebody is going to need to care for those children,” he said. “Generally, that falls on parents, unless those parents also need to go to work. So how do we take care of those child care needs for those front-line workers?”

On the Medicare home health side, NAHC would like to see authorization for reimbursement of telehealth services.

“Without a doubt, important advances have happened to provide some flexibility, but we think it’s falling short of realizing its value by not having any direct reimbursement for those services,” Dombi said.

For in-home care providers, now is the time to advocate for the industry at the grassroots level, as the situation remains fluid.

“[Providers] need to be engaged and explain why there is still a greater need for support for health care providers than currently exists, and that in-home care needs those supports as much as hospitals do,” Dombi said. “By our very informal count, there are more patients with active COVID-19 infections in home settings than there are in hospital settings. We have opportunities — we have no guarantees that further supports will be made available.”

Top Republicans in Congress planned to meet Monday with President Donald Trump to discuss the next COVID-19 aid package, The Associated Press reported.

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Excel Home Care Distributing $6M in CARES Act Funds to Its Caregivers

Caregivers at Excel Home Care can expect a pay bump in the coming weeks.

Horsham, Pennsylvania-based Excel Home Care is a non-medical personal care agency that began operating under the Help at Home umbrella in 2017. Help at Home is a Chicago-based home care company that operates in 13 states.

In May, Pennsylvania Governor Tom Wolf signed Act 24 of 2020, which granted state providers of long-term home- and community-based services relief funding from the federal Coronavirus Aid, Relief and Economic Security (CARES) Act.

On Monday, Excel Home Care announced it would distribute the entirety of the CARES Act relief funds it received from the state of Pennsylvania to its caregivers for their service during the COVID-19 public health emergency.

Excel Home Care received relief funds in excess of $6 million.

The personal care agency has earmarked all of the funds for employee bonuses. Josh Drebes, regional vice president of the company, said the pay boost is a “hero’s bonus.”

“The caregivers and the administrative support teams are counted on by vulnerable citizens,” Drebes told Home Health Care News. “We wanted to give back and support their health and well-being. We wanted to make sure that they were rewarded for providing this care through these tough times.”

As essential front-line workers began facing higher risks while performing their job duties amid the COVID-19 emergency, the question of additional pay or hazard pay has been pushed to the forefront.

Aside from rewarding workers, additional pay can also mean retaining workers. While it’s too early to tell, Drebes believes the extra funds will significantly help with the company’s retention efforts.

“Every caregiver hired by us through the end of this year is going to receive a $400 sign-on bonus,” he said. “They’re also going to qualify for the general pay, which will be a monthly bonus stipend at the end of every month for the rest of this year.”

As a company, Excel Home Care is no stranger to providing aid to its employees. In collaboration with Help at Home, the company sponsored a $1 million employee assistance fund in order to provide grants for workers facing financial difficulties earlier this year.

“They actually got to apply for money we raised,” Drebes said. “We called it the Cares Fund, and it provides grants for employees who had personal challenges related directly to the pandemic.”

In this respect, Excel Home Care isn’t an anomaly. Throughout the public health emergency, many providers have been enterprising and have provided incentives for caregivers working in the field.

Hackensack, New Jersey-based CareFinders Total Care, for example, provided appreciation pay for all workers in light of COVID-19.

“It’s definitely going to be a financial hit for the company, but I don’t know if we could really go forward as the same company and not do something like this for our team,” Jim Robinson, the company’s CEO, previously told HHCN. “It almost moves out of financial decision-making into, ‘What’s the right thing to do?’”

Meanwhile, in-home care provider Preferred Care Home Health Services supplied over 500 employees across Fort Myers and Naples, Florida, with care packages, according to the Fort Myers News-Press.

Looking ahead, Excel Home Care is focused on the fund distribution rollout.

“We want to try to get the money into the caregiver’s pockets as soon as possible,” Drebes said. “Within the next 30 days, we’re just trying to make sure we have everything all set in place.”

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Healthcare Headlines: February 2020

<h2 class="heading-medium">US On Track For One Of The Worst Flu Seasons In Decades
<p>This flu season is on track to be as severe as the deadliest flu season in the United States in more than 40 years. Check out the latest hospitalization rates, year-over-year comparisons and a nationwide map of influenza activity.&nbsp;<a href="" target="_blank" aria-label="Read more about US On Track For One Of The Worst Flu Seasons In Decades">Read more</a></p>
<h2 class="heading-medium">5 Trends For Hospitals To Watch In 2020
<p>Stay on top of the legislative news cycle in 2020 by knowing these anticipated trends from key healthcare leaders. Their predictions include surprise billing, consolidations and more.&nbsp;<a href="" target="_blank" aria-label="Read more about 5 Trends For Hospitals To Watch In 2020 ">Read more</a></p>
<h2 class="heading-medium">Treating Patients With Chronic Conditions</h2>
<p>Primary care physicians are often relied upon by their patients suffering from chronic, complex medical conditions. However, PCPs often don&rsquo;t have enough time to provide these patients with the counseling and life-coaching that treatment of these conditions often require. Read about a technique called motivational interviewing, which allows physicians to more quickly learn what&rsquo;s going on in their patients&rsquo; lives so they can tailor their care to each patient.&nbsp;<a href="" target="_blank" aria-label="Read more about Treating Patients With Chronic Conditions">Read more</a></p>
<h2 class="heading-medium">What To Expect In 2020: An Even Greater Focus On Social Determinants Of Health
<p>With this fall’s presidential election on the horizon, 2020 will likely see an increased focus on the relationship between traditional healthcare service providers and the non-medical needs that influence a patient’s health outcomes. One key and central question to making this all work: Will emerging reimbursement models accelerate investments in these social determinants of health?&nbsp;<a href="" target="_blank" aria-label="Read more about What To Expect In 2020: An Even Greater Focus On Social Determinants Of Health">Read more</a></p>
<h2 class="heading-medium">Health Policy In 2020 Will Be Made In The States
<p>With legislation in Congress likely to be blocked by partisan division and interest group opposition, it is anticipated that much of the movement and decision making in healthcare this year will be in the states. Check out this article for more on what could be occurring in your state.&nbsp;<a href="" target="_blank" aria-label="Read more about Health Policy In 2020 Will Be Made In The States">Read more</a></p>
<h2 class="heading-medium">Investment In Medical And Health R&amp;D Not Keeping Up With Needs Of Nation, Report Finds</h2>
<p>While investment in medical and health research and development continues to grow, R&amp;D spending still represents only about 5 cents of every health dollar spent. This key finding in the 2019 U.S. Investments in Medical and Health Research and Development, a new report from Research!America, indicates that the total investment isn’t tracking with disease burden. Read this piece for more on this report and its recommendations on curtailing certain diseases.&nbsp;<a href="" target="_blank" aria-label="Read more about Investment In Medical And Health R&amp;D Not Keeping Up With Needs Of Nation, Report Finds">Read more</a></p>
<h2 class="heading-medium">Hand Hygiene Protocols For ICU Patients May Reduce Infection Risk, Study Suggests</h2>
<p>New study by the Cleveland Clinic finds that hand hygiene practices for patients in the intensive care unit may be just as important for preventing infections as clinician hand hygiene. See the findings published in Infection Control &amp; Hospital Epidemiology to ensure proper practices in your practice.&nbsp;<a href="" target="_blank" aria-label="Read more about Hand Hygiene Protocols For ICU Patients May Reduce Infection Risk, Study Suggests">Read more</a></p>

Five Healthcare Trends in 2020: Your Cheat Sheet

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<p>In 2020, our nation&rsquo;s healthcare delivery and payment environment will continue its multi-year evolution. While some key trends will continue and expand, 2020 also brings new trends that will have a significant impact on healthcare providers across the continuum.</p>
<div style="background-color:#c5dde5;padding:20px;">
<p><strong>The top five trends to watch in 2020 are: </strong></p>
<li><a href="#Consolidation">Consolidation </a></li>
<li><a href="#Disruptors">System Disruptors </a></li>
<li><a href="#Consumerism">Consumerism</a> </li>
<li><a href="#Growth">Growth in Medicare Advantage</a> </li>
<li><a href="#Post-Acute">New Post-Acute Models</a></li>
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<p id="Consolidation"><strong>1. Healthcare Consolidation</strong></p>
<p>The continued &ndash; and growing &ndash; trend toward integrated production, including nontraditional partners, helps define an age of major transformation across the healthcare industry. <strong>While mergers and acquisitions between hospitals, health systems and physician practices may be waning, consolidation among unlikely partners has accelerated.</strong> These types of relationships include the ongoing integration between CVS and Aetna and the announced deal between Walmart and Amedysis.</p>
<p><strong>Why It Matters: <br />
Greater consolidation and integration across the healthcare system has the potential to play a vital role in improving patient treatment as traditional silos of care are broken down.</strong> These new partnerships are emerging in a value-based healthcare environment as they help reduce inefficiencies in care and improve care coordination for patients. While the intention is that these new organizations will improve clinical outcomes and clinical decision support for patients post-discharge, there are still risks that monopolistic entities retain the benefits of scale and efficiency rather than passing along reduced healthcare costs to consumers. In 2020, it will be important to watch for some controls in the forms of new regulation to ensure the benefits go to the consumer. In fact, in November 2019, the Medicare Payment Advisory Commission (MedPAC), under the direction of Congress, began an initial investigation as to the effects of hospital mergers and healthcare provider consolidation.</p>
<hr />
<p id="Disruptors"><strong>2. Healthcare System Disruptors
<p>A rapidly growing trend is the rise of &ldquo;disruptors&rdquo; within healthcare &ndash; these are outside sources that have not traditionally been tied to healthcare, but are seeking to radically reform the system.</p>
<p>One of the most notable disruptors is Haven, the nonprofit stemming from the joint venture between Amazon, Berkshire Hathaway, and J. P. Morgan, which is aimed at improving the healthcare for their collective 1.2 million employees. Another disruptor to the status quo is Best Buy and their expansion into home healthcare, with the intent on enabling seniors to &ldquo;age in place&rdquo; through the use of technological wearable devices, remote monitoring tools and, eventually, new care coordination services. These are just two examples of organizations seeking to address the nation&rsquo;s healthcare challenges with innovative solutions.<sup>1</sup></p>
<p><strong>Why It Matters: </strong><br />
First off, it is important to recognize that these healthcare disruptors are all new and non-traditional participants in the healthcare marketplace. <strong>They are leading a trend to interrupt and dislocate the status quo and forge new pathways to improve healthcare services in America. By nature they will upend the healthcare industry, but the timing and exact impact is unknown.</strong></p>
<hr />
<p id="Consumerism"><strong>3. Consumerism
<p>The concept of consumerism is that patients are taking ownership of care decisions based upon costs, their understanding of the full scope of options available to them based on research and trustworthy sources of information, and leveraging their use of technologies. <br />
<br />
Within this trend, consumers are increasingly searching for the best value at the lowest cost that is the most convenient to their lives. In response, healthcare providers have been asked to respond with more price transparency and demonstrated quality outcomes.<br />
<br />
Additionally, new technologies &ndash; such as wearable devices &ndash; provide consumers new ways to engage in their own healthy living and in managing certain conditions. <strong>This is important because research demonstrates that increasing a patient&rsquo;s participation in their care plan is associated with improved healthcare outcomes and reduced healthcare costs.</strong><sup>2<br />
<p><strong>Why It Matters:</strong> <br />
<strong>With more than 80% of consumers researching their healthcare options online and the increased reliance on the reputation of a hospital, physician or provider before making healthcare decisions, costs and publicly-reported quality scores are increasingly important.</strong> This elevates the need for all health settings and health professionals to manage their online reputation, to ensure the highest quality outcomes that are reported on sites such as Medicare compare and to increase transparency in terms of the patient&rsquo;s out-of-pocket costs.
<p>The Centers for Medicare and Medicaid Services (CMS) has proposed &ndash; but not finalized &ndash; new price transparency measures where all hospitals will have to &ldquo;publish the prices they negotiate with payers for standard services and items&rdquo; in order to help educate patients as to costs. However, the &ldquo;shoppable prices&rdquo; that CMS has proposed be made available will have little context for patients, and will not provide relevant data such as expected out-of-pocket costs.</p>
<hr />
<p id="Growth"><strong>4.&nbsp;Growth in Medicare Advantage&nbsp;</strong></p>
<p>Enrollment in Medicare Advantage (MA) plans has more than doubled over the past 20 years&ndash; growing from 18% in 1999 to 36.7% in 2019.<sup>3</sup> The Congressional Budget Office (CBO) projects that the share of beneficiaries enrolled in Medicare Advantage plans will rise to about 47 percent by 2029.<sup>1 </sup></p>
<p>More and more Americans are choosing to enroll in Medicare Advantage rather than traditional Medicare because of the perceived convenience and additional benefits touted by the managed care organizations. However, providers are increasingly finding that MA plans are discounting or ignoring physician decisions for the best and most clinically appropriate level of care for patients. Rather, plans are focusing on cost over optimal patient outcomes.</p>
<p><strong>Why It Matters: <br />
With health services and setting-specific care being denied by MA plans, patients, their families and physicians are increasingly appealing the plan&rsquo;s decisions.</strong> However, the appeals process can lead to delays in patients receiving the most appropriate care and significant additional administrative burden for physicians and care providers. Congressional leaders are taking notice, and in an initial effort to improve the Medicare Advantage appeals process, they have introduced the Improving Seniors&rsquo; Timely Access to Care Act (HR 3107). The legislation would reduce provider administrative burdens and increase transparency surrounding the use of prior authorization in MA, enable &ldquo;real time&rdquo; decisions by the plans, and seeks beneficiary protections based on evidence-based medical guidelines to ensure continuity during a course of treatment. <br />
<br />
<strong>Expect more Congressional activity and pressure from hospitals and health systems throughout 2020 to protect patient access to high-quality care in a timely manner.</strong></p>
<hr />
<p id="Post-Acute"><strong>5. New Post-Acute Models</strong></p>
<p>In 2020, both Skilled Nursing Facilities (SNFs) and Home Health Agencies (HHAs) will undergo significant overhauls to their Medicare payment systems. In October 2019, SNFs began a new system known as the Patient Driven Payment Model (PDPM) and in January 2020, HHAs will undergo a reform to a new system known as Patient Driven Groupings Model (PDGM). Under both PDPM and PDGM, rehabilitative therapies are no longer the driver for Medicare payments; rather, Medicare payments are tied to the complexity of patient needs rather than the volume of services delivered.</p>
<p>However, providers must be mindful that CMS expects the same, or better, outcomes for patients under this new payment model.</p>
<p><strong>Why It Matters: <br />
</strong>In the early stages of PDPM, many SNF operators responded with layoffs or significant changes to the employment of qualified physical and occupational therapists and speech language pathologists. <strong>Despite the fact that therapies will not be a driver of reimbursement levels under the new models, they will still be essential to drive quality care and patient outcomes.</strong> In fact, therapies have been shown to have a huge impact on reducing lengths of stay and readmission rates, and improving functional outcomes and quality of life.</p>
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<p><strong>How Kindred Can Help </strong></p>
<p>We specialize in the treatment and rehabilitation of the post-intensive care and complex medical patients requiring continued intensive care, including specialized rehabilitation, in an acute hospital setting. </p>
<p>Our interdisciplinary team of skilled and specialty clinicians in our long-term acute care hospitals can be the right partner for you for your patients who have been in an ICU or critical care unit or who are chronically ill and at the greatest risk for hospital readmission. </p>
<p>With daily physician oversight, ICU/CCU-level staffing and specially trained interdisciplinary teams, we work to improve outcomes, reduce costly readmissions and help patients transition to a lower level of care.</p>
<p>Additionally, Kindred remains an advocate to help shape new health policies as Congress and the Administration seek to establish value-based healthcare payments and delivery reforms.<strong></strong></p>
<p><strong>If you have a critically ill patient in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine the most appropriate care setting for your patient&rsquo;s next stage of treatment. If you are unsure of who your Kindred representative is, please visit us online at <a href="" target="_blank"></a>&nbsp;to find our hospital nearest you.</strong></p>
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<p>References </p>
<li><span style="font-size: 12px;">Bryant, Bailey, <em>&ldquo;Best Buy, Amazon and Walmart Leading Retail&rsquo;s Race into Home-Based Care,&rdquo;</em>, September 29, 2019, </span></li>
<li><span style="font-size: 12px;">Coulter A, Ellins J. <em>Effectiveness of strategies for informing, educating, and involving patients.</em> BMJ. 2007; 335(7609):24&ndash;7. </span></li>
<li><span style="font-size: 12px;"><em>Kaiser Family Foundation: Medicare Advantage, </em>June 2019,;</span></li>
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Healthcare Headlines: December 2019

<h2 class="heading-medium">CMS Is Changing How It Pays Doctors To Coordinate Care
<p>CMS has finalized rules that modify how physicians get paid to encourage primary care physicians and other clinicians to spend more time coordinating care for their patients. The intention is to help address the social determinants of health, increase patient adherence to treatment, and improve the continuity of care. Check out this article for all payment updates, including the physician fee schedule.&nbsp;<a href="" target="_blank" aria-label="Read more about CMS Is Changing How It Pays Doctors To Coordinate Care">Read more</a></p>
<h2 class="heading-medium">CDC Updates Core Elements Of Antibiotic Stewardship Of Hospitals
<p>With the March 30, 2020, deadline requiring all acute care and critical access hospitals participating in Medicare to have antibiotic stewardship programs, CMS has updated its <a href="" target="_blank">Core Elements of Hospital Antibiotic Stewardship Programs</a>. The updates provide examples of leadership commitment to antibiotic stewardship programs, highlight priority interventions and process measures, and emphasize the key role that pharmacists and nurses play in improving antibiotic use in hospitals. Read to see if your antibiotic stewardship program follows these best practices.&nbsp;<a href="" target="_blank" aria-label="Read more about CDC Updates Core Elements Of Antibiotic Stewardship Of Hospitals ">Read more</a></p>
<h2 class="heading-medium">Research Report: Remote Patient Monitoring Technologies Meeting New Needs For Hospitals</h2>
<p>Recent research shows that hospitals implementing remote patient monitoring technologies are looking for vendors who can offer patient-centric software and solutions that engage the patient in their own care. The following characteristics are the most compelling criteria: patient-centric, focused on patient engagement and empowerment, tools for patient/provider interaction, and consumer-based hardware. See how the technology is evolving to meet more needs. &nbsp;<a href="" target="_blank" aria-label="Read more about Research Report: Remote Patient Monitoring Technologies Meeting New Needs For Hospitals">Read more</a></p>
<h2 class="heading-medium">CMS Urged To Cut Prior Authorization Red Tape
<p>The AHA is asking CMS to give providers a break on prior authorization stating, &ldquo;the approach some health plans have taken negatively impacts patient care and adds significant additional cost and burden to the health care system.&rdquo; Read all of the association’s recommendations, including the request for a standardized form and response process.&nbsp;<a href="" target="_blank" aria-label="Read more about CMS Urged To Cut Prior Authorization Red Tape">Read more</a></p>
<h2 class="heading-medium">Key Culture Traits Of Consumer-Centric Hospitals
<p>As hospitals and health systems continue to work toward meeting, and exceeding, patient and family expectations of their interactions with health care, some are finding success by promoting a consumer-centric culture. Three healthcare consultants dig into this idea and provide three key takeaways to achieving a consumer-centric culture. Find out what they are and more on this strategy here.&nbsp;<a href="" target="_blank" aria-label="Read more about Key Culture Traits Of Consumer-Centric Hospitals ">Read more</a></p>
<h2 class="heading-medium">3D-Printed Living Skin With Blood Vessels Created By Scientists
<p>Scientists have created 3D-printed skin complete with blood vessels, which they hope could one day prevent the body rejecting grafted tissue. The research team combined cells found in human blood vessels with other ingredients, including animal collagen, and printed a skin-like material. Read more on this breakthrough and the patients it can help.&nbsp;<a href="" target="_blank" aria-label="Read more about 3D-Printed Living Skin With Blood Vessels Created By Scientists">Read more</a></p>
<h2 class="heading-medium">Mobilizing Public Health To Support Elders&rsquo; Longevity And Thriving
<p>Statistics about the aging population show that we are at a critical moment in preparing to support the aging population. Public health perspectives describe this substantial threat and propose to implement strategies to prevent or mitigate the suffering. Check out these considerations, including how population-based data is being used.&nbsp;<a href="" target="_blank" aria-label="Read more about Mobilizing Public Health To Support Elders’ Longevity And Thriving">Read more</a></p>

Reducing Respiratory Failure Readmissions While COPD Is on the Rise

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<p>Diagnoses of Chronic Obstructive Pulmonary Disease (COPD) have been on the rise since the early 2000s. By 2030, it is projected to be the third most common cause of death, according to the World Health Organization. It&rsquo;s already the third most common reason for hospital readmission.</p>
<p>In order to encourage health systems to improve outcomes for COPD patients, the Centers for Medicare and Medicaid Services (CMS) included COPD in the Hospital Readmissions Reduction Program (HRRP) back in 2014, which can penalize hospitals for excessive 30-day readmissions in an effort to encourage providers to tackle the problem. However, five years later, few published COPD readmission reduction programs have emerged, leading to continued inconsistency across health systems and little movement in the readmission rate.</p>
<p>Without innovative action, the care costs of COPD in today&rsquo;s value-based care world will rise right along with its prevalence.<strong> In this whitepaper, we examine the strategies providers and physicians should consider to help improve outcomes and reduce costly readmissions for this at-risk population.</strong></p>
<p><strong><img src="" data-displaymode="Original" alt="Infographic: COPD is projected to go from the 5th-most common cause of death in the U.S. to the 3rd by 2030. COPD is the 3rd-most common reason for hospital readmission." title="Infographic: COPD is projected to go from the 5th-most common cause of death in the U.S. to the 3rd by 2030. COPD is the 3rd-most common reason for hospital readmission." /></strong></p>
<h2><strong>The COPD Problem</strong></h2>
<p>COPD incidence is on the rise, and fast. Here are the stats:</p>
<li>COPD is projected to go from the fifth-most common cause of death in the U.S. to the third by 2030.</li>
<li>COPD is the third-most common reason for hospital readmission.</li>
<li>Thirty-day hospital readmissions related to COPD are high, at 22%.</li>
<li>For patients who require ICU treatment for COPD, the ICU readmission is even higher&mdash;about 25%.</li>
<li>COPD is often a multimorbidity. By 2030, about 40% of people 65 and older will suffer from three or more chronic conditions. Recognizing this, COPD is now described as a syndrome rather than a single disease.</li>
<p>This is creating a surge in demand for acute-care facilities that have the ability to successfully treat these medically complex and seriously ill patients, particularly those in need of assistive breathing devices.&nbsp;</p>
<h2><strong>Improving COPD Outcomes</strong></h2>
<p>While no single readmission reduction program has emerged as superior, individual hospitals have been implementing their own best practices in an effort to avoid CMS penalties. Here are a few case studies and the most impactful strategies providers could consider for their own care enhancements. </p>
<p><strong>An emphasis on care management.</strong> One 200-bed community hospital employed a dedicated COPD care manager to communicate with patients, document care plans, facilitate referrals and visit patients at home two to three days after discharge. After a year, hospital administrators credited this care management program with a drastic decline in COPD readmissions&mdash;from 12% to 6.7%. </p>
<p>Meanwhile, an 800-bed university hospital in the same health system chose to implement standardized electronic treatment pathways and readmission risk calculations. The academic hospital recorded only modest reductions in COPD readmissions at the year mark, citing low utilization and rigid order sets as the reasons. </p>
<p><strong>Multidisciplinary focus on COPD.</strong> An academic hospital in an underserved area took aim at CMS HRRP by taking a page out of other chronic disease handbooks, assembling an interprofessional team focused on COPD. Led by a dedicated, advanced-practice nurse, the team developed a systematic approach to ensure all patients admitted to the hospital with COPD received a pulmonary consultation. After comparing data from six months prior to the program implementation and six months after, they found that COPD readmissions dropped nearly 50%. </p>
<p><strong>Referral to pulmonary rehabilitation.</strong> In a review for a joint statement by the American Thoracic Society and the European Respiratory Society, researchers found mixed results in pulmonary rehabilitation&rsquo;s effect on 30-day, all-cause readmission rates but a nearly 50% reduction in readmissions in the long term. This is unsurprising considering pulmonary rehab typically is conducted over a period of weeks, or even months. These results indicate that pulmonary rehab is essential to long-term readmission reduction and patient outcomes. </p>
<p><strong>Identification of high-risk patients.</strong> To date, there is only one tool available to help providers
predict readmission risk specifcally among COPD patients.
The PEARL (previous admissions, eMRCD score, age, rightsided and left-sided heart failure) score was designed to and has
proven succesful in identifying patients at risk for readmission
within 90 days. But currently there is no model available for
30-day readmissions, which means there is still ample room for
improvement when it comes to identifying at-risk patients. </p>
<p>Until an evidence-based readmission reduction program emerges as the clear solution for COPD patients, it will be up to each acute-care hospital to design and implement a protocol that works for their organization and patient population.&nbsp;</p>
<h2><strong>The Role LTAC Hospitals Play in Care for COPD Patients</strong></h2>
<p>Another key strategy for hospitals and health systems to consider to aid in reducing readmissions for COPD patients is to identify downstream partners who are experts in caring for complex pulmonary patients &ndash; such as long-term acute care (LTAC) hospitals.</p>
<p>LTAC hospitals are in a unique position to care for COPD patients because they provide acute-level care to chronically, critically ill patients, with a particular competency for those with pulmonary issues. Further, the vast majority of COPD patients have multiple comorbidities, meaning they would benefit from seeing a physician or several specialty physicians every day, something LTAC hospitals offer.</p>
<p>While LTAC hospitals provide care for a very high-acuity, niche patient population, they play a vital role in achieving the efficient recovery of patients who have a high risk of readmission due to their clinical complexity. By transitioning these challenging patients to an LTAC hospital when it is the most appropriate site of care for their needs – rather than a skilled nursing facility or other post-acute care site – readmission rates can be lowered, patient outcomes can be improved and a significant portion of financial losses can be mitigated.</p>
<p>It is important for providers and physicians to identify partners who can provide expert care for complex pulmonary patients to help reduce readmissions and avoid penalties.&nbsp;</p>
<h2><strong>How Kindred Can Help Your COPD Patients</strong></h2>
<p>Acute care providers need partners who can continue to provide physician-directed care with the extended recovery time COPD patients&mdash;particularly those on mechanical ventilation &mdash;require. Kindred Hospitals specialize in the treatment of patients with complex medical issues who require intensive care and pulmonary rehabilitation in an acute hospital setting. With daily physician oversight, ICU- and CCU-level staffing, 24/7 respiratory coverage and specially trained caregivers, we work to improve functional outcomes, reduce costly readmissions and help patients transition home or to a lower level of care.</p>
<p><img src="" data-displaymode="Original" alt="Daily physician oversight, ICU-and CCU- level staffing, 24/7 respiratory coverage, Specially trained caregivers" title="Infographic: Daily physician oversight, ICU-and CCU- level staffing, 24/7 respiratory coverage, Specially trained caregivers" /></p>
<p>We are committed to pursuing innovations in care delivery and payment models to provide new tools and solutions to our patients and their families as well as to our provider and payer partners. Many of these resources and initiatives are designed to ensure efficient care management for each patient.</p>
<p>One such initiative is our effort to achieve <strong>disease-specific certification from The Joint Commission for Respiratory Failure</strong> in all Kindred Hospitals across the country. The certification recognizes healthcare organizations that provide comprehensive clinical programs across the continuum of care for respiratory failure. It evaluates how organizations use clinical outcomes and performance measures to identify opportunities to improve care, as well as to educate and prepare patients and their caregivers for discharge.</p>
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<p>Check out this video featuring our hospital teams in Houston who have successfully achieved certification from The Joint commission.
<div class="responsive-video"><iframe src="" title="Kindred Hospitals: Specialists in Caring for Patients with Respiratory Failure" allowfullscreen="true"></iframe></div>
<br />
<p>We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways. Our program structure and management protocol include:</p>
<li>A review of every new admission for potential inclusion in the Respiratory Failure Program based on qualifying criteria</li>
<li>Focused interdisciplinary care team and ventilator rounds for program participants</li>
<li>Development of an individualized plan of care and creation of interdisciplinary goals targeting the patient&rsquo;s pulmonary needs</li>
<li>Daily multidisciplinary assessment, evaluation, treatment and therapy following established clinical practice guidelines for:
<li>Ventilator liberation</li>
<li>Early mobility</li>
<li>Oral care </li>
<li>Maintenance of skin integrity</li>
<li>Disease-specific education for patients and their families while enrolled in the Respiratory Failure Program.</li>
<li>Structured performance measure and patient perception data tracking to assess and assure program quality and ongoing success</li>
<p>Additional care delivery innovations that help improve care for our respiratory failure patients include the <strong>AfterCare</strong> program and the <strong>Move Early </strong>mobility program. The AfterCare program features Registered Nurses telephonically reaching out to patients who discharge from our hospitals directly home, on a scheduled timeline, in order to identify and manage clinical gaps and medication regimens to prevent patient decline or rehospitalizations. The Move Early program aims to get patients moving as early in their recovery &ndash; including those on mechanical ventilation — as possible to combat the many potential, and detrimental, side effects of immobility in the healing process. </p>
<p><strong>Learn more about these programs:</strong></p>
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<p><strong>Reducing Rehospitalizations Through Early Patient Mobilization</strong></p>
<p><a href="" target="_blank"><img src="" data-displaymode="Original" alt="Reducing Rehospitalizations Through Early Patient Mobilization" title="Reducing Rehospitalizations Through Early Patient Mobilization" /></a></p>
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<p><strong>Improve Patient Outcomes through Post-Discharge Virtual Care</strong></p>
<p><a class="_gt" data-category="Hospital" data-action="Click-Thumb" data-label="WP-Improve Patient Outcomes through Post-Discharge Virtual Care" href="" target="_blank"><img src="" data-displaymode="Original" alt="Improve Patient Outcomes through Post-Discharge Virtual Care" title="Improve Patient Outcomes through Post-Discharge Virtual Care" height="227" /></a>
<p>In today&rsquo;s value-based care environment, and as more people develop COPD, we are committed to treating chronically, critically ill patients and to continued clinical growth with specific expertise in pulmonary care.</p>
<p><strong>To learn more about how Kindred Hospitals can help care for your chronically, critically ill patients, visit <a href="" target="_blank"></a>.</strong></p>
<hr />
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<span style="font-size: 12px;"> (2019). Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic
Society Workshop Report | Annals of the American Thoracic Society. [online] Available at:
AnnalsATS.201811-755WS [Accessed 25 Oct. 2019]. </span></li>
<li><span style="font-size: 12px;"> (2019). WHO | Burden of COPD. [online] Available at: [Accessed 25 Oct.
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Healthcare Headlines: October 2019

<h2 class="heading-medium">Does Value-Based Pay Have A Future?</h2>
While just about everyone in healthcare likes the idea of paying for outcomes, there still remains a challenge on how to fairly implement it. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was a major step away from fee-for-service for physicians; subsequently, private payers began to embrace the possibilities of value-based care, working incentives into contracts that rewarded physicians who used data to show patients were healthier and avoiding unnecessary hospitalizations. Today, with MACRA a few years in the review mirror, fee-for-service contracts are still the norm. Read the full text to learn what the shifts toward value-based care indicate for the future.&nbsp;<a href="" target="_blank" aria-label="Read more about Does Value-Based Pay Have A Future?">Read more</a><br />
<br />
<h2 class="heading-medium">Better Patient Outcomes, Not Cost Reduction, Top Priority For Provider Execs</h2>
A recent study shows that almost 60% of health system executives ranked improving patient outcomes as the most critical priority for their respective organizations. Improving patient outcomes jumped passed cost reduction, last year’s top choice. See the top five responses the study found for what healthcare leaders are prioritizing today.&nbsp;<a href="" target="_blank" aria-label="Read more about Better Patient Outcomes, Not Cost Reduction, Top Priority For Provider Execs">Read more</a><br />
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<h2 class="heading-medium">Survey: Hospital, Health System Leaders Slow To Adopt Risk-Based Payment Arrangements</h2>
<p>A new survey of hospital and health system executives and leaders reports that the entrance into risk-based payment arrangements is slow. While there is pressure for greater adoption of programs that provide Medicare reimbursements to healthcare facilities based on the value of care they provide rather than the traditional fee-for-service model, leaders site a lack of reimbursement adequacy from the federal government and access to timely data as major barriers. Read the full text to learn more about the issues causing hesitation in the uptake of these agreements.&nbsp;<a href="" target="_blank" aria-label="Read more about Survey: Hospital, Health System Leaders Slow To Adopt Risk-Based Payment Arrangements">Read more</a></p>
<h2 class="heading-medium">Pathway To Patient-Centered Measurement For Accountability</h2>
<p>The recently released executive order on improving price and quality transparency not only focuses on price transparency provisions but also calls for the establishment of a health quality roadmap. This roadmap looks to outline a process for alignment of measures across all federal programs and care settings, adoption of common measures, and elimination of &ldquo;low-value or counterproductive measures.&rdquo; Take a look at this article to understand the key questions that will need to be answered in the development of patient-centered outcomes measurement.&nbsp;<a href="" target="_blank" aria-label="Read more about Pathway To Patient-Centered Measurement For Accountability">Read more</a></p>
<h2 class="heading-medium">States Focus On High-Risk Patients To Drop Medicaid Spending</h2>
<p>According to a new Government Accountability Office (GAO) report, states are seeing mixed results when coordinating patient care and addressing the social determinants of health to manage healthcare costs for high-cost Medicaid beneficiaries. While there are many strategies deployed across the country &ndash; including the use of case managers and mandatory care management services &ndash; the efforts have had inconsistent results. Learn more about the strategies in use and their findings.&nbsp;<a href="" target="_blank" aria-label="Read more about States Focus On High-Risk Patients To Drop Medicaid Spending">Read more</a></p>