Chipping Away at Home Care Funding Hurts Everyone
Home care can help relieve some of the rising costs of health care. However, the approach that has been used in recent years is not the proper solution.
Proposed Rule Impacts Home Health Services
The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule that would trigger a 14 percent reduction in payment rates for vital home health services. This huge cut comes on top of the 14 percent rate cuts to Liberty HomeCare & Hospice since 2008. Indeed, this would leave providers across the county with an average margin of -9.77 percent by 2017. The overreaching proposed rate cuts will result in payments far below the cost of services, thereby jeopardizing care to homebound elderly and disabled Medicare beneficiaries.
The National Association of Home Care and Hospice has identified that under the CMS proposal, in the first year alone nearly 50 percent of home health agencies will be paid less than the costs of care. By 2017, over 70 percent of providers will be paid less than cost.
Cutting reimbursements can have dramatic and dangerous effects for patients. It will affect the care they receive and even determine whether or not they receive home care at all. To compound the reductions to home health agencies, there is also a recommendation that the care will also increase the cost to home care patients. President Obama has recommended that the cost of home care be passed on to the patient, beginning with a $100 co-pay in 2017.
Reduction for Home Care Funding Harms Patients
That could greatly affect patient care. A study in the New England Journal of Medicine found that seniors who faced higher copays for office visits had fewer office visits but more, and longer, hospitalizations. This strategy makes no sense, especially when home care itself can both benefit patients and reduce the rising costs of health care.
Over the past several years, there have been significant regulatory increases in costs to home health agencies. Instead of cutting reimbursements and implementing co-pays, Medicare should encourage more patients to receive home care. Home care helps patients heal faster, in the environment they prefer, and is also a proven way to reduce costly hospital readmissions.
Six straight years of cuts exemplifies the continuing of a misguided policy that is not serving the best interests of patients. They deserve better.
Investing in Hospice Care Is the Right Choice for Everyone
The Centers for Medicare and Medicaid Services announced on April 29 that the 2014 hospice reimbursement rate would include an “increase of 1.1 percent.” The CMS announced the proposed “increase” because it cited the fact that spending on hospice services has increased 500 percent since 2000.
That sounds like great news and is fiscally sound, but a closer examination of the numbers reveals the real truth. The current sequester has already mandated a 2 percent decrease in all Medicare reimbursement across the board. That means that the actual reimbursement for hospice would decrease by almost 1 percent year over year. Indeed, this is well below the actual increase in the direct cost of doing business next year. It is that kind of “fuzzy math” that has plagued the CMS and has put providers in a vulnerable position and ultimately put the care at risk.
Cutting the reimbursement rate for hospice does not reduce the overall costs for healthcare. CMS has been promoting Hospice for terminally ill patients for well over a decade. There should be no surprise that this strategy has resulted in more hospice care being provided throughout the country and it has also significantly improved outcomes and cost savings overall to Medicare.
Benefits of Hospice Care
New research published in March by Mount Sinai found that hospice enrollment saves money for Medicare and reduces emergency room stays and hospital readmissions. In that research, providers saved Medicare between $2,500 and $6,000 per patient depending on when the patient begins hospice care. That can more than offset any increase in the hospice reimbursement rate.
Patients need hospice care, because of the positive impact it has for end-of-life care as well as its impact for caregivers. Quality of life is improved, patients actually live longer than those who don’t receive hospice care, and caregivers have also seen tangible benefits. Our patients and their caregivers have given testimonials about how much hospice care has helped them.
This is not the time to manipulate numbers, and in turn, manipulate the end results for patients. Hospice care needs a stronger investment from the CMS, because that investment will pay the most dividends for all.
Rural Doctors Need More Support than Ever
National Doctor's Day
National Doctor’s Day is celebrated annually March 30th. This is a great time to remember the value of physicians throughout North Carolina, South Carolina, and Virginia. Doctors throughout our coverage area provide countless valuable services, and do all they can to help patients get better.
Rural Doctors Face Challenges Too
But many of those doctors face challenges that need to be addressed soon. For rural doctors, an individual practice can be “just not sustainable,” due to the increased paperwork, decreased reimbursement, and surge in workload. A study by the U.S. Department of Health and Human Services illustrates that 20 percent of the American population live in a rural area, but only 10 percent of physicians work there.
That creates difficult decisions for those physicians. They typically see more patients than urban doctors, but often can’t spend as much time per patient. With reduced staff, they must do much of the mounting paperwork themselves and face long hours. Add in the declining reimbursement rates for insurances, such as Medicare and the problem will continue to grow.
Recent efforts to grow the number of rural doctors have failed, a recent study in Health Affairs revealed. There are programs in place, similar to the Kansas Bridging Plan, a loan forgiveness program for doctors who agree to practice for three years in rural areas. In North Carolina, rural doctors can receive some loan forgiveness or even a service bonus of $50,000 for a 4-year commitment in high needs areas.
There needs to be more done. Rural doctors need higher reimbursement rates from insurance companies, and other measures are also on the table. Rural doctors must be appreciated through the long-term and not just on National Doctor’s Day. Providing an incentive for them is not only an investment in their practice, it is an investment for all who live in those areas.
Simple Gestures Make Major Impacts for Hospice Patients
National Patient Recognition Week
Liberty Hospice recently celebrated National Patient Recognition Week by handing out roses to all of its patients. It has become a tradition for us, and to see the smiles and gratitude that patients and their families express reminds us what an impact a small gesture can do.
That’s a good reminder for anyone who has a loved one in hospice care. Any kind of gesture can make a big impact. We have helped coordinate other kinds of surprises for our hospice patients, from a puppy to a shopping trip, to a ride on a horse. Those moments have helped rekindle a favorite memory, while at the same time creating a new one.
Many people don’t know where to start, but sometimes the best gesture you can do for a loved one occurs even before hospice care begins. By talking to your loved one about hospice care, and its many benefits, you can build a valuable communication that can educate them, as well as yourself, on what is right for your family. If you’re not sure how to start that conversation, feel free to contact us to learn how to explore the conversation.
Honor Patients
Once your loved one begins hospice care, there are many different ways to honor them. Our staff is always looking for ways to help. Our chaplains may sing with them, or our volunteers may help them write a story. There are many ways we honor our hospice patients, but many times, the involvement of a family member makes those events even more meaningful. Sometimes, just seeing a family member is just as impactful for the patient.
You may not believe you are prepared for such visits, but our volunteers, social workers, and other staff can counsel you through it all. We understand there are new, difficult emotions that come with hospice care. We also realize how hospice care improves the quality of life for patients and for their families too. Let us help you get started.
How Home Care and Hospice Can Make a Difference
News headlines have been splashed recently with terms, such as “fiscal cliff” and “debt ceiling.” Congress has been negotiating for months on ways to reduce spending while also still providing the best services to their constituents. In many instances, finding those solutions can be incredibly challenging. However, there is one obvious step to help alleviate the some of the rising costs of healthcare, while still providing top-notch service - home care and hospice.
Positive Impact of Home Care and Hospice
Home care and hospice are both proven ways to help reduce costs. A recent study showed that when used as the first post-acute setting after a hip fracture, home care saved Medicare an average of more than $5,000 per patient. Home care can also help reduce costs through lowering rehospitalization rates and improved chronic care management, as the Alliance for Home Health Quality and Innovation demonstrated in this video in November.
Hospice care can also reduce costs. A recent Duke study stated that hospice care reduced spending by more than $2,300 per patient compared to normal care, which typically included costly hospitalizations near death.
Improve Your Loved One's Quality of Life
Most importantly, both home care and hospice care improve quality of life while providing cost benefits. The overwhelming majority of patients prefer to receive treatment in their own homes, and both home care and hospice care allow that for patients. Studies have shown that hospice patients live longer than other patients in similar conditions. Furthermore, home care patients recover faster than similar patients.
These two vital care choices should be more receptive to new patients and not more restrictive. Ending costly rehospitalizations through home care and expensive hospital stays at the end-of-life should be a primary focus of how to reduce costs in healthcare. By utilizing home care and hospice services to a wider group of patients, we can look past “cliffs” and “ceilings” and optimistically consider a large potential of savings, all at great benefits to patients.
Exploring a Challenging Conversation
Educating patients and their loved ones about hospice care, and how it can boost quality of life, is one of our goals at Liberty HomeCare & Hospice Services. Hospice care is not an easy topic to address. After all, many patients feel like they are giving up, or fear that end-of-life conversations may create anxiety or added stress for loved ones.
Tips for Starting the Conversation about Hospice
End of life conversations can be difficult to address, but understanding the rewards from the quality of life that follow can help make starting those conversations a little easier. Most people prefer to have their end-of-life care at home, and those at the end of life typically live longer under hospice care than without it. Determining that care, and what tactics will be used in a patient’s final days, can create peace of mind and alleviate some of the stress that inevitably comes when a family member’s condition worsens.
Start the Conversation Early
It’s also important to start talking about end of life as early as possible. Indeed, this gives loved ones the best opportunity to express their wishes before there may be a time when they are no longer able to speak on their own behalf.
How do you start the conversation?
Consider these tips below to start the dialogue with a patient’s doctor, which may be easier than starting that conversation with a loved one. These tips includes questions to address and valuable links to make the conversation a little easier. It discusses questions about advance directives, medical treatments, and other preferences that a patient may have.
The following questions can help you determine what’s right for you as you begin end-of-life care conversations with your doctor:
- When it is your time to die, where you like to be, and with whom?
- If your preference is to die at home, what would you need to make that happen? Who would be your caregiver?
- How do you feel about depending on others at the end of life?
- Do you want to know if you have a terminal illness? Do you want others to know? Why or why not?
- What do you think a physician’s role should be in discussing end-of-life issues?
- What are your greatest fears about end of life? What would help reduce those fears?
- If faced with a terminal illness, what would be most important to you? What would it mean to live well for however much time you have left?
- Do you have an advance directive (i.e., a living will or power of attorney for healthcare)? Do you know how to get one? Do you know how, and when to update your advance directives?
- How do you think you would react if your doctor tried to discuss end-of-life care options with you? Would you feel your doctor wasn’t doing everything possible to cure your illness and save your life?
- If it was determined that you were terminally ill and could no longer eat and drink on your own, would you want artificial nutrition and hydration (e.g., a feeding tube and intravenous fluids)?
- If you could no longer breathe on your own, would you want to be hooked up to an artificial breathing device (a medical ventilator)?
- Do you feel comfortable talking to your physician about end-of-life issues?
- Have you had the conversation about your end-of-life wishes with your family members and healthcare providers? If not, are you going to discuss these matters with them, and if so, when?
- What do you know about hospice? How did you learn about it? What experience have you had with hospice?
- Do you know what hospice services are available to you?
For more information about initiating end-of-life conversations, visit http://www.considertheconversation.org/.
Creating a clear plan of action will help families make the most of the remaining time they have with a loved one.
That’s what end of life care is about: increasing the quality of life for all involved.
New Hospital Readmission Penalties Reflect Why Patients Need Home Care
The debate over the merits of the Affordable Care Act won’t end soon, but its impact has already started. More than 2,000 hospitals nationwide will have their Medicare reimbursements reduced due to high readmission rates, as detailed in this Kaiser Healthcare Report.
Readmission Problem
Those numbers illustrate how prevalent the readmission problem has become, and it also spells out how many readmissions hospitals are doing and where improvements could be made. Some hospitals in Liberty’s coverage area will not face any reduction in their Medicare reimbursements. However, many hospitals will face substantial penalties, up to 1 percent of their reimbursement totals.
Home Care Makes a Difference
Those penalties will cost hospitals millions of dollars, and reflect the changes that need to be made. Home care can make a difference for hospitals, by keeping patients at home and helping them get treatment they need for chronic conditions without having to face a return trip to the hospital within the first 30 days of discharge.
Those first 30 days after discharge are often critical. Patients can return home, and not realize the importance of follow-up care and treatment at home. Some hospitals, including those in Charlotte and Wilmington, have been successful in getting those patients set up for home care and follow up visits. However, many hospitals, particularly those in rural areas in the Carolinas and Virginia, have a much more difficult challenge.
Home care can help alleviate this burden. I’ve discussed how home care can help in a previous blog. Indeed, the latest news just echoes the importance of getting home care involved. Hospitals must work in coordination with home care companies, such as Liberty HomeCare to ensure the best outcomes for their parents. No one wants patients back in the hospital only a few weeks after discharge – that can be a drain for everyone, including the patient and their caregivers. Getting home care involved quickly after discharge is the best approach for all involved.
Hospice Care Creates Better Quality of Life
Hospice Care Makes a Difference
A new study published in the June issue of Health Affairs re-affirms something we in the hospice industry already know.
In the study, half of adults age 65 or older had visited a hospital emergency department in the last month of their life. But those who were in hospice care had dramatically fewer visits than those who were not, illustrating that they had a better quality of life.
The leader of the study, Alexander K. Smith, and other authors recommended that government, health care systems, and insurers develop policies that encourage physicians to talk to patients and their families about end-of-life issues.
Another study bolsters that argument. Earlier this year, the American College of Chest Physicians found that patients who have had end-of-life discussions were twice as likely to rate their care as “best imaginable” than those who did not. Yet, less than 15 percent of those surveyed had discussed end of life issues with their physician.
The studies reflect that many people still don’t understand how beneficial hospice care can be for all involved. That’s disappointing, considering the number of recent studies that have validated that conclusion. The Journal of Clinical Oncology reported that back in 2010, and so did the Commonwealth Fund all the way back in 2004.
Promote Education about the Benefits of Hospice Care
All of those studies reflect the need to further educate the public on the benefits of hospice care. Patients and their families often don’t realize how impactful hospice care can be, even as other families describe its positive impact. Educating the public will help reduce the number of emergency department visits, while providing a better outcome for all involved. That’s something we should all strive to see.
We Appreciate, and Need, Nurses More than Ever
National Nurses Week
National Nurses Week celebrated nurses nationwide earlier in May, and nurses at Liberty HomeCare & Hospice Services make a major difference in their patients’ lives, in the care and compassion that they provide.
Patients and their families have complimented our nurses for their care, and we always want to continue to provide that kind of exceptional care for our patients. But an increasing shortage of nurses in the coming years may make maintaining that kind of care for our home care and hospice patients more challenging.
Nurse Shortage
The shortage of nurses in the three states Liberty serves – North Carolina, South Carolina, and Virginia – continues to grow. Between the three states, there is a shortage approaching 25,000 nurses. As sobering as that statistic is, the shortage is expected to grow in the next 10 years. In fact, one of every five jobs created in 2012 has been from the health care field, including nurses.
We need to encourage more people to consider the nursing industry, as our population continues to age. But how can it be done? Liberty offers an Educational Assistance Program that has aided some employees.
Capital grants can also aid nursing schools, as can the Nurse Education, Expansion, and Development Act. This federal act would give grants to nursing schools to increase the number of nursing faculty and students. State legislation can also help improve opportunities for future nurses, and relieve some of the expected shortage.
Liberty HomeCare & Hospice Services aggressively recruits the top nurses in our coverage area. We know how vital they are to our patients’ care. We hope that these suggested measures and others can help make a difference, so all patients get the kind of care they deserve.
Maintaining Patient Trust Remains Home Care’s Goal
A disturbing news story out of Texas has made myself and everyone else associated with Liberty HomeCare & Hospice Services feel overwhelming shock and disappointment.
A doctor in Texas is allegedly the leader of the biggest Medicare fraud in U.S. history, involving more than $375 million from the Dallas, Texas area.
This incident is unacceptable, plain and simple, and doesn’t reflect the important work done by the home care industry. There are hundreds of thousands of home care workers in the Carolinas, Virginia, and the rest of the U.S. who do passionate and caring work. Indeed, these workers represent the highest moral and ethical standards in serving some of our communities’ most dependent and vulnerable seniors.
Liberty HomeCare & Hospice Services, as well as hundreds of other home care agencies, supports any effort to confront doctors or agencies that are abusing the Medicare and Medicaid systems and the patients we serve. If you are aware of any kind of abuse, or want more information, I urge you to take action by calling me directly at 1-910-815-3122 if it is related to Liberty or by visiting medicare.gov.
Expert Home Care is Vital for Seniors
The report from Texas is unsettling, but the staff of Liberty HomeCare & Hospice Services remains committed to enhancing the quality of life of our patients. We know that home care is a vital part of the health care industry, and won’t let the regrettable actions of a few taint the positive impact of so many others.
Tony Zizzamia
President, Liberty HomeCare & Hospice Services