Skip to main content

Month: February 2017

New Home Health Rules Should Help Patients But Will They Be Delayed?

by Judith Graham , Kaiser Health News

Home health agencies will be required to become more responsive to patients and their caregivers under the first major overhaul of rules governing these organizations in almost 30 years.

The federal regulations, published last month, specify the conditions under which 12,600 home health agencies can participate in Medicare and Medicaid, serving more than 5 million seniors and younger adults with disabilities through these government programs.

*Home health care provides at-home services to people coming out of a hospital or rehab facility as part of their Medicare benefits. Here, nurse Susan Sellecchia checks patient Joan Hutchins.”

They strengthen patients’ rights considerably and call for caregivers to be informed and engaged in plans for patients’ care. These are “real improvements,” said Rhonda Richards, a senior legislative representative at AARP.

Home health agencies also will be expected to coordinate all the services that patients receive and ensure that treatment regimens are explained clearly and in a timely fashion.

The new rules are set to go into effect in July, but they may be delayed as President Donald Trump’s administration reviews regulations that have been drafted or finalized but not yet implemented. The estimated cost of implementation, which home health agencies will shoulder: $293 million the first year and $234 million a year thereafter.

While industry lobbying could derail the regulations or send them back to the drawing board, that isn’t expected to happen, given substantial consensus with regard to their contents. More likely is a delay in the implementation date, which several industry groups plan to request.

“There are a lot of good things in these regulations, but if it takes agencies another six or 12 months to prepare let’s do that, because we all want to get this right,” said William Dombi, vice president for law at the National Association for Home Care & Hospice (NAHC).

Home health services under Medicare are available to seniors or younger adults with disabilities who are confined to home and have a need, certified by a physician, for intermittent skilled nursing services or therapy, often after a hip replacement, heart attack or a stroke.

Patients qualify when they have a need to improve functioning (such as regaining the strength to walk across a room) or maintain abilities (such as retaining the capacity to get up from a chair), even when improvement isn’t possible. These services are not for patients who need full-time care because they’re seriously ill or people who are dying.

Several changes laid forth in the new regulations have significant implications for older adults and their caregivers:

Patient-Centered Care

In the past, patients have been recipients of whatever services home health agencies deemed necessary, based on their staffs’ evaluations and input from physicians. It was a prescriptive “this is what you need and what we’ll give you” approach.

Now, patients will be asked what they feel comfortable doing and what they want to achieve, and care plans will be devised by agencies with their individual circumstances in mind.

“It’s much more of a ‘help me help you’ mentality,” said Diana Kornetti, an industry consultant and president of the home health section of the American Physical Therapy Association.

While some agencies have already adopted this approach, it’s going to be a “sea change” for many organizations, said Mary Carr, NAHC’s vice president for regulatory affairs.

Patient Rights

For the first time, home health agencies will be obligated to inform patients of their rights — both verbally and in writing. And the explanations must be communicated clearly, in language that patients can understand.

Several new rights are included in the regulations. Notably, patients now have a right to receive all the services deemed necessary in their plans of care. These plans are devised by agencies to address specific needs approved by a doctor, such as speech therapy or occupational therapy, and usually delivered over the course of a few months, though sometimes they last much longer. Also, patients must be informed about the agency’s initial comprehensive assessment of the patient’s needs and goals, as well as all subsequent assessments.

A patient’s rights to lodge complaints about treatment and be free from abuse, which had already been in place, are described in more detail in the new regulations. The government surveys home health agencies every three years to make sure that its rules are being followed.

NAHC officials said they planned to develop a “notice of rights” for home health care agencies, bringing greater standardization to what has sometimes been an ad hoc notification process.

Caregiver Involvement

For the first time, agencies will be required to assess family caregivers’ willingness and ability to provide assistance to patients when developing a plan of care. Also, caregivers’ other obligations — for instance, their work schedules — will need to be taken into account.

Previously, agencies had to work with patients’ legal representatives, but not “personal representatives” such as family caregivers.

“These new regulations stress throughout that it’s important for agencies to look at caregivers as potential partners in optimizing positive outcomes,” said Peter Notarstefano, director of home and community-based services for LeadingAge, a trade group for home health agencies, hospices and other organizations.

Plans Of Care

Now, any time significant changes are made to a patient’s plan of care, an agency must inform the patient, the caregiver and the physician directing the patient’s care.

“A lot of patients tell us ‘I’ve never seen my plan of care; I don’t know what’s going on; the agency talks to my doctor but not to me,’ ” said Kathleen Holt, an attorney and associate director of the Center for Medicare Advocacy. The new rules give “patients and the family a lot more opportunity to have input,” she added.

In another notable change, efforts must be made to coordinate all the services provided by therapists, nurses and physicians involved with the patient’s care, replacing a “siloed” approach to care that has been common until now, Notarstefano said.

Discharge Protections

Allowable reasons for discharging a patient are laid out clearly in the new rules and new safeguards are instituted. For instance, an agency can’t discontinue services merely because it doesn’t have enough staff.

The government’s position is that agencies “have the responsibility to staff adequately,” Carr of NAHC said. In the event a patient worsens and needs a higher level of services, an agency is responsible for arranging a safe and appropriate transfer.

“Agencies in the past have had the ability to just throw up their hands and say ‘We can’t care for you or we think we’ve done all we can for you and we need to discharge you,’” Holt said. Now a physician has to agree to any plan to discharge or transfer a patient, and “that will offer another layer of protection.”

Published: February 14, 2017 — 9:55 AM EST

We Were Again Rated CMS 5-Stars in Philadelphia Home Care!

We have made the Pennsylvania Homecare Association proud again this year, as Deer Meadows Home Health & Support Services, LLC claims yet another 5 Star Rating from the CMS (Centers for Medicare & Medicaid Services)! We are honored to accept this achievement, and will continue to provide quality, convenient, and affordable healthcare for all our patients; we expect to get 5 Stars every year!

Now, if you are asking yourself,

“What do these 5 stars represent? Why the accomplishment?”

Well, allow us to elaborate what it takes to get this top rank from CMS. It takes a lot of dedication and hard work to match the high standards that come with a 5-Star Quality Rating. Once you see some of the guidelines, you will see what we are so excited about.

What is CMS’s 5-Star Quality Rating?

The 5-Star Quality Rating System was conceived to aid patients, and their families, by making sure that they receive the best medical treatment available. This Star System aids healthcare providers as well. CMS’s System allows caregivers to speak up about various medical establishments, thus, enabling growth by pinpointing the areas that need improvement. A lack of Stars is CMS’s way of showing struggling organizations where, and how, to improve their shortcomings. Overall, the 5-Star Quality Rating System helps guide struggling establishments, and this brings about better, and more, quality healthcare providers everywhere.To get a 5-Star Rating means that the establishment has met all requirements, and is essentially a very trustworthy, and suggestable, source for medical treatment. Here is how CMS rates healthcare providers:

  • The Staffing Rating is based on hours of care provided by nursing staff in nursing homes. A high Star count in this rating correlates to a highly-dedicated staff!
  • The Health Inspection Rating is based on health inspection records spanning back three years; good and bad reports. 5 Stars in this Rating means an immaculately spotless health inspection record, and one that has been consistent!
  • The Quality Measure Rating is assessed through 11 different clinical, and physical, measures for nursing homes, and uses more than 12 million nursing assessments to assure that the quality of your healthcare is tip top. Our 5 Star Rating attests to our services’ great quality!

If you are interested in learning more about CMS’s 5-Star Quality Rating System, learn more at the CMS website.

Celebrate with Us!

So, now you can see why we are so excited to claim this 5-Star Rating for yet another year! By providing dedicated, quality care, our team of professionals has once again proven themselves to be extraordinary at what they do. Celebrate with us today as we lift our glasses to the dedicated men and women who made this happen, and to the better future that great healthcare will bring to all.

ACO (Accountable Care Organization), What’s That?

The ACA (Patient Protection and Affordable Care Act) sought out to implement innovation into the medical world. Their plan was to create an improved quality of safe healthcare, while also managing to reduce costs for Medicare patients. In the beginning of 2012, the ACA accomplished their goal, and organized the ACO.

ACO (Accountable Care Organization) represents an organization of medical professionals, hospitals, and other healthcare providers. These men, women, and institutions, have voluntarily joined together to assure that health care patients get the quality treatment they deserve in a timely manner, as well as cutting down their costs for healthcare.

How Does This Program Work?

When ACO is practiced correctly, it produces a lot of savings from reducing costs. This savings goes directly back to Medicare, thus making it easier for those who cannot obtain health care to, well, obtain it! This system is a self-sustaining cycle of benefits when played out efficiently.

What Are Some of the Guidelines?

ACO is solely voluntary, so health care providers are not forced to participate in the organization. Just remember, providers all over the country have begun to provide their health care with this organization; ACO is a dear friend of Medicare, thus a dear friend of the people!

Speaking of people, anyone who has Medicare will remain with their Medicare rights. This saves health care patients from all the headaches that come along with finding a doctor. As a healthcare patient, you can choose any doctor or provider you want!

There are some alternative options offered at The CMS Innovation Center. Check these links out for more information!

How Can Providers Get Involved?

CMS (Centers for Medicare & Medicaid Services) provides a vast range of opportunities for healthcare providers out there who are inclining towards ACO. They provide classes, and training programs, for ACO. One program among these learning sessions is the ACO Accelerated Development Learning Sessions (ADLS), which helps the executives, and leaders, of medical establishments trek towards an ACO future.

  • Firstly, ADLS provides tools necessary to understand if the medical provider is ready for AOC; due to the different stages of development in medical guidance, not all providers are ready to start using AOC.
  • Secondly, ADLS helps medical providers form lucrative goals to obtain, and provide, a system that advocates better healthcare, treatment, and lower costs for patients.
  • Thirdly, ADLS will teach organizations interested in ACO how to develop an action plan.

Find more information on this program at the ADLS website.

Once the training process is complete, providers are faced with the choice of which program they want to use. Medicare provides many of these ACO programs for providers. The following will elaborate on some of these possible programs:

  • Medicare Shared Savings Program is a fee-for-service program that allows practitioners to become an ACO provider. If you are a provider, apply today!
  • Advance Payment ACO Model provides practitioners with a program that significantly grows incentives program for those who are in the Shared Savings Program.
  • Pioneer ACO Model is designed for the new pioneers of coordinated care. Unfortunately, this program is no longer accepting applications now.

ACO is quickly growing as Medicare’s strong right hand. This system is not just good for the patients, but also for providers and the healthcare establishment. We highly recommend you consider implementing ACO into your practice, but make sure you are in a current stage of development that will allow this. Stay updated with ACO news at the CMS website, as they are always up to speed with what you need to know about ACO!