How Home Health Providers Can Play A Greater Role In Reducing ED Visits

Home Health Care News | By Patrick Filbin

In order to reduce emergency department visits, home health care providers should be honing in on relationships with primary care providers and patients. 
 
That is the thesis of a new wide-ranging study conducted by researchers and clinicians at the University of Virginia Health. 
 
“The increasing number of home health referrals after ED use in order to improve the transition from hospital to home points to the role that home health care providers can and should play in communicating with PCPs,” Catherine Harris, director of Continuum Home Health at the University of Virginia, said at the National Association for Home Care & Hospice’s (NAHC) annual conference last month. “Providers should be playing a larger role in educating and assisting patients with fostering a strong PCP relationship for health maintenance and prevention.”
As a way to investigate home health care’s role in reducing unnecessary ED visits for seniors, Harris and her colleagues investigated the prevalence of ED utilization among a group of home health patients. 
 
The study reviewed 233 emergency department visits made by 195 home health patients and tried to pinpoint why patients made visits to the ED, whether or not those visits came before or after an in-home visit and if they had admitted themselves to the ED or if a home health aide recommended an ED visit. 
 
The study found that 130 of those patients visited the ED after hours, meaning those visits likely were costlier and less convenient for hospital staff and for the patient. Meanwhile, 149 patients had spent between 1 and 8 hours at the emergency department. 
 
“I have no doubt that our robust attempt to handle these calls and have our staff call the patient back is one of the reasons why so few of these were actually happening during office hours,” Harris said. “We found it fascinating that the vast majority,85, were in the ED for less than four hours — which speaks to the fact that they went in, they got turned around, they got dealt with for whatever that one issue was, and then they were sent back home.”
 
Of the 233 ED visits, 202 were sent home, while 30 were held for further observation. 

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A New Biden Proposal Would Make Changes to Advantage Plans for Medicare: What to Know

USA TODAY | By Maureen Groppe

WASHINGTON − The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans.

“We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra.

If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs.

Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage plans.

Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.

Here’s what you need to know.

Extra Medicare Benefits

Nearly all Medicare Advantage plans offer extra benefits such as eye exams, dental and fitness benefits. They’re offered at no additional cost to seniors because the insurance companies receive a bump up from their estimated cost of providing Medicare-covered services.

But enrollees use of those benefits is low, according to the Centers for Medicare and Medicaid Services.

To prevent the extra benefits serving primarily as a marketing ploy, the government wants to require insurers to remind seniors mid-year what’s available that they haven’t used, along with information on how to access the benefits.

“The rule will make the whole process of selecting a plan and receiving additional benefits more transparent,” Becerra said.

Broker Compensation Limits

Because many seniors use agents or brokers to help them find a Medicare Advantage plan, the administration argues better guardrails are needed to ensure agents are acting in the best interest of seniors. Officials said the change would also help reduce market consolidation.

“Some large Medicare Advantage insurance companies are wooing agents and brokers with lavish perks like cash bonuses and golf trips to incentivize them to steer seniors to those large plans,” said Lael Brainard, director of Biden’s National Economic Council…

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2023 RIHC Home Care Chartbook, Co-Sponsored by NAHC

The Institute is excited to announce the 2023 RIHC Home Care Chartbook is now available online! 

Highlighted by data on Medicare Advantage home health patients, workforce trends, and more, the Chartbook is an invaluable tool for understanding the role home care plays in the U.S. healthcare landscape. 

Released annually, the Chartbook, co-sponsored by the National Association for Home Care & Hospice (NAHC), and compiled and charted by KNG Health Consulting LLC, summarizes and analyzes statistics on home health from a range of government sources. The Chartbook offers a glimpse of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies. The Chartbook includes updated statistics from the Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, the Medicare Current Beneficiary Survey, and other data from CMS. 

We would like to thank 2023 Chartbook sponsor NAHC for their continued support of the Institute and the Chartbook. Learn more about NAHC at www.nahc.org.

A copy of the 2023 RIHC Home Care Chartbook is available here. 

Please join us for a webinar with the team from KNG, along with our co-sponsors at NAHC, on Wednesday, December 6th at 2 pm ET. Register now here.

For more information on the Chartbook, please reach out to the Institute's Executive Director, Jen Schiller, at [email protected] or (771) 203-0595.

How CMS’ Goal To Enroll All Medicare Beneficiaries In ACOs Could Impact Home-Based Care Providers

Home Health Care News | By Joyce Famakinwa
 
The U.S. Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030.
 
Currently, roughly 13.2 million Medicare fee-for-service beneficiaries are assigned to an ACO. 
With this in mind, there has been more activity and investment around accountable care organizations (ACOs), including for at-home care providers, which are strategically collaborating with these organizations.
 
The Walgreens Boots Alliance-backed VillageMD — a Chicago-based primary care services organization that has an at-home care arm — is one provider that is working heavily in the ACO space. The company is a participant in the ACO REACH Model, for example. 
 
Andrea Osborne, senior vice president of ACO operations and delegated services at VillageMD, pointed out that the ACO REACH model allows providers more leg room to approach CMS about various concerns and suggestions.
 
“We actually get to go to CMS and have conversations, and say, ‘Hey, the Medicare rule isn’t working for us,’” she said Tuesday during a panel discussion at the annual LeadingAge conference in Chicago. “‘We’d like to try it that way.’ We have these conversations.”
Amid the pandemic, the company approached CMS about expanding at-home care services, for instance.
 
“We said, ‘We want to be able to use home health care anywhere,’ and then they actually ended up opening that up for everyone,” Osborne said. “That’s because we had tested these models, so it’s really important that when you are in these partnerships – if there are barriers to care that are Medicare regulations – you’re speaking with your ACO partner, because we actually can get opportunities to test changing those rules.”
 
Medicare Shared Savings Program (MSSP) ACOs are an opportunity for home-based care providers to enter the space.
 
The majority of MSSP ACOs are hospital-based. As a result, these ACOs are focused on a patients’ post-acute stay after a hospitalization, according to Andy Edeburn, a consultant at Elder Dynamics, an advisory services company for aging services providers.
 
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