In The News

Enhabit CEO's Advice to Providers: Learn to Work with Conveners

McKnight’s Home Care / By Diane Eastabrook
 
Conveners can be an important ally for home health firms as they negotiate contracts with Medicare Advantage plans, according to Enhabit Home Care & Hospice CEO Barb Jacobsmeyer. 
 
Jacobsmeyer told investors during a conference in New York Wednesday that conveners, who work as intermediaries negotiating rates and services between payers and providers, are gaining a better understanding of home health’s value.
 
“They are taking that full-picture approach that they are going to be responsible for the cost of care, so we actually think engaging more proactively with conveners and getting into more agreements with them is probably the way we need to go because they do get it,” Jacobsmeyer explained. 
 
Still, the Enhabit executive admitted to the audience at Citi’s 2023 Healthcare Services, Metech, Tools and HCIT Conference that her attitude about conveners is an about-face from what it was roughly a year ago. At that time, she shared the view of some providers that conveners can make it difficult to negotiate lucrative rates and contracts with payers. Jacobsmeyer said Enhabit’s payer innovation team, which negotiated 18 contracts with Medicare Advantage plans late last year, helped change her attitude about conveners. 
 
Jacobsmeyer said the payer innovation team has become especially integral to the company as the payer mix shifts more from traditional fee-for-service Medicare plans to MA plans. She said in the past year the company has seen a 4% decline in fee-for-service plans and an 11% increase in MA plans. 
 
Jacobsmeyer told the conference negotiating payer contracts at lucrative rates is becoming especially important in home health given ongoing uncertainty surrounding Medicare rates. For 2023, the Centers for Medicare & Medicaid Services increased the Medicare reimbursement rate a skimpy 0.7% and instituted a 3.925% behavioral rate cut totaling $635 million. The second half of the behavioral health cut could go into effect next year, as well as a temporary clawback of overpayments related to the Patient-Driven Groups Model (PDGM) in excess of $2 billion.
 
“Certainly you could anticipate that we will get the other half of the behavioral adjustment, but with a market basket that will offset that,” Jacobsmeyer speculated. “But, I think the big topic is going to be the clawback. Right now the $2 billion number is out there.”

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What Does a Funeral Do?

By Barbara Karnes

I've been thinking about funerals. Doesn’t everyone? Maybe not. What does a funeral do? It honors the person that has died and brings support and comfort for the living. Funerals are about people coming together, a “send off” kind of gathering and sharing support for the beginning of our grieving journey. 

We used to lay the body out in the living room. Family and friends came to our home, paid their respects to the one that died and gathered around the grieving. Sometimes church and clergy were involved but often not.

Gradually, as we became more "civilized," our end of life rituals became more varied and elaborate. Visitations were held in funeral homes, and funerals were conducted in a church for the grieving before the gathering at the cemetery.

Today, we are looking, thinking, re-evaluating the comfort found in end of life rituals and services. 

We are considering Life Celebrations before we actually die so we can enjoy the party. I’m not sure there is much support for the grievers there, but there is lots of love and affirmations for the person facing the end of their life.

We are having in-home gatherings, going back to having the body in the "parlor".

Memorial services with the body not present are popular, generally with a nice portrait picture in place of the body. It tends to deflect the pain, or so people say. I’m not so sure about that.

When planning your burial in your Advance Directive, here are some things to think about:

Funerals are for the living. They are to bring comfort. Recognizing the life lived by the person that died is comfort to the living.

Funerals in churches are tradition. They tend to be attended because that is what we do when a life ends. Funeral services are about listening. Listening to others share kind words, listening to clergy saying redeeming words, singing praising songs. If you are not “churchy” then you can skip a church funeral. Have a service of sharing, of pictures; a gathering of friends and acquaintances in the funeral home with the body present. (There is something reflective about seeing the body laid out. Yes, my special person is dead).

Visitations, I’m sad to say, are becoming less and less a part of the end of life traditions. Why sad? Because visitations are about visiting, about sharing, about interacting, all of which is support for the griever. A visitation is a community experience at a time when support is the most comforting. A time where words have less meaning than a hug, an embrace, or a presence just sitting quietly.

 

DEA Proposes Rules to Govern Post-PHE Prescribing of Controlled Substances via “Telehealth”

From NAHC

On Friday, February 24, 2023, the Drug Enforcement Administration (DEA) released proposed rules intended to govern the prescribing of controlled substances via telemedicine for application at the end of the COVID-19 Public Health Emergency (PHE).  The proposed rule — — Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation (RIN 1117-AB40/Docket No. DEA–407) – was developed in conjunction with the Departments of Health & Human Services and Veterans Affairs and is anticipated to become effective at the end of the PHE (which is scheduled to end on May 11, 2023).  DEA is allowing only 30 days for comment and will accept comments received on or before March 31, 2023.

The proposed rules focus on prescribing of a controlled substance via telemedicine consultation by a medical practitioner when no in-person evaluation of the patient has been conducted. For these types of consultations, the proposed rules would allow medical practitioners to prescribe a 30-day supply of Schedule III-V non-narcotic controlled medications, or a 30-day supply of buprenorphine for the treatment of opioid use disorder without an in-person evaluation or referral from a medical practitioner that has conducted an in-person evaluation, as long as the prescription is otherwise consistent with any applicable Federal and State laws.   However, the proposed rules would prohibit prescribing of any Schedule II substances or the general prescription of a narcotic controlled substance via a telemedicine encounter as the DEA believes this would pose “too great a risk to the public health and safety.”

The proposed rule does allow for the prescribing of any controlled substance which a practitioner is legally permitted to prescribe under applicable laws and regulations via a qualifying telemedicine encounter if the patient has been referred for treatment by a practitioner who has conducted an appropriate, in-person medical evaluation.  Prescribing of controlled substances as a result of a telemedicine encounter would be time-limited for each patient (unless conducted by VA practitioners) such that practitioners could prescribe a medication only for a period of 30 days before an in-person medical evaluation must be conducted.  Prescriptions written in response to a telemedicine encounter will require additional practitioner recordkeeping, including an indication on the prescription document that the prescription was written as the result of a telehealth encounter.

The DEA has created a useful table that outlines the proposed rules.

While the rule was released only a few days ago, there has been widespread concern expressed by proponents of telemedicine, particularly with respect to the potential harmful impact the rules could have on behavioral health treatment.  However, based on an initial review and discussion with individuals in the hospice field, the National Association for Home Care & Hospice (NAHC) believes that the rules, if implemented, could also create barriers to timely access to drugs for pain and symptom management in hospice care, palliative care, and home health care.

NAHC is in the process of examining the rule and will be discussing it with member agencies and other stakeholder groups.  We welcome input from providers, including prescribing practitioners, as to how these proposed rules would impact the practice of hospice care, palliative care and home health care.  Please submit any comments to Theresa  Forster ([email protected]),Katie Wehri ([email protected]), and Mary Carr ([email protected]) at your earliest convenience.

 

Providers Push Back on Senate Committee Move to Slash Home Care Funding in VA Bill

McKnight’s Home Care
 
Home care providers are lobbying a Senate committee to reverse its recent decision to remove a central provision from the Elizabeth Dole Home Care Act. The provision would allow the Department of Veterans Affairs to fund nursing home-level home care at 100% of the cost of nursing home care. Currently, the VA can only fund home care at 65% of the cost of institutional care.
 
“We urge you to keep section 3 in the Elizabeth Dole HCBS Act, which will provide veterans a choice as to where they receive care by raising the 65% cap on non-institutional care,” Vicki Hoak, CEO of the Home Care Association of America, wrote in a Feb. 14 letter to the chair and ranking member of the U.S. Senate Committee on Veterans Affairs.
 
HCAOA, many of whose members provide VA-funded home care, learned earlier this month that the Senate committee intended to eliminate Section 3 of the bill. In the letter to the committee, Hoak referred to a General Accounting Office (GAO) report that found the average cost of institutional care per veteran in nursing homes was $268 per day, or nearly $98,000 per year. That compares to VA data showing the average cost per veteran receiving non-institutional care was only $5,500 a year.
 
She also mentioned that allowing the VA to offer home care alleviates the strain on nursing homes. Most nursing homes have limited capacity to serve veterans with special needs, especially those needing dementia, ventilator or behavioral care, she wrote. 
 
“Removing the 65% cap on nursing level care in the home setting would provide relief to the capacity issues of institutional care while providing access and choice for veterans,” Hoak wrote. 
 
She told McKnight’s Home Care Daily Pulse that if a veteran hits the 65% cap and still needs services, they need to go to a nursing home. It doesn’t negate the obligation of the VA. And it’s not just home care that contributes to the cap; respite and adult day care services also add to the cost, she said. 
 
Removing the provision in the bill hurts those veterans who want to stay in their homes as long as possible, she said. 
 
“Everyone wants to age in place, but when they need the care we put a cap on the care,” she said.

Our members and home care providers are encouraged to continue to use HCAOA’s Legislative Action Network to send updated messages to members of Congress to urge them to keep the Dole Act intact and oppose efforts to eliminate or reduce HCBS funding.

Click to send a message to your legislators.

 

Senate Panel Launches Effort to Shore up Health Workforce and Ease Crippling Shortages

Fierce Healthcare | By Robert King

A key Senate panel is launching a major effort to shore up the healthcare workforce after lingering shortages have roiled the industry. 
 
The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing Thursday on addressing the crisis. Some of the policy solutions include expanding the Graduate Medical Education program and growing teaching health centers. 
 
“A shortage of healthcare personnel was a problem before the pandemic and now it has gotten worse,” said HELP Committee Chairman Bernie Sanders, I-Vermont. “Health care jobs have gotten more challenging and, in some cases, more dangerous.”
 
Sanders said Thursday that in the next decade there will be a shortage of more than 120,000 doctors as well as a massive need for 450,000 nurses within the next two years. The staffing shortage has been particularly acute among nurses, as hospitals have turned to pricey contract labor to shore up capacity.
 
Lawmakers detailed where the panel could go to combat the problem. 
 
Ranking Member Bill Cassidy, R-Louisiana, said that one of the biggest potential barriers could be the education requirements for nursing educators, which his home state is looking into. 
 
“States have to ask—what does that student need to know to effectively care for patients and whom can they learn it from?” he said during the hearing. “That will be a way to remove a real choke point in terms of educating these nurses.”
 
Sanders added that the panel could look into expanding residency slots for the GME program and “increase student loan debt forgiveness and scholarships provided” under the National Health Services Corps.
 
There are some potential must-pass vehicles for the panel to include reforms, chief among them extending mandatory funding for the National Health Service Corps and the Teaching Health Centers GME program. 
 
Another program set to expire in 2023 is the Children’s Hospital GME program that helps to train pediatricians and other pediatric specialties.
 
“It is important that funding for these programs is extended on time, in a bipartisan fashion, with the appropriate spending offsets,” Cassidy said.

 
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