In this twice-monthly newsletter, you will find policy developments, research, and updates on how health care organizations are striving to shift more health care delivery into the home – meeting patient needs where they are and expanding access to quality health care.
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Congress: Crist, Suozzi Introduce Bill to Empower Seniors to Stay in Their Homes Longer (5/6) - U.S Representatives Charlie Crist (D-St. Petersburg) and Thomas Suozzi (D-NY) introduced the Home Modification for Accessibility Act, legislation that provides tax incentives for home modifications (a penalty free early retirement withdrawal and lifetime tax deduction of up to $30,000) so that seniors and those with disabilities can more easily and safely continue living in their own homes. Under this legislation, homeowners will be able to take proactive measures to modify and update their homes, allowing them to safely and comfortably age in place, and creating new job opportunities for skilled laborers and contractors. Bill text can be found here.
Department of Health and Human Services (HHS): US Set to Extend COVID-19 Public Health Emergency (PHE) Past July (5/16) - Monday, May 16, was the deadline for the Biden Administration to announce if it would end the PHE on July 15, and it did not give notice, meaning the emergency will continue into the summer. HHS Secretary Becerra has the authority to extend the emergency for 90 days at a time, and HHS said it would give at least 60 days' notice before ending the emergency. The PHE provides for several CMS waivers to continue, including those enabling care in the home, such as expanded use of telehealth and the Acute Hospital Care at Home program.
Centers for Medicare and Medicaid Services (CMS): Medicaid Program; Reassignment of Medicaid Provider Claims (5/16) - CMS issued a final rule allowing Medicaid to directly pay for independent home health aides' benefits, including health insurance. State Medicaid agencies can now allow home health aides not working with an agency to have employee benefit premiums and union dues deducted from their paychecks. The policy is not mandatory for states, but removes federal barriers for states wishing to use the system. These regulations are effective June 15, 2022.
Research and Polling
Journal of Pain and Symptom Management: A Randomized Controlled Trial of a Novel Home-Based Palliative Care Team Centered Around Community Health Workers Improved Patient Outcomes (5/17) - While home-based palliative care models have shown benefits, their common reliance on palliative care trained physicians (MDs) and advanced practice nurses (APNs) as the central providers can create models that are both expensive and difficult to replicate. The objective was to determine whether a novel home-based palliative care team centered on a community health worker (CHW), nurse (RN), and social worker (SW) could improve symptoms and quality of life for patients with serious illness.
Cambridge University Press: Care innovations and health disparities: An exploration of COVID-19 outcomes in inpatient and hospital-at-home care settings (5/16) - Although exploratory in nature, the results suggest that HaH may help combat sources of health disparities that have dominated the pandemic. Although inpatient care resulted in inpatient readmissions, mainly among Black and Hispanic patients, AH-HaH stays were not associated with any inpatient readmissions. The equivalent distribution among ADI quintiles of patients who became severely ill within 30 days of their AH-HaH stay suggests that HaH may be able to leverage innovation to reach vulnerable populations and reduce the impact of factors that contribute to inequity.
Millbank Memorial Fund: Direct Care Workforce Policy and Action Guide (5/18) - This white paper/toolkit examines the challenges direct care workers face and outlines administrative, funding, policy, and regulatory levers that states can use to offer them better support. The guide is designed to help states understand the complexity of the issues regarding the current direct care workforce shortage, and the role states can play in strengthening and improving this critical workforce. In particular, the guide offers concrete examples of thoughtful and innovative ways states are working to overcome the challenges that have long plagued the workforce.
AJMC: Characteristics of Home-Based Care Provided by Accountable Care Organizations (5/12) - This study describes the use of home-based services in accountable care organizations (ACOs). Twenty-five percent of respondent ACOs had formal home-based care programs, 25% offered occasional home visits, and 17% were actively developing new programs. Home-based primary care was the most common program type. Half of programs were established within the past 3 years. Funding sources included direct billing for services, health system subsidies, and ACO shared savings. A majority of respondents expressed interest in expanding services, but were concerned about their ability to demonstrate a return on investment (ROI), which was reported as a major or moderate challenge by three-quarters of respondents. Expanding Medicare ACO home-visit waivers to all risk-bearing ACOs and covering integrated telehealth services would improve the financial viability of these programs.
Home Healthcare Now: A Theoretical Framework of Home-Based Professional Nursing Practice (May/June 2022) - This article introduces a descriptive middle-range theoretical framework unique to professional nursing practice provided in the patient's home. The variety of care models provided in the home, ranging from non-skilled home maintenance service to hospital-at-home programs, reinforces the need to clearly define and describe the home-based professional nursing practice. This framework includes six concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy), and four relational statements of the concepts that describe the experience of patients in their homes and home-based providers.
Home Health Care News: The Power of ‘Higher-Level’ Home-Based Care Research (5/16) - Various coalitions have been launched over the last couple of years in order to vie for better home-based care legislation in Washington, D.C. There’s also Moving Health Home, which vies for home-based care generally and includes providers across the spectrum – from home care and home health providers, to even companies like Amazon (Nasdaq: AMZN).
News and Market Developments
Health Affairs Forefront: The Lagging Adoption Of Home Blood Pressure Monitoring: Has Policy Hindered Quality? (5/19) - Due to the many errors associated with in-office blood pressure measurement, clinical guidelines emphasize the importance of home blood pressure monitoring (HBPM) for the diagnosis and management of hypertension. However, the specifications for the CQMs that determined our performance did not allow for inclusion of most home blood pressure readings. We were working hard to improve our clinical quality measure performance, but I questioned whether we were actually improving quality.
Modern Healthcare: Bayada, home care trade groups form alliance to tackle workforce challenges (5/18) - Bayada Home Health Care, the National Association for Home Care and Hospice, and the Home Care Association of America are seeking partners to join their Home Care Workforce Action Alliance. They aim to catalyze action to resolve a severe workforce shortage the members say is leaving potential patients without care.
Home Health Care News: Accountable Care Organizations Are Diving Head First Into Home-Based Care (5/16) - A new study on ACOs and home-based care from the Institute for Accountable Care (IAC) found that accountable care organizations (ACOs) have considerably increased their home-based care arsenals over recent years. In order to keep up the home-based momentum for ACOs, the IAC and Mechanic make a few policy recommendations: 1) Expand home-visit waivers to the Medicare Shared Savings Program (MSSP) ACOs taking downside risk; 2) Expand the hospital-at-home waiver to independent medical groups; and 3) Allow for payment for telehealth in conjunction with home-based primary care services on a permanent basis.
MedTrade: Home-Modification Bill Could Lead to Lower Costs, Partnerships for Home Care Providers (5/13) - The Home Modification for Accessibility Act (H.R. 7676), introduced in the House last week by Representatives Charlie Crist (D-FL) and Tom Suozzi (D-NY), would allow older adults to deduct home-modification expenses from their taxes. If passed, the bill would provide a boost to aging-in-place efforts, spurring greater partnership between home care companies and home-modification businesses. Home care industry leaders and home-modification stakeholders such as Right at Home and HomesRenewed are heralding the bill as a major step forward.
healthleaders: The Future of Nursing is at Home (5/13) - The COVID-19 pandemic has reminded the public that nurses are the backbone and the heart of our healthcare ecosystem. Throughout the past two years, nurses willingly put themselves at risk of infection from COVID-19 every day, while working long hours and experiencing burnout, to have a positive impact on the health of their patients. The challenges of the pandemic have caused significant turnover, as many nurses retired early or decided to leave their direct patient care jobs for less stressful positions. With more than 20% of hospital nurses saying they intend to leave their jobs, what else can they
Fierce Healthcare: Study: Medicare needs to improve reimbursements for home care to entice more ACO investment (5/12) - An AJMC study found that Medicare needs to make more home care services reimbursable for accountable care organizations to entice more providers to offer such care. Researchers surveyed 151 ACOs over their home-based care programs. They found that 25% of ACOs had a formal program, while 25% offered occasional visits and 17% had programs in development. The study also looked at the home-based care programs for 40 ACOs that were surveyed, finding 49 home-based initiatives. The most popular were programs based on primary care (37%) and care coordination (24%). Only 13% of ACOs offered home care programs based on social needs, and 11% offered acute hospital-level services.
Inside Health Policy: CMS Finalizes State Option To Deduct Union Dues From Medicaid Pay (5/12) - On May 12, CMS revived a policy that lets states use part of a provider’s Medicaid payments to cover consenting independent home health workers’ dues for unions, third-party health care and training. The Obama administration’s version of the policy had been reversed by the Trump administration. Biden’s CMS argues that allowing these deductions will lead to a better trained and more competent workforce, while the need for consent from the independent practitioners, expected to include home health workers, helps protect them.
Home Health Care News: Signs Suggest Elective Procedure Admissions into Home Health Are Reaching Pre-Pandemic Levels (5/11) - The average age of an Amedisys Inc. patient is about 78. The current age of the oldest baby boomer is about 77, which suggests that a whole new population could be entering its census in the near-term future. On top of that, elective procedures are returning to pre-pandemic levels, representing about 8% of the company’s home health admissions. In addition to demographic tailwinds and an expected 5% year-over-year increase for its home health admissions, any forthcoming pro-home-related legislation (such as the Choose Home Act and the temporary extension of the Acute Hospital Care at Home waiver) would essentially be icing on the cake for Amedisys.
Home Health Care News: Former Google Exec Raises $9.5M, Launches In-Home Care Startup Reverence (5/10) - As the New York-based company continues to build its technology platform, its aim is to partner with health plans and coordinate the care of seniors receiving home-based care. Backed by Target Global, Reverence will use the funding to build out a suite of products and services enabling the delivery of in-home care. The company has also earmarked some funds for the purposes of growing its team. A pitch deck shared by Business Insider suggests Reverence’s 2022 markets will be New York, New Jersey and Pennsylvania. By 2023, the startup is eyeing an expansion across much of the Midwest and East Coast, with a national footprint by 2024.
Health Affairs Forefront: How To Support Patients Who May Be Caregivers Too (5/11) - Health care systems can leverage technology to obtain accurate and more complete information about patients at every clinical encounter. The CARE Act, which has been enacted in more than 40 states and the District of Columbia, requires hospitals to record the names of caregivers of patients who are hospitalized. However, simply asking patients about their caregiving role is not enough. Many individuals continue to fall through the cracks, especially those from minoritized and marginalized populations. Health care systems must equip patients with resources that optimize their capacity to provide care for others, while also receiving health services themselves. Strategies may include offering a focused response to their individual needs and social circumstances, including virtual medical visits, telehealth, same-day appointments, mobile screening programs, home visits, and lab and diagnostic facilities closer to home.
Home Health Care News: MidCoast Health System, Resilient Working to Fix Health Care’s ‘Forever Crisis’ (5/10) - Seniors in rural areas often face more hurdles to gaining access to home-based care, especially in comparison to their urban counterparts. Resilient Healthcare’s recent Rural Health Initiative aims to address this. The program is the latest development for the rapidly growing in-home care provider, which specializes in treating higher-acuity patients. MidCoast Health System became the initiative’s first participant. In addition to showcasing Resilient’s momentum, the new initiative also reflects the increasing focus on rural health overall, with an increasing number of home-based care providers and primary care groups targeting such underserved communities.
Home Health Care News: CVS Health Using Home Health, Hospice Providers to Deliver Care Further Upstream (5/9) - CVS Health recently floated the idea of home health acquisitions and partnerships. Mostly, it has repeatedly doubled down on the idea that it wants to get into the home. To get a closer look at CVS and Aetna's plans in the home, Home Health Care News sat down with Aman Gill, the director of product strategy and innovation at Aetna, for a conversation.
PR Newswire: Alliance for Home Health Quality and Innovation Adopts New Name: Research Institute for Home Care (5/9) - The Alliance for Home Health Quality and Innovation will operate under a new name – Research Institute for Home Care – and adopt a new tagline: "Advancing home care through research." In announcing the change, the Institute will focus on improving access to and delivery of care in the home by promoting research to inform policy and identify best practices and patient care models. The Institute will consider sponsoring a wide range of studies that inform clinical and policy areas, including qualitative and quantitative, clinical trials, observational studies, and prospective and retrospective studies.
Home Health Care News: Alivia Care CEO Opens Up About Embracing Value-Based Care Learning Curve (5/8) - As the larger health care continuum continues to embrace value-based care, and home health readies itself for the expansion of the Home Health Value-Based Purchasing (HHVBP) Model, Alivia Care seems like a company ready to navigate these new waters. Alivia Care is a provider of home health, hospice and palliative care. The company operates across 32 counties in North Florida and Southeast Georgia. The company is making a concerted effort to move further into the risk-based environment through its joint ventures with Programs of All-Inclusive Care for the Elderly (PACE) organizations and REACH ACOs. During the podcast conversation, CEO Susan Ponder-Stansel described Alivia Care's value-based care journey, the value-based care learning curve, and explained why home health fits well with the company’s other services.
Home Health Care News: Payment ‘Patchwork’ Limiting Near-Term Scalability of Home-Based Palliative Care (5/5) - Home-based palliative care is an untapped business opportunity for many home health and hospice providers in the U.S., but multiple factors continue to hinder near-term scalability. To dramatically boost access and expand the market, policymakers will need to rethink traditional Medicare benefits and launch new demonstration programs, while simultaneously monitoring the ever-evolving role of Medicare Advantage (MA). Additionally, private investors will need to further support emerging palliative care startups to fuel innovation.