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.
Moving Health Home will host a reception for members, partners, funders, and others dedicated to expanding home-based health care options for Americans. We plan to meet at 6 PM PT (local time) on Monday, November 14th. The location will be in the venue expo, and be confirmed upon RSVP.
Please RSVP if you plan to or are interested in joining us. We hope to see you there!
Centers for Medicare and Medicaid Services (CMS): Request for Comment on Medicaid Program Face-to-Face Requirements for Home Health Services and Supporting Regulations (10/21) - CMS announced an opportunity for the public to comment on CMS' intention to require practitioners to document that there was a face-to-face encounter with the Medicaid beneficiary prior to the physician making a certification that home health services are required. Comments are due by December 21, 2022.
Department of Health and Human Services (HHS) Office of Inspector General (OIG): Home Health Agencies Used Multiple Strategies To Respond to the COVID-19 Pandemic (10/18) - OIG urged CMS to evaluate how the use of telehealth affected the quality of home health care during the COVID-19 pandemic. The OIG surveyed 400 home health agencies (HHAs) in the fall of 2021 about their experiences during the pandemic. Among the challenges HHAs faced with telehealth during the pandemic were access to phone service, internet and equipment; assessing patients with the remote technology; and lack of reimbursement. The agency is recommending CMS collaborate with the Administration for Strategic Preparedness Response (ASPR) Technical Resources Assistance Center to apply what it learned during the COVID-19 public health emergency (PHE) to update or develop emergency preparedness training for HHAs on future infectious disease outbreaks. CMS has agreed with the recommendations. For additional coverage, see McKnights Home Care.
HHS: Renewal of Determination That A Public Health Emergency (PHE) Exists (10/13) - On October 13, Secretary Becerra renewed the COVID-19 PHE declaration for another 90 days. The new expiration date for the PHE is January 13, 2023. Renewal of 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.
Department of Labor: The Department of Labor Proposes Independent Contractor Rule that Targets Home Care (10/13) - The U.S. Department of Labor (DOL) published a Notice of Proposed Rulemaking on Oct. 13 to help employers and workers determine whether a worker is an employee or an independent contractor under the Fair Labor Standards Act. In the statement, the DOL singled out home care as one of nearly a dozen industries in which worker misclassification is a problem. The Department of Labor seeks comments on the proposed rule, which is published in the Federal Register. Comments may be submitted by Nov. 28, 2022. For additional coverage, see McKnights Home Care.
Axios: Home Health Patients and Advocates Sue Becerra (10/12) - Three disabled Medicare beneficiaries and two organizations are suing HHS Secretary Xavier Becerra, alleging he restricted the availability of home health services for individuals who need aides for short periods of time. The lawsuit in U.S. District Court for the District of Columbia comes as home health agencies face looming Medicare payment cuts that the providers say will reduce the number of visits for some patients, or result in the loss of care entirely. For additional coverage, see McKnights Home Care, Home Health Care News.
House of Representatives: Introduction of Nursing Home Pandemic Protection Act of 2022 (10/12) - On October 12, Reps. Gottheimer (D-NJ), Fitzpatrick (R-PA), and Sherrill (D-NJ) introduced the Nursing Home Pandemic Protection Act of 2022 (H.R. 9166), which would establish requirements for skilled nursing facilities, nursing facilities, and assisted living facilities to manage the outbreak of COVID-19.
Research and Polling
Journal of the American Society of Nephrology: Is Home Dialysis the Way Forward for Medicare? Assessing Potential Cost Savings Associated with Peritoneal Dialysis (10/14) - Amid the Advancing American Kidney Health initiatives and the ESRD Treatment Choices Model, efforts to increase peritoneal dialysis (PD) utilization are accelerating. This study analyzes the differences in Medicare spending on PD versus in-center hemodialysis (HD). A substantial portion of PD cost savings was concentrated in the first 90 days of dialysis initiation. Continued surveillance of home dialysis complications and health care costs is critical under the ESRD Treatment Choices Model, which financially incentivizes home dialysis, but thus far, clinical and economic indicators are pointing in the right direction.
University of Michigan National Poll on Health Aging: Poll Shows High Interest in Taking Medical Tests in the Comfort of Your Own Home (10/13) - According to a report from the National Poll on Healthy Aging, 82 percent of older adults say that in the future, they would be somewhat or very interested in taking a medical test at home. The vast majority (92 percent) of older adults agree that the results they receive from these tests should be shared with the person’s doctor or other provider. But among those who actually have bought and used a home test for a non-COVID-19 infection such as HIV or a urinary tract infection, just 55 percent shared their result with their primary care provider. 74 percent of older adults see at-home tests as more convenient than ones taken through their health care provider. For additional coverage, see Eureka Alert.
Home Health Care News: How Home-Based Care Organizations Are Training Their Care Staff (10/13) - As home-based care providers face severe staffing shortages, effective training programs that keep staff engaged remain crucial. A survey from HCP gathered data on training from 335 agencies, including private-duty home care, home health, hospice and palliative care providers. The results are meant to paint an overview of common training practices, as well as how effective those practices are. The survey also highlighted some of the obstacles that stood in the way of staff completing their training.
Journal of the American Geriatrics Society: Prevalence of Use and Characteristics of Users of Home-Based Medical Care in Medicare Advantage (10/12) - Home-based medical care (HBMC) is longitudinal medical care provided by physicians, advanced practice providers, and, often, inter-professional care teams to patients in their homes. This study used de-identified medical claims and enrollment records for MA beneficiaries during calendar years 2017 and 2018 linked with socioeconomic status data in the OptumLabs Data Warehouse. MA beneficiaries who received HBMC are older, experience greater chronic and serious illness burden, and higher levels of facility-based care than those who did not receive HBMC. MA plans need strategies to identify patients that would benefit from HBMC and develop approaches to deliver such care to this impactful, often invisible population.
Clinical Case Reports: Telemedicine Allows for Effective Communication Between a Medically Complex Cancer Patient and His Virtual Hospital Medical Team (10/11) - Good physician–patient communication is key for effective hospital care. This case report describes a patient diagnosed with an acute pulmonary embolism and bacteremia who was treated in a virtual hybrid hospital-at-home program. Constant communication with the virtual and in-home healthcare teams enabled a unified knowledge of the patient's wishes.
Healthcare IT News: About 80 Percent of Emergency Patients Avoided Hospital Admission in SA Virtual Care Service Trial (10/11) - In partnership with SA Ambulance Service, regional hospitals and aged care facilities, the SA Virtual Care Service (SAVCS) provides an individualized assessment service via video link for urgent patients on scene with responders. Responders can turn to senior and specialist medical clinicians for help via video on an electronic tablet to assess, monitor, and determine the most appropriate and safe options for emergency patients. The SAVCS pathway brings the expertise of clinical teams that is normally only available in the ED to the patient's home.
JAMA Health Forum: Financial Incentives to Facilities and Clinicians Treating Patients With End-stage Kidney Disease and Use of Home Dialysis (10/7) - Home dialysis rates for end-stage kidney disease (ESKD) treatment are substantially lower in the US than in other high-income countries, yet there is limited knowledge on how to increase these rates. This study reviews how the End Stage Renal Disease Treatment Choice model affect home dialysis rates. The study suggests that higher incentives may be necessary to affect behavioral change by dialysis clinicians and facilities towards home dialysis. For additional coverage, see McKnights Home Care.
Wellsky: How the Pandemic Changed Post-Acute Care Forever (10/1) - Since the beginning of the COVID-19 public health emergency (PHE), there has been mounting evidence that the continuum is shifting away from institutional care toward less expensive home-based alternatives, such as the Hospital at Home waiver. Patient-expressed preferences for receiving health care services at home did not originate because of the pandemic, but it appears that the sentiment was significantly strengthened by it. Shifting to home-based care alternatives and away from post-hospital in a facility will require additional organized services at home to maintain health stability.
“The past several years have demonstrated that the home is a viable site of clinical care, and we don’t have to go back to the way things were,” said Krista Drobac, Founder, Moving Health Home. “With the use of technologies like telehealth, remote patient monitoring, virtual disease management, as well as remote lab services to improve diagnosis and monitoring, we can make home-based care a reality and accessible to all.”
News and Market Developments
Home Health Care News: GE’s Healthcare Arm Dives Further Into Home-Based Care (10/20) -GE Healthcare, the $17.7 billion health care arm of General Electric (NYSE: GE), is further investing in the home-based care space through a remote patient monitoring (RPM) partnership with AMC Health. This week, the two companies announced a joint venture that will allow GE Healthcare clinicians to offer RPM as a virtual solution to care outside of a traditional hospital environment in the home.
Healthcare IT News: A Closer Look at the Tech Needed for New Care-At-Home and Aging-In-Place Models (10/20) - Healthcare IT News sat down with Ashish Shah, CEO of Dina, an AI-powered platform for care-at-home models, to discuss health IT's role in aging in place. Connecting care teams and enabling information sharing among hospitals, group practices and, most importantly, families is crucial to helping more senior citizens get health care at home.
Signify Health: Signify Health Expanding In-Home Diagnostic Testing Program (10/18) - Moving Health Home member, and value-based care platform Signify Health is building out its offering for in-home testing and diagnostics. The program, which is offered to Medicare Advantage and Medicaid members, aims to support early detection of some of the diseases and chronic conditions that have the largest impact on the Medicare population, such as chronic obstructive pulmonary disease, peripheral arterial disease, colorectal cancer, chronic kidney disease and diabetes. Diagnostics and preventive services are provided during an in-home evaluation visit conducted by Signify Health, with the goal of making access convenient and comprehensive. For additional coverage, see Fierce Healthcare.
McKnights Home Care: How to Bring Primary Care to the Homebound (10/18) - Homebound Americans have more complex and costly medical conditions on average than the general population. The increasing number of homebound Americans and growing realization that patients do better in their homes are combining with technological advances to drive a shift toward primary care in the home. Delivering basic healthcare services and providing help with daily activities for homebound Americans require a team-based approach to primary care that includes non-traditional providers such as community-based organizations (CBOs) and social service agencies.
Modern Healthcare: November and Beyond, Industry Stakeholders Weigh in on Their Hopes for Congress (10/18) - Providers are eager to secure prolonged reimbursement for temporary programs enacted during the COVID-19 public health emergency, which was last extended this month. The end of the pandemic will, for instance, mark the end of the Acute Hospital Care at Home waiver, unless Congress acts quickly on bipartisan legislation, the Hospital Inpatient Services Modernization Act, to extend the program allowing hospitals to treat certain patients at their homes. More than 200 health insurance companies and hospitals have received waivers for the program.
Home Health Care News: Why One Home-Based Care Veteran Sees Home Modification As A Major Growth Area (10/17) - TruBlue Total House Care, a senior-focused home repair company that specializes in house care, recently welcomed Carrie Coumbs as the company’s new senior strategic advisor. Under Coumbs’ guidance TruBlue is ensuring that the location that a senior calls home was in fact supporting their aging. Looking ahead, Coumbs believes that home modifications will play a larger role in MA plans goals of keeping seniors safe.
Fierce Healthcare: The Three Cs of Home Care: How Home Visits Complement, Connect, and Coordinate to Improve Mental Health and Other SDOH Outcomes for Seniors (10/17) - As health insurance programs increasingly move away from traditional-fee-for-service models to more holistic plans, a growing focus of whole-patient care for seniors is identifying social barriers that keep them from seeking preventive health care. Using the three Cs – complement, connect and coordinate - at home care services can defragment care and ensure that mental health issues and other barriers to care are being addressed.
McKnights Home Care: Home Care is Ripe for Value-Based Care (10/17) - Value-based care is opening up new horizons for home care providers, but the payment model also is creating challenges. Value-based care is a great opportunity for the healthcare industry to mitigate costs by identifying patients at risk for certain diseases early and begin treating them in the home. The model ties provider payments to the quality of care rendered and rewards them for both efficiency and effectiveness. The model replaces the traditional fee-for-service approach that pays providers on the amount of care.
Home Health Care News: PE Firm Tenex Capital Reportedly Seeking Buyer For Team Select Home Care (10/17) - The private equity fund Tenex Capital is reportedly seeking a buyer for Team Select Home Care, a home-based care services provider that serves the medically complex pediatric population as part of its business model. Tenex has begun taking bids on Team Select in a process that started about a month ago. The financials of the process include “about $35 million of pro forma adjusted EBITDA, on about $250 million of revenue. The two aspects of Team Select’s business model that make it relatively unique are its commitment to pediatric patients and its involvement in the paid family caregiver model.
MedCity News: Why Care At Home Belongs in Health Equity Strategies (10/16) - Moving care into the home provides value in terms of lower costs and better clinical and safety outcomes, but one topic that doesn’t get enough attention is the opportunity care at home provides to address health equity in communities. The care models that have arisen in this space, from Hospital at Home to chronic care management, offer better interactions between patients and providers, and allow us to more meaningfully address the numerous factors affecting health equity.
Home Health Care News: 5 Home Health CEOs Tease Plans, Priorities For 2023 (10/14) - In the remaining months of 2022, leaders across home health care are focusing on addressing the U.S. Centers for Medicare & Medicaid Services’ (CMS) pending payment rule, rolling out new programs to enhance care delivery, staff continuity and more. Home Health Care News asked five CEOs to break down their plans for the rest of the year, and how achieving these goals would move their organizations forward.
Home Health Care News: UnitedHealth Group Continues To Tout At-Home Capabilities, Walmart Partnership (10/14) - UnitedHealth Group remains steadfast in its commitment to value-based care and the growth of Medicare Advantage. One of those offerings will be the home health care with the pending acquisition of LHC Group Inc. Starting in 2023, UnitedHealth Group will jointly develop 15 Walmart health clinics in Florida and Georgia and will extend the partnership into additional geographies over time. Another focus will be to meet people where they are, which includes expanding the company’s clinical capabilities to care for people more holistically in their homes.
McKnights Home Care: Inequality in Home Care Must Be Fixed (10/13) - The traditional home care business model is broken, Arosa CEO Ari Medoff says. Low wages and a system that punishes workers when a client passes away or leaves home care must be fixed. In this McKnight’s Home Care Newsmakers podcast, Medoff talks about attracting, training and treasuring home care workers.
Home Health Care News: Homecare Homebase’s Data-Driven Pushback Against The Home Health Proposed Payment Rule (10/12) - The CMS proposed home health payment rule for 2023 reasonably ruffled feathers across the industry. Commenters pointed out that the proposal would reduce access to care and worsen the patient-to-clinician ratio. One of the public commenters on the rule was the home-based care software company Homecare Homebase (HCHB). The company’s comment leveraged its extensive well of data to push back against the proposal and CMS’ methodology. Home Health Care News recently caught up with Scott Pattillo, chief strategy officer at HCHB, for its latest episode of Disrupt. Pattillo gave a breakdown of HCHB’s comment and what the data says.
Stat News: Medicare's Cuts to Home Health Are a Step in the Wrong Direction (10/11) - Despite the popularity and advantages of home health care, access to it is being threatened by deep cuts proposed by Medicare. In its latest proposed rule, Medicare is considering implementing a permanent nearly 8 percent cut in payments to home health services. More than 25 percent of home health users across the country are over the age of 85, and 43 percent have five or more chronic health conditions, compared to just 22 percent of all Medicare patients. That means these cuts will target some of the sickest, most at-risk older Americans.
Patient Engagement HIT: Patient Engagement Strategies for Home Healthcare Providers (10/11) - As home health care becomes a regular fixture in medicine, it will be key for clinicians delivering home-based care to understand key patient engagement strategies. Regardless of whether a clinician delivers care in an ambulatory site, a hospital, or in the home, patient-centricity, communication, and education are all important. Patient engagement strategies for home healthcare don’t stray too far from engagement in other forms of care; patient-centricity and education are essential. Home healthcare providers need to utilize unique strategies that allow them to deeply engage with the patient in the home setting.
Home Health Care News: Walgreens Boots Alliance Fully Acquires CareCentrix, Fast-Tracking Itself into the Home (10/11) - Walgreens Boots Alliance is accelerating its plans to invest in the post-acute care space and in the home. Walgreens initially announced a $330 million investment in CareCentrix in October of 2021. At the time of the deal, Walgreens gained a 55% stake in CareCentrix at an $800 million valuation, with an option to buy the remaining equity interests. Walgreens announced it was fast-tracking its way into the home by acquiring the remaining 45% stake in CareCentrix for $392 million. The deal is expected to be finalized in March of 2023.
McKnights Home Care: Home Care Firms Team Up on Dementia Training (10/11) - ComForCare is teaming up with At Your Side Home Care on a memory care training program to help home care teams address dementia-related challenges. The two firms launched DementiaWise, an occupation-based and team centered program designed specifically for home care workers. Students and faculty at Duke University’s Occupational Therapy Doctorate Program and Partnerships for Health evaluated the program and found home care workers who completed the program felt better equipped to care for clients living with dementia and their families.
OHSU: Hospital at Home: Amid Hospital Capacity Crisis, OHSU Offers an Alternative (10/11) - With brick-and-mortar hospitals at or near capacity, Oregon Health & Science University is ramping up a new service to provide patients with hospital-level care within the comfort of their own home. Hospital at Home currently has about eight patients admitted at any one time. Even though that’s a small fraction of OHSU’s overall capacity of 576 licensed hospital beds, the program has an important impact on OHSU’s ability to care for all patients — inside the hospital and out.
McKnights Home Care: EMTs Play Key Role for Home Care Providers (10/11) - Paramedics and emergency medical technicians are the backbone of MedArrive, a two-year-old care management platform that enables healthcare providers and payers to extend care into the home. MedArrive uses more than 50,000 EMTs and paramedics nationwide to provide in-home episodic and longitudinal care to patients who have chronic conditions and may be frequent users of emergency departments. States see the power of having the paramedic in conjunction with having the x-ray tech, the nurse, the PT and OT all being able to treat the patient in the home
Home Health Care News: A Further Breakdown Of Home-Based Care Services In Medicare Advantage For 2023 (10/10) - Ahead of the annual enrollment period Medicare Advantage (MA) organizations have been offering a peek into what benefits they’re offering seniors in 2023. Notably, many will give their beneficiaries access to home-based care services. The number plans offering in-home support services has grown exponentially over the years. Next year, 1,091 plans will include these services as part of their offerings, compared to 729 in 2022, 429 in 2021 and 223 in 2020. The top three organizations offering the most plans with in-home support services are Elevance Health, Humana Inc. and Centene Corporation. Cigna and SCAN Group were also included in the top ten list.
Forrester: Acute Home Care Is The Best Medicine For US Hospitals (10/10) - From dramatic policy and practice change to groundbreaking digital innovation, a new frontier of medicine was born: acute care at home. Also known as hospital-at-home, acute home care is a modern-day hospital imperative that confirms the popular saying “There is no place like home.” This delivery model of care transcends the softer kinds of “home care” commonly delivered by the home health agencies of today. The benefits of acute home care include improved mortality, decreased readmissions, decreased length of stay, significant cost reduction, improved functional recovery, overall positive evaluations, lower levels of family member stress, and increased patient satisfaction. In the future of healthcare, acute home care will be the most innovative and pragmatic solution for managing spiraling healthcare costs, an insurmountable influx of patients, the spread of infectious disease, and the safety of patients and hospital staff.
Home Health Care News: What Prior Authorization Changes Mean For Home Health Providers (10/10) - Home health providers could potentially see a speedier prior authorization process thanks to legislation moving through Washington, D.C. In addition to requiring electronic prior authorization, the Improving Seniors’ Timely Access to Care Act requires MA plans to publicly share what their prior authorization rules are, it also requires them to share with CMS their approval rates, denial rates and overall just adds more transparency to the system. The Improving Seniors’ Timely Access to Care Act is designed to improve health care for seniors by, in part, reducing those burdensome prior authorization processes.