‘Putting All the Pieces Together’: Data Drives Work to Improve Home Health Care

University of Colorado | By Mark Harden

As a Medicare program to incentivize home care quality goes nationwide, Judith Ouellet, PhD, MPH, crunches the numbers to report on the program’s results.
 
Medicare’s parent agency has expanded a program that seeks to improve the quality and efficiency of home health care services, and Judith Ouellet, PhD, MPH, a University of Colorado Department of Medicine researcher, is helping in the effort to assess home health quality under the program.
 
Ouellet is a senior instructor in the Division of Health Care Policy and Research, a division made up of interdisciplinary researchers who design and conduct health outcomes research, economic analysis, and evaluate efforts to improve the quality of health care services.
 
She is the division’s lead on a project to assess the implementation of the Home Health Value-Based Purchasing Model program, or HHVBP, now being rolled out nationwide by the U.S. Centers for Medicare & Medicaid (CMS), the agency that runs Medicare.
 
Just as a primary care doctor regularly uses a stethoscope and a surgeon employs a scalpel, Ouellet’s medical tool of choice is data. It’s the tool she’s using to help protect homebound patients.
 
‘Inadequate, uncoordinated care’
 
Home health care encompasses a variety of services provided for those with an illness or injury outside of a hospital or skilled nursing facility. Medicare generally pays for certain home health care services – such as medically necessary part-time or intermittent skilled nursing care, physical and occupational therapy, and medical social services – if a doctor certifies a patient needs the care and if a patient has difficulty leaving home for care.
 
The home care usually is provided by a Medicare certified home health agency. There are more than 11,000 home health agencies nationwide – 84% of them operating for profit – serving roughly 3 million patients in a typical year, the National Center for Health Statistics says.
 
→ Research Shows Impact of Caregiving on Parents’ Employment, Health
 
When it works the way it should, home health care can be less expensive, more convenient, and as effective as care provided at a hospital or skilled nursing facility. But a CMS report on home care before the start of the HHVBP model said that “Medicare beneficiaries who qualify for home health care often receive inadequate, uncoordinated care for their chronic health conditions, resulting in more visits to the emergency room, more admissions to the hospital, or more placements in a skilled nursing facility.”…

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Fix Prior Authorization: Ask Your Members of Congress to Cosponsor the Improving Seniors' Timely Access to Care Act

Many APTA members report that medically necessary physical therapist services are delayed — greatly impacting patients’ clinical outcomes — because of the amount of time and resources they spend on documentation and administrative tasks. In a recent APTA survey, nearly 75% of respondents indicated that prior authorization requirements delay access to medically necessary care.

The Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532) aims to improve the current prior authorization system by requiring the Centers for Medicare & Medicaid Services to streamline the way Medicare Advantage plans use prior authorization. This legislation would establish an electronic prior authorization process, require real-time decisions for services that are routinely approved, increase transparency by requiring MA plans to report to CMS on their use of prior authorization (including their rates of approval, denial, and average time of approval), and press them to do a better job of incorporating input from health care providers in their authorization programs and decisions. 

Please ask your members of Congress to cosponsor the Improving Seniors’ Timely Access to Care Act. Taking two minutes to send a letter may save you and your patients time, money, and negative clinical outcomes in the future.

Thank you for taking action and for your support of APTA advocacy

Take Action Now

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Lawmakers Press CMMI's Fowler on Lack of Cost Savings for Alternative Payment Models

Fierce Healthcare | By Emma Beavins

Republicans on the House Energy and Commerce Committee lambasted the failure of CMS’ Innovation Center to save U.S. healthcare dollars during a recent hearing on value-based care.
 
Republicans suggested a variety of drastic actions like stopping projects that haven’t demonstrated cost savings, slimming the Center’s funding or shutting it down.
The Center for Medicare and Medicaid Innovation (CMMI) is tasked with driving the transition to value-based care. It runs demonstration projects that test different payment models and strategies for CMS to engage in the healthcare system to improve patient outcomes. 
 
Several CMMI models pay for medical technology and virtual care, like telehealth services in the dementia-focused GUIDE and remote monitoring services in its primary care VBC model, Making Care Primary.
 
Republicans took issue with CMMI’s spending and lack of savings since the center's establishment in 2010 by the Affordable Care Act, which projected it would save nearly $80 billion over two decades. According to a September 2023 report by the Congressional Budget Office, CMMI spent $5.4 billion more than it saved in its first decade. In the next decade, CBO estimates CMMI will increase spending by over a billion dollars. 
 
Because of this, Republicans said CMMI has failed as a money-saving project for U.S. healthcare. Elizabeth Fowler, deputy administrator of CMMI, who has been at the center for three years of its 14 years in existence, fought back, saying that CMMI has engaged in valuable projects, even if it’s not yet reducing costs. 
 
Republican Chair of Energy and Commerce Cathy McMorris Rodgers, R-Wash., said CMMI is “unsustainable” and said she has, “a hard time believing any objective observer could look at the results thus far and describe CMMI as a success.”
 
Republicans tempered their criticisms with recognition that CMMI’s Accountable Care Organization REACH model has been successful in driving ACO creation and bringing more value-based care into the system.
 
Fowler spoke on behalf of the Center during the hearing. In her opening statement, Fowler enumerated the value of CMMI in driving the transformation of the U.S. healthcare system. When lawmakers drilled into why the Center has not generated savings, Fowler said CMMI’s voluntary participation model can make it hard to generate cost savings as providers can drop out or in as they please.
 
Fowler repeatedly stressed that CMMI views all its programs as successful because they generate important lessons for the Center. She also said that Congress should look at how CMMI is improving quality of care, which is another one of its statutory mandates…

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President's Message

Posted: June 18, 2024

I’m back. Well, somewhat. Since late March I have been dealing with a significant injury to the shoulder on my dominant arm. For much of that time, I have been getting some quality instruction in how the other half lives—our clients. While I am not nor was not homebound, I have been struggling with self-care, figuring out how to do everything with only my non-dominant hand, and attending outpatient physical therapy for the last six weeks. Thankfully, my fractures are healing well, and my function is improving every day.

Please remember that the journey that our clients are going through is not an easy one, and one that they probably didn’t plan for. I was able to improvise, adapt, and overcome with the help of my family, a good case manager, and a few purchases of adaptive equipment from Amazon. Many of our clients don’t have the support system or resources to succeed like I have. In fact, we may be their only support. Please be sure to remember that as you interact with your clients throughout your work day.

Sincerely,

Phil Goldsmith
President
APTA Home Health