Update on SGR Repeal Bill

Yesterday, the House Ways and Means and Senate Finance Committees released a draft legislative proposal to eliminate the Medicare Sustainable Growth Rate (SGR) formula. The proposal would replace the SGR formula with a reformed fee-for-service (FFS) payment system which focuses on value over volume and encourages providers to take advantage of alternative payment models (APMs).  The revised FFS system would freeze current payment levels for ten years, but allow individual providers earn performance-based incentive programs.  After 2023, providers participating in advanced APMs would receive annual updates of two percent, while other providers would receive one percent.

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Social Media for LTC Facilities

Imagine living thousands of miles away from a loved one living in a long term care facility yet still being able to see daily or weekly updates of them.   Imagine being on your lunch break and seeing live-tweeted pictures of your mother doing crafts in her nursing home.  Well, situations like these are no longer fantasies because for many long term care facilities, this is a reality.  Through the utilization of social media, LTC facilities have been able to keep communication at the forefront of their agenda.  People no longer have to wait to see their family members because social media has made it possible for them to be part of their everyday life.  Having social media for your LTC facility adds value to your organization and differentiates you from your competitors.  Also, any unsolicited posts praising your facility for outstanding care and treatment of a family member is marketing that you cannot buy!

LTC facilities can utilize many of the most popular social media outlets to expand their online reach.   We recommend Facebook, Twitter and/or a blog to share information, news, events, multimedia (like YouTube videos).  Many senior living facilities have even used YouTube to provide virtual tours of their facilities, testimonials from residents, and some have made videos solely for entertainment purposes!  Click here to see one made a couple years ago.  Twitter and LinkedIn can be used to build professional relationships with other organizations and leaders in the LTC industry.

However, one must keep in mind that social media must be used with extreme caution.  There should never be pictures posted that would cause viewers to lose faith in your services or facility.  The following are a few tips to ensure proper use of social media: patient information should always be kept private unless you receive written permission, certain posts should come with a disclaimer, medical advice should never be offered, and online postings need to be monitored regularly to make sure they do not violate any policies.  But, if you choose HMS as your social media consultant, you will never have to worry about any of these privacy violations-we know the ins and outs of both healthcare and social media.

We understand nothing will ever replace face to face communication.  Still, social media can help you, your staff, your patients, and their families all stay connected.  Keep relationships alive and thriving! If you want more information on how to successfully integrate social media into your facility, please don’t hesitate to call us at (203) 294-6659.  Let’s connect!

CMS Clarifies its Definition of ‘Homebound’

CMS has clarified the definition of “homebound,” stating that any person “shall be considered ‘confined to the home’ (homebound) if the following two criteria are met:”

  1. The patient needs the aid of supportive devices such as crutches, canes, wheelchairs, walkers, the use of special transportation or the assistance of another person to leave their residence because of illness or injury.  Or, the person has a condition “such that leaving his or her home is medically contraindictated.” The patient must meet one of the previous requirements AND two additional requirements defined below.
  2. The patient is unable to leave their home AND that leaving their home requires a considerable effort.

“The Change Request 8444 also provides examples of temporary absences from the home-and in need of assistance-and how the patient would still be considered homebound.”  These new instructions are intended to prevent confusion and provide a clearer guide.

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Tiptastic Tuesday: The New Flu Vaccines

According to the Centers for Disease Control (CDC), you’re most likely to contract a virus from early October until the end of May.  Viruses can cause side effects such as fever and dehydration in healthy people but can be potentially lethal to children, the elderly, and anyone with an underlying illness.  In order to reduce your chances of contracting the virus, the CDC recommends anyone over the age of six months get a flu shot.  This year, the CDC offers a variety of flu shot options.  Here’s a peak at the new options:

  1. Egg-free vaccine: Most flu vaccines are grown in eggs in labs.  This year, an eggless vaccine, called Flublok, has been developed by the Protein Sciences Corporation right here in Connecticut.  Described as a medical breakthrough, the vaccine is made without using a live flu virus. It’s also made without mercury preservative thimerosal and doesn’t contain antibiotics which contribute to the growth of antibiotic-resistant pathogens. Some say it’s more effective than other vaccines and clearly, it’s perfect for those with egg allergies. (Click here to read more about Flublok).
  2. Four-strain vaccine:  Most flu shots protect against three strains but because viruses can easily mutate into new strains, a new four-strain vaccine has been developed this year called the quadrivalent vaccine. It’s a smart choice to get, especially for healthy women.  Tip: Get it soon, this new vaccine may run out early.
  3. Smaller needle vaccine: Long needles deliver a dose past your skin and into the muscle below.  For those with needle phobias, there is now a smaller needle which gently jabs the skin.  If you can’t stand needles at all, the nasal spray vaccine is still available.
  4. Find a vaccine provider anywhere:  If you don’t have a primary care physician, don’t worry!  You can get a flu shot at your nearest pharmacy, community center, and many other locations.  Go to the CDC’s Flu Vaccine Finder and simply punch in your zip code to find a flu clinic near you!

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Home Health: Rebasing 101

The Patient Protection and Affordable Care Act requires Medicare to reset (rebase) the home health services episode payment rate.  Once rebasing is implemented, rebasing will severely impact home health reimbursement over the next four years.  The new changes will also affect home health quality reporting requirements.  Essentially, CMS is proposing a 3.5% reduction per year for the next four years.

CMS will not be changing therapy payments because adjusting home health PPS factors therapy into the case mix is a complex process that requires more comprehensive analysis and structural changes to the home health PPS system.

With rebasing, CMS predicts that, on average, agencies will see a 1.5% cut in reimbursement this year and an overall reduction in home health payments of $650 million. After updates, the net effect will be a $290 million reduction in payments.  Home health agencies also face the likelihood that it will be at least four years until payment rates rise again.

Below is a list of resources to help you better understand rebasing:

  1. NAHC Whitepaper 
  2. Hall Render Killian Health
  3. Healthcare Association of HI
  4. Visiting Nurse Associations of America

Small Businesses Wary of Online Insurance Marketplace

Thousands of people in Connecticut have submitted applications to buy health care coverage through the state’s new insurance exchange but small businesses haven’t been nearly as eager.  In the first three weeks, only 30 companies applied to purchase health benefits through Connecticut’s Small Business Health Options Program (SHOP) run by Access Health CT which aims to provide affordable insurance choices to small business with 50 or fewer employees.

Small companies are hesitant to make changes to their current benefit plans because they are confused about the financial impact.  Also, a few brokers say that they were confused about when the exchange was open, believing it was set to open on November 1st, instead of the October 1st.  Although insurers have submitted rates for health plans sold under the exchange, some rates have not been made public for small group insurance plans that are sold outside the online marketplace, thus confusing business owners even more.

Brokers remain skeptical about SHOP’s main attraction, a tax credit paying up to 50 percent of an employer’s premium cost, is only available to companies with less than 25 workers, and whose average employee wages are less than $50,000.  According to a 2011 study, less than 36,000 Connecticut firms will be eligible for the tax credit.

Many companies in Connecticut may stop offering insurance and instead will tell their employees to buy coverage through the exchange’s individual market.  Some companies are choosing to stick with their current plans which are offering them the opportunity to renew their benefit plans early at their current rates.

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