Kenyon Connects

We are beginning to hear a great deal about ACOs these days, and many in the home health industry are trying to find ways to be included.  Of concern is the emerging potential that ACOs will try to create their own home care agencies and bypass the existing agencies in their areas. Now, as never before, home health has the opportunity to step front and center in the health care delivery system.  To prepare for this opportunity, home health agencies must understand the guidelines and focus of the demonstration projects. Knowing this will help agencies prepare to partner with any ACO that may be developed in their area, or, in an ideal world, be part of one that a strong home health agency has developed themselves. Continue reading “Accountable Care Organizations (ACOs) and Home Health: What are the Opportunities?” »

In recent posts I’ve explored some of the reasons why it would be beneficial for the home health industry if Nurse Practitioners (NPs), Advanced Practice Nurses (ARNPs), and Physician Assistants (PAs) were given more independence to make decisions about care and to sign off on important Medicare reimbursement paperwork.  This will be especially true if Congress goes ahead with its plans to cut Medicare payments to physicians and more and more doctors refuse to include Medicare patients in their practice. 

But there are even more reasons why greater independence should be granted to nurses:  the times simply demand it.  Continue reading “It’s Time To Turn Advanced Nurses Into Home Health Decision Makers” »

Even as Congress is contemplating making further cuts to Medicare payments to physicians, there are laws in the works that could dramatically reduce the administrative burden and costs for home health agencies.  The Home Health Care Planning Improvement Act would allow Nurse Practitioners (NPs), Advanced Practice Nurses (ARNPs), and Physician Assistants (PAs) to order home health services under Medicare. A bill that has been slowly moving through both the Senate and the House, a recent study commissioned by National Association for Home Care & Hospice (NAHC) found the Home Health Care Planning Improvement Act could potentially do even more to improve quality of care to millions of Americans. Continue reading “Could This Pending Law Save Home Health?” »

It looks like physicians are realizing what all of us in home health have known for the past eleven years: major cuts in Medicare payments hurt.

With Congress returning next week for a lame duck session, doctors and the AMA are stepping up their campaign to press lawmakers to put off the major reductions in Medicare payments that are scheduled to take effect in December 2010.  If Congress does not act, physicians who treat the elderly under the federal program will see a 23% cut in their fees starting December 1, 2010. Continue reading “Home Health Update: Physicians Lobby Against Medicare Fee Cuts” »

The contributions nurses make to the health and wellbeing of the patients we serve has a long history of positive results and outcomes.  Prior to the early 1920s, nurses worked with physicians as independent practitioners.  Nurses were sovereign in their decision making, and performed their jobs without interference or governance from any other discipline.

In the early 20s, the American Medical Association (AMA) began to see nurses as a threat to the fiscal stability of their medical practitioners.  Paul Starr’s enlightening book, “The Social Transformation of American Medicine,” outlines the purposeful and direct effort by the AMA to pass state and federal laws that put nursing under the direct control of doctors.  They were successful, and these laws, and more, are still in place today.

Yet, this stronghold is beginning to weaken. As modern healthcare puts more and more strain on our resources, nursing is reestablishing itself as a viable, strategic, and independent profession.  At the heart of this trend is the push for nurses to take their rightful role, in tandem with doctors, in the move to improve medical care in this country. Continue reading “Nurse Power: The New Voice In Home Health.” »

In a recent editorial, noted health policy expert Kenneth E. Thorpe, PhD, Chair of the Department of Health Policy & Management at Emory University’s Rollins School of Public Health, took the recent Centers for Medicare and Medicaid Services (CMS) cuts in home health to task. Citing the successes of home health throughout the health care system as evidence, Thorpe decries the cuts and finds them to be both politically and fiscally irresponsible. Thorpe goes on further to state that, “…the one notion Democrats and Republicans can all rally behind is that quality, innovative, and cost-effective health care begins in the home.”

Those of us who spend our days in home health know, first hand, the value of the work we do. More than any other care delivery system in the country, home health reduces readmissions to hospitals, decreases nursing home admissions, and helps patients with chronic illnesses, such as diabetes and hypertension, to be monitored and receive medication in the comfort of their own homes. Continue reading “Health Policy Expert Recommends CMS Reconsider Home Health Cuts” »

The health care reform bill was big to say the least. There are so many elements and different timelines it is hard to know where to begin – and even more difficult to keep track of it all. Gratefully, someone has taken the time to put together the timelines for the implementation of the different pieces of the bill. Much to my surprise, and perhaps yours, many of the key elements were activated this year. No longer can insurance companies deny coverage based on pre-existing conditions, deny coverage to an adult child who is in college, increase rates without justifying the increase to a government panel, nor can they put lifetime dollar limits on care. Additionally, starting this year, small businesses will receive a tax credit for the health insurance they provide their employees. Over the next five years other elements of the bill will become active. For a full list of the issues and the timeline for initiation, click here.

Today, Thursday, September 23, 2010, is a banner day for Americans.  Eight important reforms in the Patient Protection and Affordable Care Act went into effect.  These reforms give Americans new rights and benefits, effective immediately.  While all provisions of the law will be in place by 2014, today we can all rest a little easier because:

• Lifetime Limits have been abolished: Prohibits insurance companies from imposing lifetime limits on benefits so that Americans with private insurance coverage will never have to worry about their coverage running out.

• Preventive Health Services are now covered:  All new plans must provide FREE coverage for over 100 preventive services, including mammograms for women over age 40, screenings for colorectal cancer for those over age 50, depression, smoking cessation programs, and autism for children age 18 months to 24 months.

• The Appeals Process has been improved: Requires that new group or individual health plans offer an effective process for appealing coverage decisions, such as refusals to cover procedures partially or at all. Consumers first file an internal appeal with their insurers, but if they are not satisfied they can appeal to an impartial reviewer.

• Rescissions are prohibited: Prohibits the abusive practice whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs.

• The ability to choose your own doctor has been enhanced: Expands consumer choice by ending the insurance company practice of limiting a consumer’s ability to choose a doctor in his/her own insurer network.

• Restrictions on Emergency Room care have ended: For new plans, consumers can no longer be charged more for emergency services obtained out-of-network.

• Pre-existing condition exclusions for children has been eliminated: Bars health insurance companies from placing pre-existing condition exclusions on coverage for children through age 18 for any new plans

• Coverage to young adults has been extended: Plans that provide dependent coverage to children must now make that coverage available until the child turns age 26.

We’ll keep a close eye on what’s changing and when.  As for now, the next new round of improvements will take place on January 1, 2011.  What a healthy way to celebrate the New Year! 

I recently received an email from the President’s office that talked about the changes we, as Americans, can expect to see from the healthcare reform legislation signed into law on March 23, 2010. This important legislation, known as the Patient Protection and Affordable Care Act (PPACA), not only impacts our options for insurance, these new guidelines go further than ever to support your clients as they strive to receive full coverage – and full payment – from their insurance providers.

I want to share with you some of the important points outlined in the email I received. There are a number of ways PPACA improves how insurance will be delivered in the future, including:

• Insurance companies can no longer cancel your policy if you get sick. Right now, insurance companies can retroactively cancel a policy if you become ill or if you or your employer made an unintentional mistake on your paperwork. The new law puts a stop to this practice. Continue reading “Your Rights Under The New Health Care Reform Law” »

Starting in September 2010, a provision in the new healthcare legislation will make it possible for young adults to remain on or be added to their parent’s health insurance plans until they turn twenty-six.  While this may not directly impact your Home Health and Private Pay clients, it is possible some of your clients may have grandchildren that could be covered by their parents’ insurance.  Additionally, some of your staff may have young adult children that are impacted by this new law as well.

As a courtesy, I recommend you remind anyone involved with your agency about the new law. In a world where so many are uninsured, it is nice to be able to deliver some good news.