Medicare dis-incentivizes home health care in ACA’s name (US)

When it comes to home health care, the C in CMS (Centers for Medicare and Medicaid Services) should perhaps stand for ‘contradiction’. According to recent reports appearing in the pre-holiday ‘dead zone’ of late last week, CMS has decreed that it must save, as part of a four-year plan under ACA, $58 million (0.3 percent) in fiscal 2015 (starting 1 Oct) from home health agencies which were formerly touted as a great way to save money. To put this in perspective: in 2013, Medicare paid about 12,000 home health agencies $18 billion to provide services to 3.5 million patients. In the US, Medicare has always had more restrictive rules for home and community-based services (HCBS); state-administered (but Federally subsidized) means-tested Medicaid still pays for the vast majority of long-term care (well over 60 percent, according to another Federal agency, Housing and Urban Development [HUD]), which strikes many observers as one pocket to another. So where are the contradictions?

  • Conundrum #1: CMS has emphasized post-discharge, post-acute care as part of reducing acute care costs, exemplified in the penalty for 30-day same-cause readmissions. Nursing home expenditure is at least three times more costly than in-home LTC (a conservative estimate used by HUD).
    • But CMS plans to cut Medicare home health funding in total so fewer people may receive it at all or less of it even if needed. What will be their alternative, and the effect on outcomes? (more…)

A kudo for kiosks: HealthSpot Station adds $8 million funding

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/05/booth-Dr.-Jenkins-with-attendant-300dpi-website.jpg” thumb_width=”150″ /] In a week of small funding announcements, HealthSpot announced an add of $8 million to its 2013 $10 million round, totaling $18.3 million of a $20 million offering (SEC filing). Investors are not disclosed. In three years, HealthSpot has raised an impressive total funding of $23 million (CrunchBase), although the company is still in pilot in a handful of locations around their Ohio HQ and reports minimal revenue. The company’s hosted, fully enclosed kiosks with both telehealth monitoring and virtual consult capabilities debuted at the end of 2012 at International CES New York. According to their website, their markets are facility waiting rooms, pharmacies, schools, military bases and prisons. Their partnerships have been notable: EHR Netsmart, telemedicine network Teladoc and a co-location arrangement with Canadian pharmacy kiosk MedAvail [TTA 23 Jan]. They are also on the board of the Alliance for Connected Care lobbying advocacy group [TTA 13 Feb], which will certainly aid their cause by plumping for increased telehealth coverage by Medicaid beyond the present 20 states and Medicare beyond rural special programs. Yes, they will be at ATA 2014, if you are attending. Mobihealthnews

Powerhouse DC lobbying for telehealth, telemedicine

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye observes from a houseboat anchored at a remote Pacific island, with coconuts and occasional internet to Editor Donna.

Telehealth and telemedicine have reached a US milestone of sorts: the formation of a Washington, DC-based ‘advocacy’ (a/k/a lobbying) group constituted as a business non-profit. The Alliance for Connected Care is headed by three former Senators (two of whom were ‘amigos’) from both sides of the aisle and backed by a board including the expected (giants Verizon, WellPoint, CVS Caremark, Walgreens)–and the surprising (much smaller remote consult provider Teladoc and HealthSpot, the developer of the HealthSpot Station kiosk–hmmm, must be a fair chunk of their marketing budgets there) flanked by six well known ‘associate members’ including Cardinal Health and Care Innovations (another hmmm). There’s also a hefty ‘advisory board‘ including the American Heart Association and the NAHC (home care). The leadership team members are all members of major Washington law/lobbying firms. Tom Daschle is recognized as one of the most influential former Senators in town via DLA Piper, though himself not a registered lobbyist (OpenSecrets.org). Trent Lott and John Breaux hung out their own shingle and were recently bought by mega-lobbyist Patton Boggs. To put a fine point on it, more high-powered one does not get. The Eye sees that the time is prime for the Big Influence and…

What the Eye sees is Big Financial Stakes: Private insurers are required to cover telehealth in 20 states, as does Medicaid in most. The VA is a major user. But the great big trough of Medicare is new territory; covering 16 percent of the population, the use of telemedicine and telehealth is limited to certain geographic areas. (MedCityNews) This marks the infamous tipping point: the clarion call to ‘build significant and high-level support for Connected Care among leaders in Congress and the Administration’, ‘enable more telehealth to support new models of care’ and ‘establish a non-binding, standardized definition of Connected Care through federal level multi stakeholder-input process’ (whew!) Big companies want in, insurers want reimbursement, and they want it from somewhere as well. Toto, we’re not in the Kansas of Small anymore with ‘connected health’–we are now in the Oz of Big Money and Power Players. Alliance release (Oddly the website looks preliminary despite the big announcement and backing.)

More on this strategy: It’s called ‘soft lobbying’ and it is the latest thing in the Influence Wars. The Alliance for Connected Care is a 501(c)6 non-profit, similar to a business league like the Chamber of Commerce, and this has become a popular tactic. It’s also a less regulated, less transparent way to shape coverage, public opinion and exert influence on legislators. See this well-timed examination from the Washington Post on the corn syrup versus table sugar wars. ‘Soft lobbying’ war between sugar, corn syrup shows new tactics in Washington influence

Ohio Telehealth bill passed by Senate – goes to Governor

HB 123, the Ohio health bill supporting telehealth, was passed unanimously by the Ohio state Senate on the 30th of January. [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/02/Ohio-State-Senate.jpg” thumb_width=”150″ /]The bill has now made its way to  Governor John Kasich for signature and to become law.

This bill requires the Department of Medicaid to establish Medicaid payment standards for the provision of telehealth services offered by medical facilities.  The rules governing what telehealth services would be covered will be decided by the Medical Director following existing regulations. With the 30-0 vote in the Senate, Ohio now joins 45 other states in modernizing thier healthcare practices.

This bill and the three others in the US House of Representative which were reported earlier (Yet another House Bil on Telehealth, TTA Dec 20, 2013) shows a welcome growing awareness of telehealth by US legislators.

Is nothing private in your EHR? Another disturbing trend out of Swampland.

According to a solicitation posted by the Department of Health and Human Services (HHS-Ed.) on Sept. 4, the CMS (Centers for Medicare and Medicaid Services) is commissioning the National Academy of Sciences (NAS) to study how best to add social and behavioral factors to electronic health record reporting.  Washington Free Beacon

So a non-profit online publication, which one would site on the conservative or libertarian side (part of the Center for American Freedom), breaks a huge story, way ahead of the mainstream media, which has major implications for privacy, data security, public health, how goes your doctor or hospital visit and the level of care you receive. Is this EHR TMI (too much information)? The Federal inclusion is being linked to Stage 3 of the Meaningful Use program and reimbursement under Medicare, Medicaid and the Children’s Hospital Insurance Program (CHIP). The NAS already is working on this with the Institute of Medicine to draft suggestions for collecting this behavioral data and identifying “core social and behavioral domains to be included in all EHRs.”

With linking the data to outside Nosey Parkers agencies such as public health entities, the possibilities for identified data becoming insecure or compromised increase dramatically. Will it be accessed (abused) by other entities involved in ACA such as the IRS, state Medicaid databases and Social Security? How much of this data will accidentially leak out in non-deidentified files? Will breaches of millions of non-encrypted records become the norm? Another important and oft-overlooked factor is the additional workload on already overworked hospital and clinical staff, who presently struggle to get comprehensive vital data correctly into multiple fields and screens on present EHRs–a major pain point among many speakers and participants at this past week’s iHT2 Health IT Summit. Finally, there’s the patient. He or she will be pressed to answer, due to penalties baked into the ARRA/HITECH MU3 incentives, the most personal questions about their life and behavior particularly if the diagnosis is one of what euphemistically was called a ‘social disease’. Having spoken this week to those in public health both at iHT2 and at Health 2.0 NYC, this Editor can see it as a deterrent to getting the care they need–or choosing evasion rather than truth with their doctor because there are no more confidences. Even the California Healthcare Foundation, hardly on the right wing, sounds an alarm in iHealthBeat.

‘Green Houses’: a better model for senior living (US)

“Let’s abolish the nursing home”–Dr. Bill Thomas

In the US, the ‘Green House Project’ model has made tremendous progress in developing homes for older adults as an alternative to nursing homes. A ‘design for living’ for 10-12 residents, a Green House is a home-like model built from the ground up with private rooms, bathrooms and community living. Currently 260 homes are open or under development across 32 states. From their website, the intent is for “Those who live in, work in, and care about a Green House [home] share the duty to foster the emergence of late-life development within the daily life they create together.” The care ratio is also much higher; care teams are organized on self-managed work teams to care for the mostly high acuity residents (including dementia). Yet costs, according to NPR, are about the same as the median for nursing homes nationally (many residents are on Medicaid) and in quality of life, it respects residents habits, privacy with the outcome that it supports residents longer in a level of independence.

The Green House concept came from the work of Bill Thomas MD, a geriatrician who also developed the Eden Alternative and frequently writes on ChangingAging.org. The news is the backing of the Green House Project by the prestigious and well-funded Robert Wood Johnson Foundation and NCB Capital Partners. The Project provides the model and guidance to independent organizations for organization, implementation and certification of these homes. MedCityNews was wowed by it (Wall Street Journal link does not work, however). See the video from RWJF on what they saw as ‘a catalyst for significant social change’.  Green House Project website   RWJF page on their support of this ‘force multiplier’.

What if you added non-intrusive health tech to these homes? The opportunities could be as varied as the ELSI Smart Floors and alert system for safety (Charles)…fitness bracelets/wearables to monitor basic vitals and ADL/activity (Jawbone, Misfit, AFrame)…biosensor ‘tattoos’ (Toni). Tablet/PC based socialization/brain stimulation (GeriJoy, GrandCare, It’s Never 2 Late). Could this humane environment move to a higher level with a touch of tech?

[This video is no longer available on this site but may be findable via an internet search]