By Stephen Tweed

What a delight it was to spend an hour over lunch having a one-on-one conversation with Bill

Dombi, Vice President for Law, with the National Association for Home Care & Hospice.  Bill has been a long time friend, and it’s always a delight to spend time with him hearing about the inside track on what’s going on in Washington.

Bill and I are in Indianapolis, IN speaking at the Indiana Association for Home and Hospice Care.   I drove up early to hear Bill’s “State of Home Care” keynote address.

Major Issues in Home Care & Hospice

There’s probably no one who has an inside track on what’s going on in the Executive Branch, the Legislative Branch, and the Judicial Branch of the United States Government as it relates to home care and hospice than Bill Dombi.  In his speech this morning, he highlighted some of the major issues that our industry is facing in 2015.

• Companionship Services Exemption – The overtime issues has not been put to bed. This Thursday, Bill will be presenting oral arguments before the US Court of Appeals in the District of Columbia in the appeal of a Federal District Court ruling that overturned the DOL’s rule regarding overtime.  A decision on the overtime issue is expected in late June.
• SGR – Sustainable Growth Rate – Congress has finally passed a law that fixes the coming reduction in Medicare reimbursement to physicians once and for all.  The SGR been delayed one year at a time for a number of years.  This fix takes $70 Billion from Medicare payments to hospitals, nursing facilities, and home health care to pay for the increased payments to physicians.  It will come in the form of a 1% cut beginning in 2018.
• Hospice Payment Proposal – A new method for reimbursing Hospice has been proposed that pays a higher per diem for the first 60 days, then a reduced per diem post 60 days, and a supplement during the last 7 days of life.
• Drug Liability – There’s a question of who pays for medications during hospice care;  Medicare Part D or the Hospice.
• Medicaid Managed Care – There’s a clear trend across the country for state Medicaid programs to contract with managed care organizations.  Currently, about one in four Medicare patients are dual eligible for both Medicare and Medicaid.  There are several demonstration projects going on right now to look at bundled payments for dual eligible beneficiaries.
• CMS Star Rating – CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. The Star Rating is coming to Home Health Care as CMS combines outcome measure and process measure from home health compare into a single score.  It will be a five star, nine point scale (with half-stars).
• Value-based Purchasing – Demonstration projects will begin in 5 to 8 states with mandatory participation in the program.  Between 5 and 8 % of Medicare payments will be withheld from agency reimbursement, and 70% of that will be paid back to agencies providing the highest value.

Welcome to “The Platinum Era of Home Care & Hospice”

Despite all of the challenges presented by these issues, Bill called the time in front of us “The Platinum Era of Home Care & Hospice.”  Because of consumer awareness, economic forces, political support, and technology, home care and hospice will continue to grow.  The USA loves home care, and the aging of the baby boomers means a high demand for in-home care services.

According to Bill’s forecast for home care & hospice, “It’s going to be a very good year.”  Here’s why:

• Politicians love home care
• The system is shifting to purchasing outcomes and not activity
• Consolidation will continue but the big companies will not crowd out the small ones
• Technology favors home care and remote patient monitoring and telehealth will continue to prove value

The real issue for most agencies will be the workforce.  Said Bill Dombi, “He who has the workforce wins in Home Care.”  Develop a happy, productive workforce and you too will be a winner.

For more on how Leading Home Care can help you grow a productive and happy workforce, visit our web site.  For more on becoming a member of Caregiver Quality Assurance, contact Diane West at 502-339-0653.