Advocates Say Better Pay Could Help Home Care Provider Shortage

Source: public news service

ST. PAUL, Minn. – With a serious workforce shortage expected to worsen, home care providers are pushing state lawmakers to increase pay for tens of thousands of Minnesota caregivers.
The home care providers say a 5 percent pay boost for caregivers, many of whom make just above minimum wage, could help make the field more attractive to newcomers.

Pam Gonnella, co-chair of the Best Life Alliance, says after her daughter suffered a brain injury as a child, the family relied on home-based caregivers for about 25 years, allowing her daughter to live as independently as possible at home.

“They became a part of our family, and that’s why my heart is with the people who are working in this field, because I know firsthand how dedicated many of them are to their work,” she states. “But it hurts me when I feel that they’re not getting paid very much for the work that they do.” Gonnella and the Best Life Alliance are backing House File 2706, which they argue will help maintain community services for people with disabilities and older adults across Minnesota.

The bill would also give most workers a raise of about 55 cents an hour  Supporters of the bill admit it could be an uphill battle to get the measure approved in this last week of the legislative session. But Steve Larson, senior policy director of The Arc Minnesota, a group that advocates for people with disabilities, says the timing is crucial, because the state has vacancies for more than 8,000 caregiver and staff positions.

“We aren’t providing the quality care that we would like to, just because we’re short on staff,” he explains. “One of the major reasons for that is the level of wages at this current time. And so, we think we’re in a crisis situation.”

Larson says the state lags behind in reimbursement payments to these workers, which is one reason for the high turnover rate.

So far, a bipartisan group of more than 30 house lawmakers has signed on as co-authors of the 5 percent pay raise bill.

Ventilator Coding Requirements Revised in Favor of Patients


WASHINGTON, D.C. (May 6, 2016)—As anticipated last week, the DME MACs collectively released revised coding and coverage requirements for ventilators in the Frequent and Substantial Servicing (FSS) payment category. The new guidance removes the imminent death criteria from the coverage, which is now applicable under the following conditions:
Neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease.

The announcement, which can be found here, explains, “Ventilator technology has evolved to the point where it is possible to have a single device capable of operating in numerous modes, from basic continuous positive pressure (CPAP and bi-level PAP) to traditional pressure and volume ventilator modes. This creates the possibility that one piece of equipment may be able to replace numerous and different pieces of equipment. Equipment with multifunction capability creates the possibility of errors in claims submitted for these items.”

The announcement also discusses issues related to upgrades and conditions needed to authorize payment for a second ventilator, which can only occur in cases of medical necessity, and not for spare/back-up equipment.

AAHomecare has been actively working with our members and other stakeholders in the respiratory care sector to pursue relief on ventilator clinical requirements. This revised coding and coverage is a direct result of industry, clinical groups, consumer groups, manufacturers and suppliers engaging CMS and the DME MACs to advocate for needed adjustments to the medical necessity requirements for these essential products.

AAHomecare will provide further analysis upon review.

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Bill Introduced in Senate to Improve Rural Hospital Reimbursement Rates


WASHINGTON, D.C. (May 4, 2016)—U.S. Senators Johnny Isakson, R-Ga., Lamar Alexander, R-Tenn., Mark Warner, D-Va., and Sherrod Brown, D-Ohio, introduced bipartisan, budget-neutral legislation last week to ensure hospitals are fairly reimbursed for their services by the federal government so they are able to remain open and functioning, especially in underserved and economically struggling regions.

The Fair Medicare Hospital Payments Act of 2016 (S.2832) would correct a flawed formula that results in disproportionately low Medicare reimbursement payments to hospitals in rural and low-wage areas.
“Rural hospitals are the lifeline of their communities, but too many Georgia hospitals have been forced to close their doors in recent years. These hospitals serve some of the least economically developed areas in Georgia, and unfortunately, as a result, they receive some of the lowest Medicare payments in the country” said Isakson, a member of the Senate Finance Committee. “Establishing a national minimum level for hospital payments will help to prevent future closures of hospitals in these medically underserved areas and ensure patients have access to emergency and needed care.”

“Like many hospitals, Tennessee hospitals are getting less and less from Medicare, while hospitals in other areas of the country get more and more for the same services, because of a flawed formula,” said Alexander, chairman of the Senate health committee. “This bill will protect Tennessee hospitals, and others around the country, from shrinking Medicare reimbursements that make it harder for them to recruit skilled doctors and nurses, make payroll, pay bills and care for patients.”

“Rural hospitals are a lifeline to hundreds of thousands of Virginians, and are at the heart of many of our communities,” said Warner. “However, hospitals in rural areas face unique challenges, and many struggle to stay afloat—challenges that are exacerbated by the federal government’s skewed payment system for services provided to Medicare beneficiaries at these hospitals. The bipartisan Fair Medicare Hospital Payments Act would do much to help keep Virginia’s rural hospitals financially viable, by ensuring that the Medicare funding they receive is reflective of their costs of providing care. Under this bill, hospitals in five of Virginia’s 11 statistical areas would receive readjusted reimbursements that more accurately and fairly reflect their costs to provide care.”

“To ensure that seniors on Medicare—especially those in Ohio’s rural and underserved area— can continue to get the care they need, the hospitals serving them must be fairly reimbursed for the care they give,” said Brown. “Under the current system, many hospitals in Ohio are paid less for the same lifesaving care they provide as their counterparts in other states across the country. This legislation will help protect the health and safety of all Ohioans by making sure all hospitals in Ohio receive sufficient reimbursement for the services they perform so they can continue to serve our communities.”
Specifically, the Fair Medicare Hospital Payments Act of 2016 would establish a national minimum “area wage index” of 0.874. The area wage index is based on the relative hospital wage level in the hospital’s geographic area compared to the national average. Over the past three decades, legislative and regulatory changes have combined with broader economic trends to create an uneven playing field that has resulted in hospitals losing out on millions of dollars in Medicare payments annually.

Additional co-sponsors of the Fair Medicare Hospital Payments Act of 2016 are U.S. Senators Jeff Sessions, R-Ala., and Tim Kaine, D-Va.

CMS Releases Medicare Advantage Quality Data for Racial and Ethnic Minorities


WASHINGTON, D.C. (April 20, 2016)—The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health released data detailing the quality of care received by people with Medicare Advantage by racial or ethnic group.

“This is the first time that CMS has released Medicare Advantage data stratified by race and ethnicity. LLCreasing understanding and awareness of disparities and their causes is the first step of our path to equity,” said Dr. Cara James, director of the CMS Office of Minority Health. “While these data do not tell us why differences exist, they show where we have problems and can help spur efforts to understand what can be done to reduce or eliminate these differences.”

The data are based on an analysis of two sources of information. The first is part of the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS collects information from medical records and administrative data on how well the needs of Medicare beneficiaries are met for a variety of medical issues, including diabetes, cardiovascular disease, and chronic lung disease. The second part is the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, which is conducted annually by CMS. CAHPS focuses on the health care experiences of Medicare beneficiaries across the nation.

The database presents HEDIS and CAHPS scores for different racial and ethnic groups at the level of individual Medicare contracts and is intended to be used to improve quality and accountability. The information provided by this database is not used to evaluate care through the star ratings program Medicare Advantage and Part D Star Ratings program nor is not it used for payment purposes.

“These data are a good first step in understanding disparities in Medicare Advantage,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “We look forward to working with plans in closing the differences in the quality of care that people with Medicare Advantage receive.”

A report summarizing the data accompanied the release. Analysis of the quality of care delivered to beneficiaries showed that Asians and Pacific Islanders typically received care that is similar to or better than the care received by whites, whereas African Americans and Hispanics typically received care that is similar to or worse than the care received by whites. African Americans and Hispanics also reported their health care experiences as being similar to or worse than the experiences reported by whites. This data help to highlight the racial and ethnic disparities that occur within health care.