Meet the CMS Administrator Nominee

Admin

by | Dec 6, 2024 | Admin, Advocacy, Breaking News, CMS, Hospice, Medicare Advantage

by Tim Rowan, Editor Emeritus

Mehmet Oz, MD, MBA is the CMS Administrator nominee in the new administration that assumes power on January 20. A popular TV personality and former gubernatorial candidate, the public side of Dr. Oz is well known, but the details of his life and his qualifications to head a $1.16 trillion government program less so. We reached out to the nominee’s PR firm on November 22 to request an interview but have not received a response. We gathered the following background information from his web site and other sources.

Heritage and Education

Mehmet Cengiz Öz was born on June 11, 1960 in Cleveland, Ohio, of Turkish immigrant parents. Raised in Wilmington, Delaware, he holds dual U.S. and Turkish citizenship and comes from healthcare roots. His father, Mustafa Oz, graduated at the top of his class at Cerrahpaşa Medical School in 1950 and moved to the United States to join the general residency program at Case Western Reserve University in Cleveland, where Mehmet was born. His mother, Suna Atabay, was the daughter of an Istanbul pharmacist.

Mehmet graduated with a biology degree from Harvard University in 1982. He earned an MD at the University of Pennsylvania School of Medicine and an MBA from Penn’s Wharton Business School in 1986. He completed his surgical training at NewYork-Presbyterian Hospital and served as a professor of surgery at Columbia University.

CMS Administrator Nominee Dr. Oz

Completing his general surgery residency and cardiothoracic fellowship at Columbia-Presbyterian Medical Center in New York City, Oz became an attending surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center in 1993. He was later appointed professor of surgery at Columbia University in 2001. An advocate for integrating alternative medicine with conventional practices, he co-founded the Cardiac Complementary Care Center in 1995.

During his time at New York-Presbyterian, Oz patented the Mitraclip, a small implantable clip that can be placed using a catheter to repair the heart’s mitral valve. Oz reported earning over $333,000 in royalties from that product in his 2022 disclosures.

Rise to Fame

Oz gained national attention through appearances on “The Oprah Winfrey Show.” Winfrey’s production company, Harpo Productions, and Sony Pictures produced the daytime syndicated program, “The Dr. Oz Show,” which debuted in 2009. It won 10 Emmy Awards during its run.

The program, which focused on health and wellness topics, aired until 2022, when he left it to run for the U.S. Senate in Pennsylvania, winning the Republican nomination and eventually losing to Democrat John Fetterman. Oz is also a prolific author, with eight of his books on the New York Times bestselling list. The Dr. Oz Show gained in popularity during its run but occasionally faced criticism for promoting unproven health products and practices.

Finances

Most of what can be learned about Oz’s personal finances comes from disclosures he made during his Senatorial campaign. He reported a salary of $2 million as host of The Dr. Oz Show and $7 million from his stake in Oz Media. He was also paid $268,000 as a guest host on Jeopardy in 2021. In addition to salaries, Oz and his wife, Lisa, reported investments in big tech, health care, private equity funds, and various real estate holdings.

Oz’s 2022 financial disclosures showed Amazon stock worth up to $25 million; Microsoft, Apple, and Alphabet (Google) stock, each valued up to $5 million, and Nvidia stock valued up to $1 million. He also owned stock in UnitedHealth Group worth up to $500,000, and in CVS Health (Aetna), valued at up to $100,000. They also owned shares in privately owned gas station and convenience store chain Wawa valued between $5 million and $25 million. His 2022 disclosures showed he earned $5 million in dividends from his investment in Wawa.

The Oz’s also reported a real estate portfolio that includes residential and investment properties in New Jersey, New York, Pennsylvania, Florida, Maine, and his parents’ native country, Turkey, each valued from $1 million to $25 million. His 2022 disclosures also showed an investment property in Palm Beach and a cattle farm in Okeechobee, Florida, worth up to $5 million each, and $500,000 worth of cattle.

In addition to these investments, Oz currently runs the non-profit organization HealthCorps, which trains teenagers to share the organization’s curriculum on mental health, physical health, and nutrition. He also serves as Global Advisor and Stakeholder at iHerb, a company that sells supplements, personal care, grocery, and beauty products.

CMS Administrator Nominee

What Kind of CMS Would Oz Create?

What we know of Dr. Oz’s opinions regarding Medicare and Medicaid we learned from his 2022 Pennsylvania campaign message. During that campaign, Oz was a vocal supporter of privatizing Medicare. In 2020, Oz co-wrote an opinion piece in Forbes, suggesting “an affordable 20% payroll tax” to fund a “Medicare Advantage For All” program that could replace private insurance.

His plan, co-authored with Steve Forbes, suggested a 20% payroll tax, half paid by the employer, which the government would use to purchase a Medicare Advantage plan for everyone. The proposal did not explain how this would replace private insurance as MA plans are administered by insurance companies. Of course, this was four years ago, before it was widely known that MA plans pad patient assessments and deny care at a higher rate than straight Medicare does.*

CMS Administrator Nominee Outlook

Uncertainties to keep watch over include the CMS Administrator’s supervision over Medicaid and negotiating Medicare drug prices. If confirmed by the Senate, Oz would have the power to approve states’ requests to change their Medicaid plans, such as adding work requirements for beneficiaries.

He will also oversee drug price negotiations. The Inflation Reduction Act gave CMS the power to negotiate with pharmaceutical marketers to reduce the price of popular medications for people covered by Medicare Part D. The first round of negotiations concluded in August, and the next slate of drugs up for negotiations will be announced in February.

In nominating Dr. Oz, the President-elect said Oz will “help cut waste and fraud.” Whether that goal or seeing to the health of the more than a third of Americans insured through CMS programs becomes Mehmet Oz’s priority should be the first question asked in his Senate confirmation hearings.

Statement from National Alliance for Care at Home

I congratulate Dr. Oz on his nomination for CMA Administrator, I believe it generally is a good thing for patient care when physicians engage in public service and public policy leadership. I am still learning about his priorities and approaches for CMS and am looking forward to speaking with him about the importance of a vibrant and growing care at home sector. Home care and hospice offers CMS the greatest win-win opportunity in American healthcare; people get the independence and dignity they want and deserve while the taxpayers and families save on the costs of unnecessary hospitalization and institutionalization.

Steve Landers, MD, MPH

Chief Executive Officer, National Alliance for Care at Home

* Click to read previous Rowan Report news articles and analyses of Medicare Advantage plans.

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Tim Rowan, Editor Emeritus

Tim Rowan is a 31-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Healthcare is Heading Home

Advocacy

by | Nov 21, 2024 | Advocacy, Editorial, Other Sites

Web Golinkin, Forbes Books Author

Healthcare is Heading Home, and That's a Good Thing!

Healthcare is heading home

As the Baby Boomer generation ages, the home healthcare market is expanding. GETTY

During my long career in healthcare, one of the biggest trends in healthcare delivery has been the shift from hospital / inpatient to outpatient care. The compound annual growth rate (CAGR) of outpatient services was roughly 8 percent from 2017 to 2022, while inpatient services grew 1-3 percent during the same period. Outpatient services now represent more than 50 percent of total U.S. healthcare spending.

Particularly during the past 20 years, there has been significant growth in new outpatient facilities and channels, including retail-based and urgent care clinics, freestanding ERs, imaging centers, dialysis centers, ambulatory surgery centers, rehabilitation clinics, behavioral health clinics, and telehealth / virtual care.

The shift towards outpatient care has been driven by multiple factors, including patient desire for convenience, the need to reduce costs, and rapid advances in medical science and technology. Now, however, a new trend in healthcare is pushing the boundaries of outpatient care increasingly into the home.

This article explores the rapid expansion of home healthcare, the factors driving its growth, and the important distinctions between home care, home health care, and hospital-at-home models.

Macro Growth Drivers

The U.S. home healthcare market has experienced exponential growth, projected to reach nearly $510 billion by 2027 (roughly equaling the projected size of the outpatient market), according to various industry reports. This represents a CAGR of approximately 8 percent from 2020 to 2027. Several factors contribute to this rapid expansion:

  1. Aging Population: One of the primary drivers of growth in home health care is the aging population. As the Baby Boomer generation reaches retirement age, there is a significant increase in the need for healthcare services tailored to older adults, many of whom prefer receiving care in the comfort of their homes.
  2. Rising Chronic Conditions: The prevalence of chronic diseases such as diabetes, heart disease, and respiratory illnesses is increasing. Home healthcare services, including skilled nursing and rehabilitation therapies, provide essential support for managing these conditions.
  3. Technological Advancements: Innovations in telehealth and remote monitoring technologies have transformed healthcare delivery. Patients can now receive real-time consultations and monitoring from healthcare professionals, reducing the need for in-person visits and enhancing the appeal of home healthcare .
  4. Cost-Effectiveness: Home healthcare is often more cost effective than traditional hospital care. By providing services at home, patients can avoid expensive hospital stays, and insurance providers are increasingly recognizing the value of home-based care, offering incentives for its use.
  5. Patient Preference: There is a growing preference among patients for receiving care in their own homes. This trend is driven by the desire for comfort, familiarity, and independence, as well as the recognition that home care can lead to better health outcomes.

Main Types of Service

Three basic types of home healthcare have emerged. It is important to understand the differences between them, as each type serves different needs and patient populations and requires different kinds of providers and support:

  1. Home Care: This term typically refers to non-medical assistance provided in a patient’s home. Services may include personal care (such as bathing and grooming), companionship, meal preparation, housekeeping, and transportation. Home Care is often used by individuals who need assistance with daily living activities but do not require regular medical intervention.
  2. Home Health Care: In contrast, Home Health Care involves medical services provided by licensed healthcare professionals. This may include skilled nursing, physical, occupational, and speech therapy, as well as home health aide services. Home Health Care is typically prescribed by a physician and is intended for patients recovering from illness, surgery, or managing chronic health conditions.
  3. Hospital-at-Home: This model represents a more recent innovation in home healthcare, allowing patients to receive acute-level care in their homes instead of in a hospital setting. Hospital-at-home programs provide comprehensive medical services, including monitoring and treatment for serious conditions, under the supervision of healthcare providers. This model aims to reduce hospital congestion, lower healthcare costs, and improve patient satisfaction by delivering hospital-level care in a familiar environment. In addition, there is growing evidence that it improves clinical outcomes and reduces hospital readmissions.

Future Growth Drivers

Several key drivers will underpin further growth of home healthcare:

    • Policy Changes and Regulations: Government policies have increasingly supported home health care. Centers for Medicare & Medicaid Services (CMS) and other government programs incentivize home-based care, reflecting a broader strategy to reduce healthcare costs and improve care quality.
    • Healthcare Provider Initiatives: Many providers are expanding their services to include home healthcare options as part of their overall care continuum. This integrated approach helps streamline patient transitions from hospital to home, improving coordination and outcomes.
    • Market Competition: The growing number of home health care agencies and providers has fostered competition, driving innovation and improvements in service delivery. This competition encourages providers to adopt new technologies and practices that enhance patient care.
    • Public Awareness and Education: Increasing awareness of home health care options has led to more patients and families opting for these services. Educational campaigns and outreach initiatives have helped to demystify home health care, making it a more accepted alternative to traditional care settings.

Obstacles to Growth

Despite its rapid growth, the home healthcare sector faces several challenges:

    • Workforce Shortages: The demand for qualified home health care professionals exceeds supply, leading to staffing shortages. This is exacerbated by the demanding nature of home health work and competitive wages offered by hospitals and other healthcare and non-healthcare settings.
    • Regulatory Hurdles: Navigating the regulatory landscape can be complex and burdensome for home healthcare providers. Compliance with Medicare and Medicaid requirements, as well as with state regulations, often demands significant administrative resources. This can restrict the ability of smaller agencies to scale and compete effectively.
    • Insurance Reimbursement Issues: While insurance providers increasingly cover home health services, reimbursement policies can be inconsistent. Challenges related to payment models, including delays and denials, may hinder access to necessary care for patients and impact the financial viability of home health agencies.
    • Technology Adoption: Although technology is a key growth driver, some providers and patients resist adopting new tools. Ensuring that healthcare professionals are adequately trained in using telehealth platforms and remote monitoring devices is critical for successful implementation.

Positive Future Outlook

The outlook for home health care remains positive, as the sector adapts to evolving consumer needs and preferences. Several trends are expected to shape its future:

  1. Integration of Technology: The continued integration of telehealth and artificial intelligence (AI) into home healthcare will enhance service delivery and patient monitoring. Wearable devices and remote patient monitoring systems will likely become standard tools for managing chronic conditions at home.
  2. Focus on Value-Based Care: As healthcare systems shift toward value-based care models, home healthcare will play a pivotal role in managing patient outcomes and costs. Providers will increasingly be held accountable for the quality of care delivered at home, leading to a greater emphasis on patient engagement and satisfaction.
  3. Expanding Service Lines: Home healthcare providers and agencies will likely expand their service offerings to include mental health support, palliative care, and specialized rehabilitation services. This diversification will cater to the broader needs of patients, particularly those with complex medical conditions.
  4. Enhanced Collaboration: There will be a growing emphasis on interdisciplinary collaboration among healthcare providers, including hospitals, primary care providers, and home health agencies. This collaboration will facilitate smoother transitions of care and improve overall patient outcomes.
  5. Increased Investment: As the demand for home health services continues to escalate, investment in the sector is expected to grow. Venture capital and private equity firms are increasingly recognizing the potential of home healthcare, leading to innovations and improvements in service delivery.

The growth of home healthcare is a testament to the changing landscape of healthcare delivery. Driven by demographic shifts, technological advancements, and evolving consumer preferences, this sector is poised for continued expansion.

As challenges such as workforce shortages and regulatory hurdles persist, the future of home health care will depend on the ability of providers to innovate and adapt.

Nevertheless, healthcare is moving inexorably towards the home. That is good news for millions of patients who need acute, transitional or long-term care in the most comfortable environment, and for providers and third-party payers who are seeking to maximize the value of care being delivered.

# # #

Marcylle Combs Care at Home Worker Safety
Web Golinkin
Web Golinkin has focused his career on making health information and care more accessible and affordable. He has done this as CEO of five companies over the past 35 years, including three he co-founded.

These companies include the largest cable TV network devoted to health (America’s Health Network), one of the nation’s largest operators of retail-based clinics (RediClinic), a leading population health management company (Health Dialog), and one of the nation’s largest operators of urgent care clinics (FastMed). Web also co- founded the Convenient Care Association and served as its Chair for many years. He has been widely covered in the national media and has spoken at numerous healthcare conferences.

A magna cum laude graduate of Harvard, Web grew up in New York City and Long Island but has lived in Houston since 1988, so he is almost a Texan. A longtime runner and fitness enthusiast, Web enjoys tennis and golf—as long as he can walk and carry his bag. Web has been married to the same extraordinary woman for 39 years, and they have two amazing sons who make him proud every day.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Forbes Author Posts. For more information or to request permission to use, please contact Forbes.

2025 Final Rule

Advocacy

by | Nov 8, 2024 | Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

CMS Releases Home Health Final Rule 2025

Last week, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) final rule. Included in the final rule are updates the Medicare payment policies and rates for Home Health Agencies (HHAs), intravenous immune globulin (IVIG) items, and payment rates for Durable Medical Equipment (DME) suppliers. Estimates indicate that CMS payments to HHAs will increase by 0.5% over 2024.

Partnership for Quality Home Healthcare

The Partnership for Quality Home Healthcare issued a press release in response to the final rule.

[We] were again disappointed that the Centers for Medicare & Medicaid Services (CMS) continued its policy of cuts by finalizing a -1.975 percent permanent cut to home health.

The Partnership for Quality Home Healthcare

The Partnership urged Congress to intervene to “fix the broken payment system” that continues making payment rate cuts year after year. The cuts are reducing patient access. According to recent data, patient visits per 30 days are down nearly 20 percent. The partnership notes workforce shortages, capacity limitations, and closures of providers as the primary reasons behind the decline in patient visits. 

Legislative Action

As we have reported previously, a number of organizations have worked together to advocate for home health with members of Congress. NAHC and NHPCO (Now The National Alliance for Care at Home), The Partnership for Quality Home Healthcare, and others, have proposed bipartisan legislation, the Preserving Access to Home Health Act (S. 2137/H.R. 5159).

NAHC last year filed a lawsuit claiming that CMS used flawed formulae in their calculations of budget-neutrality. That lawsuit has been paused while NAHC/NHPCO follow administrative processes required by the judge. Once those administrative paths are exhausted, The Alliance will look at next steps to continue their objections to the pay cuts. The overturning of “Chevron Deference” will open new avenues for The Alliance as well.

CMS Facts

CMS published its Final Rule Fact Sheet after the issuance of the final rule for CY 2025. According to the fact sheet, the 2025 rule:

    • Finalizes a permanent prospective adjustment of -1.975% (half of the calculated permanent adjustment of -3.95%) to the CY 2025 home health payment rate to account for the impact of implementing the Patient-Driven Groupings Model (PDGM)
    • Includes the final CY 2025 home health payment update of 2.7%
    • Adds an estimated 1.8% decrease to reflect the permanent behavior adjustment
    • Also has an estimated 0.4% decrease that reflects the updated FDL

This yields an aggregated 0.5% increase in payment rates over 2024. 

Increase=Decrease

Despite the overall 0.5% increase in payment rates, PQHH, The Alliance, and many other organizations see this as a drastic pay cut. The increase will not account for inflation, higher operating costs, or any other adjustments. These organizations continue to call upon you to contact your Senators and Representatives as well as to support them in their ongoing efforts with the bipartisan bills and the lawsuit. 

CMS Proposed Rule CY 2025

Ongoing Updates

The information in the 2025 final rule is still being analyzed and is further complicated by the change in leadership at the national and local levels after this week’s election. Please see our Upcoming Events section on the website for several webinars discussing these issues. The Rowan Report will continue to bring additional insights as they become available.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

End of an Era

Advocacy

by | Oct 25, 2024 | Advocacy, CMS, Editorial, Regulatory

by Kristin Rowan, Editor

NAHC President Bill Dombi Retires

Earlier this year, with the announcement of the merging of NAHC and NHPCO, Bill Dombi announced his retirement from his position as President of the Association. Shortly after that announcement, The Rowan Report interviewed Bill and asked about the ongoing litigation against CMS as well as his thoughts on his tenure at NAHC. At the time, Bill was not prepared to speak about his upcoming retirement.

Remembering the Past

This week, at his final Annual Convention & Expo as association President, Bill shared his vision for the future of home health and hospice. Bill shared the story of the first time he faced an adversary…way back in kindergarten. He met his first bully and it took only a day for him to stand up to his nemesis and fight back. His bully walked away with a broken nose and Bill spent time with his nose in a corner.

“I was smiling the entire time,” Dombi shared, “and learning that’s not the way to do it. You’ve got to go to law school instead.”

How it Began

A young litigator, bright-eyed and ready to take on the world, Bill was initially hired to tackle a lawsuit against the Medicare program for denying care that should have been offered. He walked into the office that day and found boxes upon boxes with thousands of patient records and denied claims. Bill had to comb through each of these to select the 12 best plaintiffs to be named in the case. The amount of information was overwhelming, he recalled. It got a little easier when he was able to add members of Congress to the plaintiff list.

Nearly 40 years have passed since that day. “That day that I said yes was the beginning of a stunning opportunity that I had to be a part of an incredible team of people,” Bill reminisced.

First Steps Forward

That day will live in NAHC history as the first day of Bill’s tenure with the association. He promised his wife and children they’d be in Washinton D.C. for “just three or four years.” They stayed for 37. This day led to his first case against Medicare, Duggan v. Bowen. A case that rewrote the Medicare home health benefit. “It’s not perfect, but it was a monumental move forward,” Bill stated.

A Career Marked by Achievements

While is Bill is often hesitant to take full credit for what he has accomplished, and regularly credits his team for the strides made for home health and hospice patients, there is no doubt that he has been a driving force behind NAHC’s momentum and a key player in its advances at state and federal levels. 

Among Bill’s many accomplishments are:

  • Creating the Medicare Hospice Benefit. Today, one out of every two decedents have used hospice in the last 12 months of their life, which is an enormous increase since its launch.
  • The growth of the Medicaid program. The program went from having no home services in 1965, to being the largest home health program in the world.
  • Increasing access of care for pediatric patients, those receiving private duty nursing, the severely disabled and the elderly.
  • The transition of making hospital-at-home care permanent in Medicare.
  • Ever-growing technologies and improving the focus on in-home care.
  • Several lawsuits that Dombi led at NAHC against private insurers and others, to ensure that specific patients—including several with amyotrophic lateral sclerosis (ALS)—weren’t arbitrarily denied the coverage they needed.
NAHC President Bill Dombi Retires

“That’s where my heart, my soul is; that’s where my aggressiveness is born, representing those very vulnerable people.”

Bill Dombi

President Emeritus, National Association for Home Care & Hospice

Where it's Going

As Bill wrapped up his final appearance on stage as NAHC President, he made some predictions and shared his hopes for the future of care at home. “I see a future where we see a whole transformation of health care. A future where the minds, hearts, operations, payments, and everything else are focused arund a home care direction,” he shared, “Not everyone can or should receive care at home, but it would be the ideal default before someone is hospitalized or moved to a nursing facility.”

Bill’s more specific hopes for the future of care at home include:

  • Nursing school curricula specific to care at home
  • Physician education including care at home
  • The leaders of CMS and/or DHHS have backgrounds in or a deep understanding of care at home
  • Technology visionaries working on tech solutions for care at home
  • Every state of the union and Presidential debate includes a discussion on care at home

Dream Big

Bill openly admits that his “wish list” for care at home may be fantastical, but he will continue to encourage all those who work in the care at home industry to continue to fight to move in that direction.

“We have to stand ready and be capable of working in all forms to defend ourselves against being bullied around,” he said. In typical fashion, Bill’s statements brought the crowd to its feet. He fittingly exited the stage to a standing ovation with Tom Petty’s “I Won’t Back Down” echoing through the hall. 

As the music faded on Bill’s tenure, The Alliance CEO Steve Landers offered, “Bill, we won’t back down. Just so you know, we’re not going anywhere.”

The Legacy Lives On

Bill may be retiring from his post as President of NAHC, but his accomplishments, his passion for care at home, and his legacy will live on. National Alliance for Care at Home has established The William A. Dombi Scholarship Fund at his alma mater, the University of Connecticut. Bill’s contributions to care at home can hardly be overlooked when the scholarship fund has nearly doubled its initial goal of $50,000. 

Incoming and continuing students at UCONN who are majoring in political science can apply for the scholarship. The scholarship prioritizes awarding money to students focused on public policy and/or health care policy. Contributions to the scholarship fund can be made here. 

On a Personal Note

I spoke with Bill briefly during this week’s national convention & expo. I couldn’t let the event pass without acknowledging his contributions personally. When I started working in the care at home industry nearly 16 years ago, I saw Bill speak at a convention. Most of what he said was beyond my limited knowledge of care at home at the time. But, when I introduced myself afterward, he was gracious and offered any assistance he could offer in the future. Since then, as I have delved deeper into the world of care at home, Bill has been a voice of reason, of passion, of resilience, and of steadfast commitment to advocating for the current and future recipients of care at home. He has impacted countless lives. For his guidance, for his character, and for his relentless pursuit of reform for care at home, I can only echo the sentiments of my colleagues and friends:

“Thank you, Bill, for everything.”

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

National Alliance for Care at Home: An Interview with Dr. Steve Landers Part 1

Admin

by | Oct 25, 2024 | Admin, Advocacy, Regulatory

by Kristin Rowan, Editor

Alliance CEO Landers

For more than a year now, The Rowan Report has been providing updates on the merger between the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC). This week, we attended the first National Alliance for Care at Home (The Alliance) Annual Home Care and Hospice Conference and Expo. We had the opportunity to sit down with Dr. Steve Landers, inaugural Chief Executive Officer of The Alliance.

Dr. Steven "Steve" Landers

Dr. Steven Landers brings his almost 20 years of experience to The Alliance as its first CEO. Dr. Landers is a board-certified physician in family medicine, geriatric medicine, and hospice and palliative medicine. He has dedicated his career to seeking home- and community-based solution to traditional healthcare. His focus is on providing compassionate, dignified, and cost-effective care to patients.

Dr. Landers graduated from Case Western Reserve University School of Medicine, where he completed a geriatric medicine fellowship at the Cleveland Clinic.

Dr. Landers is no stranger to NAHC and NHPCO, having previously served on the board of directors for NAHC.  He has met with Congress, state legislatures, CMS, and PAC officials, providing testimonies, discussing home care policy and regulation, and advocating for care at home.

Steve lives in Little Silver, New Jersey, with his wife, Allison, and their three sons. His hobbies include golfing, fishing, hiking, traveling, enjoying good food and watching horse racing. When he is not taking part in these activities, you can find him cheering on his sports teams — the Browns, Cavaliers, Guardians and Indiana Hoosiers.

The Alliance Landers
The Alliance Landers

Dr. Steven Landers: On the Record

The Alliance Landers
The Rowan Report:

What do you know about the status of the ongoing lawsuits, going back to the 2024 final rule?

Dr. Steven Landers:

One, we should probably bring Bill [Dombi] into it because he’s truly a technical expert on it and I’m still getting up to speed on it. My understanding is there is no active lawsuit at the moment. We were asked to go back and take some additional administrative steps, which we’re doing. Then we’ll be able to evaluate what further legal paths are possible.

RR: 

That leads me to, not a question, but an observation I’d like you to comment on, Steve. For 45 years, the organization has been run by attorneys and the emphasis in lobbying and advocacy has been ‘you need to stop this cut because it’s hurting businesses and also it’s hurting patients.’ The way you’re talking, you emphasize as you begin with how it’s hurting patients. And so I’m wondering if the organization being run by a physician and not an attorney indicates that different emphasis going forward.

Steve: 

I certainly am going to do everything I can to tell the story of how policies impact patients and families. That will be part of what I try to do every single day using my experiences as a physician to do that.

RR:

Would it be exaggerating to say “new day, new emphasis” at The Alliance?

Steve:

Well, The Alliance is new in and of itself, so The Alliance is a new day for the industry, a hundred percent. We brought together two legacy organizations. The opportunity to have a stronger voice is very real and certainly I am going to bring a clinical perspective. I’m also a family caregiver. I have my own personal experiences with home care and hospice that have instructed how I think about these things.

And there is every opportunity here to get stronger, to try to make a bigger impact. I would not diminish the truly heroic work that’s been done by advocates within our associations in the past. There’s a lot of love and care that’s happening out in our country because of the leadership that’s been in place. But as you can see by some of the things that we’re talking about, we need to do better. We need to find another way to tell these stories to somehow get somebody to listen.

The Alliance
RR:

You recently released a statement about your position as CEO of The Alliance and your vision going forward. There was a commitment attached to that. Can you speak to that?

 

Steve: 

Yeah, so that’s one of the things that I’m really happy we’re doing very early in our work with the Alliance. For membership, whether to join or to renew membership, we are requiring an attestation from our members around their commitment to quality and to compliance. We’re requiring any provider member to attest to having a program in place for quality and compliance. And we’re requiring that they attest that they monitor the OIG exclusion list and don’t take referrals for employees that are people that are on that list. Also for home health and hospice providers, we’re asking that they attest that they do their level best to participate in the Medicare Home Health and the Medicare Hospice Quality Reporting program.

In order to make a difference on behalf of our members and make a difference on behalf of the people that need care at home, we have to have as credible and high integrity of a voice as possible. And so this is just one simple step of additional things that we’ll consider going forward. We want to make sure that our alliance, our coalition is high integrity and has a deep commitment to quality and compliance.

RR:

It’s one thing to ask people to sign an attestation. It’s another to find the bad players and help CMS to get rid of them.

Steve:

And we’re right there as a partner in that. I think you’ll see more announcements from us in the future about what we’re doing to help with that. I mean, on one hand, we’ve made many proposals around fighting fraud and hospice in particular. If you followed the hospice policymaking, both Legacy NAHC and Legacy NHPCO over the last year have made many policy recommendations. And you’ll definitely see us both advocating for anti-fraud measures as well as having resources within our association to focus on those topics.

The Alliance Landers
Interviewer 1:

Just to clarify, did either of the legacy organizations have this same kind of attestation?

Steve:

No, this is new. The impact of the legacy organizations cannot be questioned. It’s been amazing. But, it’s a new day and we are looking at ways to increase our impact. So, this is a new part of our membership process that we feel strongly about to just take another step to ensure that our coalition, our membership, is of the highest integrity possible. We are walking the walk and talking the talk with respect to quality and compliance.

RR:

Thank you, Dr. Landers

This article is part 1 of 2 interviewing Dr. Steven Landers. Read the rest of the interview here.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

An Interview with Dr. Steven Landers, Part 2

Advocacy

by | Oct 25, 2024 | Advocacy, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Medicare Advantage is Killing Us...Literally

This is part 2 of 2 in the interview with Dr. Steven Landers. You can read part 1 here.

Medicare Advantage article by Dr. Landers

Earlier this week, Dr. Landers published an article in the NAHC Report. The article cited three studies and analyses on the number of enrollees in both Medicare and Medicare Advantage who do not receive the care to which they are entitled. During our recent interview with Dr. Landers, he addressed this article.

Dr. Steven Landers: On the Record

The Rowan Report:

You wanted to address something you recently wrote. Is this the same topic you mentioned the opening session, or is this something else?

Dr. Steven Landers:

No, this is a focused piece on the emerging research that we’re seeing around when people miss out on home health. It’s a life and death issue. I want to be sure that we, as an alliance, I, as a physician, and us, as advocates, that we are conveying that these issues around home health cuts and barriers are potentially deadly. This is not a trivial matter. It’s not an administrative or technical financial issue. It’s about people’s lives.

RR:

The article mentioned a study that said that the numper of people not getting the home care that they’re entitled to is almost double with Medicare Advantage enrollees over traditional Medicare.

Steve:

That was from a study that’s referenced there from a few years ago. The Partnership for Quality Home Health Arcadia Analysis that came out this year actually showed that those trends are worsening. We know that they’re not getting the needed care in Medicare Advantage and traditional Medicare.

In both cases it’s too high, but it’s higher in Medicare Advantage. It’s more common that people don’t get the prescribed care in Medicare Advantage. And we also know that that’s going up in both traditional Medicare and Medicare Advantage. The access has gotten worse because of the Medicare home health policy and because of the way that Medicare Advantage has grown and handled these issues.

Medicare Advantage Landers
Interviewer:

I guess the big giant question is what do we do, especially when margins for both traditional Medicare and Medicare Advantage are so low?

Steve:

One, we’ve got to start improving access to home healthcare. And the way that we do that is we end this march of payment cuts that are being set forward by Medicare. I mean, right now the leaders of Medicare are in their rulemaking process and they have choices to make. They can either do things that reverse this trend and put us on a path to better access or I think continuing these cuts will hurt beneficiaries.

And the other piece is the Medicare advantage front. We need more scrutiny and evaluation and potentially oversight here to make sure Medicare Advantage beneficiaries have access to high quality home healthcare.

“The results of this study demonstrate that among MA members referred to home health after acute hospitalization, those who did not receive home health services experienced higher mortality and lower readmissions than those who received these services.”

Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage Members

Elan Gada, MD, Paul Pangburn, MHA, Chris Sahr, MS, MBA, Chad P. Schaben, MPH, Richard Young, MS

RR:

Where does the problem lie?

Steve:

People don’t get home health when it’s prescribed and mortality rates are substantially higher. There could be [anecdotal] reasons that this is happening. I’ve tried to think of them. I can’t really come up with them when you see it in three different analyses, especially one done within the Medicare Advantage plan. They have great data. It was well thought out and this is serious business and it really should be a kitchen table discussion for families like ‘what’s going here?,’ because obviously home healthcare is a beloved service that families care deeply about.

We’ve seen home care become a presidential campaign issue because it’s good policy and also because the folks running, Vice President Harris, who brought it up, and former President Trump, who chimed in sort of a me too, being enthusiastic about the concept. They’ve got to know that this polls well, that the families care about this stuff.

Editor Emeritus Tim Rowan provides an analysis of the study from UnitedHealth Group here.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Introducing “The National Alliance for Care at Home”

Admin

by | Oct 25, 2024 | Admin, Advocacy, Regulatory

by Tim Rowan, Editor Emeritus

National Alliance for Care at Home

The merger of the National Association for Home Care and Hospice and the National Hospice and Palliative Care Organization, which was inked on July 1, became official this week in Tampa, Florida. The new National Alliance for Care at Home said farewell to retiring NAHC President Bill Dombi and gave a rousing welcome to incoming Alliance CEO, Steven Landers, MD. Both Bill’s farewell address and Dr. Landers’ introduction speech ended with the same theme. We do what we do for the good of our patients. Yes, there is money. Yes, there are politics. In the end, our legacy and our future are about people.

Dr. Steven Landers

Integrity, Quality and Compliance

That future will begin with a commitment to patient care excellence. Dr. Landers closed his opening address with an announcement. From now on, every member, upon beginning or renewing their annual membership, will be asked to sign an attestation pledging their company and themselves personally to commit to Integrity, Quality, and Compliance. “Our members will be known to the world as the best in the industry,” he proclaimed. “They will assure patients, families, and payers that they participate in Medicare and Medicaid quality performance standards.”

In a press conference the next day, Dr. Landers elaborated that NAHC and NHPCO have always worked with public and private payers and law enforcement agencies to rid our industry of those who are not in it for noble reasons. Those cooperative efforts will continue, he told the reporters. The new attestation will further assure the world that members of The Alliance publicly join that mission. One is reminded of a code of conduct common to all our national military academies. “We will not lie, steal, or cheat, nor tolerate among us anyone who does.”

Emphasis on Advocacy

The Alliance is new, and Dr. Landers candidly admits he is gradually learning his new role as he goes along. But he is guided by a commitment to care in the home that has been with him since medical school. “I didn’t want to be just another cog in the system,” he told 2,000+ attendees. “The first time I went along on a home visit, I immediately realized that this is what I wanted to commit my career to.” Through his years at the VNA and Cleveland Clinic, he saw the power of in-home care, including its ability to extend live expectancy and reduce the total cost of care.

Bill Dombi

A Semi-Farewell at Best

National Alliance for Care at Home Dombi

Bill Dombi will serve the new Alliance through the end of this year before fully entering retirement. Following his closing address on the last day of the conference, during which he summarized his 38 years with NAHC (years that began with a promise to his wife Lynn that they would only have to leave their home in Connecticut for the DC area for three to four years), I asked him what he planned to do that first day in January. He said that he accumulated a ton of frequent flyer miles during his career and that they would love to travel somewhere other than state and national association conference cities.

He also mentioned the ongoing legal actions he initiated to force CMS to develop more honest formulae for calculating Home Health reimbursement and added, “It is very difficult to change litigators in the middle of a lawsuit.” Draw your own conclusion but take it from one who knows how difficult it is to completely walk away from this mission and its people. We may not have heard the last of William A. Dombi.

# # #

Tim Rowan, Editor Emeritus

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com

National PACE Awareness and National Fall Prevention Month

Advocacy

by | Oct 10, 2024 | Advocacy, Clinical

by Kristin Rowan, Editor

New Fall Prevention Study: An Interview with Dr. Ann Wells

Fall Prevention Month

September was National Fall Prevention month. Accidental falls are the number one cause of injury and death among adults over the age of 65. Fall Prevention month attempts to raise awareness on preventing falls, reducing the risk of falls, and helping older adults live without the fear of falling. The National Council on Aging also promotes advocacy on behalf of fall prevention funding and offers training and other materials to help prevent falls. Read our complimentary article this week about a nurse charged in the death of a patient who fell here.

National PACE Awareness Month

September was also PACE Awareness Month. The Program of All-Inclusive Care for the Elderly )PACE) is a Medicare and Medicaid program that helps seniors with long-term care needs to live independently and age in place. The program includes an interdisciplinary team of professionals working together to coordinate care. There is no co-pay, deductible, or coverage gap and the amount paid each month doesn’t change, no matter what care services the patient needs. All Medicare and Medicaid services are covered as well as medically-necessary care and services that are not typically covered. Coverage includes prescription drugs, doctor care, transportation, home care, checkups, hospital visits, and nursing home stays when necessary.  Access more information about PACE here.

InnovAge Fall Prevention Dr. Wells

InnovAge has been tapped to participate in a fall prevention study. The study is conducted by LeaHD, a research and training center established in partnership with Brown University, Boston University, and University of Pittsburgh in the Center on Health Services Training and Research. The Rowan Report sat down with Dr. Ann Wells, Chief Quality and Population Health Officer of InnovAge. Dr. Wells said of the study, “[it] will help us better understand the multi-faceted factors contributing to falls among seniors and develop intervention strategies tailored to their unique needs.”

Dr. Ann Wells, Chief Quality and Population Health Officer

Rowan Report:

Dr. Wells, thank you for taking the time to speak with me today. Why don’t we start with a little background on you. How did you come to be involved in elder care and PACE programs?

Dr. Ann Wells:

By trade, I am in internal medicine doctor, focused on the geriatric population. I have spend 20 years in medical leadership working in population health. Population health is the approach to healthcare that evaluates and improves outcomes in subgroups with similar needs and the populations as a whole through team care and analytics. Through my work in medical leadership and population health, I was approached by InnovAge to be part of their leadership team.

RR:

You mentioned the PACE program. What do you think is the key difference, or differences, between PACE programs and other types of senior care?

Ann:

The PACE model is health care’s best kept secret and we don’t want it to be a secret anymore. Most patients and families don’t want institutional care. 86% of seniors value remaining in the communities in which they live.

In order to qualify for PACE programs, the patient has to qualify for nursing home levels of care. The program delivers services designed to help them stay in the community. PACE leverages an 11-member interdisciplinary team that includes a primary care provider, a registered nurse, a driver, a master-level social worker, PT, OT, a dietician, a PACE center manager, a home care coordinator, and a personal care attendant. The team coordinates care for medication, medical care and transportation with wrap-around social support and in-home support to help with bathing, shopping, and dressing. They also coordinate specialty care, make appointments with contracted specialists, provides transportation and a chaperone if needed, sends medical records in advance of the appointment, and gets notes back from the specialist.

Participants can come to a center for primary care, PT, or OT. They can also enjoy the center for socialization and activities. Patients provide permission to talk to each caregiver to make sure they are getting the care they need. Almost 90% of patients are dual-eligible. Roughly 10% are Medicaid only. The small remainder are Medicare only and pay the difference out of pocket.

RR:

There is a lot of information about the PACE program that I didn’t know before. Thank you for that. Can you tell us a little about InnovAge?

Ann:

InnovAge is the largest provider of the PACE program based on number of participants. They are both a delivery arm and a health plan. InnovAge administers care from 20 centers in six states.

RR:

And what your role is as Chief Quality and Population Health Officer?

Ann:

The Clinical Value Initiative aims to ensure the company is managing revenue and participant expenses including risk adjustments, ensuring the most accurate risk score, resource management, payment integrity or a claims audit process, and network optimization. Through these initiatives, the average inpatient rate for hospital admissions was 5.5% and the average time from enrollment to placement in a nursing home is three years. These initiatives and the PACE program are reducing hospitalizations for participants and keeping patients in their homes and in their communities longer.

RR:

September was National Fall Prevention Month. The number of injuries and deaths due to falls among seniors over age 65 is staggering. But, InnovAge, using the PACE model, has reduced falls. How does that program work?

Ann:

Any fall that has a major fracture is very difficult to recover from. InnovAge leverages the STEADI program. Stopping Elderly Accidents, Deaths, and Injuries (STEADI). This program includes screening, assessing, and intervening.

Screening

All participants are asked intake questions to screen for risk. Have you fallen in the last year? Do you have a fear of falling? Statistically, once a patient has fallen once, the risk is much higher for another fall.

Assessing

At enrollment, and again yearly, the patient receives an in-home assessment with an environmental safety evaluation. We look at things like lighting, rugs, grip bars, ramps, a non-slip rug in the bathroom. PACE arranges for installation and payment for any items they might need to lower the risk of falls. OT & PT conduct yearly evaluations as well. Do they need a walker? Do they have proper footwear? Have they had a recent eye screening and do they have glasses? They also evaluate leg strength and balance. If there is a deficit, the patient can do PT at the center.

In addition to the in-home assessment, we conduct a root cause analysis if there is a fall to determine why they fell and what they need to prevent a future fall. Clinical pharmacists also evaluate medicine regiments and optimize medications to reduce or eliminate side effects and improve safety.

Intervention

When there is a patient at high risk for a fall, due to any of the factors we find in the screening and assessment, we employ some intervention. PERS units, emergency alert pendants and wristwatches, are provided for high-risk patients. Units with fall detection and emergency activation buttons place automatic calls to a call center. The call center will try to contact the patient and send an ambulance if they can’t be reached or need assistance.

RR:

InnovAge has recently been selected to participate in a national study for the prevention of falls. Tell us about that study and how InnovAge will participate.

Ann:

LeaHD approached InnovAge to help improve their training for chronic care. InnovAge has a population that aligns with their research. The research topic is to evaluate whether they can predict risk of falling with new enrollees. From there, we will assess whether we can create more tailored interventions to lower risk. The hope is that the study will inform us, as an industry, what we should be asking a new patient to determine their actual risk of falling. In turn, the study will inform caregivers on how they can identify high risk patients and prevent future falls.

Fall Prevention InnovAge Dr. Ann Wells
RR:

What is the timeline and goal of the study?

Ann:

The study will run for one year, starting in October, 2024. There is a data scientist working on the project who will conduct and write the study. We are hoping to publish sometime in 2026. The goal is finding interventions; gaining insight on which systems can be executed to reduce the risk.

RR:

That sounds fascinating. I can’t wait to read the results of the study. Is there anything else about InnovAge that you’d like to share?

Ann:

Just that our mission is to help seniors live independently in the community and to advocate for the PACE model of care. We are excited to have three new centers – one in California and two in Florida. The goal is to spread the PACE model and grow the individual centers. InnovAge is the largest provider of PACE based on number of patients enrolled. We are dedicated to expanding and serving more seniors across the country.

RR:

Thank you, Dr. Wells for your time and your insight. It’s been a pleasure talking with you. Please stay in touch and keep The Rowan Report updated on the progress of your study.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Home Health in a Post-Chevron World

Admin

by | Sep 27, 2024 | Admin, Advocacy, Audits, Regulatory

by Elizabeth E. Hogue, Esq.

The "Wicked Witch" Chevron is Gone

On June 28, 2024, the U.S. Supreme Court overturned a decision of the Court in 1984 often referred to as “Chevron.” The Chevron case said that Courts must defer to administrative actions that are reasonable interpretations of ambiguous statutory language.

 In Loper Bright Enterprises v. Raimondo, however, the U.S. Supreme Court abandoned the decision in Chevron and said that:

    • The “deference that Chevron requires of courts reviewing agency action cannot be squared with” the Administrative Procedure Act (APA). The APA “specified that courts, not agencies, will decide ‘all relevant questions of law’ arising on review of agency action…even those involving ambiguous laws – and set aside any such action inconsistent with the law as they interpret it.” 
    • The framers of the U.S. Constitution envisioned that the final “interpretation of the laws” would be “the proper and peculiar province of the courts.” 
    • The views of the executive branch should inform the judgment of the judiciary, not supersede it. 
    • “Chevron’s presumption is misguided because agencies have no special competence in resolving statutory ambiguities. Courts do.”

What Does it Mean for Providers?

The short answer is that we don’t know yet. It is unclear how the new standards of the Loper Bright decision will be applied and affect health care providers. The Supreme Court said that the recent Court decision does not call past cases into question that were based on Chevron, but existing regulations are not insulated from challenges. It is likely that several providers will “swing for the fences” for favorable rulings based on Loper Bright!

One possible “candidate” for disruption is the reliance of administrative law judges (ALJs) on Chapter 8 of the Medicare Program Integrity Manual. This section offers an overview of use of inferential statistics and statistical sampling to estimate overpayments in Medicare audits. Chapter 8 of the Manual is only nine pages long. ALJs routinely use this section of the Manual to hamper providers’ ability to mount a compelling defense that challenges auditors’ methods using widely accepted standards within the statistical community. Challenges to this practice based on Loper Bright may prevent ALJs from reliance on these sections of the Manual.

Chevron Deference Gone

Another possible target is the use of sub-statutory and even sub-regulatory guidance from the Centers for Medicare and Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs) by fraud and abuse enforcers to make determinations about illegal conduct, especially under the False Claims Act (FCA). Defendants arguably now have a better chance to challenge the basis of claims of illegal conduct in light of Loper Bright. 

The story of Loper Bright has not been written by any means. Surely providers should use this significant change in the law to their benefit whenever possible.

# # #

Elizabeth E. Hogue, Esq.
Elizabeth E. Hogue, Esq.

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

©2024 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

NHPCO and NAHC Announce New Name and Website

Advocacy

by | Sep 12, 2024 | Advocacy, Breaking News, Regulatory

by Kristin Rowan, Editor

The Alliance

Since the announcement that the National Hospice and Palliative Care Organization and the National Association for Home Care and Hospice would merge, the default name for the combined entities has been “The Alliance.” NAHC President Bill Dombi and Interim NHPCO CEO Ben Marcantonio, along with a transition board and other members have been working since August of 2023 on the merger. In June of 2024, the two organizations signed an official affiliation agreement.

Alliance Updates

In the last year, the two organizations have spoken about the work they’ve been doing to create the new affiliation. They jointly hosted a town hall to answer questions, and Bill Dombi has spoken at state and national association meetings about the merger. On August 26, 2024, The Alliance named its inaugural CEO, Dr. Steven Landers.

National Association for Care at Home (NACH)

Our industry loves its acronyms and this one rolls off the tongue like we’ve been using it for years. Although, we may all need to perfect the German guttural sound to differentiate it from NAHC.

In a press release on Sept. 5, 2024, the two associations officially announced that The National Alliance for Care at Home (NACH) is the new name of the combined organizations. Along with this announcement, The Alliance has also launched its new logo (below) and new website at www.AllianceForCareAtHome.org.

From The Alliance

Statements from both organizations outline the path forward and the mission and vision for the new affiliation:

    • The National Alliance for Care at Home will Combine the Strengths of the Two Largest National Organizations Representing Healthcare Providers Delivering Care Primarily in Homes
    • The Alliance Will Provide Unparalleled Resources and Representation to Support the Care-at-Home Community
    • This Alliance will be the leading authority on transforming care in the home. We will implement that mission under a new name that welcomes providers across the care continuum to join – the National Alliance for Care at Home
    • The Alliance will be your advocate, your resource, and your network to help you reach your goals

The new logo for NACH is, according to the press release, both an homage to the past and a symbol for the future. It creates a visual representation of both NAHC and NHPCO. The star shape of the logo is representative of the stars on the American flag, part of the NAHC logo. The visual aesthetic of the logo is reminiscent of the lotus flower from the NHPCO logo. The individual sections of the logo represent people holding hands, the visual representation of the coming together of types of care. The white space in the middle is meant to symbolize a house or home.

The logo is based on guidance from a workgroup comprised of members from both organizations, whose input has helped shape the Alliance brand.

The National Alliance for Care at Home

About Us

This press release also included a new boilerplate, describing the National Association for Care at Home, rather than two separate descriptions of each organization. This is probably still a temporary description, as it mentions that they are still in the process of combining operations and Communications Officers from both separate organizations are listed as press contacts. 

More to Come

Despite the announcement of the new CEO and the new name, the merger is far from over. There are logistical and operational hurdles still to overcome, a new board to enstate, the combining of assets and competencies, and a restructuring of existing employees. We will continue to report on press releases coming from NACH.

# # #

Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

NAHC NHPCO Town Hall

Advocacy

by | Aug 9, 2024 | Advocacy, CMS, Hospice, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

The Alliance

On June 18, 2024, the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) announced they had met in Washington D.C. to formally sign an affiliation agreement between the two organizations. After 18 months of meetings, conversations, and compromises, the two groups announced their “Alliance” would be the leading authority of the care at home community.

Bill Dombi Ken Albert Town Hall Alliance

During the opening keynote address at the NAHC Financial Management Conference in July, Bill Dombi, President of NAHC and interim President of The Alliance, and Kenneth Albert, Chair of the Transition Board of Directors overseeing the merger, spoke about the progress they have made.

Albert spoke of the thoughtful consideration the board and members of both organizations have put into this change. They are focusing on the biggest concerns of home health and hospice providers both now and in the future. The unification will create one voice as they advocate for home health and hospice in Washington D.C.

New Leadership

Albert and Dombi shared the stage at the NAHC Financial Management Conference about the ongoing search for a CEO of the new organization. According to Albert, there were some candidates who were very excited about the role, but whom the board did not feel there was a great fit. Contrarily, there were candidates the board eagerly wanted to move forward with who declined to continue the process. According to Dombi, the search has gone outside care at home as they look for the right fit from qualified candidates from multiple industries. Both agreed that they felt the search was close to over and they should have an announcement about the new CEO, and possibly the new name, sometime in August of this year.

New Resources

The conjoined organization promises more than just new leadership. Currently under construction is a new logo and website to encompass both groups. Dombi alluded to new resources for providers, training for quality care, and other tools for the industry. While the organization’s name and leadership are forthcoming, the website is projected to launch sometime in the spring of 2025. 

Operating as One

Since the announcement of the merger last year, and even before the deal was inked, NAHC and NHPCO have already been integrating. Dombi told The Rowan Report in a previous interview that the two groups have already been lobbying together, working on policy together, and integrating the management of the two associations. 

The Last NHPCO Conference and the First Alliance Conference

September, 2024 marks the final standalone event for the NHPCO. The 2024 NHPCO Annual Leadership Conference runs September 16-18, with a pre-conference September 14-15 in Denver, CO. The conference will have on-demand access until December 31, 2024. NAHC members will receive member rates to the NHPCO conference. 

The “2024 Home Care and Hospice Conference and Expo” will be the last conference held solely by NAHC, but we are seeing quite a few hospice companies on the exhibitor list and expect this to be a sneak peek at future conferences. The national conference is scheduled for October 20-24, 2024 in Tampa, Florida. This will also mark the final conference for Bill Dombi as President. Dombi announced earlier this year that he will retire at the end of 2024.

NAHC NHPCO Alliance Town Hall
NAHC NHPCO Alliance Town Hall

Town Hall

With quite a few remaining unanswered questions about the future of the two organizations, NAHC and NHPCO hosted a virtual Town Hall on July 31, 2024. With more than 250 association members from both groups in attendance, Bill Dombi and Ben Marcantonio, interim-CEO for NHPCO, along with Kenneth Albert and Melinda Gruber, Vice Chair of the Transition Board of Directors.

Naming "The Alliance"

Albert mentioned that there has been some success using the term Alliance, but it is not a long term solution. The finalization of the name is awaiting some trademark issues to be ironed out and that announcement, which they had hoped to be able to make in July, is coming soon.

CEO Search Update

Gruber thanked the search committee and recruiting firm for their work on the CEO search. Gruber reiterated that they are nearing the final selection phase and after board approval, an announcement will be made. 

Website

Ben Marcantonio, current interim CEO of NHPCO and future CIO of The Alliance confirmed that the new website will allow access to both legacy websites (the current NAHC and NHPCO websites). The new website will have a preliminary version this fall with a fully completed version next spring.

Members of either organization will have full access to the preliminary version of the website this fall. Currently, members can only access information from their own organization, but Marcantonio stressed that if there is information you need, they can help you access it.

Integration

There are eleven committees working together to integrate the two associations. advocacy, programs, education, and HR are a few of these workgroups that each have two to three high priority goals that will most effectively bring about the integration of the two groups. Work plans are now in place to create significant integration by the end of the calendar year. 

Policy and Advocacy

Bill Dombi presented an updated on the joint policy and advocacy issues The Alliance is undertaking. “What stands out for the immediate term has been how the resources have been employed of the two legacy organizations under the banner of The Alliance, focusing on hospice and palliative care,” Dombi said, “In a matter of weeks we saw significant regulatory and legislative action taking place.”

Hospice

The Hospice Final Rule 2025 has undergone an intense review and indepth analysis by members of both teams. The rule will have “tremendous impact” under the Medicare hospice program.

According to Dombi, the two organizations have come together to jointly fund a research project for the Special Focus Program to understand the impact and targeting. Dombi is hopeful that U.S. Representative Earl Blumenauer’s (D-OR) discussion draft will serve as a stepping stone for Hospice reform.

Home Health

The ongoing battle in Congress against CMS is gaining momentum. Dombi said there is a “tremendous amount of support” in Congress to role back the authority of CMS to institute rate changes and rate cuts under the Patient Driven Groupings Model (PDGM). “We have gained a seat at the table, which really helps,” Dombi said. We are continuing with litigation challenging Medicare’s validity of the regulation which has set all these rate cuts in motion.

Medicaid Home and Community-Based Services

The Final Rule modified in a positive way the 80/20 requirement. “We agree with the intentions of improving the status of direct care workers who positively impact so many lives. But in the absence of additional funding, it’s very very difficult to support this rule,” Dombi said. The modification stepped back from the more “draconian” interpretation, but The Alliance is not yet satisfied with the result. There is talk of a joint lawsuit challenging the validity of that rule.

Private Duty

The Private Duty Home Care world, one of the less regulated in the industry, is gaining a lot of attention from Fair Labor Standards as well as Non-Compete Laws. There is currently a joining of forces around solutions that will help Private Duty in the workforce arena, more specifically the Credit for Caring Act, which is gaining some traction, and would offer some financial support for family members who are paying for home care services directly.

The Alliance Needs You

Bill Dombi’s final statement in the Town Hall meeting centered on advocacy. He called for everyone who was in attendance and every member of both legacy organizations to join the fight. Everyone needs to part of that team of advocacy.

Final Thoughts

There is much more news to come out of these to associations as we near the end of 2024, and still more through the first quarter of 2025. The Rowan Report expects additional announcements to be made at both the NHPCO and NAHC annual conferences and we will be there to update everyone on the progress and statements coming out of those two meetings. 

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Chevron Deference Derailed

Advocacy

by | Jul 12, 2024 | Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

Chevron Deference

“A government agency must conform to any clear legislative statements when interpreting and applying a law, but courts will give the agency deference in ambiguous situations as long as its interpretation is reasonable.”

This statement followed the unanimous (minus the three who did not take part in the decision) U.S. Supreme Court decision in the Chevron U.S.A., Inc. v. National Resources Defense Council. The case is known for establishing the extent to which a federal court should defer to a government agency’s interpretation of an ambiguous statement when constructing statutes.

Breaking Down Chevron Deference

For those of you who don’t have a law degree, here’s what that means:

  • When a statutory term (required by law) is not explicitly defined and explained by Congress, there is room for interpretation
  • When a government agency interprets that statutory term, the interpretation may come under question
  • As long as the interpretation is not arbitrary (random), capricious (impulsive or unpredictable), or contrary to the statute (opposite the intent when put into practice), federal courts should give more weight to the government agency’s interpretation than to any other interpretation

Implications

At the time, the Supreme Court argued that if Congress leaves a term open to interpretation, it is either stated openness to interpretation, or an implied openness to interpretation. If a statute is implicity open, the intent of Congress is to allow a government agency to create provisions and regulations from that statute as they see fit. 

No one foresaw the impact this ruling would have on commerce and regulation in the U.S. To date, the Chevron Doctrine has been cited nearly 18,000 times in federal court decisions. The application of a statute based on agency interpretation could no longer be questioned or changed by judicial review.

Chevron Deference in Home Health

Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it.

Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022.

The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. However, CMS has already stated that their final position is that budget neutrality has been calculated within the law. 

NAHC Comment: 2023 CMS Rule

“That proposal also fails logically in that it puts care access in severe jeopardy in applying a budget neutrality reconciliation methodology that takes PDGM-induced behavior changes to assess what otherwise would have been expended by Medicare in the absence of PDGM. In doing so, CMS fully fails to meet its obligation to ensure that the transition to a new payment model is budget neutral.”

  1. NAHC Comment Source

Chevron Deference Repealed

In a landmark ruling on Friday, June 28. 2024, the Supreme Court removed the power of federal agencies to interpret laws and ruled that the courts should rely on their own intrepretation of ambiguous laws. Justice Elena Kagan, who dissented the ruling, predicts this change “will cause a massive shock to the legal system.”

Chief Justice John Roberts explained in his opinion that the Chevron Deference is inconsistent with the Administrative Procedure Act (APA). The APA is a federal law which contains instructions for courts to review actions by federal agencies. According to Roberts, the APA directs courts to decide legal questions using their own judgment. Therefore, he noted, agency interpretations of statutes are not entitled to deference. “…it remains the responsibility of the court to decide whether the law means what the agency says,” concluded Roberts.

NAHC to Refile Lawsuit after Chevron Deference Repeal

2024 Final Rule

In April, 2024, the lawsuit filed against CMS regarding the methodology for calculating budget neutrality was dismissed. Now, NAHC can refile the lawsuit and force CMS to justify its decision to enact repeated reimbursement cuts for home health.

In an interview on Wednesday, Bill Dombi told The Rowan Report, “This improves the chances of success for our lawsuit. CMS is going to have to support their regulatory interpretations going forward. Congress is going to have to offer more detail in its legislative language, leaving less to being open to interpretation.” Regarding the PDGM lawsuit, CMS argued that the law was clear and the agency’s interpretation was valid. The overturning of Chevron Deference allows the possibility of arguing that CMS’s interpretation of the law is flawed. 

80/20 Rule

Dombi also explained that the Ensuring Access to Medicaid Services rule, also known as the 80/20 rule, was “drawn out of a whole cloth.” Previously, there were limited avenues available to challenge this rule. The repeal of Chevron Deference significantly improves the ability to challenge the 80/20 rule. The argument now, Dombi told The Rowan Report, is “Does CMS even have the authority to do this?”

More to Come

The Rowan Report anticipates more news coming out of Washington D.C. and the NAHC office regarding the 2024 pay cuts and the 80/20 rule. We will provide ongoing updates and information as it becomes available.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

NAHC and NHPCO Sign Affiliation Agreement

Admin

by | Jun 21, 2024 | Admin, Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

BREAKING NEWS

In a joint statement on June 18, 2024, NAHC and NHPCO announced that the Board Chairs and CEOs of each organization met in Washington. During this meeting, they formally signed the affiliation agreement. This is a union of the two largest advocate organizations for care at home providers. They hope to unify the voice of the care at home community. The combined resources of the organizations will provide education, expert advice, and increased advocacy for policies that help deliver the best care to those who need it most.

After 18 months of discussions, meetings, and challenges, the two organizations have agreed on terms for the combining of the two groups.

 

“The affiliation of NAHC and NHPCO is a historic event,” said NAHC President and CEO William A. Dombi. “Unifying the voice of health care at home has been a longstanding goal of NAHC, as it is the essence of the original formation of NAHC in 1982. Combining our two organizations will significantly strengthen that voice for the benefit of our members and the patients they serve.”

Read the full press release from NAHC and NHPCO here.

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Kristin Rowan, Editor
Kristin Rowan, Editor

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

The Future of NAHC: An Interview with Bill Dombi

Admin

by | May 30, 2024 | Admin, Advocacy, CMS, Regulatory

by Kristin Rowan, Editor

NAHC President Bill Dombi announced at last week’s CAHSAH annual meeting and expo that he would end his tenure at NAHC and retire at the end of 2024. We reached had an interview with Dombi on Thursday, May 23rd. He said he was not prepared to speak yet about his upcoming retirement, but we should hear more about that soon.

In the meantime, he provided additional details from his session at CAHSAH. We also discussed updates on the lawsuit against CMS and the status of the merger between NAHC and NHPCO. Tim’s article from last week talks about Dombi’s progress with Senator Wyland.

Ongoing Litigation

When we last spoke with Bill, he told us about the lawsuits filed against CMS. The suit claims that the budget-neutral calculations were based on faulty data and outdated software. These calculations determined the reimbursement rate reductions. Dombi explained the process for those lawsuits.

“The first round of the battle is around whether the court has the power to hear the case either at all or at that point in time. The courts are littered with litigation that have been dismissed on jurisdictional grounds,” Dombi offered. The court dismissed the lawsuit and the case is now closed. The Department of Justice (DoJ) attacked jurisdiction to get the case dismissed. Most concerning, according to Dombi, was the DoJ’s question of whether the statute passed by Congress precluded any litigation. If the courts had found in their favor, they would have dismissed the lawsuit no further suits could be filed. Luckily, that argument didn’t hold. The second attack was whether NAHC had expedited administrative review, which is the argument that caused the dismissal. Now, they have to establish that it would be futile to get CMS to agree to expedited judicial review.

Next Steps

In light of the dismissal, NAHC had to decide whether to appeal the ruling, exhaust the expedited review step with CMS, or both. Ultimately, they decided not to appeal and is pursing the review with CMS. This process could take up to 6 months, according to Dombi. Although they are pursuing the review, CMS has already stated that their final position is that the budget neutrality has been calculated within the law. Dombi feels the review is futile because CMS is not going to change their position. Now, they just have to prove the futility.

Two-Step Approach

Advocacy from NAHC, NHPCO, and other individuals and organizations was always intended to be a two-pronged effort: Litigation and Congress. The two do not interfere with each other. Even though the court dismissed the litigation suit in favor of judicial review, the approach in Congress continues. Of Senator Wyland, Dombi said, “A year ago at this time, his view was that home health agencies needed no relief. Now, he’s indicated a willingness to find a way to help home health agencies and recognizes that the cuts have been harmful to home health agencies and others that provide care.” According to Dombi, it was the personal stories and individual provider information that was crucial in swaying Wyland. The organizations continue to meet with other members of Congress to persuade them in the same way.

Dombi Provides Merger Update

Last year, NAHC and NHPCO announced they would join forces and merge into a new, as yet to be named, organization. That merger is still moving forward, but there are a lot of odds and ends to tie up. Dombi told us, “Nothing is final, final, but I don’t see anything but tailwinds moving forward.” The two organizations are still hoping for a July 1, 2024 launch of the organization. There is an active, open search for a new CEO to actively run both organizations as one. According to Dombi, no one has been slated for that position yet, so they may end up launching before there is a CEO in place.

The two organizations have already started integrating. They have lobbied together and they have worked on policy together. Additionally, they are integrating the association management system and building a website. “We feel confident enough that it’s going to reach the finish line that we’re investing time and money in these elements,” Dombi said. The two organizations can continue to operate together without a CEO, but there are a lot of decisions that need to be made that won’t be made until after there is a CEO.

After the Merger

Once the merger is complete and the two organizations operate under a new name with a new CEO, Dombi and his counterpart Bill Marcantonio of NHPCO will stay on for some time. Dombi will take the title President Emeritus and Council to the organization and Marcantonio will become the Chief Integration Officer. The new name of the organization has not been announced. Dombi says a lot of things are tied together, from an action standpoint, and it’s better to announce all of those details together along with the new name.

Reflections From Bill Dombi

When asked what was next for him after the merger is completed and he moves to retirement, Dombi reflected on his career:

 

“I’m proud of what I’ve accomplished in my life, but I’m more proud of what the people I work with I have accomplished. It’s not the first time we’ve tried to merge the two organizations, but this time, we had all the right ingredients and I’m proud of that. I live with the confidence that my constituency is up to the challenge. Every time they get kicked back, they’re right back at it.

To see where we are today compared to the 70s, we are so many light years ahead of where we were then. I mean, we’re talking about a hospital level of care at home. That was part of the dream. The fore-runners of healthcare at home truly believed those things were possible. The problems that caused the workforce shortage are multi-faceted, so the solutions are multi-pronged.”

Bill Dombi Spring Tour
We will continue following the story of both the lawsuits and the merger and update you as soon as there is more information.
Kristin Rowan, Editor
Kristin Rowan, Editor
Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only.
editor@therowanreport.com