Healthcare Changes

Amber Home Health Care

I cannot believe it is May 2016 already. Where did the whole year go? It was only 2015 the other day. Well, we are thankful for a milder winter than what we had last year. At least, less people threatened to move to warmer climates this winter.

On the Healthcare front, lots has been going on. Medicare has continued to be a challenge to work with for providing Home care. Massachusetts is one of the pilot states for a new form of payment called Pay for Performance. In this model, Centers for Medicare and Medicaid Services, CMS tracks how well an agency is doing in certain measures which include Quality measures from the assessments submitted by the agency on start of care compared to the discharge date. It also includes how patients are satisfied with the care they got (Patient Satisfaction surveys),and some other interesting measures which include if the agency staff received the flu shot, if the patient  had the shingles vaccination and if the patient has Advance care planning in place. These last measures, the agency gets points for reporting it whether good or bad.

Meanwhile face to face requirements continue for all Medicare patients. To qualify for Home care, the patient must have seen their Doctor for the reason they need home care less than 90 days prior or less than 45 days after the start of Home Care. Lack of this results in a denial of payment to the agency.

The interesting thing about the reimbursement is that they compare the agency to itself a year before and then against similar size agencies. The best of the agencies gets rewarded an extra percentage prorated up to 3% and the worst gets punished up to 3 % deduction in payment.

Meanwhile MassHealth got more interesting too. Due to all the recent fraudulent activity in the state, MassHealth implemented a Prior Authorization Request condition to limit excessive use of Medicaid money. They also instituted a face to face encounter requirement just like Medicare.

All this takes some navigating for Home care agencies to survive. We, at Acclaim, are however taking it in stride because we know we are giving the best care possible, honestly and ethically.

The experience of care we give is what keeps people coming back to us despite an environment in Worcester of monopoly and non-existent patient choice.

We hope all our patients have the best experience with their care that heals them, supports them and gives their loved ones the confidence that no matter what, Acclaim Staff will stand by them when it counts.