by Katie Matlack, Medical Analyst at Software Advice

The iPad has been heralded as a gamechanger in a number of sectors. What will its impact be in home health? Pretty significant, I think. That prediction is based on the way the device empowers home health care workers to streamline logistics, and get more done. Below, I’ve identified three concrete ways the iPad is poised be a big hit within home health below (I’ve expanded further in a longer post on my blog at Software Advice, too).  

1. It can replace costly equipment. The iPad has a ton of processing power. And developers can easily build new apps. Given those two factors, the device is impressively extensible. Think about blood pressure cuffs that can plug into an iPad, or disposable EKG electrodes that do the same. Will home caregivers soon just carry a kit of electrodes, cuffs and sensors around? I imagine that day is not far off. After all, a company called Square has already built a credit card reader add-on for an iPhone.

2. It facilitates EHR adoption in home health. Though EHRs have been available for the home health specialty for some time, it’s never been simple for home health care givers to access these programs on the go… until now. The touchscreen is intuitive and offers an efficient way for caregivers to capture hundreds of data elements. Furthermore, a growing portion of the population is already familiar with how to use an iPhone and the iOS. This could decrease the levels of apprehension home health care givers have about using a tablet device.

3. It can transform logistics. As I wrote in my original article,

Home health workers can use existing iPad apps from gas station locators and mileage counters to the built-in camera to help them save time and be more efficient. For example, caregivers could use the camera to snap photos of receipts for expenses reports. Sharing information in real time is now as easy as a home health care team using a shared calendar. Some home health software programs have scheduling features built in, too.

For more discussion on how I think the iPad will transform home health, including a discussion of how the device might be used for accountability purposes in the future, please check out my recent blog post. If you have any comments, please feel free to send me an email at katie@softwareadvice.com I’d really appreciate the feedback! Thanks for reading.

 It is easier to find your imagination and your sense of humor with children. A person with dementia could make a mistake by not remembering you and you would sigh feeling slighted and sorry for their cognitive loss.

Babysitting recently, I easily became Mama Bear with Baby Bear, a delightful three year old, living in a cave under the stairs. We both felt the safety of our time together as we lay down on the floor over and over – many times – to go to sleep and wake up to Granma Bear’s breakfast of grits, bacon and fresh banana muffins.

Also recently I was told that a five year old child said “I love Julia. She makes the best pizza!”

“But,” I objected, “I didn’t make the pizza, I helped shovel pizza slices onto paper plates for hungry kids.” My informant joked, “You now know how you are remembered.” (Gee, to think that I could have made ALL those pizza pies!).

Please consider that this entire holiday season promotes the amazing cup of kindness we have shared once upon a time. “Auld Lang Syne” a Scots poem written by Robert Burns is traditionally used to celebrate and start the New Year in many English-speaking countries. In the days of “Auld lang syne” is equivalent to “Once upon a time.”  We are connected through centuries to the heart of memory, love, loss and gratitude. “For all these lives,” we say at remembrance services, “we give thanks.”

In the same spirit, the “Yes, Virginia” editorial written in 1897 is a reply to the letter from eight-year-old Virginia O’Hanlon who asked if there really was a Santa Claus. “Not believe in Santa Claus!” the editor wrote. “You might as well not believe in fairies.”

Especially grieving widows and widowers reply with a twinkle in their eyes that they may not be having a Christmas tree or other holiday rituals like usual but they are busy helping bring joy and gratitude for the holidays with Santa on this earth since ancient times.

Some elders are often cynical saying “It’s about the imagination – the importance of it. But as you get older like us, you lose your imagination along with everything else.”

But the imagination is extremely important. Another elder who is losing her eyesight and can no longer walk has to use her imagination to get by. She calls out in strong agreement, “Mine is getting stronger!”  Is yours getting stronger?  Do you still have your imagination?

By Julia Soto Lebentritt.  A published poet and producer, Julia Soto Lebentritt is author of As Long as You Sing, I’ll Dance: The bond not the burden – the blessing not the burn–out of caregiving (release date May 2012). She is a Bereavement Facilitator at the Community Hospice of Rensselaer County.

PART 2 of 3

Aside from the various rounds of budget cuts, long-term care providers may face –  if they have not lobbied Congress and the agencies over them –  a series of  regulations on Medicare and Medicaid that reduce payments and patient service. They are as follows:

RELATED FEDERAL REGULATIONS AND LEGISLATIVE PROPOSALS

Cuts To Home Health Care

• The Centers for Medicare and Medicaid Services issued regulations to cut home health payments by 3.79 percent in 2011 and eyeing another 3.79 cut in 2012. The total 7.58 percent cut and $39.7 billion in rate cuts required by President Obama’s the Patient Protection and Affordable Care Act through 2019, would mean if reduced payment to home health care agencies and hospice care facilities and compromised patient service to seniors.

The National Association for Home Care and Hospice (NAHC) say the cuts will lead to half to 88 percent of all home health care agencies – currently 35 percent – being paid less than the costs of care to Medicare. With the cuts, the agencies will go out of business, harming senior care.

The association says the Centers for Medicare and Medicaid (CMS) base the cuts on senior care provider coding behavior, leading to increased Medicare expenses, but the group protests that home health agencies are caring for sicker patients in need of therapy, nursing care and home health care.

Consequently, the association is calling on Congress to forbid the CMS from implementing cuts in addition to those under Obama’s the Patient Protection and Affordable Care Act (PPAC) until the rate changes of the new law go into effect. The group urges Congress to pass the Home Health Care Access Protection Act (H.R. 5803, S. 3315) for what it deems responsible for assessment of coding changes before new rate reductions are imposed.

Physician Encounter Requirements

• The association also calls for the federal agency CMS to issue guidelines, clarify any vague points and launch education and awareness efforts to support a regulation finalized in last November that requires that a physician or certain non-physician practitioner meet with a patient before his or her home health care agency may receive Medicare and Medicaid payment. President Obama’s the Patient Protection and Affordable Care Act (PPAC) mandated a physician face-to-face encounter and CMS sets the encounter to occur no more than 90 days before or 30 days after the start of care. The National Association for Home Care and Hospice asks that the federal agency release interpretative guidelines for its regulation, clear up ambiguities and teach stakeholders or long-term care providers.

Cuts To Hospice Market, Payments (PPAC)

Alarmed by the legal provision of Obama’s the Patient Protection and Affordable Care Act, the association is also asking federal lawmakers to ensure a safe and secure market for the Medicare hospice benefit to maintain sustainable Medicare hospice care reimbursement rates and provide for rural hospice care patients.

The National Association for Home Care and Hospice is responding to sections of Obama’s the Patient Protection and Affordable Care Act (PPAC) that would reduce the hospice market basket by 1 percent per year in addition to a 3 percent reduction from 2013 to 2019, resulting in hospice care Medicare reimbursement cuts of $7 billion during that time frame. The new law asks the U.S. Department of Health and Human Services to collect the data to further revise budget-based payments for hospice care revisions occur Oct. 1, 2012.

Cuts To Hospice Care by BNAF

Additionally, former President Bush’s 2009 budget included a regulation to eliminate the budget neutrality adjustment factor (BNAF) for the hospice wage index, resulting in a 4 percent cut in hospice Medicare reimbursement rates. This amounts to $2.29 billion Medicare payment reductions over five years. The Centers for Medicare and Medicaid (CMS) announces that this new policy would stretch over seven years, which started in Oct. 1, 2009.

NAHC argues that the law and regulation will drive community hospices out of business, especially in rural areas.

A Cap On Exceptions For Outpatient Therapy

• The Coalition to Protect Senior Care, an amalgamation of senior care and long-term care advocacy groups, urges Rep. Nancy Pelosi (D-Md.) and Speaker of the House Rep. John Boehner (R-Ohio) to extend the exceptions process for Medicare Part B outpatient therapy services against a cap that went into effect Jan. 1, 2010.

Reduction Of Unused Drugs In Long-Term Care

• Another rule states that all Part D plan sponsors must contract with network pharmacies serving long-term care facilities to dispense brand productions in 14 days or fewer increments. This is meant to reduce drug supplies from the original, requisite 30 days and, ultimately, the number of unused drugs in long-term care facilities.

Erasing Cost-Sharing For HCBS Patients

• Additionally, CMS releases a regulation that eliminates Part D cost-sharing for full benefit, dually-eligible persons receiving home and community-based services (HCBS). The rule has been delayed until Jan. 1, 2013.

Observation Status

• The Leadership Council on Aging Organizations (LCAO) calls on Sens. John Kerry (D-Mass.) and Olympia Snowe (R-N.H.) and Reps. Joe Courtney (D-Conn.) and Tom Latham (R-Iowa) to support (S. 818/H.R. 1543), the Improving Access to Medicare Coverage Act of 2011 to address the problem of Medicare beneficiaries being placed in observation status instead of being admitted to hospitals, especially acute care hospitals, as inpatients. The term “observation status” is used to describe the outpatient status of a patient in a hospital bed who is not considered an inpatient. Patients in observation status receive medical and nursing services, tests, medications and food and are present among inpatients.

While the Medicare statute requires patients to have at least three days of inpatient (not counting discharge) to qualify for Medicare-covered care in a skilled nursing facility, beneficiaries not classified as inpatients in skilled nursing facilities are not covered by Medicare Part A and neither are their prescription drugs. LCAO seeks to correct this condition by pushing S. 818 and H.R. 1215, both of which pieces of legislation would amend the Medicare statute’s on hospital extended care services” to establish that beneficiaries in observation status are inpatients in the hospitals. The bills would hark back to periods of observation on or after Jan. 1, 2011 but only for beneficiaries appealing these services in 90 days of the enactment of the act.

The Council includes AARP, AFSCME retirees, Alliance for Retired Americans, Alzheimer’s Association, Alzheimer’s Foundation, American Federation of Teachers Program on Retirement and Retirees, American Society in Aging, B’nai B’rith International, Catholic Health Association of the United States, Center for Medicare Advocacy, Inc., Easter Seals, Families USA, Leading Edge, Medicare Rights Center, National Academy of Elder Law Attorneys, National Association for Home Care and Hospice, National Association of Area Agencies on Aging, National Association of Nutrition and Aging Services Programs (NANASP), National Association of Professional Geriatric Care Managers, National Association of Social Workers, National Association of State Long-Term Care Ombudsman Programs, National Association of States United for Aging and Disabilities (NASUAD), National Caucus and Center on Black Aged, Inc., National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care, National Hispanic Council on Aging (NHCOA), National Senior Citizens Law Center, The Voice for Midlife and Older Women,  (OWL), PHI and the Quality Care through Quality Jobs.

The council as a whole could not be reached for comment.

PRESIDENT’S HEALTH CARE REFORM LAW AND MEDICARE

Obama’s the Patient Protection and Affordable Care Act (PPACA) and its amendment, which changes Medicare law, guarantees coverage to 32 million uninsured people and expands coverage in 2014. The president’s law costs $940 billion over 10 years.

PPACA would extend coverage beyond the current 83 percent to 95 percent. Aside from forbidding lifetime dollar limits on policies, cancellation of policies following illness or denying coverage to people with pre-existing conditions, the law would also pay all of the health care costs of the newly eligible individuals and provide for permanent Medicaid participation. Plans are offered through state-based purchasing pools called insurance exchanges in 2014.

There would be no tax increase until 2018 but an increased Medicare payroll tax only to individuals making more than $200,000 or married couples making more than $250,000.

For seniors, the law closes the coverage gap in Medicare prescription drug benefit that seniors fall into once they have spent $2,830.

Seniors get a $250 rebate this year once they hit this ceiling. This year, seniors received a discount on brand-named drugs, initially 50 percent off. The gap will be eliminated in 2020 and seniors will be responsible for 25 percent of the cost of their medicine until Medicaid catastrophic coverage kicks in.

CMS rules stipulate that cost-sharing under Medicare Part C or Medicare Advantage cannot exceed that of original or traditional Medicare for three specific services such as chemotherapy administration, kidney dialysis services and skilled nursing care. Beneficiaries not charged for senior stay for the first 20 days.

Conclusion next week…

Vladimire Herard is a freelance writer in Chicago. She was a health writer and online publication freelancer for the Guidance Channel, Longtermcare.com and States News Service for five years. For Community Development Publications, a publication chain in Silver Spring, Md., Ms. Herard wrote and edited newsletter articles about senior health and housing (Housing the Elderly Report and Aging News Alert); substance abuse prevention and treatment funding (Substance Abuse Funding Newsletter); health care financing (Inside HCFA); and food and product safety issues (Inside FDA) for four years. She has written articles about public education reform, county affairs, crime and community development for the Chicago Defender daily newspaper, the Syracuse Post-Standard and Syracuse Herald-American daily newspapers in New York state and the Pride of Syracuse monthly newspaper in New York state for five years. A print journalist for 18 years, Ms. Herard holds a master’s degree in newspaper from Syracuse University and a bachelor degree in liberal arts from Loyola University in Chicago.