By: Alyssa Gerace in Senior Housing News

Policymakers are looking toward a revised payment system for post-acute care services as a way to change healthcare delivery from a “fee for service” model to more coordinated, accountable care, but there’s risk inherent in bundled payment models.

Under the traditional fee for service Medicare model, the program pays widely varying rates for beneficiaries depending on what post-acute care setting they are in—skilled nursing facilities, home health, inpatient rehabilitation hospitals, or long-term care hospitals—even if they’re getting the same or similar care.

“Bundled payments have the potential to improve care coordination and quality of services, rationalize service use, and lower potentially avoidable readmissions,” says the Medicare Payment Advisory Commission (MedPAC) in itsJune report to Congress.

In 2011, at the recommendation of MedPAC, the Centers for Medicare & Medicaid Services (CMS) launched a Bundled Payments for Care Improvement Initiative to test different bundle designs, where one benchmark price across multiple providers would cover all services given, no matter the post-acute care setting, during a defined time period following a hospitalization or other “triggering” event.

The CMS pilot found that there are advantages and disadvantages to possible approaches of bundled payments, MedPAC continues.

“Each decision involves trade-offs between increasing the opportunities for care coordination and requiring providers to accept risk for care beyond what they furnish,” says the report.

Despite the risk, bundled payments would give providers—especially those not ready to assume even greater risks associated with other payment reform models such as accountable care organizations—a way to gain experience in care coordination across a spectrum of providers and settings, according to MedPAC.

Bundled payments for post-acute care services could serve as a gateway to larger healthcare delivery system reforms, says MedPAC, which plans to continue looking into how best to proceed with payment reform in the next year.

Read the June report.

By: Catherine Candisky in The Columbus Dispatch

The federal government has awarded Ohio $169 million to help keep seniors and the disabled in their homes instead of in more expensive, and often less preferred, nursing homes.

Ohio was one of 16 states awarded funding through the Affordable Care Act’s Balancing Incentive Program. The additional aid is provided to help states reach a goal of using at least half of their long-term-care spending on non-institutional care by 2015.

Currently, about 43 percent of Ohio’s long-term spending is directed to home- and community-based care, up from 39 percent in 2009, according to Ohio Medicaid officials.

There are no waiting lists currently for PASSPORT and other state home-care programs for Medicaid-eligible Ohioans, said state Medicaid Director John McCarthy. The federal aid, however, will help make it easier and faster to access services.

“Ohio’s seniors and people with disabilities prefer to receive services in their homes rather than in institutions,” said Greg Moody, director of the Governor’s Office of Health Transformation.

In recent years, state leaders have pushed to expand home- and community-based services and reduce institutional care to save millions in long-term care spending. Gov. John Kasich’s two-year budget proposal directs an additional $31 million to be spent on home- and community-based services.

Participation in the Balancing Incentive Program also qualifies Ohio for an additional 2 percent match from the federal government, which currently covers about 65 percent of Medicaid program costs. States pay the rest. The higher rate will be paid July 1 through September 2015.

In addition to spending goals, federal regulations require Ohio to ease access to services, provide case-management services free of conflicts of interest and utilize a standardized assessment to determine what services an individual is entitled to receive.

By: Elise Viebeck in The Hill

Home care workers are demanding final rules from the Obama administration that would give them federal minimum wage and overtime protections.

The Paraprofessional Healthcare Institute (PHI), which represents home health aides, certified nurse aides and personal care attendants, called on President Obama to extend the protections of the Fair Labor Standards Act to its members.

The group pointed to Obama’s promise in December 2011 to ensure home health jobs offer the same wage-and-hour standards as other healthcare posts.

“Eighteen months have passed,” said PHI President Jodi M. Sturgeon in a statement. “The nation’s home care workers — primary women, half of whom have incomes low enough to qualify for public assistance like food stamps and Medicaid — are counting on the president to show them the dignity and the respect they deserve.”

Home health aides are currently not entitled to federal minimum wage and overtime protections because the Fair Labor Standards Act classifies them as companions to the elderly and disabled.

The Supreme Court affirmed the so-called “companionship exemption” in 2007, but said federal regulators could reshape it at any time via rule-making.

The Obama administration proposed a new rule in 2011, and according to PHI, the Labor Department sent a draft final rule to the White House Budget Office in January.

That office is now in the process of finalizing the rule, which is controversial among the elderly and disabled.

Advocates for these groups have expressed concerns that applying federal labor standards to home health jobs will increase costs and lead families to institutionalize their loved ones.

By: Brenda Cronin in Wall Street Journal

Throughout the ups and downs of the recovery, the health-care sector has remained a jobs engine, notching 11,000 of the 175,000 positions added in May.

The Labor Department’s tallies for the health-care sector reflect a trend toward more outpatient care, with hospitals shedding almost 6,000 jobs last month while doctors’ offices and ambulatory care centers added workers.

“The most fundamental thing is that care is being moved out of the hospital…to outpatient settings,” said Mark Pauly, a professor of health-care management, business economics and public policy at the University of Pennsylvania’s Wharton School. “This has been a fairly strong pattern over the last five years. Hospital employment has slowed fairly dramatically but has been more than offset by employment in the outpatient sector and in doctors’ offices.”

Two reasons behind the shift, Mr. Pauly said, are cost-containment and technology. That means fewer patients are in hospitals or skilled-nursing facilities and more are at home, receiving care.

That, in turn, has powered demand for home health-care aides. Almost 7,000 such positions were created in May, the Labor Department said. Job-seekers are taking notice.

“I get up to 300 resumes a day,” said Mary Ann Johnson, a clinical staffing specialist at VNA Healthcare in Central Connecticut, a partner in the Hartford Healthcare System. Ms. Johnson has seen the nonprofit’s workforce double to 800 today from 400 in 1998, when she began working there.

Ms. Johnson places individuals with a variety of skills and degrees — such as registered nurses or certified nursing assistants — to care for geriatric patients at home. The pay and duties vary, she said, with home health aides usually starting at $11.25 or $12 an hour, depending on their experience, and some making $15 or $16 an hour. Registered nurses usually start at $30 an hour, she said, with those who have specialties such as cardiac care making closer to $40 an hour.

The tenure also varies, Ms. Johnson said. “We’ve had nurses with us for 35 or 40 years,” she said. “For the younger workers, the average tenure is about two years or so.”

While Ms. Johnson receives many resumes from health-care industry veterans, she also is fielding some from career-switchers: “A fair number of them come out of the information-technology field and the financial field.”

Partners in Care, an affiliate of the Visiting Nurse Service of New York, also is seeing demand rise for home health aides. In 2013, Partners in Care says it has averaged 388 hires a month. The organization, which trains and places home health aides, has nearly tripled in size since 1999, said Jay Conolly, vice president of human resources at Partners in Care. He attributes that growth in part to fewer hospitals being built in New York City—as well as demographics. “The baby boomers in the next 25 years are going to age…and they’re going to stay home,” he said.

Postings on job-search websites support the trend. In May, health care was the top hiring sector at SimplyHired.com. During the month, the website posted 381,667 health-care jobs, up more than 25% from the tally last year.