Weekly roundup

Nurse Leader Insider, July 31, 2016

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Hospice Final Rule for 2017 raises payments
Last Friday, CMS issued a final rule outlining fiscal year 2017 Medicare payment rates and wage index and the Hospice Quality Reporting Program (HQRP) for hospices serving Medicare beneficiaries. As finalized, hospices would see a 2.1% increase in their payments for FY 2017 (reflecting an estimated 2.7% inpatient hospital market basket update, reduced by a 0.3% productivity adjustment and a 0.3% adjustment required by law. The changes represent an total increase of approximately $350 million.
The HQRP updates include two new quality measures. The first, Hospice Visits When Death is Imminent, will assess hospice staff visits to patients and caregivers in the last three and seven days of life. The second, Hospice and Palliative Care Composite Process Measure, will assess the percentage of hospice patients who received care processes consistent with guidelines. 
This final rule includes a description of the Hospice CAHPS® Survey, a model of survey implementation, survey respondents, eligibility criteria for the sample, and the languages in which the survey is offered, among other details. CMS expects to begin public reporting hospice quality measures via a Hospice Compare site in CY 2017. 
The final rule also describes a potential future enhanced data collection instrument, as well as plans to publicly display quality measures and other hospice data beginning in calendar year (CY) 2017.
The final rule will be published in the Federal Register on Friday, and becomes effective on October 1.
Source: CMS
CMS extends home health moratoria efforts in six states
CMS announced late Friday it is extending home health agencies (HHAs) in Florida, Texas, Illinois, and Michigan.  It is also extending for six months and expanding the temporary provider enrollment moratoria on new Medicare Part B non?emergency ground ambulance suppliers in New Jersey, Pennsylvania, and Texas. In addition, the statewide expansion also applies to Medicaid and Children’s Health Insurance Program (CHIP). 
CMS also announced the Provider Enrollment Moratoria Access Waiver Demonstration(PEWD), which gives CMS the ability to allow for provider and supplier enrollment exceptions in the moratoria areas if access to care issues are identified and for the development and improvement of methods of investigating and prosecuting fraud in Medicare, Medicaid, and CHIP.
Source: CMS
(Qualified) help wanted
The biggest factor that makes recruiting caregivers difficult isn’t the low pay. It’s a lack of qualified applicants, according to a recent survey by, of Austin, Texas, which matches homecare workers with patients and families.
Fifty-five percent of respondents cited a “lack of qualified candidates” when asked to name the biggest factor that makes recruiting caregivers difficult. In contrast, only 7% said a lack of applicants was the major problem; 9% cited competitive wages; 13% said high turnover was the biggest issue. Sixteen percent said finding caregivers in close proximity to patients was the biggest factor. The average agency in the survey needs 15 applications a week to meet its hiring goals, according to CareInHomes.
Agencies in the survey are optimistic about future hiring—76% of agencies said they would hire more caregivers this year than in 2015, while only 1% reported fewer hires. “This statistic … [is] an indicator that homecare companies see a lot of opportunity for growth,” CareInHomes stated.
Looking to the future, 70% of the responses said caregiver shortage would be a top-3 challenge. Other challenges at the top of the list were caregiver turnover, named by 52% of respondents, attracting new clients (43%), increasing competition (29%), and minimum wage increases (29%).
“It’s interesting to note that the minimum wage is only increasing in a few areas currently, but this was a concern spread pretty evenly throughout responses nationwide,” the surveyors stated.
Democratic party platform includes home health
The Democratic Party’s official 2016 Platform, adopted at the party’s national convention last week, emphasizes the importance of homecare in ensuring long-term care, and calls for increased support for family caregivers as well as expanding and strengthening the homecare workforce.
The 2016 Platform emphasizes the importance home and community-based care in a section titled “Ensuring Long-Term Care, Services, and Supports.” The language in the section notes that the country faces “a long-term care crisis” that prevents too many seniors and people with disabilities from living with dignity at home or in their communities.
“The vast majority of people who are aging or living with a disability want to do so at home, but face challenges finding and affording the support they need to do so,” the Platform states, and calls for programs that emphasize independence rather than institutionalization, structured to support homecare as a choice. The party also calls for policies that help family caregivers, ensuring they have the support, respite care, and training needed to support their loved ones.

Source: Democratic Platform Committee

Medication underuse has its own risks
Underuse of medications—not misuse—were associated with mortality and hospitalization among older patients, according to study that was published in the most recent British Journal of Pharmacology.
Researchers conducted an 18-month study of 503 people who were at least 80 years of age. They excluded nursing home residents, persons with known dementia, and patients receiving palliative care.
The study found that 58% of participants were taking five or more medications daily for chronic conditions, but few of the older adults were taking medications appropriately. Just 17% of the study population was not affected by any kind of underuse or misuse, whereas 67% were underusing medications and 56% were misusing them, with an unknown amount of overlap between the two groups. 
“Polypharmacy [daily doses of five or more medications] underuse and misuse was highly prevalent in adults aged 80 and older. Surprisingly, underuse and not misuse, had strong associations with mortality and hospitalization,” the researchers concluded.
Source: McKnight’s, Wiley Online Library  


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