National Association for Home Care & Hospice (NAHC) President Bill Dombi touched on the importance of recent community-based palliative care legislation during a Sunday night policy update at the Washington, D.C.-based industry group’s 2021 Financial Management Conference.
The bulk of his update, however, was spent urging industry insiders to band together and throw their support behind the Choose Home Care Act of 2021.
“This may not look like a call to action, but this is the direction that we’re asking you to take,” Dombi said at the event. “This is about [making] noise in Washington. People listen when it’s loud. You’re not the only one asking Congress to do things. This is why you have to be extraordinarily loud.”
Specifically, Dombi asked the industry to rally behind the bill by sending a message to their state senators, asking them to co-sponsor the legislation.
Originally introduced Thursday by U.S. Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.), Choose Home aims to support in-home care options by providing a home-based care alternative to nursing homes. If passed, the legislation would allow certain patients to receive an add-on to the existing Medicare home health benefit for 30 days after a hospital stay.
“This is a very targeted, cost-effective benefit,” Bruce Greenstein, chief strategy and innovation officer at LHC Group Inc. (Nasdaq: LHCG), said during the FMC presentation.
Greenstein, one of the architects of Choose Home, noted that the legislation would only apply to post-acute patients that are coming out of the hospital after at least a three-day stay. These patients must qualify for both a skilled nursing facility (SNF) stay, as well as home health services.
“It’s not hospital-at-home. It’s not exactly SNF-at-home,” he said. “It’s patients that meet the specific criteria, but are deemed as capable and appropriate for getting their care at home.”
Overall, there is a 34% overlap between post-acute care patients who go to a SNF and those who go to home health, according to the LHC Group executive. In many ways, the current health care environment has paved the way for Choose Home, he added.
“That’s been going on within the federal sector through [regulatory waivers], in terms of bringing out new flexibilities like hospital-at-home, for example,” Greenstein said. “Our marketplace has been advancing quite quickly with new products and new companies. … Our industry continues to advance in terms of capabilities and acumen and taking care of more complex patients at home.”
Additionally, Dombi believes Choose Home will be an opportunity for home-based care providers to form new partnerships.
“If you’re a private-duty home care company that doesn’t do Medicare home health, this is a partnering opportunity for you,” he said. “This is not also for every home health [provider]. This is going to take an infrastructure change. It’s going to take enough volume to be able to handle it. Not everybody can be there, but there is room for partnering.”
So far, Choose Home has gained the support of organizations such as AARP, LeadingAge and others.
That said, the legislation is already facing opposition from some nursing home operators.
“While we were on Capitol Hill explaining this benefit and the cost savings, we started to see questions pop up from people’s folders,” Greenstein said. “They were printouts of emails coming from nursing home operators that were already talking about the deleterious effects this will have on the nursing home industry, that it’s going to come out of their budget and that we’re taking their patients.”
Aside from Choose Home, Dombi also touched on the need for hospice and home health providers to deliver palliative care during the policy update.
One way to accomplish this would be to modify the standards under the Medicare home health benefit in order to allow a portion of palliative care services to be delivered by home health providers.
Last week, SB 2565, was introduced. Broadly, the legislation would expand access to palliative care and mandate that the Centers for Medicare & Medicaid Services (CMS) bring into play a demonstration program.
“We don’t think that needs to go to Congress,” Dombi said. “That’s CMS — and CMS alone. We’ve rewritten the Medicare coverage standards, and we’ll be shortly presenting that to CMS in hopes they see the wisdom of adding the word ‘palliation’ or ‘palliative’ throughout the Medicare coverage standards.”
Sens. Jacky Rosen (D-Nev.), John Barrasso (R-Wy.), Tammy Baldwin (D-Wisc.) and Deb Fisher (R-Neb.) are sponsors of SB 2565, the “Expanding Access to Palliative Care for Seniors Act.”
“As someone who stepped away from my career to care for my parents and in-laws as they aged, and as a co-founder of the Senate’s Comprehensive Care Caucus, I have an insight into the challenges that seniors and families face when dealing with palliative or hospice care,” Rosen said in a statement. “This package would also reduce barriers to hospice care for seriously ill patients who rely on blood transfusions to maintain quality of life.”
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