Similar actions have been taken with Medicare-certified nursing homes.
The Centers for Medicare & Medicaid Services (CMS) on Thursday released the ownership data for all Medicare-certified hospice and home health agencies.
The information for more than 6,000 hospices and 11,000 home health agencies can be viewed on the CMS website. This data release follows similar measures for ownership transparency with the nation's nursing homes.
"It's plain and simple: families deserve transparency when making decisions about hospice and home health care for their loved ones," Xavier Becerra, U.S. Department of Health and Human Services secretary, said in a statement.
"President Biden has called for unprecedented action to increase transparency—and we are making more data publicly available than ever before,” Becerra said. “Shining a light on ownership data is good for families, good for researchers, and good for enforcement agencies. We will continue delivering on the President's directive to promote competition and protect consumers."
In making this information public, consumers, researchers, and enforcement agencies alike will be able to identify owners with a history of poor performance, examine how market consolidation impacts consumers with increased costs without necessarily improving quality of care, and evaluate the relationship between ownership and changes in healthcare costs and outcomes.
Since April 2022, CMS has made ownership data for all Medicare-certified hospitals and nursing homes available to the public. This data also includes information on mergers, acquisitions, consolidations, and other changes of ownership.
The hospice and home health data, which dates to 2016, released Thursday includes enrollment information, National Provider Identifier (NPI), CMS Certification Number (CCN), and details on whether the agency is owned by an individual or organization.
"Transitioning to hospice care is often an emotionally overwhelming time for many families," Chiquita Brooks-LaSure, CMS administrator, said in a statement. "Making this data public increases transparency, giving families the information needed to help them identify the best care for their loved one."
"Providing information is a hallmark of this administration's efforts to improve care because we understand that having good information allows people to make the best choices possible."
Ochsner Health’s chief academic officer outlines the effects of staffing shortages in testimony before the Senate's Health, Education, Labor, and Pensions Committee.
Besides obvious staffing issues, healthcare’s workforce shortage is preventing patients from receiving the care they need due to the lack of providers, Leonardo Seoane, MD, executive vice president and chief academic officer at Ochnser Health, testified during a recent U.S. Senate hearing on the workforce shortage in the healthcare sector.
HealthLeaders spoke with Seoane about his testimony, how Ochsner has navigated the workforce shortage, and future actions he hopes to see from policymakers.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: What workforce issues did the hearing address?
Leonardo Seoane: It was really addressing the workforce crisis we find ourselves in post-pandemic, which is a shortage of all healthcare providers, not just physicians. I think the Association of American Medical Colleges does a very good job of advocating and speaking to the fact that, and their biannual report said, there's going to be anywhere from a 34,000 to 120,000 physician shortage by 2034, with the median being 64,000.
I also found out it varies regionally, but really it is a national crisis. There's a shortage of lab techs, surgical techs, and nurses. It's really across the spectrum of healthcare jobs that we're seeing this crisis.
HL: How did you prepare your testimony?
Seoane: It truly takes a village and I'm privileged to work at an organization like Ochsner where we have an incredible team that is collaborative and collegial. I worked with the chief nursing officer, head of human resources, head of talent management, and our government relations team. We all came together and, really, I was the spokesperson for a lot a work that has been done by that entire team. We talked about the key points we wanted to convey, and one was that the senators understood that this is a healthcare crisis.
It was a team effort to be able to tell our story and what we are seeing right here, boots on the ground, but we wanted to do more than that. We also wanted to give some solutions.
The other key point we wanted to convey is the importance of public-private partnerships, because that's how we've addressed this. We've partnered with our local state legislators that have allocated $25 million to the community colleges to help scale pilot programs such as the Ochsner Pre-apprenticeship LPN Program, for high school students. They spend half a day in high school and the other half taking dual enrollment courses to earn credit toward their LPN. Students complete clinicals at Ochsner and are supported as they learn our culture and how to focus on patients. This also increases our high school graduation rate because we've got them engaged, these students have one-year free tuition at a community college in Louisiana, and then they become an LPN.
HL: With rural communities becoming healthcare deserts, what do health systems like Ochsner that provide care to people in these areas need from policymakers?
Seoane: One is to support the ability to do telehealth and to develop innovative models of delivering care like digital medicine. Ochsner has a digital hypertension, digital diabetes program which is more than just digital monitoring; it's digital management of diabetes and hypertension. It allows the patient, instead of having to come and see the doctor four times a year to get their blood pressure managed, to manage it remotely.
We've got good data that says it improves blood pressure and diabetes management and decreases hospitalizations and ER visits. There's a lot of regulations that inhibit the ability for us to use telemedicine or these new digital programs. Some of that is federal, some of that is local and the licensing of physicians and ability for me to do telemedicine across state lines does need a comprehensive plan.
The other parts of it are financial and reimbursement. A lot of these are not reimbursed. Currently, Medicare doesn't reimburse these digital models, but as we talked about with the looming crisis of physicians, we do need to leverage technology in our innovation.
HL: How do you feel your testimony was received?
Seoane: I think you go by the feedback you get. I received a beautiful letter from Chairman Sanders thanking me for my testimony and was asked by his team to follow up, and maybe even do a site visit to Ochsner and see these innovative programs and how we're doing things. And I see that as very successful because I'm told that doesn't happen very often after a testimony.
Senator Cassidy, who invited me to speak on behalf of the Gulf Coast and independent academic medical centers like Ochsner, also has been very gracious in thanking me, saying that it was very effective and the senators really took note of our message.
HL: As healthcare continues to try to stabilize the sector to prepare for the influx of people in the coming decade, do you think it will see action from policymakers?
Seoane: I was really encouraged with what Chairman Sanders said to open the hearing: “I don't like having hearings just for the sake of having hearings. When I have a hearing, I'd like to see policy come out of that.” He was committed to bipartisan work on this because the truth is the nursing shortage, the physician shortage, the allied health shortage, it impacts every one of us when we need access to healthcare. I'm hoping that that we will see action because of the testimony.
Sheets emphasizes the value of home health in the healthcare continuum and patient-centered care.
Before stepping into the CEO role at Interim Health in 2019, Jennifer Sheets’ career had progressed from working as a transplant ICU nurse to CEO of different hospital systems. It wasn't until two members of her family needed home health services that she realized the importance of home and community-based services.
Believing that the future of healthcare was in the home, she transitioned from acute care to post-acute care in the mid-2000s, working for several home health and hospice organizations. HealthLeaders spoke to Sheets about her experience as a clinician helping her as a leader, hiring and keeping employees engaged, and issues facing the sector.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders:How has your experience as a clinician helped you in your role of CEO?
Jennifer Sheets: My clinical background has greatly influenced my leadership style. That ability to think critically with a care-planning methodology has always given me an advantage and a different viewpoint on business operations. I think it's really helped me in how I lead people, how we think about the business, and most importantly, never forgetting the people that are at the bedside and the patients that need us the most.
In my time as a hospital CEO, what was obvious to me was how many people got lost in the system—patients we saw coming back to the hospital that we thought we had discharged safely but they weren't able to continue with their care plan, or they weren't able to get placed in a nursing home or rehab, or they discharged very quickly so we would see that revolving door back into the hospital. It became obvious to me that we were missing something somewhere, and that's when I went down my journey of driving integrated care. I think that's the biggest opportunity for our country when you think about the healthcare spend and delivery, most importantly from the home health point of view.
HL: How has that experience enabled you to support Interim Health's clinicians?
Sheets: We talk a lot about why we do what we do. A lot of what you find, especially once you get in the C-suite is oftentimes a lot of finance, investment, or business-brained people from a lot of different industries. While all those things are super-important, we can't lose track of the fact that everything we do touches everyone's son, daughter, mother, and father, and you have to remember that at the core of healthcare, it's not just about business, revenue, and cost. It is about increasing access to care, making sure we're taking care of those people, and providing critical services. We talk a lot about results, just like anybody else, but we also spend a lot of time talking about how we engage our workforce, how we find, train, and keep the best people, how we add real consumer-directed care.
Everybody out there talks about patient-centered care, but the reality is that nobody provides it. Interim Health wanted to be that company to put that stake in the ground, and we did in 2019. What we really focus on, which I think is wildly different, is how do we think about the whole person? Not just the diagnosis that everyone is looking at but whether they have access to the resources they need.
HL: With the growing demand for aging services, how can providers leverage their experiences on the job to get policymakers to address issues like low reimbursement rates?
Sheets: There's a rebasing of home health rates which is not right and we also don't think it's something that CMS has the authority to do, but it’s another cut to our industry. The cumulative impact of these Medicare cuts is billions of dollars carved out of the Medicare program at a time when more and more people need our services. As providers, we're already facing significant challenges coming out of the pandemic—workforce, increasing costs, etc.—but these cuts now threaten patients’ care and access. Small, rural, medically underserved communities unfortunately are going to be uniquely harmed because of the increased cost of serving these populations.
These regulatory changes are hard to deal with and they're very damaging. When you think about vocal everyone in the industry is, they're especially burdensome for small- and medium-sized businesses that are trying to figure out how to grow and mitigate these challenges. We work with lots of the top home health companies to really push back on these home health rate cuts. We certainly don’t agree with the base rate cuts that have already happened, but what we're really pushing for now is a stop to any new cuts. There should be no new cuts in our space because the reality is even if home health and hospice services were growing, it should be exactly what we want to see in our country. It's the lowest-cost care setting, it's where the outcomes are better, it's where people want to be, and it's the biggest bang for the healthcare dollar at 1/40th if we can keep that person at home.
The one thing I would also call out is that coming out of the pandemic, home health saw an increase in the knowledge of the services that home health and home care can provide. Going into the pandemic, different healthcare professionals and patients didn't know what could be done in the home. The pandemic made people realize that there were other options. What we've seen as an industry is about a 40-45% increase in the number of referrals into home health. Unfortunately, what we've also seen is that there's a 30-48% non-admit rate, due to the labor shortage.
HL: How has Interim Health navigated the workforce shortage?
Sheets: We focus on the experience not just the job. We launched different programs to help show clinicians they were made for home care; they just didn't know it yet. Looking back at my time in the transplant ICU, I loved what I did, but I had no idea what happened to my patients when they left the ICU unless they ended up back in my ICU. One of the unique opportunities that home health offers is for a nurse to have continued engagement with a client. If you drive integrated care like we do, even if the patient is not in home health but is being supported by the home care side of the business, you can still have a touchpoint and can see the progression of that patient. That really connects with clinicians who are in this to impact lives. We focus on the fact that you can have not just a job, but a relationship with your patients.
We focus on flexibility in work schedules. We have other programs in place like career pathing, to help people learn more about disease processes and how to provide the best care. We do a lot of recognition.
The challenge in our industry in general is that we’re never going be able to pay what the hospitals pay because of reimbursement rates, so we have to attract our workforce in a different and unique way, and it's more about commitment to purpose and commitment to outcomes.
HL: By 2030, about 20% of the nation's population will be of the age where they would possibly need some type of aging service. Looking at the current efforts to advocate for and strengthen aging services, do you think the sector will be ready by then?
Sheets: There's still a lot of work to be done, and if we are going to be prepared for this influx of folks, we must be coordinated better. We must be coordinated better from acute to post-acute. We also must be coordinated better with the decision-makers in Washington, D.C. who are working on increases or cuts to reimbursements. If we're going to be ready, we must push as much care as we can down that healthcare continuum.
The reality is the home is where people overwhelmingly want to receive care, but on top of that, it's where the outcomes are better. In a pandemic, it's where transmission is most minimized. It's also where the cost is less. We need to be pushing care in the home for people who can receive care in the home. Then, if they can't receive care in the home and they need to be in a skilled nursing facility for some reason, or they need a rehab center, we still need to be keeping them in the lowest level, high-quality setting available.
In my opinion, the biggest thing that needs to change is that instead of a care delivery system that has the hospital at the center and the hospital will send patients out to the rehabs, home health, etc., depending on the patients, the home needs to be in the center and we need to focus on how to keep people happy and healthy and independent at home for as long as possible. That's what it's going to take for us to handle the numbers coming at us.
Healthcare and aging services are difficult to access in rural or more remote areas, with residents typically having to travel miles to the nearest provider.
The demand for aging services continues to grow, and by 2030, about 20% of the nation's population will be of the age where they may need to utilize them.. Expanding PACE would enable older adults the comfort of aging in place by ensuring they have access to the care and services they need in their community.
"We appreciate the committee's work and dedication in examining PACE and urge HHS and Congress to adopt these recommendations as quickly as possible," Shawn Bloom, president and CEO of the National PACE Association, said in a statement.
"A holistic approach that truly connects health and human services is unique and an integral aspect of PACE that improves the health and quality of life of rural elders and caregivers," Bloom continued.
Expanding PACE into rural communities would improve the "fragmented" state of long-term care services there, according to the committee.
To expand PACE to these areas and make care more accessible, the key advisory committee recommended different strategies, including:
Supporting a PACE pilot program that focuses solely on Medicare beneficiaries
Considering how to extend telehealth coverage to PACE organizations
Supporting the development of a rural PACE resource guide to promote the model to rural and tribal communities and provide technical assistance and case studies from successful programs for these communities
Less than 5% of the nation's nursing homes are owned by private equity firms.
A proposed rule requiring skilled nursing facilities todisclose ownership and management information to the Centers for Medicare and Medicaid Services is a distraction from finding solutions to “real issues,” says Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living.
The proposed rule, issued in February by the U.S. Department of Health and Human Services (HHS), is part of the Biden administration's efforts to ensure safety and improve quality of care in the nation's nursing homes—particularly those owned by private equity firms.
However, as of 2020, only 4.7% of nursing homes are owned by private equity firms. Considering the workforce shortage and growing demand for aging services, along with the recent introduction of the Healthcare Transparency Act, private equity looks to be the least of the sector's problems, according to Parkinson.
"If we truly want to improve America's nursing homes, we need policymakers to prioritize investing in our caregivers and this chronically underfunded healthcare sector," Parkinson said.
A 2021 study by Weill Cornell Medical College found that residents in private-equity-owned nursing homes receive lower quality long-term care and Medicare spending goes up. Researchers found that residents at private equity-owned facilities were 11% more likely to have an emergency room visit and 8.7% more likely to be hospitalized.
As a result, their Medicare costs were 3.9% higher, $1,080 annually, per patient.
Private equity interest in healthcare isn't new, but over the last few years there's been an increase. In the aftermath of the pandemic, low reimbursement rates and rising operating costs have nursing homes across the country struggling financially.
In reviewing the language in the Healthcare Transparency Act, Robert Slavkin and Greg Limoncelli of Akerman LLP law firm, which represents private equity groups interested in healthcare, say revisions will need to be made. Private equity firms go where the equity is wanted, and while there are valid concerns, the bill comes across as a "deflection move," according to Limoncelli, co-chair of the firm's senior living and care sector team and partner in the corporate practice group.
"There are real problems in our healthcare system, and a more concerted effort needs to be taken, but I think this is probably the wrong step," he explained.
Potential revisions should be determined on whether a private equity firm owns all of a facility, a percentage, or is one of multiple entities with an ownership stake, Slavkin notes.
"There is an overriding philosophy at the government level that healthcare is not supposed to be a money-making venture," Slavkin said. "The reality is much more nuanced than that. In order to be able to stay in business and provide quality care, there has to be the ability to create the revenue in order to support that."
As attorneys who represent private equity groups, Slavkin and Limoncelli keep them mindful of compliance requirements, policies, trainings, and regulations involved with owning a nursing home or home health agency.
"The private equity firms can't … just say, 'well, we're just going to throw money at things and not have to bear any of the responsibility,’" Slavkin said. "But, on the other hand, the government can't be restricting these sources of cash, equity, and investment from these aspects of the healthcare industry because ultimately it does help if monitored and managed appropriately."
Larsen is hoping to foster an educational and creative culture at Harbors.
Ryan Larsen joined Harbors Home Health and Hospice as its CEO in December 2022, a move that brought him back to his home state of Washington. His father worked as a pharmaceutical representative for more than 30 years, which started his interest in healthcare, even leading him to begin working as a certified nursing assistant (CNA) in high school.
With a mixture of hospital communications and healthcare administration experience, Larsen is planning on leading Harbors Home Health and Hospice into the post-pandemic era, nurturing a culture of education and creativity to provide the best quality of care.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: How did you get started in home health and hospice?
Ryan Larsen: I switched over to a provider relations management position with a hospice agency, opening new territories, generating growth, and learning how businesses interact with other businesses. After getting my master’s in healthcare administration, I was hired on to assist a personal care agency and ended up overseeing the whole state for that agency.
During that time, I thought I'd like a more all-encompassing route, so I worked with the ownership group, establishing their skilled home health agency, taking them through accreditation, and Medicare certification. Then the ownership group acquired a hospice agency that came up for sale, so we were able to create this all-encompassing system for patients who needed long-term personal care support, short-term skilled support, and end-of-life support.
I grew up in the Pacific Northwest, I'm from Washington, and was able to land this position with an agency that has been around for over 40 years and has a wonderful established footprint here in Grays Harbor and Pacific counties.
HL: Considering your experience as a CNA, from the practitioner perspective, what are some changes affecting home health and hospice post-COVID?
Larsen: It was scary for clinicians, families, and clinical staff, but for home health and hospice care, we did see an uptick in patients but there was also a big fear with letting people in their homes. A lot of agencies had to rely on travelers and then also balance that with fear from patients, the clinical team, and the all-around unknown.
I think a lot of agencies just try to kind of stay afloat but those that were successful kept pushing forward with education and training and building culture and building team and thinking outside the box. It pushed the creativity and boundaries of different agencies on how they could provide care, how they could be efficient with it, how they could be safe with it, how they could work with the hospital systems and clinics and the skilled nursing facilities and assisted living facilities to continue to provide quality care.
HL: Was there anything that you implemented or used as a workaround strategy during that time?
Larsen: It was always keeping the bigger picture at the front. It was inevitable that COVID was going to either quiet down or we were going to get used to living with it.
I did focus a lot on training and education because we're only going to continue to see nurse shortages, therapist shortages, things like that. So, implementing those training programs and those first-year nurse programs and also building leadership tracks because people want to learn and grow.
I was also transparent with the information we were giving them. We would hear that the COVID vaccine is mandatory, then the next day we would hear that it wasn't mandatory, so being transparent and open and honest in our communication helped drive growth. Then we also got creative on when and how we scheduled staff.
HL: As the demand for aging services increases, what are some trends you're noticing?
Larsen: It's not only dealing with the aging population, but you have this shift in healthcare in general where you're starting to see even hospitals are pushing hospital-at-home programs. You're seeing oncology at home, dialysis at home, you're seeing an increase in home health and hospice, and skilled care being pushed toward individuals’ homes.
You have a lot of nurses who have worked in the field for 30 years, so they're starting to retire. Bringing in a brand new nurse and expecting them to be able to fill the position of a seasoned veteran nurse, for example, is just not realistic. There's a shift in the workforce and I don't think I'm alone in this sentiment.
Home health and hospice agencies have been cast aside when it comes to healthcare. What I'm trying to do is create a rebranding, so to say, for home health and hospice, because it’s such a valuable service and it saves money for Medicare. I think we're starting to see a shift in focus on how home health and hospice care is viewed from the type of leadership entering that field, the creativity being brought in, and then also the skills of our clinicians.
I'm starting to see first-year clinicians that are coming out of school showing interest in home health and hospice care, but for them to be successful, agencies are going to need to create some sort of educational culture where we're not throwing these first-year therapists and nurses into the deep end. At Harbors, we're trying to create that training culture.
HL: What are some other objectives you have for your first year at Harbors?
Larsen: People were just trying to stay afloat during COVID, and there was a lot of fear. These first years coming out of it are going to be very focused on getting back to the basics, the training, the onboarding of staff and patients, communication, and building relationships with different facilities and clinics in the area.
We're getting back to what patients need, what the community needs, what our medical partners need. What can we do to really bring a voice to the patients, bring a voice to our clinicians and then also manage the expectations of the administrative team as well? We just gave our website a facelift and have been getting back out into the community, as well.
Harbors has been a wonderful pillar in this community for over 40 years. We've got a wonderful board and staff that go above and beyond for the patient, so I'm very lucky to be able to join this team here at this point in my career.
Editor's note: This story was updated on 4/11/2023, correcting the name of the organization.
Proposal also includes updates to SNF reporting and purchasing programs.
The Centers for Medicare & Medicaid Services (CMS) have issued a proposed rule featuring a 3.7% Medicare payment increase under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year 2024.
As part of the Biden administration's efforts to improve the safety and quality of care in the nation's nursing homes, the proposed rule includes proposals for both the SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) Program for fiscal year 2024 onward.
The rule would also eliminate the requirement that facilities waive their right to a hearing in writing, instead considering a facility's failure to submit a request in a timely manner a constructive waiver.
Payment Rates Increase
After considering feedback from stakeholders on the FY 2023 SNF PPS proposed rule, and to ensure accurate Medicare Part A SNF payments, CMS finalized a PDPM parity adjustment factor of 4.6% in the FY2023 SNF PSS final rule. The adjustment would be phased in over a two-year period, resulting in a 2.3% reduction to SNF PPS payment rates in FY2023 and again in FY2024.
These impact figures don't incorporate the SNF VBP reductions for certain SNFs subject to the net reduction in payments under the SNF VBP. Those adjustments are estimated to total $184.85 million in FY2024.
Changes to SNF QRP measures
There are three proposed adoptions, one modification, and three proposed removals to the SNF QRP measures.
Proposed adoptions
Discharge Function Score (DC Function) — Would assess a facility's status by assessing the percentage of SNF residents who meet or exceed an expected discharge function score, and uses mobility and self-care items already collected on the Minimum Data Set (MDS); would replace Application of Functional Assessment/Care Plan measure.
CoreQ: Short Stay Discharge — Would calculate the percentage of individuals discharged from an SNF, within 100 days of admission, who are satisfied with their SNF stay via questionnaire responses.
COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date — would report the percentage of stays in which residents in an SNF are up to date with recommended COVID-19 vaccinations in accordance to most recent U.S. Centers for Disease Control (CDC) guidance.
Proposed Modifications
COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) — The proposed modification would require SNFs to report the cumulative number of HCP who are up to date with recommended COVID-19 vaccinations in accordance to most recent CDC guidance.
Proposed Removals
Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function — Measure performance among SNFs is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made and the proposed DC Function measure is more strongly associated with desired resident functional outcomes.
CMS proposed the removal of the Application of the IRF Functional Outcome measure and Change in Mobility Score for Medical Rehabilitation Patients measure because the costs associated with both measures outweigh the benefits of their use in the program.
Changes to SNF VBP measures
There are four adoptions, one replacement, and a few policy changes proposed for the SNF VBP measures.
Proposed Adoptions
Nursing Staff Turnover — A structural measure that has been collected and publicly reported on Care Compare and assesses the stability of the staffing within an SNF using nursing staff turnover; facilities would begin reporting for this measure in FY2024, with payment effects to begin in FY2026.
Discharge Function Score — Would assess functional status by assessing the percentage of SNF residents who meet or exceed and expected discharge function score, and use mobility and self-care items already collected on the MDS; also proposed for the SNF QRP.
Long Stay Hospitalization Per 100 residents — Would assess the hospitalization rate of long-stay residents.
Percent of Residents Experiencing One or More Falls With Major Injury — Would assess the falls with major injury rates of long-stay residents.
Proposed Replacement
Skilled Nursing Facility 30-Day All-Cause Readmission Measure — This measure will be replaced with the Skilled Nursing Facility Within Stay Potentially Preventable Readmissions.
Proposed Policy Changes
Increasing the payback percentage policy from 60% to a level such that the bonuses provided to the high-performing, high-duals SNFs do not come at the expense of the other SNFs.
Updating administrative methodology policies that are required to address the changes needed to accommodate the proposed addition of quality measures into the program's scoring methodology.
Additional updates on the validation process being established for the quality measures and standardized assessment data for SNFs.
New partnership ‘throws down the gauntlet for what home-based healthcare can aspire to be.’
AccentCare, a post-acute services provider, announced Tuesday it has entered a joint venture with Memorial Hermann Health System to expand access to care in the home throughout the greater Houston, Texas area.
In addition to non-medical home care, AccentCare provides home health, palliative care, telehealth, hospice, and care management services. The partnership will unite not only AccentCare and Memorial Hermann, but the health system formerly known as Texas Home Health and the provider formerly known as Seasons Hospice and Palliative Care, into one business entity.
"Home-based care is a setting that is becoming increasingly important," Teal Holden, senior vice president of ambulatory and post-acute services for Memorial Hermann, said in a statement. "By joining with a national and local leader like AccentCare, we will significantly advance our capability to both innovate and optimize care in the home-based care setting."
The agreement, finalized April 1, will strengthen the presence of both organizations in south Texas. Headquartered in Dallas, AccentCare has 30,000 professionals serving more than 210,000 patients across 30 states.
As one of the largest nonprofit health systems in southern Texas, Memorial Hermann's 6,700 physicians and 31,000 employees provide care to patients across more than 260 sites.
"We are two award-winning healthcare organizations, rising to today's healthcare challenges and joining together to become even better," AccentCare CEO, Steve Rogers, said in a statement. "This partnership with Memorial Hermann throws down the gauntlet for what home-based healthcare can aspire to be in south Texas."
Nursing homes are already struggling to hire enough staff for efficient and safe operations, so a potential staffing mandate wouldn't be helpful.
The American Hospital Association (AHA) and American Health Care Association (AHCA) sent a joint letter to the Centers for Medicare and Medicaid Services on Monday expressing their concerns about the proposed federal staffing mandate.
CMS introduced the proposed rule earlier this year, which would require the nation's nursing homes to have a set number of workers on staff. The healthcare sector as a whole is struggling amid an historical workforce shortage, aging services providers in particular, and the proposed mandate would do more harm than good, according to the letter
"We anticipate many nursing homes will be forced to further reduce their capacity and even close their doors if they are unable to meet these staffing mandates," the letter stated. "This would accelerate the domino effect across the entire continuum of care and leave vulnerable seniors with fewer care options."
In the letter, addressed to CMS administrator Chiquita Brooks-LaSure, the AHA and AHCA note that nursing homes lost 210,000 workers from February 2020 to December 2022—the most of any health sector. While there has since been some "modest" growth, it's estimated that nursing homes won't return to pre-pandemic staffing levels until 2027.
"Furthermore, mandating staffing levels is a simplistic, one-size-fits-all approach to the needs of complex and unique nursing home residents and patients," the letter stated. "In short, specific staffing levels should be a clinical decision customized to the resident population and facility characteristics rather than a policy decision made with lack of regard to real-life situations."
The AHA and AHCA urge CMS and policymakers to consider other ways of addressing the workforce shortage, even if they take longer to remedy the situation. Some suggestions the organizations provided include:
Augment the depleted workforce with foreign workers, with Congress creating a temporary visa option for RNs, certified nurse assistants, and other needed roles.
Support apprenticeship programs for nursing assistants and other critical support staff roles to develop a pipeline of workers with customized skills and improve employee retention and employer reputation.
Pass the Building America's Healthcare Workforce Act which would extend flexibility given to nursing homes during the public health emergency, allowing nurse aides to remain in their roles beyond the required four months and for their additional time to be applied toward their CNA training.
Adopt policies that would expand loan repayment and incentive-based programs to retain existing talent and attract new talent.
Direct the Government Accountability Office to study business practices of travel nurse staffing agencies during the pandemic, including high prices and excessive profits, and how they contribute to the workforce shortage.
Here's a roundup of four HealthLeaders articles on recruitment and retention strategies.
This week is Careers in Aging Week, dedicated to celebrating employees and bringing attention to the different career opportunities in aging services.
It's anticipated that by 2030, about 20% of the nation's population will be over the age of 65 and potentially require some type of aging service. In the meantime, providers and agencies are making efforts to bolster their workforce amid a persistent shortage affecting the healthcare sector.
Here are four HealthLeaders articles that illustrate recruitment and retention best practices for aging services.
Clarion Forest Visiting Nurses Association provides home health care to Clarion, Forest, and Jefferson counties in Pennsylvania, which are largely rural. In addition to having to compete with larger organizations offering higher wages, Lisa Steiner, CFVNA's CEO and CNO, said she and other providers struggle to find talent that want to live and work in the area.
Despite financial strains due to low reimbursement rates, Steiner and her staff do the best with what they have, boasting a family oriented workplace culture and a community that's proud and appreciative of the work they do.
The current job market is highly competitive, and a lackluster job posting and non-user-friendly application process can drive away potential employees.
A job posting should detailed and clearly illustrate all expectations and requirements for the role, according to Eric Holwell, senior vice president of strategy at Bayard Advertising. The application process should also be intuitive and able to be completed quickly.
Set Your Caregivers up for Success: Q&A with Aishling Dalton-Kelly Part One and Two
More than half (57%) of caregivers quit within the first 90 days of joining an agency, which Dalton-Kelly attributes to agencies hiring just to have someone on staff, rather than someone who really understands the role of a caregiver. By equipping caregivers with the resources they need, whether it's an employee manual or training program, from the beginning, agencies are setting them up to be successful in the field.
In part two, Dalton-Kelly makes a case for caregivers given a voice in upper management within agencies, as well as ensuring that they know their rights and how to advocate for themselves.
