HCA President Al Cardillo joined a recent home care Industry Roundtable hosted by the Law firm Hodgson Russ and the Albany Business Review.
Check out the Business Review’s transcript of the program offering perspectives on the home care workforce challenge statewide, including approaches that providers and HCA, through legislation, are taking to address it, plus the role of technology and other issues confronting the field.
“The federal system that was created to fund home care was created in the 60s, and in the 70s in New York State,” says Mr. Cardillo in one part of the exchange. “It’s a very different world today in terms of who goes into the hospital, how sick they are when they come out, who goes into nursing homes, and who we want being cared for in the community.”
He adds: “The funding structure that wraps around home care needs to be modernized to the way that services are provided today.”
HCA and our Western New York members, Catholic Health Home Care and Visiting Nursing Association of WNY (VNA), were featured in a Buffalo Business First article on the impact of home care labor shortages. Catholic Health Home Care describes a workforce drop of 500 to 335, and VNA similarly reports a decline in home health aide employment due in large part to competition from other fields and wage policies. Citing our annual report on home care trends, HCA notes: “Our data shows that some of the shortages that exist are having an impact on starting care; hospitals’ need to discharge patients; and agencies not being able to always admit the patient or be able to provide services in a timely basis.”
“Brooklyn-based Metropolitan Jewish Home Care, doing business as MJHS Home Care, plans to lay off more than 100 employees amid significant business challenges,” writes Crain’s New York Business, quoting HCA on some of the financial challenges faced by the industry. See the report here.
“Certified home health agencies have been especially vulnerable to costly mandates, inadequate payor rates and exposure to systemwide volatility in the home and community-based marketplace,” said Roger Noyes, director of communications at the Home Care Association of New York State, in an email.
Continue reading “Crain’s NY Business: Home Care Agency plans layoffs in challenging market”
Home Health Care News conducted a wide-ranging Q&A interview with HCA’s new President Al Cardillo, covering his background in health care, as well as specific topics like wage-and-hour rules, compliance, value based payment, a new Medicare home health payment reform model and more. Read the interview here.
Home Health Care News recently reported on the movement of new regulations to create an advanced home health aide designation in New York State. “The new regulations deal mostly with medications,” says HCA. “The real opportunity area seems to be for patients who are unable to self-administer medications, due to memory issues or the complexity of their medication needs.”
“A lot depends on how an agency opts to utilize this new designation,” HCA adds. “Right now, it’s unclear whether any potential new costs will outweigh the savings. It’s also unknown how [payers] and workforce dynamics will drive this cost calculation.”
HCA was recently quoted in an article for Home Health Care News on new litigation affecting compensation 24-hour/live-in services. “Going forward, the issue is, if aides get paid for every hour, it will cost the system an incredible amount of money,” said Andrew Koski, HCA’s vice president for program policy and services. “If that funding should not be available or if the aides are not paid adequately, then you’re going to have basically very hard-to-find agencies and aides that are going to work these [24-hour care] cases… The only alternative [for patients] is to go without care, get less care than you need or go into an institution.” Read the full article here.
HCA was quoted in a Home Health Care News article about a state budget provision limiting the number of contracts that a Managed Long Term Care plan can have with a Licensed Home Care Services Agency. “We are very concerned about the impact of arbitrary contract limits on continuity of care and individualized contracting relationships that might have specific clinical, cultural or language value, even if the LHCSA does not have the case volume to help an MLTC stay within its contract limit,” HCA says in the article, which can be read in full here.
POLITICO PRO sought HCA’s comment on a state budget proposal to allow for community paramedicine. HCA has, in the past, expressed concerns with community paramedicine legislation because these past proposals seemed to encourage the circumvention of existing licensure requirements for care provided in the home. This prompted a multi-association effort to draft a new bill based on existing licensure roles. The Governor’s proposal appears to largely track with the spirit of this multi-association approach, favored by HCA.
“HCA appreciates the direction of Governor Cuomo’s community paramedicine proposal,” said Roger Noyes, a spokesman for the group. “We specifically appreciate its recognition of needed collaboration between EMS and duly-licensed home care providers for any services that would occur in the home setting. … HCA is optimistic about the approach included in the Governor’s budget and needs to review it further for possible syncing with other existing collaboration initiatives and approaches.”
You can read the article here.
Home Health Care News has reported on the impact of major winter storms on home care providers, including the work of HCA member Visiting Nurse Service of New York (VNSNY) to reach patients in need.
In addition to meeting the new emergency prep regulations at the federal level, agencies in New York are already required to meet a set of ‘pretty robust state regulations, according to Roger Noyes, director of communications of the New York State Home Care Association (HCA-NYS). Providers have “needed to fine tune their existing protocols, policies and procedures” to meet the additional federal requirements, he told Home Health Care News.
The state also recently enacted a law that requires input from home care providers in county emergency management plans. The association worked to link up providers with local emergency management officials in a statewide campaign that has so far reached 40 of the 62 counties in New York.
Home Health Care News (HHCN) reports on HCA’s grant to expand use of HCA’s first-in-the nation home care sepsis screening and intervention tool.
The Home Care Association of New York State (HCA-NYS) has been awarded a grant of nearly $150,000 to fight and prevent sepsis—one of the leading causes of hospitalization.
The grant comes from the the New York State Health Foundation (NYSHealth), and will provide training and implementation of HCA’s sepsis-intervention protocols with home care providers across New York State. Continue reading “How One Home Care Association is Taking on Sepsis”
The Second Department, Appellate Division on September 13 issued decisions in Andreyeyeva v. New York Health Care, Inc. and Moreno v. Future Care Health Services, Inc. — two cases with similar facts involving 24-hour, live-in aides and which pose a major impact for home care providers and their patients.
The court held that, to the extent that the aides were not “residential” employees (who “lived” on the premises of their employer), the aides were entitled to be paid the minimum wage for all 24 hours of their shifts, regardless of whether they were afforded 8 hours for sleep (including 5 hours of uninterrupted sleep time) and three hours for meals (also known as the so-called “13-hour rule”).
As Politico news reports, “the Home Care Association of New York State has met with the Cuomo administration and stressed that without state action, its members will be decimated as home care providers could face millions of dollars worth of financial liabilities.”
“The court’s decision, which invalidates the so-called 13-hour rule that providers have relied on in good faith for these services, opens up major potential exposure for wage costs, and this exposure results from discrepancies in state regulations and guidelines,” said Roger Noyes, a spokesman for the Home Care Association of New York State.
Read the full article here: http://www.politico.com/states/new-york/albany/story/2017/09/14/appellate-court-ruling-rattles-home-care-industry-raises-fears-of-collapse-114494
The National Public Radio (NPR) program “Marketplace Weekend Edition” reached out to HCA last week about the serious workforce infrastructure challenges in home care.
This issue has gained national prominence, in part due to a recent public hearing by the state Assembly’s core committees on Health, Aging, Labor and the Task Force on People with Disabilities, chaired by Assembly Health Committee Chairman Richard Gottfried. HCA Executive Vice President Al Cardillo testified at the hearing, prompting the NPR interview request.
In the interview, Mr. Cardillo described the stresses of workforce recruitment and retention challenges on: workforce continuity; the patient experience of care; and system costs, especially at a time of continued, enormous fiscal pressures on the home care industry. These pressures all coincide as the need “far exceeds the number of workers,” Mr. Cardillo said. He provided concrete examples of ways in which workers need to be matched to the individual and his or her specific care needs, amid the workforce shortage. Continue reading “NPR’s Marketplace Brings HCA’s Voice on Workforce Issues to National Audience”
Politico New York reports on a ruling in the New York State Supreme Court, Appellate Division, First Department, which holds that live-in home care aides are not necessarily a category of employee who need only be paid for 13 hours of a 24-hour shift. According to the court, live-in aides who fall outside of that category would be entitled to be paid for each hour of a 24-hour shift.
“The cost differences are staggering,” said Al Cardillo, executive vice president for the Home Care Association of New York State. “This would have major implications.”
Read the full Politico report at https://hca-nys.org/wp-content/uploads/2017/04/Appellate-Court-ruling-has-home-care-agencies-on-edge.pdf.
Home Health Care News reports that “The New York State Supreme Court ruled on April 11 that caregivers can be paid for sleep and mealtimes in a 24-hour shift, representing a major upset for home care providers if the decision is upheld.”
“This case has potential far-reaching impacts on the costs of services,” Roger Noyes, director of communications at the Home Care Association of New York (HCA) told HHCN. “For those providers that do have a high concentration of 24-hour, live-in cases, the new costs would be enormous.”
However, data on the prevalence of 24-hour, live-in caregiving is not entirely conclusive across the industry, according to Noyes.
“If the Tokhtaman or other rulings hold, this will add significant new labor costs and regulatory distinctions that the state needs to sort out both in terms of its published requirements for providers and in its establishment of Medicaid rates to cover labor costs,” Noyes said. “Otherwise, providers are left in limbo as far as the requirements while subject to a hole in reimbursement for meeting the costs of compliance.”
Read the full story at http://homehealthcarenews.com/2017/04/court-ruling-could-mean-24-hour-wages-for-home-health-aides/.
As Home Health Care News reports, “Lawmakers, too, were pushing for a delay to give agencies more time to comply with the significant changes. The Home Care Association (HCA) of New York worked with New York Congressman John Faso to urge CMS to delay the effective date as recently as March 27, when Rep. Faso sent a letter to CMS Administrator Seema Verma.”
“Home care providers understand the rationales and goals of the CoP changes, and they report vigorous and hurried efforts to get their staff trained and ready,” the letter reads. “Moving back implementation by six months will allow for all parties involved to be better prepared to operate and ultimately provide quality care to home care beneficiaries.”
Rep. Faso’s letter can be read here.
Bloomberg Health Law Reporter has written about a new bill signed into law that would create flexibility in the assignment of home health aides for an expanded set of tasks.
The law creates a new designation called an “Advanced Home Health Aide.” HCA has led similar proposals to allow for flexible assignment of home health aides, under the discretion and oversight of nurses. We support the intent of the new law, but, as HCA told Bloomberg, ‘‘the implementation phase still requires additional work. Among many issues still unaddressed are the need for funds to train and compensate advanced home health aides under the state Medicaid program and other payers, as well as the need to address the cost of new oversight duties for home care agencies.”
‘‘These cost factors are all the more important in the context of a new statewide minimum wage hike set to go into effect on Dec. 31,” HCA added.
You can read the article here.
HCA Executive Vice President Al Cardillo and colleagues from the state’s quality improvement organization (IPRO) were featured this weekend on a widely broadcast radio-news program to promote sepsis public awareness and describe clinical initiatives being partnered by IPRO and HCA.
The radio coverage, as part of the Upstate Issues weekly program, spanned several radio stations, including WGY (810 AM and 103.1 FM) and FM stations: The River (99.5), Kiss FM (102.3), Oldies 98.3, and PYX 106 (106.5).
A link to the segment online is at http://wgy.iheart.com/onair/upstate-issues-57169/a-deadly-ignorance-15142256/.
The Utica-Observer Dispatch reports on HCA’s efforts to raise awareness about the sepsis crisis, including our work with partners on a first-in-the-nation sepsis screening tool for home care nurses. Read the article here.
HCA Board Member Elizabeth Zicari, President of HCA Home Care, had an op-ed recently published in the Rochester Democrat and Chronicle newspaper about the work her organization is doing to participate in Bring The Vote Home-NY, an HCA-organized effort to help seniors vote from home.
“During this year’s presidential election season, we hear a lot about voter turnout, polls, and voter registration issues, but one important constituency demands attention: the 400,000 elderly, chronically ill, and persons with disabilities in New York state who receive home care services,” Ms. Zicari writes. “Many of these individuals are homebound, meaning they have difficulty getting to the polls on Election Day. Others have life-limiting illnesses or disabilities that hinder their access to election sites because of transportation issues or the incredibly taxing effort it takes to leave home — access issues that many of us take for granted.”
Read the whole op-ed at http://www.democratandchronicle.com/story/opinion/guest-column/2016/08/27/campaigning-help-make-voting-easier-patients/89462544/
Modern Healthcare reports on the impact of Medicare home health cuts proposed for 2017. Quoting HCA, the report notes that “New York Medicare-certified providers have been operating at a loss on Medicare payments for several years in a row, said Roger Noyes, a spokesman for the Home Care Association of New York State. Noyes said 60% of New York agencies have reported having to reduce staff or cut other costs to function, and half have used a line of credit or borrowed money for operating expenses over the last two years … He said the reimbursement cuts haven’t fully accounted for regional variations, such as higher wages for workers and high concentrations of hospital-based certified agencies and dual-eligibles in some areas of the country. Some New York agencies have had to close, Noyes said, while others have cut staffing or are looking at consolidating.”
Crain’s Health Pulse reported today on a new rule offering flexibility for home care physician orders. “Home care agencies say a new rule under consideration by the Department of Health would make it easier to get reimbursed for physician-ordered services,” Crain’s reports. The rule would extend the physician order deadline to “12 months after admission to the agency, or prior to billing, whichever is sooner,” in an effort to align state and federal requirements.
“We appreciate the state’s support for a sensible timeline that has worked under Medicare,” said Joanne Cunningham, president of the Home Care Association of New York State, in a statement. “This proposal ensures that providers and physicians can focus on the initiation or modification of the care itself.”
Today, HCA President Joanne Cunningham had an op-ed published in the Albany Times Union where she outlined one of HCA’s major positions and concerns – that the Governor’s proposed $15 wage mandate must be funded and not draw energy or focus at a time when other home care program and reimbursement needs must be addressed in the state budget.
She stressed the enormous impact of the mandate – a stunning $1.9 billion for home care – but noted that the industry is “troubled” by the fact that “this new mandate draws focus away from home care needs long left unaddressed.” HCA “has long advocated for improved reimbursement to support home care worker wages and benefits,” she wrote. “We agree that staff should be compensated in measure to the valued work they do.” However, “funding for this wage mandate is vital,” and “past history gives us pause” when it comes to the state’s past promises to cover unfunded labor mandates.
Several news outlets gave press coverage about the impact of a minimum wage increase on home care. The coverage stemmed from legislative hearings where lawmakers questioned state health officials about the impact, and where health organizations delivered testimony about our impact analysis. That analysis finds that a minimum wage increase to $15 per hour would have a $1.7 billion impact on New York’s home care community whose reimbursement is capped by Medicaid. Below are some links to the news stories:
State must pick up $2.9 billion tab for higher wages, providers tell legislators (Crain’s Health Pulse, January 26, 2016)
No plan to account for wage hike (Times Union, January 26, 2016)
Health providers predict big trouble from $15 minimum wage (Gannett News Service, January 25, 2016)
WNYC reports on new federal overtime requirements for home health aides, reporting that “home health agencies operate on thin margins and most actually lose money, according to Roger Noyes, a spokesman for the Home Care Association of New York State. Noyes said employers now will have even greater incentive to limit overtime by using more workers to cover shorter shifts. ‘That affects the aide, and that affects the patient who might have multiple care-givers coming into their home — especially for those patients that require a lot of care,’ Noyes said.”
Listen to the report here.
The Albany Times Union explores the impact of minimum wage changes in fast-food on other sectors of the economy, including home care. According to the report, “‘We have heard some concerns about recruitment issues in home care stemming from market forces at play, such as wage changes in other industries,’ said Roger Noyes, spokesman for the Home Care Association of New York State.” Read the full report here.
The Wall Street Journal reports on a home care legal settlement which prompted a response from HCA. As reported by the Journal:
“Roger Noyes, a spokesman for the Home Care Association of New York State, which represents state home health-care providers, said they ‘provide a vital, cost-effective service to elderly, disabled and chronically ill New Yorkers.’ The activities of these agencies are ‘heavily regulated’ or monitored by state officials, Mr. Noyes said. The vast majority of them have internal procedures to make sure they comply with regulations and staff supervisions, he said.”
Read the Wall Street Journal article here.
Crain’s Health Pulse reports on HCA’s Home Care-Hospital Collaboration Program: “Back in 2013, the Home Care Association of New York State and the Iroquois Healthcare Alliance pushed for an initiative that supported home health care providers, hospitals and doctors as they hashed out collaborative models. Their ally was state Sen. Kemp Hannon (R-Nassau), who in February introduced legislation (S.1110) that established a program in the Department of Health ‘to facilitate innovation in hospital, home care agency and physician collaboration in meeting health care needs in communities.’ The bill was adapted in the state budget; it creates a statute within the Public Health Law to support ‘Hospital-Home Care-Physician Collaboration’ programs. The collaboratives can include long-term care facilities, behavioral health, supportive housing and other providers. The new statute provide a framework for programmatic, financial and regulatory support to facilitate transitions in care; use of clinical pathways; application of telehealth/telemedicine services; health home development; development and demonstration of new models of integrated or collaborative care; bundled payment demonstrations; and other initiatives. HCA said the new models are distinct from DSRIP in that they are ‘more open and flexible, may be smaller or larger in scale, and may be developed and implemented by different configurations of collaborating providers.'”
Download the report here.
The Utica Observer-Dispatch reported on legislation to create an “advanced home health aide” designation. The paper reported: “’The Home Care Association of New York State has long supported proposals for the flexible assignment of home care personnel,’ said Communications Director Roger Noyes. ‘In past years, we have advanced such proposals of our own, as a way of promoting access and continuity of patient care, as well as making the health care system more efficient in the care of patients at home.’ There still are, he noted, though, concerns that need to be addressed, including financing.” Read the article here.
“Lourdes at Home’s growing physical therapy department has received some glowing praise. The therapy team has won the Home Care Proud contest of the Home Care Association of New York State,” states News Channel 34 in Binghamton.
See the news report here.
The Albany Business Review reports on education levels and wages in health care, quoting HCA Board Member Joseph Twardy of the Visiting Nurse Service of Northeastern New York and HCA President Joanne Cunningham. “We’ve heard several stories about home health aides who enter the health care profession, distinguish themselves in their work on behalf of patients, and then move on to mentorship roles of their own,” Ms. Cunningham says in the article.
The Utica Observer Dispatch examines New York State proposals to allow home health aides to perform certain additional tasks under the supervision of an RN. “By being able to have a home health aide perform certain tasks under the nurse’s direction, that creates some more flexibility for assignment of aide personnel,” says HCA Communications Director Roger Noyes in the article.
Read the article here.
City & State magazine named HCA Communications Director Roger Noyes to its list of “40 under 40” Rising Stars.
Read the article here.
In the latest edition of Caring Magazine, HCA Communications Director Roger Noyes reports on the major changes occurring in New York’s Medicaid home care program.
Read the article here.
HCA’s Communications Director Roger Noyes writes a personal essay about his Great-Great Aunt Clara Noyes who headed the Red Cross’ Nursing Division during World War I. The article appears in the online Caring Magazine, a publication of the National Association for Home Care and Hospice (NAHC).
Read the article here.
State Senator Cecilia Tkaczyk visits with home care patient William Sprague, who suffers from schizophrenia, was homeless and had to go to the hospital multiple times before obtaining an apartment and getting home care services from Always There Home Care to help manage his condition. Read about her visit in the Middletown Times Herald Record.
Read the article here.
The Dunkirk Observer reports on Congressional efforts to streamline the home health authorization process. “Since it was implemented two years ago, the Medicare face-to-face documentation requirement has only created enormous new cost pressures for providers seeking to comply with the complex and duplicative mandate,” says HCA President Joanne Cunningham. “Worse yet, the current requirements have also placed undue limitations on access to care for the vast majority of Medicare beneficiaries whose clinical conditions are, without question, supported by the Medicare benefit and determined by the physician as requiring home care services. HCA greatly appreciates Congressmen Reed’s leadership in seeking a solution that maintains the important bridge between a home care provider and its physician community while mitigating the administrative burdens on both.”
Read the article here.
Inside Health Policy reports on an HCA-backed letter by New York’s Congressional Delegation seeking relief from Medicare documentation requirements for authorization of home health services.
HCA talks to the Utica Observer-Dispatch about the growing incidence of dementia and its impact on home care.
Read the article here.
In the June 2013 edition of Caring Magazine, HCA Communications Director Roger Noyes reports on the efforts of home care providers in response to Hurricane Sandy, as well as state policy initiatives to assist home care providers in their emergency response roles.
A letter to the editor in today’s edition of the Times Union responds to generalizations about home care in a recent story about the home care survey and inspection process. (See here.) The Times Union also published an editorial about the issue on July 22 here.
HCA President Joanne Cunningham had a budget op-ed published in the Journal News on March 20 and co-wrote an op-ed in the March 27 Rochester Democrat and Chronicle with HCA Board Chair Vicky Hines, President and CEO of the Visiting Nurse Service of Rochester and Monroe County. The Journal News op-ed can be read here. The Democrat and Chronicle op-ed can be read here.
The Albany Times Union today published an op-ed by HCA President Joanne Cunningham entitled “Cuomo’s plan puts home health care in peril.” In the op-ed, Ms. Cunningham writes: “The governor’s $1 billion blow to home care will mean that successful, cost-effective home care models will fold, including agencies that have served their communities for decades. Chronically ill, elderly and disabled New Yorkers will spend more time in hospitals, nursing homes and institutions. Medicaid costs will increase; and the entire health care system will suffer.”
Read the full op-ed here.
HCA President Joanne Cunningham was quoted in a March 18 Times Union article on the inclusion of an unfunded wage mandate for home care in the state budget. “There is a sense it’s pretty loose and could be interpreted pretty broadly,” Ms. Cunningham says.
Read the article here. Ms. Cunningham was also interviewed about this for a report by WAMC public radio.
HCA was quoted in a Wall Street Journal article on aspects of the state budget — including an unfunded home care wage mandate — which do not save state dollars. In the article, entitled “Savings Plan Isn’t All Savings,” HCA is quoted as saying of the home care wage mandate that: “It’s a proposal that would add costs to providers in the context of a Medicaid redesign process aimed at making health care more efficient.” Read the article here.
The New York Times reached out to HCA President Joanne Cunningham seeking HCA’s perspective on assertions made by Governor Cuomo’s administration about Medicaid spending in the state budget. As HCA has extensively reported to the membership, the Governor singled out home care in his budget speech on February 1 using misleading data and politically-charged rhetoric about home care administrative costs and rates of spending.
Continue reading “HCA President Quoted in NY Times Article on Medicaid Spending”
The New York Post has published a letter to the editor by HCA President Joanne Cunningham in response to an op-ed about the cost of Medicaid.
Ms. Cunningham writes: “Elizabeth Lynam points to Medicaid spending differences between New York and other states, but New York is different for other reasons — high labor costs, extensive mandates and standards, high taxes and a disproportionate number of chronically ill patients (“Where Cuomo Should Cut Medicaid,” Post-Opinion, Nov. 30).
“HCA has advanced numerous legislative proposals for making Medicaid even more efficient,” she adds. “While previous governors have been slow to embrace our constructive approach, we look forward to bringing our ideas to the incoming Cuomo administration for its consideration during the upcoming budget.”
Read the complete letter
The New York Times today published a letter to the editor by HCA President Joanne Cunningham on federal health reform. She writes: “Home health care has received much attention lately as part of the national health reform debate … these services are a vital component of the health system, caring for the elderly, people with disabilities and the chronically ill, and helping patients avoid higher cost service use, like acute-care emergency room visits, lengthier inpatient stays or premature nursing home admission.”
Read the full letter
HCA President Joanne Cunningham appeared on the December 6 CBS Evening News broadcast to discuss the impact of proposed home health care cuts as part of national health reform efforts. “A health care reform bill that includes significant cuts is very troubling because what it means is that patients don’t get served, services get cut, programs get cut,” Ms. Cunningham said.
View the clip online.
HCA was quoted in an October 4 article in Newsday entitled “Lawmakers eye Medicare trims to pay for health overhaul.”
In the article, HCA describes the financial fragility of home care in New York State, noting that growth in the number of new certified home health agencies has been capped by a statewide moratorium and, in fact, the state has seen a loss in the number of Certified Home Health Agencies (CHHAs).
HCA Communications Director Roger Noyes “said Medicare cuts, combined with shrinking state Medicaid funds, could result in more agencies closing,” according to the article, which can be found here.
The Associated Press (AP) ran a story today on the Governor’s proposed cuts to home care, noting: “The trend of moving more patients from hospitals and nursing homes into less expensive home care treatment faces potential budget cuts in New York despite its potential to save government millions of Medicaid dollars.”
The story, which ran in several news outlets throughout New York State, included an interview with David Senecal, a patient at HCA-member agency Visiting Nurse Association of Albany, Saratoga, Rensselaer. Mr. Senecal has quadriplegia after injuring his spinal cord when he was 13. In 1980 “he was able to get home care and for the first time since the accident, felt independent,” the report states.
The story also quotes HCA President Joanne Cunningham, who described the devastating proposed home care cuts, and said: “Today’s home care patient 20 years ago would be in the hospital or nursing home.”
Read the article online.