The national fervor to increase the minimum wage is about to take over Private Duty home care. A final rule issued by the US Department of Labor mandates that companies who provide a home care worker for “companionship and safety” are now required to pay at least minimum wage. The rule further states that companies providing such care will also be mandated that home care worker be paid overtime when required.
The U.S. Department of Labor has taken a hands off approach when it comes to home care workers in the past. But changes in the healthcare industry have caused them to change course according to a post on the Supreme Court of the United State Blog.
The department reversed course on the issue after concluding that home care has changed markedly, with fewer elderly and disabled individuals going to nursing homes or other institutional providers, and opting instead to remain in their homes and get their assistance there.
It all started with Long Island Home Care v. Coke, a case heard eight years ago in front of the Supreme Court when a home care worker brought suit demanding to be paid minimum wage. The worker lost the case based on the latest amendment to the Fair Labor Standards Act that said that”domestic workers” were not entitled to minimum wage.
Now thanks to the Department of Labors change of heart and a federal court ruling that upheld the wage increase, the supreme court will decide again whether Private Duty home care workers are subject to the same rights as the rest of the workforce.
The rule to increase wages was supposed to go into effect October 13th but will likely be delayed while the Supreme Court hears the case.
If the Supreme Court finds that Home Care workers are now subject to the Fait Labor Standards Act then home health aides may find themselves in line for more increases as the fight to increase the national minimum wages reaches its conclusion.
More and more consumers are choosing at home care options over institutional care settings. With an entire industry shifting to home based services, it is time to give home care workers that same status as we give others in the workforce. It is a necessary step to force improvement in an industry that is now responsible to caring for the most vulnerable of our countries citizens.
Home Health is considered by many analysts to be a major are of growth in healthcare in the coming years. With the retiring Baby Boomer demanding more convenient, personalized and home based care options, Home Health Care is in an excellent position to capitalize on massive influx of new patients.
But with all the potential in the home care market there have been even more challenges. Fraudulent activity and substandard care have caused consumer trust in home health care to erode. In response to the fraud, regulatory agencies have added restrictions, cut reimbursement and doubled down on law enforcement. The punitive nature of this enforcement has stifled innovation and caused home health agencies to be overly cautious with new service delivery models.
The regulations surrounding insurance reform and the proliferation of Accountable Care Organizations have many independent small to medium-sized home care companies grasping at ways to grow census in a system becoming increasingly exclusive. The companies who fail to innovate and develop multiple revenue streams have been forced to close their doors while other are working to develop new service delivery models to meet the rising demand for home care services.
Some of that demand can be found in specialized services focusing on diagnoses that cause the most hospital readmissions. There is a push to reduce hospital readmissions under the new Accountable Care system that penalizes hospitals for return trips to the ER after a hospital stay. To accomplish this goal hospitals are partnering with Home Health Care companies to find new ways to treat patients who are at high risk for readmission.
These programs often include disease education, raising awareness of community resources and frequent visits from Home Care professionals to help with the transition. What is more, these programs are often reimbursed outside of the traditional Medicare system Home Care companies have become comfortable with.
Home Health Care programs that prove the ability to reduce health care cost are often funded by third-party insurance “carve-outs” or grants which fund healthcare innovation. Palliative Care, Care Transition and disease management programs are all examples of programs that are being funded by these sources.
The innovation game isn’t just for the large Home Care companies. A small to medium sized company can jump in if they have a solid structure that favors permanent over contract employees. A company who works almost entirely with contractor may find it difficult to control cost and quality in a newly developed program that could sudden operational changes. However companies who focus on permanent employees may find the cost of change easier to manage.
Home Care companies who are able to innovate in the new Accountable Care system would thrive in the years to come. More innovation can only serve to improve the greatest healthcare system in the world.
Questions about this post? Email AnthonyFischer@elderadvocacygroup.info
There Is More Technological Innovation Coming To Healthcare
Just as healthcare systems are fully implementing electronic medical records, even more technological innovation is coming to healthcare. But instead of targeting providers these innovations will be available directly to consumers.
So who is driving the new innovation inspiration? Google of course. For those who have tracked Google lately this is no surprise. Google recently founded a holding company called Alphabet. That company has declared war on Diabetes, naming the disease as an area of focus.
Don’t expect Alphabet, a spin off of Google X, to stop at Diabetes. An investment bank Cowen and Company has tracked Google and thinks the tech giant could be on the verge of making major investments in new healthcare innovations.
A recent report by the investment bank says: “A closer look at Google’s vast health care efforts,” the report says, “reveals that the company is targeting very large markets with an expansive list of projects that with even minor success could justify the company’s recent investments.”
An article by Mark Bergen of re/code.net, a tech blog focusing on dot coms, cites Google’s major investments in companies focused on telemedicine, dermatology and Diabetes.
With the new influx of money into healthcare research and development, Google hopes it can add a spark to the industries normally slow pace. Picking up that pace would be advised as the healthcare industry prepares for the enormous and expensive challenge of caring for the retiring Baby Boomer generation.
Healthcare systems, who are already struggling with a shrinking workforce and lack of licensed professionals, are looking for any way to provide quality care at a lower cost. Medicare and other third-party insurers would also welcome innovations that allow patients to receive lower cost care at home.
They say necessity is the mother of invention. That cliché is more true today than it has ever been as the nation tries to avoid a potential healthcare crisis caused by a title wave of aging Baby Boomers.
Michigan Lags Behind Other States In Home Care Regulation
Home Care services will play a key role in the ever-changing healthcare system. With an avalanche of Baby Boomers nearing retirement age, the healthcare system is desperate for services that provide quality care cost efficiently while keeping patients from making costly emergency room visits.
Baby Boomers are also demanding more innovation and service improvements in healthcare just as they have of every other service they have consumed. Skilled Home Care, Hospice and Telemedicine have proliferated as a result. So much so that lawmakers and policy wonks in Washington are expecting a dramatic increase in Home Care utilization over the next decade.
So what’s holding the rapidly growing home care industry back? Fraud. New companies have sprung forth to meet demand with many founders having little to no experience in healthcare service delivery. Without the proper expertise to compete by providing quality service, owners turn to fraudulent schemes to make ends meet.
As a deterrent to fraudulent behavior the FBI has made a public spectacle of Medicare fraud busts. The FBI press releases have had their intended effect but they have also had the unintended consequence of deterring patients form using the service. That combined with the reluctance of doctors to refer to potentially fraudulent providers has slowed the development of this much needed service.
Most states have faced the fraud problem head-on by requiring companies to apply for a state license in addition to the federal Medicare license. The extra requirements have served as their own deterrent to Medicare fraud.
Still there are four states in the union that don’t require any additional licensing to operate a home care company. Michigan, Ohio, Iowa and Massachusetts all refrain from further regulating the home care industry. To their credit Ohio and Massachusetts require additional licensing for the professionals that work in the industry. However Michigan Home Care Companies remain the least regulated and companies in the state remain a major target of the FBI’s Medicare fraud task force.
The increase in fraud could have something to do how easily an entrepreneur can open a home care agency in Michigan. Even with little to no knowledge of the healthcare system. Potential owners can also obtain a license to operate a home care at a relatively small cost. Normally expensive costs like labor can be purchased cheaply through contractual agreements with payment deferred until after the operator receives the license.
This year the federal agency overseeing Medicare and Medicaid reimbursement (CMS) finally issued a moratorium on new home care licenses. However the move comes after many fraudulent companies are already in operation in Michigan.
Another factor contributing to fraud is the infrequency of home care regulation provided in the current system. Federal Medicare regulations require that licensed home care agencies be inspected
every two years. The Centers for Medicare and Medicaid Services (CMS) depend on third-party regulators to facilitate the survey process. Organizations like the Community Health Accreditation Partner (also known as CHAP) and the Joint Commission provide professionals to conducting inspections. Although all inspectors receive training a shortage of inspectors often puts the process behind schedule.
The gap between inspections (known in the industry as surveys) opens a window of non-compliance with agencies able to ignore regulations without fear of inspection. During this time agencies often go without key staff like Qualified Administrators, Clinical Directors, Medical Directors and key office staff to cut overhead cost and squeeze more profit out of the bottom line. This practice adversely effects care and lowers the inter-agency accountability. Without key healthcare professionals taking an active part in the company, owners often cut corners and open the door for fraud.
Not A Small Problem
The fraud problem isn’t limited to small companies or start-up companies. Large companies with years of experience have also fallen into fraudulent habits either through malicious intent or negligent.
More regulation, especially in Michigan can help stem the tide of fraudulent behavior. Additional state licensing, requiring licensed administrators and an increase in inspection frequency can help fix a horribly flawed system. For now consumers should make themselves aware of the warning signs of Medicare fraud as well as asking their lawmakers to increase home care regulations.
The cost efficiency of home care service can go along way to saving the healthcare system. Until fraud is rooted out however the American taxpayers will have to foot the bill for billions of dollars in increased healthcare cost.
Like it or hate it, the Affordable Care Act (aka Obama Care) was the most significant legislation to be passed into law since the Patriot Act. The sweeping reform of the healthcare system had the country in an uproar after along passing along party lines in a democrat controlled congress. Now the uproar has been reduced to a murmur as more and more American’s seek to get coverage from the insurance marketplace.
The GOP prefers an open market that will allow competition to lower cost for consumers and increase accessibility for consumers.
But the changes in how consumers buy insurance is nothing compared to the changes in the healthcare system at large since the ACA’s passage. The insurance reimbursement to Hospital systems and the physicians has changed drastically. Quality Care Thresholds have also changed making reimbursement based on outcomes and not volume of patients treated. Mountains of policy and regulations changes have occurred as a result.
It is the mountain of new rules that makes the notion of totally repealing Obama Care a false premise. It can only be tweaked but never rolled back completely.
This may be disconcerting for the one issue voters out their who hope a vote for a Tea Party Candidate can get them the type of healthcare reform they prefer.
So if the law can’t be repealed, how can we effect change?
The Affordable Care Act is so complex federal agencies are still working on the regulations that will enforce the spirit of the law. Decisions on how healthcare organizations are funded, the availability of expensive treatments and quality of care indicators are all being discussed as you read this post.
The ACA gives government agencies more power over our healthcare decision then any other point in our American history. Now is the time for consumers to stay vigilant and voice concerns over the new policies and program being put into place.
The 2016 Presidential Candidates need to back away from sound bites full of empty rhetoric and educate the voters on how they can effect change moving forward. Adhering strictly to the talking points won’t accomplish this.
If the Republican field is truly serious about protecting the healthcare consumer from government overreach they should appoint a healthcare advisor to each of their campaigns to take a hard look the new regulations are having on real people. Otherwise any talk about improving the healthcare system is a waste of our time.
The Baby Boomers have drastically changed nearly every industry over the last sixty years. So it should be no surprise that they are having significant effect the healthcare industry as well.
In fact Baby Boomer’s present the single largest challenge the American healthcare industry has ever faced. The Boomers will be using the system at historic rates as the industry tries to meet demand with an aging and depleting workforce.
The Post World War II generation is also demanding changes in the healthcare system causing a shift to home-based services such as home care, visiting physician services and hospice. That is a demand lawmakers believe America’s health care system can rise too.
In July, Senator Ron Wyden (D-ORE) told Medpage Today that he believes a Baby-Boomer inspired revolution is coming to healthcare.
“I believe Medicare and Medicaid are going to lead a revolution in caring for people at home,” Wyden said, especially for chronic illnesses such as cancer, diabetes, stroke, and Alzheimer’s, which account for 93% of Medicare’s costs.
Home Care can save the Medicare system money. With technological advances in the Bio-med field and electronic medical records, the licensed healthcare professional can access medical information and order treatments just as efficiently than a hospital facility. For patients who don’t need 24 hour monitoring by a Register Nurse or physician, home care can be a very cost effective service delivery system.
Hospital systems have already figured this out. They are investing more time and resources into home care services as a way to boost patient outcomes and cut hospital readmission. Minimizing readmission is a key part to the new reimbursement system Medicare has put in place as a result of the affordable care act. By having some control over the patients healthcare delivery after discharge, hospitals hope to curb readmission and provide better outcomes.
With the healthcare industry already embracing the shift to home care and lawmakers willing to fund it. Look for more innovation in the field of home health care over the next fifteen years. Innovation that could save the Medicare system from financial collapse.
Just when you thought all the fuss about Obama Care was over. Wednesday’s ruling by Federal Court Judge Rosemary Collyer put the Obama Care fight back on the table and thrusting it into the political spotlight after years of battle.
At the core of the judges decision is funding for the monstrous trillion-dollar healthcare program which was allocated by executive order instead of the regular appropriations process.
Because congress was passed over in the appropriations they did not have the opportunity to excercise their constitutional duties. Now according to the Judge they can sue for the right to fund (or defund) the program, a lawsuit that will likely land Obama Care on the steps of the supreme court once again.
What does the Republican lawsuit mean for consumers. Not much considering Republicans are not likely to strip millions of American’s of health coverage during an elections cycle. However if congressional republicans are success in the suit against the executive branch you may see some changes to the health insurance market place.
If you are hoping that the Collyer’s decision will be the beginning of the end of Obama Care keep hoping. Reams of paper have already been used to write the regulations guiding the implementation of the wide-reaching health care law. Consumers may see some tweaks but don’t expect the program to completely roll back. But don’t expect that to stop the candidates from talking about it as Obama Care will become a hot campaign issue once again thanks to the ruling.