MICHIGAN HOME CARE AND HOSPICE ASSOCIATION

CLINICAL OPERATIONS COMMITTEE

June 16, 2016

9:30AM – 12:00PM

At the Okemos Office

MINUTES

  1. Call to Order
  2. Introductions – Sara opened the meeting with introductions
  3. Approved minutes from May 2016Annual Conference meeting were approved as written.
  4. Agenda Additions –

Palliative Care –

Medicare Demo on PreAuthoriation -

Language for Patient Rights to be added to Regulatory

Home Health Aide Training-

  1. Executive Director’s Report– Barry wasn’t immediately available, but Sara did share that Hospice Home Medicaid appropriation dollars may be included in this year’s budget and this is decided by the State with each yearly budget. Also that there are other Medicaid dollars that will be benefiting private duty, but not sure of detail at this time and will have Barry share. Barry came in later in meeting and shared that he is meeting with the directors of the states where pre-auth is being implemented and is going to keep close with them as the states that go up before us share their experiences (MI goes up Jan 1st, 2017). He will have a face to face with these folks the week of July 18th. A new board was re-elected with Amy as secretary, Sara as President (explaining how the President elect becomes the next President as well as how the nominating committee works. Don Gillespie is chair of this committee as part of his commitment as past president). The government at the federal level as well as state level are frustrating the states when it comes to many issues that affect home care and hospice as well as other community home providers. The State explained there was a lot less money in the Medicaid budget than was expected. The victories included a 15% increase in private duty nursing reimbursement. Attempted to get 20% but only able to receive 15%. Hospice Residences will have 2.5 mill for room and board. Tricounty in home budget was increased to 2.5 million as well. Also MOWs dollars were provided. Be ready to vote in the primaries coming up!
  2. Announcements/Reports:
  3. Regulatory Update
  4. NGS – June 7th, in Indianapolis. 94% error rate on our Michigan Cert review. Audit was done between 1/16 and 4/16. Many of these were corrected with more information on appeal, but this will not change the outcome of our data being reported. Only 65% appealed these denials. There is a job aid on their site on the probe and educate audits. This NGS meeting was a more challenging meeting with more concerns being expressed than in the past. The answers to concerns were very vague. There are 101 agencies that have had meetings with 1:1 education, but were vague and not specific about what was common issues and that many others had concerns that they were not able to set up these meetings. Next meeting is in Oct. Deb asked how you know if you have been denied and Sara explained that it shows in the billing system as well as a letter is sent. Sara shared that her agency had 4 of 5 denied and that it was not clear that the physician had incorporated into their office record. Chris also stated that this is very important that the physician has to show that it is part of the record. She also clarified that you may have to wait to get the letter before a meeting can be set up. Recommended getting meeting scheduled. Several others present had more claims denied than accepted. Recommending that a statement be added that says that the info is added to the physician record as well as make sure you have a copy of the actual visit note.
  5. MILARA – Amy Parkinson shared that the team will be meeting this month and that all and any concerns regarding their surveys could be shared at this meeting with answers / clarifications requested. Shared her email and/or asked to email Mary at MHHA if you have questions to submit. Deb shared that the surveyor asked to see their “corrections manual” that Deb actually did have! She said that she was not rude on that visit, but was short. Her name was Yolanda. She was wondering if there was any connection between the state survey and the CHAPS survey. The communication from CHAPS was approved about an hour after the state visit. Group discussion was that it would be very surprising to have this be planned in any way.
  6. BCBSM Regulatory/QI Committee – No Report. Regulatory will meet today.
  7. Education Committee – No Report. Next meeting in June 21st.
  8. MPRO –Katie Brown shared that they just had rehospitalization summit on June 2nd. The speakers were very good and it was a very good conference. It was hospitals, physicians and home care agencies that attended. Over 400 registered and over 300 showed up. Good food and speakers for all participants and it was no charge conference! Battle Creek shared their collaborative that includes more physician engagement at a collaborative that is held monthly where they work out ways to reduce hospitalization. Presentations are posted on website. Katie will send a link to show the key note speaker’s plane crash experience. Katie recommended her for our conference and will pass on the CEU. Another speaker talked about having a stroke at age 40 and he was on location in Detroit as a reporter on the K. Kilpatrick case. CMS sent someone to speak about health care disparaties as well.

Next Monday, there is a collaborative at Beaumont Royal Oak Hospital from 9 – 11:30 for the southeast Michigan area. Looking to work with providers on how to deal with “high utilizers”. Katie will send info to Mary to have available.

May 5th, there is a home health collaborative. She explained there is a portal for SNFs that is something they would like to put in place for home health. The common areas were education for physicians and caregivers, handoffs, and patient and caregiver engagement (see handout). Next meeting is June 29th from 9:30 to 11:30am at MPRO in Farmington Hills.

  1. Sub-Committee/Task Force Reports:
  2. IV Therapy/Infection Prevention – Deb explained that not a lot of feedback on the manual, and no more folks asking to join. The small group that meets is currently meeting on the West side of MI and are meeting next week Wednesday?. Has a new policy and procedure manual from INS from a recent conference and they will review the manual and cross reference.
  3. Psych Home Care – No report
  4. Rehab Subcommittee – No report. Will be meeting next in July after Clinical Ops. We will be meeting July 21st, but will be
  5. New Business:
  6. No New Business.
  7. Sharing Segment
  8. Survey Report- Sara shared their CHAPS survey. Discussed the rule about what the physician order needs say and why. Was not surprising and felt the review was done by a pleasant group of folks. Karen was the name of one of the nurses. One issue was regarding Tb testing between home care and hospice policy language. Christine shared that they had an HCHC survey and then a revalidation survey from the state with 5 surveyors. They were professional and asked for articles of incorporation and that they were reviewed. If there is “one instance” then they were cited. Is this accurate? Amy to ask at next MILARA meeting. Are they bringing in multiple surveyors and also that they want 24 hours access. Quotations were taken out of context for reports. Leader was Linda and Yolanda was there as well. Also had a complaint survey with two surveyors (one being Rick) that showed up at two different locations. Discussed whether to move MOS to chart review as part of plan of correction and this was supported by the group. Reminded that it was a federal requirement to minimally review at least 10% of charts quarterly.
  9. Pam would like to know what is considered the referral rate for a private duty should be and how to measure? What is the benchmark?
  10. Agenda Additions
  11. Palliative Care – Sara explained that there is added to our board a Palliative Care seat due to the fact that PC is much more in the forefront with need for more help caring for the chronically ill patients. It also was supported by our HPCAM board that was incorporated into our board. Mike Jasperson was elected for this position. No formal meeting yet, but will have this be a potential. Will be discussed at Hospice meeting as well. Several folks stated in this meeting that there would be interested in attending this. Sara suggested a survey monkey to ask what topics on agenda as well as need to include hospice members as discussion was how it crosses both entities as well as being a medical program.
  12. Medicare Demo on PreAuthoriation- More to come at regulatory meeting.
  13. Language for Patient Rights to be added to Regulatory
  14. Home Health Aide Training- Barry shared that there is funding for personal care assistant program from DOL where a company call PHI would be used as well as maybe our MHHA department could use that would stipulate that the persons trained would be guaranteed $10 per hour. Non-profit can get the funding, but the for profits can send folks to get trained by contracting with area schools to provide the training. Discussed whether there is a need for a separate certification for a different curriculum than the CENA program. Amy suggested that we try to change to rules for CENA recertifications to allow for home health work to be counted. Deb and Christine offered that this program may be more suited toward private duty only.

Meeting adjourned at 11:15. Regulatory meeting this month is to follow.