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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

Early Hospice Payment Reform Analysis Presented by CMS, Abt Associates

April 2, 2013 05:12 PM

Hospice stakeholders attending the National Association for Home Care & Hospice’s (NAHC) March on Washington heard the initial findings of an analysis performed by Abt Associates for the Centers for Medicare & Medicaid Services (CMS).  Abt is CMS’ contractor for development of a new hospice payment model.

While work on the payment model is not complete and payment changes have not yet been decided on, the findings indicate that CMS and Abt are looking broadly at hospice cost report, claims, and beneficiary data to gain a better idea of hospice care delivery patterns.  Additionally, Abt is analyzing care patterns related to the hospice face-to-face to determine whether the new requirement is having an impact on hospice use.

Presenting on behalf of Abt was Michael Plotzke Alyssa Pozniak and Brant Morefield also on hand from Abt to answer attendees’ questions.  Plotzke discussed three areas under exploration as part of Abt’s work for CMS:

  • Trends in Hospice Cost Reports           
  • Trends in General Inpatient Utilization (GIP)
  • Impact of the Face-to-Face Requirement on Hospice Benefit Periods


Abt examined cost reports for freestanding hospice providers from 2004 through 2011, eliminated problem cost report data, conducted analysis and drew several conclusions:

  • The average cost of drugs, biologicals, and infusion costs, per patient have decreased over the period
  • Medical supply costs, per patient, have remained steady over time
  • Roughly one-third of providers report zero inpatient costs, causing skewed average costs.  Providers frequently report zero inpatient costs with non-zero inpatient days
  • Up to 25 percent of providers report no costs in their non-reimbursable cost centers, despite the requirement to provide bereavement services
  • Total costs per patient have not significantly increased from 2004-2011

Analysis:  The findings clearly indicate that a significant number of hospice cost reports are inaccurate - reporting of no inpatient costs despite reporting of inpatient days; failure to report nonreimbursable costs despite requirements to provide non-reimbursed services. As a result, decisions related to payment reform may not be based fully on the actual cost experience of hospice providers. 

The findings support the need for refinements to the hospice cost report, and CMS’ plans for changes to the hospice cost report are expected to be made public in the near future.  The findings also clearly indicate that CMS is studying a wide range of hospice payment and care-related issues (including GIP) and CMS will be in a much better position to explore reform of payment for levels of care other than routine home care in the future.

Takeaway:  All hospices must make a concerted effort to ensure that cost reports are filed correctly; additionally, hospices should prepare for the expansion of cost report requirements.  NAHC’s Home Health and Hospice Financial Managers Association (HHFMA) has developed a Uniform Chart of Accounts for Hospice that represents the organization’s “best guess” of the additional items CMS will be requesting on the cost report.  For more information, please see: NAHC Report Feb. 20, 2013.


Abt examined trends in hospice use of GIP to better understand the characteristics of hospice providers who do and do not provide GIP services and found the following:

  • 25 percent of all hospice beneficiaries had at least one GIP day in 2010-2011; the average number of GIP stays per beneficiary was 1.11 days
  • 79 percent of all hospice providers provided at least one GIP day in 2010-2011; there was variation in use of GIP among hospice providers depending on age, size, share of GIP days, geographic location
  • A higher proportion of older hospice providers used GIP compared to newer hospice programs
  • Only half of small providers provide GIP versus nearly all large providers use GIP
  • The South has the greatest number of hospice providers, but the lowest percentage of hospices that use GIP
  • Most GIP stays are short (5.7 days) but length of stay varies by site of service

Analysis:  The variation in use of GIP raises questions about what factors contribute to use or non-use of GIP by hospice providers, such as whether GIP is being used appropriately - too frequently or too infrequently, for example - by some hospice providers, do some hospices have difficulties securing a site for GIP.  Are hospices, for whatever reason, substituting a different level of care for GIP? 

Takeaway:  This is an opportune time for hospice providers to analyze their own operations and ensure that they are complying with GIP usage rules.


CMS asked Abt to study the impact that imposition of the face-to-face requirement might be having on hospice usage.  Abt examined the number of consecutive benefit periods for beneficiaries with a first benefit period start date between October 2009 and January 2010, and the number of consecutive benefit periods for beneficiaries with a first benefit period start date between Oct. 2010 and Jan. 2011. 

Abt found the following:

  • The percentage of beneficiaries who did not make it past their second benefit period is nearly identical for the period impacted by face-to-face as compared with the period not impacted
  • There were some minor differences in discharge status across the two groups; slightly more benefit periods ended in live discharge or were still in hospice, but fewer periods ended in death for the periods affected by the face-to-face compared to the period not affected

Analysis:  While it was expected that the face-to-face requirement might result in more live discharges (based on patient’s failure to meet eligibility criteria) that was not the case.  Abt intends to conduct additional analysis for later periods of time to see if the findings change.

Information related to Abt’s research on behalf of CMS in the area of hospice care was also presented at a poster session at the Academy of Hospice and Palliative Medicine’s annual meeting in New Orleans.  Links to the posters follow:

Hospice Cost Reports:  Benchmarks and Trends, 2004-2011

Analysis of Trends in General Inpatient Care (GIP) Utilization

Analysis of Face-to-Face Visit Requirement

During the presentation, representative of CMS urged members of the hospice community to submit recommendations and thoughts relative to payment reform as well as their insights on Abt’s research findings.  As additional information becomes available from Abt’s research into hospice payment, further coverage will be available in NAHC Report and Hospice Notes




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