A Home Care Visit with Senator Jerry Moran and Marilyn Tavenner, Acting Head of CMS
April 11, 2013 09:15 AM
It is not every day that a home care patient can say they spent a birthday with their U.S. senator and a top government official. Shirley Webb, a patient of Douglas County Visiting Nurses Association in Lawrence, Kansas, turned 88 in her own home while being treated for a serious wound on the bottom of her foot. On that special day, she learned she would be discharged from home health services later in the week. In addition, she received a visit from Senator Jerry Moran (R-KS) and Marilyn Tavenner, acting administrator at the Centers for Medicare and Medicaid Services (CMS).
The Kansas Home Care Association has a history of building strong relationships with the Kansas congressional delegation and encouraging its members to take a first-hand look at what home care achieves. “We have hosted home visits with both of our senators, Pat Roberts and Jerry Moran, and last year Representative Lynn Jenkins made a home visit,” said Jane Kelly, executive director of the Kansas Home Care Association. “Those are the members we feel we can count on since they have seen home care in action.”
There are 112 Medicare-certified agencies in Kansas. About one-fourth of the counties in Kansas are served by just one or two home care providers, but the impact on access to care is far reaching. Home care in many of these counties means the difference between a patient receiving or going without needed care.
“I knew we must be doing the job right with the home visits when I received a phone call from Senator Moran’s office asking if we would help him host a home visit with the acting administrator for CMS,” Kelly recalled.
Senator Moran takes his community’s interests to heart. Before becoming a Kansas senator, he spent 14 years representing Kansas’s first congressional district, which spans 69 counties, and served in the Kansas state legislature for eight years. A native of Western Kansas, Moran has tirelessly fought to address the unique health care needs of rural Kansans.
Throughout his political career, Senator Moran has had a close working relationship with the Kansas Home Care Association, and he has supported home care to ensure Kansans get high-quality care, even if they live in the most remote parts of the state. “Access to home care and other quality health care services determines whether Kansans can remain in the communities they call home and whether their children can return to raise families of their own,” Moran said. “As a member of the Senate Rural Health Caucus, I understand that cities and towns are strengthened when Kansans have access to health care networks within their own communities and that home health care services are an integral part of this. Home health care allows individuals to receive the important care they need in their homes with their families, where they feel most comfortable. And home health services are a cost-effective alternative to other forms of care, especially when an individual may live a long distance from a hospital or clinic.”
Moran also supports effective use of technology to better meet the needs of rural patients, and he cosponsored the Fostering Independence through Technology Act of 2011. The legislation would create a pilot program for home care providers who use telehealth in rural and other underserved communities to receive incentive payments through Medicare.
Senator Moran is a firm believer that government officials should see firsthand how programs are being implemented at the local level. So he has continuously made home care visits to observe the full scope of services that Kansas agencies provide. Doing so has also showed him the roadblocks these agencies confront. “Many of Kansas’s health care providers operate on tight margins,” he said, “to provide quality care to Medicare and Medicaid beneficiaries spread across a wide area. Each time I visit one of these facilities and meet the individuals providing care to Kansans, I learn something new about the unique challenges they face.”
Senator Moran uses these experiences to better represent and advocate for his constituents. After hearing about many of the issues health care providers were facing in the state, he invited Ms. Tavenner to spend a day getting a first-hand look at health care delivery in Kansas and meeting with local health care providers. It was one of several similar invitations he has extended to Tavenner. It was also the third time she has agreed to go on a health care tour of the Sunflower State — to Moran’s delight. “I am very pleasedMs. Tavenner accepted my invitation to accompany me on these visits,” Moran said, “and I hope the conversations she has with Kansans will give her valuable perspective for her work in Washington, DC.”
Moran and Tavenner spent the morning of their health care tour in the home of Douglas County VNA patient Shirley Webb, a mother and grandmother who spent most of her married life traveling with her husband on active duty in the Air Force. Shirley was having her second episode of care for a foot wound, so Moran and Tavenner had the opportunity to meet Lori Lee, RN, Webb’s caregiver from Douglas County VNA. Also there were Judith Bellome, CEO of Douglas County VNA, and Shannon Lovejoy, associate director of government affairs at the National Association for Home Care & Hospice (NAHC).
Shirley suffers from peripheral neuropathy and was not aware of the severe wound and infection that developed at the bottom of her foot. Once Shirley’s podiatrist saw the condition of her foot, he recommended that she seek immediate care. Shirley was admitted to a hospital emergency room in Lawrence, Kansas, where the doctors considered amputating the wounded foot, debrided the wound, and started her on intravenous antibiotics. Fortunately, the wound slowly began to heal with close monitoring, so Shirley was discharged to the VNA with aperipherally inserted central catheter line and wound care instructions. In addition to nursing, Shirley’s plan of care included physical therapy so she could get around with a walker, occupational therapy to make her safer at home, and personal care from an aide. Two of Shirley’s daughters also visited daily to assist with grocery shopping and cooking.
Senator Moran asked Shirley how she made the decision to receive home care after being discharged from the hospital. She responded that the hospital provided her with a list of numerous options for receiving care while her foot healed. She chose to recover at home by receiving home health services from the VNA, which offers a range of services including home health, hospice, and private duty. As a nonprofit home health agency, the VNA has provided over $500,000 worth of charity care in the last 18 months.
Shirley’s care was covered by the Medicare home health benefit, and like many home care patients, she valued the services she received. “It’s the only way to get well,” she said. “It’s very important to be in your own home with your own things while you recover.”
Nurse Lee showed Tavenner and Moran how Shirley’s treatment had progressed. The original wound spanned across her foot, but as the two visitors saw, the remaining evidence of the wound was only about an inch long. Bellome explained that her agency was able to care for Shirley at home for two months at half the cost of a one-day hospital stay.
Moran was curious to see how the VNA uses technology to improve care for patients. “Home care is leading the way in the use of technology, but there is a need for CMS to reimburse for telehealth services and purchases of the appropriate equipment,” Bellome told them. She also demonstrated how the VNA uses different telemonitor attachments to monitor blood pressure, weight, heart rate, and oxygen concentration, thereby facilitating care coordination and reducing re-hospitalizations. The VNA is able to remotely monitor the information, check in with the patient by phone to see if there are abnormal trends, and share data with physicians. The devices can also be used by patients for reminders and educational information, Bellome explained, and her comment led Tavenner to mention potential funding opportunities through innovation grant programs being developed by CMS.
Bellome also cautioned Moran and Tavenner about current proposals to impose a copayment on home health care. If beneficiaries have to make a copayment, she explained, they will be more likely to put off necessary treatment, leading to increased hospitalizations and care in more costly settings. Nurse Lee added that “the majority of the patients I see struggle to make ends meet and would not be able to afford a copayment.” Moran acknowledged that he could see his own father refusing to receive treatment if he had to come up with a copayment for services.
"A home visit can be a very powerful way to help government leaders understand the value of home care and hospice,” said NAHC President Val J. Halamandaris. “We are grateful to Senator Moran for his advocacy of home care and his efforts to bring the head of CMS on a home visit in Kansas. We are pleased Acting Administrator Tavennerwas able to see first hand how home care can benefit patients who wish to recover at home while providing cost savings to the Medicare and Medicaid programs.”