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National Association for Home Care & Hospice
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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

MedPAC Poised to Recommend Zero Update for Hospice for FY2016

January 8, 2015 04:54 PM

The Medicare Payment Advisory Commission (MedPAC) met in late December to discuss Medicare payment policy recommendations for inclusion in its forthcoming annual March Report (Report) to Congress. In making recommendations, the Commission uses a standard framework to assess payment adequacy, including provider access to capital, financial margins, access to care - including numbers and growth in providers, as well as growth in utilization - and quality.  In addition to preliminary approval that the Report recommend elimination of the update for hospice payments in Fiscal Year (FY) 2016, Commissioners supported reprinting of previous MedPAC recommendations that have not yet been implemented.

Specifically, those recommendations state that the hospice payment system be reformed to better reflect the costs of hospice care over the course of the episode and that the Centers for Medicare & Medicaid Services (CMS) conduct medical review of hospice providers that have a high proportion of long-stay patients.  It should be noted that the latter recommendation (related to medical review) had not been implemented by CMS due to a legislative drafting error; that error was corrected as part of the IMPACT Act, which was signed into law in October.

Presentation slides and a transcript of the discussion are available online.  MedPAC’s next meeting, at which final votes will be taken on payment recommendations for FY2016, will be held on Jan. 15-16, 2015.

As prelude to discussion of its hospice recommendations, MedPAC staff provided insights into the current state of hospice care in the United States.  During 2013, more than 1.3 million Medicare beneficiaries were provided hospice services by over 3,900 hospice organizations; Medicare hospice outlays for that year were approximately $15 Billion. 

In recent years, the growth in hospice provider supply has been driven largely by entry of for-profit hospices into the field.  Between 2012 and 2013, the percent of Medicare decedents using hospice services increased from 46.7% to 47.3%.  Use of hospice has grown most rapidly among beneficiaries aged 85 and older. In 2013, 55 percent of these beneficiaries used hospice at the end of life.  In recent years, average length of stay has remained relatively stable at about 17 or 18 days.  About 25 percent of decedents have a length of stay of 5 days or less and lengths of stay for 10 percent of decedents exceed 246 days.  For-profit providers generally have longer lengths of stay than non-profits -- averages of 105 days vs. 68 days.

MedPAC projects an average margin of 6.6 percent for hospices in 2015.  This estimate takes the following into account: the 2012 margin, market basket updates, legislative adjustments, the impact of the sequester, the phase-out of the budget neutrality adjustment factor (BNAF), and assumptions about increased cost growth in 2014 and 2015 due to increased regulatory requirements.  Absent the sequester, the average margin projection would be 2 percentage points higher.

Commission members engaged in additional hospice-related discussion on a number of issues.  Of note were discussions of differences between for-profit and non-profit hospice organizations and their use of financial margins, concerns about the small amount of the total Medicare budget that is spent on hospice ($600 B. vs. $15 B.), discussion of how use of the hospice benefit could be expanded while maintaining the element of individual choice, and a broader discussion about provider and patient engagement in discussions of end-of-life choices.




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