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Testimonials

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. 

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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.

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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

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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 element...it’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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

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

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

National Quality Forum Advances Hospice Quality Measures

Final opportunity for pre-rulemaking public comment closes Jan. 12
January 8, 2016 08:35 AM

As reported in the December 2, 2015 issue of NAHC Report, each year the National Quality Forum (NQF) convenes its Measure Applications Partnership (MAP) to review standardized performance measures that the Department of Health & Human Services (HHS), including the Centers for Medicare & Medicaid Services (CMS) is considering for use in federal health programs. In late November the MAP released its plan for the current review cycle; the plan included two specific measures under consideration for the Hospice Quality Reporting Program (HQRP), one for oncology care and timely referral to hospice, and six measures under consideration for the Home Health Quality Reporting Program (HHQRP). Also under consideration is an advance care plan measure for the Medicare Shared Savings Program (MSSP). Coverage of the latest action related to the home health measures was reported in the January 6 issue of NAHC Report. This article will address hospice quality measures developments.

Since the November issuance, the MAP requested initial public comment, held meetings to review the measures under consideration, and taken preliminary action. The MAP is accepting comment on its preliminary action through January 12, 2016, at 6 p.m., and will meet again at the end of January to finalize its recommendations to HHS/CMS. If CMS chooses to utilize any of the measures under consideration, it will include those in forthcoming rulemaking (as part of the annual payment rules) to once again allow for public comment.

Following is information related to the current status of hospice-related measures under consideration by the MAP for use by CMS/HHS, along with some preliminary concerns/comments that the National Association for Home Care & Hospice (NAHC) has submitted, as well as NAHC’s draft comments for submission during this second public comment period.

Hospice stakeholders and others may comment on the measures online by 6 p.m. on January 12 here. Please send your feedback on hospice-related measures to Katie Wehri at Katie@nahc.org.

MUC15-227

Measure: Hospice visits when death is imminent - Assess hospice staff visits to patients and caregivers in the last week of life

Members of the hospice staff considered for the measure include: nurses (registered nurse, licensed professional nurse or nurse practitioner if acting in the role of a nurse), hospice aides, physicians (or nurse practitioner or physician assistant if acting as the attending physician), chaplains or spiritual counselors, therapists (physical therapist, occupational therapist or speech language therapist), medical social workers, and volunteers. General inpatient and continuous care visits made are excluded from this measure.

MAP Preliminary Decision: Encourage continued development

MAP Rationale: CMS noted that based on pilot results and feedback from the Technical Expert Panel (TEP) and Caregiver Workgroup, this measure was recently updated and is now a set of two measures:

Measure 1 assesses percent of patients receiving at least one visit from registered nurses, physicians, nurse practitioners or physician assistants in the last three days of life. Measure 2 assesses percent of patients receiving at least two visits from medical social workers, chaplains or spiritual counselors, licensed practical nurses and hospice aides in the last seven days of life. CMS also noted that due to these revisions, the measure(s) would require further testing and analytics prior to implementation.

Numerator:The numerator of this measure will be the number of patients in the denominator who receive hospice staff visits in the last week of life. Members of the hospice staff whose visits are considered for the measure include: nurses (registered nurse, licensed professional nurse or nurse practitioner if acting in the role of a nurse), hospice aides, physicians (or nurse practitioner or physician assistant if acting as the attending physician), chaplains or spiritual counselors, therapists (physical therapist, occupational therapist or speech language therapist), medical social workers, and volunteers.

Denominator:The denominator is the number of hospice patients who are discharged as expired within a defined target period.

Exclusions:Patients who received continuous home care or general inpatient care only in the last week of life.

NAHC Initial Comment:Hospices do not currently collect and report all the visit data that is included in this measure and only some of it is captured on the Medicare hospice claims.  The visits for nurses (registered nurse, licensed professional nurse or nurse practitioner if acting in the role of a nurse), hospice aides, physicians (or nurse practitioner or physician assistant if acting as the attending physician), therapists (physical therapist, occupational therapist or speech language therapist), and medical social workers are reported on hospice claims but chaplains or spiritual counselors and volunteers are not. This creates a burden for hospices as they do not currently have the infrastructure to capture and report this data. Regardless, any measure utilized in the HQRP must be properly vetted to ensure that it is, in fact, related to quality of hospice care to reduce the incidence of inappropriate conclusions that might be drawn from the measure. We believe visit measures are practice indicators that neither take into account the condition and other characteristics of the population served by the hospice nor the quality of care delivered during the visit. A visit measure should not be used in the HQRP unless its direct relationship to hospice quality has been proven, and that connection can be readily drawn by the public.

NAHC Comment Round 2:We appreciate the MAP’s preliminary recommendation to encourage continued development of this measure and assume the inconsistency between the numerator and the description of the two measures would be resolved with continued development. We believe the development of the measure will bring to light some of the concerns with this measure. For instance, currently there is difficulty in obtaining the visit data for some of the disciplines, a visit is not yet defined for the measure, and not all hospices utilize all of the disciplines (i.e. physician’s assistant, nurse practitioner). Further, currently under Medicare, physician assistants do not have an explicitly defined role. It would be helpful if the MAP and CMS could provide clarification as to how this would be addressed should the measure be implemented. Any visit measure should not be used in the HQRP unless its direct relationship to hospice quality has been proven, and the public can readily draw that connection.

The definition of a visit that hospices are most used to currently is that found in the Medicare Claims Processing Manual, Chapter 11. Here a visit is described as:

The total number of visits does not imply the total number of activities or interventions provided. To constitute a visit, the discipline, (as defined above) must have provided care to the beneficiary. Services provided by a social worker to the beneficiary’s family also constitute a visit. For example, phone calls, documentation in the medical/clinical record, interdisciplinary group meetings, obtaining physician orders, rounds in a facility or any other activity that is not related to the provision of items or services to a beneficiary, do not count towards a visit to be placed on the claim. In addition, the visit must be reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patient’s plan of care.

As CMS acknowledges in this Manual, a visit does not imply the total number of activities or interventions provided. There are many activities and interventions that the disciplines listed for this measure provide that we believe directly impact quality but are not currently counted by hospices as visits. These include interventions such as hospice physicians consulting with the attending physician regarding the plan of care, chaplains making calls to the patient’s established clergy for assistance with implementation of the plan of care, volunteers providing supportive services to the patient’s family that reduce caregiver stress while not actually visiting the patient (i.e. running errands, planting a garden, organizing outstanding bills, cleaning out a garage and other such items that are causing stress for the caregiver/patient, etc.). Again, any visit measure should not be used in the HQRP unless its direct relationship to hospice quality has been proven, and the public can readily draw that connection.

MUC15 – 231

Measure:Hospice and palliative care composite process measure - Assess percentage of hospice patients who received care processes consistent with guidelines at admission

This is a composite measure based on select measures from 7 NQF- endorsed measures: NQF #1641, NQF #1647, NQF #1634, NQF #1637, NQF #1639, NQF #1638, and NQF #1617. These measures are part of the Hospice Item Set (HIS), and this composite process measure calculates the patients who meet the numerator criteria for all of the select measures of the above-referenced NQF measures.

MAP Preliminary Recommendation:Encourage Continued Development

MAP Rationale:Although MAP encouraged continued development, members noted the need to balance this measure with what is relevant to the patient, and not limit to only check box quality measures.

Numerator:The numerator is patients who meet the numerator criteria for all of the select measures of the 7 NQF-endorsed measures: 1641, 1647 (modified), 1634, 1637, 1639, 1638, and 1617. Specifically, these measures are: NQF #1641 Hospice and Palliative Care – Treatment Preferences NQF #1647 (modified) Beliefs/Values Addressed (if desired by the patient) NQF #1634 Hospice and Palliative Care – Pain Screening NQF #1637 Hospice and Palliative Care – Pain Assessment NQF #1639 Hospice and Palliative Care – Dyspnea Screening NQF #1638 Hospice and Palliative Care – Dyspnea Treatment NQF #1617 Patients Treated with an Opioid Who Are Given a Bowel Regimen

Denominator:All hospice patients

Exclusions:Patients under 18 years of age

NAHC Initial Comment:This measure uses existing and readily available data and more closely aligned with hospice processes directly impacting quality of care.

NAHC Comment Round 2:We appreciate the MAP’s preliminary recommendation to encourage continued development of this measure and the recognition that this measure be balanced with what is relevant to the patient, and not limited to only check box quality measures.

MUC15-415

Measure:Proportion admitted to hospice for less than 3 days

Proportion of patients admitted to hospice for less than three days - Percentage of patients who died from cancer, and admitted to hospice and spent less than 3 days there

MAP Preliminary Decision:Support

MAP Rationale: Approximately 500,000 patients will die of cancer in 2015. A 2014 study (Obermeyer Z, Makar M, et al) found that in Medicare fee-for-service beneficiaries with poor-prognosis cancer, a comparison of those receiving hospice care (60%) vs. not (control) showed that hospice patients had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life, along with significantly lower total costs during the last year of life. This NQF-endorsed measure addresses an important gap area identified by MAP in end-of-life care for reporting by oncologists, is fully-specified and tested, reflects patient-centered care, and addresses the important areas of care coordination and appropriate use. MAP discussed the timeframe of 3 days suggesting that a longer time, such as seven days or more might be better. MAP noted that the NQF Committee reviewing this measure for endorsement also suggested that a longer timeframe might be useful. MAP recommends that the NQF Committee re-evaluate the timeframe of this measure during NQF's upcoming cancer project and consider potential unintended consequences of patients being moved to hospice to avoid counting in the mortality statistics. MAP noted that the measure could be expanded beyond cancer patients. Patients and families value this type of information for public reporting.

Numerator:Patients who died from cancer and spent fewer than three days in hospice

Denominator:Patients who died from cancer who were admitted to hospice

NAHC Initial Comment:This MIPS measure is very good. Hospices have reported seeing an uptick in late oncology referrals as payment policies have changed. We recommend that it be considered for broader utilization by other provider types, for causes of death other than cancer, and the length of stay be extended to a longer timeframe. Earlier referral to hospice means end-of-life pain and symptoms can be aggressively addressed and crises, such as hospitalizations, can be avoided.

NAHC Comment Round 2:We applaud MAP for supporting this measure and recognizing that the timeframe perhaps should be extended as well as recognizing the value of this type of measure with patients who have a diagnosis other than cancer.

MUC15 – 578

Measure:Advance care plan

Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan

MAP Preliminary Decision:Support

MAP Rationale:This measure is aligned with PQRS/MIPS, addresses an important need for patients and caregivers and is a cross-cutting communication and care coordination measure applicable to all Medicare patients.

Numerator:Patients who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

Denominator:All patients aged 65 or older

No exclusions

NAHC Initial Comment:This measure for MSSP is a good starting point to promoting advance care planning, a necessary component to quality care. We recommend that this measure be added to the quality programs of other provider types and, eventually, be expanded to include measures assessing provider compliance with patient’s advance directive. Consideration should also be given in the future to including in the measure assessment of whether providers inform patients of the availability of advance care planning discussions, and provide referral in cases where the patient indicates an interest, if not directly having the discussion. This would be an especially appropriate measure for all physicians considering the fact that two new physician billing codes for advance care planning were added to the Physician Fee Schedule in 2016.

NAHC Comment Round 2:As submitted in previous comments, we believe this measure is a good starting point to promoting advance care planning, a necessary component to quality care. We recommend that this measure be added to the quality programs of other provider types and, eventually, be expanded to include measures assessing provider compliance with patient’s advance directive. Consideration should also be given in the future to including in the measure assessment of whether providers inform patients of the availability of advance care planning discussions, and provide referral in cases where the patient indicates an interest, if not directly having the discussion. This would be an especially appropriate measure for all physicians considering the fact that two new physician billing codes for advance care planning were added to the Physician Fee Schedule in 2016.

 

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