First-time Attendees: Logistics
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1 First-time Attendees: Logistics Thomas Cornwell, MD President, AAHCM AAHCM
2 Downstream Revenue: HomeCare Physicians Referrals to CNS Home Health and Hospice Home Health Hospice Private Duty HCP Referrals 3,235 1, CNS Total 41,793 8, Percent 7.80% 13% 9.50% CNS Home Health and Hospice is owned and operated by Cadence Health which also owns and operates HomeCare Physicians % of 4,633 Dr. Cornwell s certifications and recertifications for home health were with CNS. 53% were with 60 other home health agencies. In many of these cases the outside home health agency referred the patient to HCP.
3 Marketing: HomeCare Physician 2013 Referral Sources Source Referrals Percent Doctors 61 19% HHA 58 18% Hospital/Rehab 57 17% ALF 44 13% Group Homes 40 12% Word of Mouth 32 10% Other 34 10% Total % Note: These numbers are representative of a very mature program. New program referrals largely come from home health agencies (80%).
4 HomeCare Physicians Payer Mix 2013 Payer Source Number % Medicare Only % Medicare + Supplemental % Medicare + Medicaid 98 9% Medicare Advantage 29 3% Medicaid Only 24 2% Medicaid Manage Care 31 3% Insurance 57 5% Uninsured 9 1% HMO Only 6 1% Total %
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6 Medicare House Call Codes/Payments 1997 New New (Min) AHCCS 3 IDPA $ (20) $57.53 $58.99 $43.91 $ $ (30) $77.58 $85.34 $63.29 $ $ (45) $ $ $ $ (60) $ $ $ $ (75) $ $ $ $ Estab Est. (Min) AHCCS 3 IDPA $ (15) $45.43 $59.39 $44.18 $ $ (25) $65.54 $89.64 $66.84 $ $ (40) $94.92 $ $ (60) $ $ $ $ Additional 1998 higher level Medicare house call codes 2 IDPA: Illinois Department of Public Aide 3 Arizona Health Care Cost Containment System (Arizona Medicaid) Shaded payments are most frequently used house call codes Note: Medicare Payments vary by locality. These are for Locality 15. Place of Service Code for Home = 12
7 Domiciliary (Assisted Living) CPT Codes/ Payments 2005 New New (Min) AHCCS 3 IDPA $ (20) $62.80 $59.37 $44.18 $ $ (30) $91.76 $86.27 $63.83 $ $ (45) $ $ $ $ (60) $ $ $ $ (75) $ $ $ $ Estab Estab. (Min) AHCCS 3 IDPA $ (20) $48.73 $64.61 $48.03 $ $ (30) $76.88 $ $75.09 $ $ (40) $ $ $ $ (60) $ $ $ $ Additional 2006 higher level Medicare house call codes 2 IDPA: Illinois Department of Public Aide 3 Arizona Health Care Cost Containment System (Arizona Medicaid) Shaded payments are most frequently used house call codes Note: Medicare Payments vary by locality. These are for Locality 15. Place of service code = 13
8 Care Plan Oversight (CPO) and Home Health Certification / Re-certification Payments Medicare Reimbursement IDPA 3 Total # Total # Total # Total # CPO HH G $78.73 $ $ $ CPO Hospice G $78.73 $ $ $ HH Cert G $77.50 $56.61 $ HH Re-cert G $65.35 $43.78 $ In 2001 CPT codes and changed to G0181 and G0182 respectively 2 Medicare began paying for certification and re-certification of home health in IDPA: Illinois Department of Public Aide Note: Medicare payments vary by locality. These payments are for locality 15.
9 House Call Program Logistics: Billing other commonly billed procedures CPT Procedure Medicare $ Debride: Subcutaneous $ Debride: Muscle $ Toenail Debridement $ Dest. granulation tissue (AgNO3) $ Unna Boot $ Change G-tube $ Cerumen Removal $ EKG $ Rhythm Strip $ Medicare Payments vary by locality. These are for Locality 15 for 2014.
10 HCP Patient Satisfaction FY13 N=200 % Excellents Level of support provided your family and/or caregiver 82% Provider spending adequate time and not seeming rushed 84% Provider s level of courtesy and friendliness 91% Provider s explanation of medical condition and treatment 83% Provider s level of compassion 85% Ability to obtain a timely house call for an urgent problem 82% Staffs level of courtesy and caring with the office is called 89% Overall quality of care provided by HomeCare Physicians 88%* Likert Scale: Poor, Fair, Good, Very Good, Excellent * Other responses: Very good 9%; Good 3%; Fair 0%; Poor 0%
11 HCP Patient Satisfaction FY12 N=152, FY12 N=152 Respondents were asked in the past 12 months: Yes No Uncertain FY13 FY12 FY13 FY12 FY13 FY12 1. HCP s services have reduced my trips to the Emergency Room: 82% 85% 13% 9% 5% 6% 2. HCP s services have helped me avoid hospitalizations: 80% 87% 15% 10% 5% 3% 3. HCP s services have helped me avoid being placed into a nursing home: 80% 84% 10% 11% 10% 5%
12 5/14/09 2/18/11 (1 year, 9 months (645 days)) 44 Emergency Department Visits (avg 16 days between visits) 27 Hospitalizations over half required ICU days (avg 25 days between stays) HCP First Visit 3/2/11 (365 Days) 1 ED visit + 1 Hospitalization (May 2011) Expected: 25 ED visits, 15 Hospitalizations Following Year: 0 ED, 0 Hospitalizations
13 1/1/12-12/5/12 17 Emergency Department (ED) Visits 13 Hospitalizations (69 Days) Multiple rehab stays HCP First Visit 12/5/12 1 ED Visit/1 Hospitalization 12/18/12 (4 days) 0 ED Visits/0 Hospitalizations in 2013 Passed away at home 7/22/13 on hospice
14 Cost of End of Life Care 25.1% of the $556 billion Medicare dollars goes to care in last year of life Riley, Lubitz; Health Services Research 4/2010 From 2000 to 2009 deaths increased at home 30.7% to 33.5% and decreased at hospitals from 32.6% to 24.6%, use of hospice increased from 21.6% to 42.2% ICU stays in last month increased from 24.3% to 29.2% Hospitalizations in last 3 months of life increased from 62.8% in 2005 to 69.3% in 2009 Short hospice stays (<3 days) increased 22.2% to 28.4% (40.3% were preceded by hospitalization with ICU stay) Teno; Change in End of Life Care for Medcare Beneficiaries JAMA 2/2013
15 End-of-Life Care HomeCare Physicians Patient Deaths Number Percentage Total % Home 1,521 74% Hospital % Nursing Home 102 5% Unknown 37 2%
16 HomeCare Physicians and End-of-Life Care 9/1/12-8/31/ deaths 79% died at home 71% where on hospice Average length of stay 2.1 years Median length of stay 0.56 years 25 died in first 30 days 23 (92%) died at home : 898 referrals to health system owned CNS hospice 36% died in the first two weeks of service vs. >50% nationally HCP works with an additional six hospices Decreased hospital mortality: of 2,049 deaths over past 13 years 74% at home vs 33.5% nationally. This is additional 835 deaths at home over 13 years = 64 deaths per year = 5.4 deaths per month.
17 High-Cost Medicare Beneficiary Spending Top Quartile Second Quartile Bottom Half Medicare Spending % of Total Mean 85% $24,800 11% $3,290 4% $550 Total 100% $7,310 Medicare Spending % of Total Mean Top 5% 43.1% $63,030 Top 6-10% 18.4% $26,900 Top 11-25% 23.5% $11,430 Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services. Note: Spending reported in 2005 dollars
18 Average Traditional Medicare per capita Spending, 2009 $60,000 $55,763 $50,000 $40,000 $30,000 $20,000 $10,000 $4,584 $9,702 $- Bottom 90% Top 10% Average Source: The Kaiser Foundation
19 Costs of Care Before vs During HBPC for 2002 (per patient per year) *includes HBPC cost N=11,334 $103,048,728 Total Cost of VA Care Before HBPC During HBPC Change $38,228 $29,136* -$9,092 (- 24%) P < Hospital $18,868 $7026 $11,842 (- 63%) Nursing home $10,382 $1382 $9000 (- 87%) Outpatient $6490 $7140 $650 (+ 10%) All home care $2488 $13,588* $11,100 (+ 460%)
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24 Patient Assistance : Central DuPage Auxiliary donates $30,000 to patient assistance 4/00: HCP receives a $15,000 grant from DuPage County for the Patient Assistance Fund 2001 HCP receives a $300,000 estate gift to permanently endow the patient assistance fund
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27 HomeCare Physicians Public Relations Sun Times Front Page Tribune (6) Daily Herald (11) Local Newspapers (35) Medical Publications (21) TIME Magazine, UIC Magazine (cover) Television: PBS Healthweek, WGN News, local CBS, NBC, ABC News; 1998/1999 contacted by NBC Dateline; 2002 & 2009 contacted by Oprah Winfrey s producer
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