November 2018 Newsletter
Executive Director's Message
Jill and Family Hunt for a Tree

The Importance of C onnections During the Darker Days of the Year

As I write this, the holiday season is in full swing. In our family, annual traditions are treated with a good deal of reverence, especially by our teenage/young adult children who are getting ready to head out into the big, wide world. While new dishes can occasionally be introduced onto the Thanksgiving table, none can be eliminated - even the ones no one seems to eat (I'm talking about you, Brussels sprouts). The day after Thanksgiving, we drag our Thanksgiving houseguests, including our aging parents, to the local Christmas tree farm to cut our tree. As usual, this year we chose one that's a lot bigger in our living room than it looked outdoors. The process of getting it into the stand and covered in lights produced a few moments of predictable spousal conflict that the kids seems to count on and enjoy as much as any other ritual.
Traditions are important because they provide a sense of continuity even as things are constantly changing. My dad and his wife were regular holiday guests when our kids were small, but they're both gone now. Still, my kids are lucky enough to still have three spry grandparents in their lives. While several of them don't like to have their ages revealed, my husband and I are 50 and 55 and none of our parents were especially young when they had children. 
This year, my mother and my father-in-law joined us for the holiday. My mom is still running a small business and my father-in-law is still playing golf. Watching them got me thinking about the risks of social isolation in older adults. Both of them live alone. My mom lives in a city, so she has many public transportation options if the time comes that she can no longer drive. My father-in-law lives in a New York suburb where a car is really the only option. They each still have friends and activities they like to pursue, but they've also each lost their only sibling and some important friends. 
Social isolation is a major health and wellness concern among older people. I'm glad to see that helping older adults remain connected and engaged is emerging as a priority in many community and statewide efforts to improve the health and wellbeing of Vermonters. 

Jill Mazza Olson
Executive Director
Vermont Update
Last week, the VNAs of Vermont submitted comments on the proposed "Regulations for the Designation and Operation of Home Health Agencies" dated September 26, 2018. Our primary policy goals for the rule are to reduce barriers to access to long-term care services, better align state requirements with federal requirements, and reduce unnecessary administrative burdens. We will be working closely with state officials and other stakeholders to resolve these concerns before the rule is finalized. 

Federal Update

Since our last newsletter, the Centers for Medicare & Medicaid Services (CMS) has released the final home health prospective payment rule for calendar year 2019.  As expected, the rule includes a plan to phase out the "rural add-on" and outlines a new payment model known as the patient driven groupings model (PDGM) that CMS plans to roll out in 2020. 

The rural add-on represents approximately $1.2 million in reimbursement to Vermont home health agencies. These payments help defray the added costs of caring for people in rural communities. Across Vermont, home health and hospice agency caregivers drive more than 6 million miles every year to make 1 million visits, providing affordable, high-quality and essential health care services. All but two of Vermont's not-for-profit home health agencies serve communities that meet the federal definition of "rural." 
Under the methodology, one small agency in Vermont will see the rural add-on reduced from 3 percent to 1.5 percent beginning on January 1, 2019. Six agencies will see a reduction from a 3 percent add-on to a 2 percent add-on in 2020 and a 1 percent add-on in 2021 before payments go away entirely in 2022. 

The 2019 payment rule also includes a small increase, the first Medicare increase to home health agencies since 2009.  According to the National Association for Home Care and Hospice, Medicare cuts added up to a nearly 14 percent cut to the baseline between 2009 and 2018. The impact on Vermont agencies is not yet clear. 

Agencies are still analyzing the impact of the patient driven groupings model. The National Association for Home Care and Hospice is holding a series of regional briefings including one in the Boston area on March 13. Early estimates provided by CMS suggest that the impact on Vermont agencies will be neutral or positive.

Upcoming Events
Second Thursday of each month  | 3 to 4 p.m.
Hosted by VNAs of Vermont
QI Scholars Initiative: Space Available
Began September 27 | 3 to 4 p.m.
CME/CEUs offered for this event
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10-month program
Webinars and in-person sessions

November  29 | 11:30 a.m. to 1 p.m.
Hosted by VNAs of Vermont
Dec. 5, Jan. 30, Mar. 20 | 5:30 to 4 p.m.
Hosted by OneCare
In-person session
Dec. 5, Jan. 30, Mar. 20 | 3 to 4 p.m.
May register for the series or one webinar
Hosted by VNAs of Vermont
Two part series
December 11 & 13 | 11:30 a.m. to 1 p.m.
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Home Health:
December 12 | 2 p.m. to 4 p.m.
December 13 | 11:30 a.m. to 1 p.m.
Hosted by VNAs of Vermont
Two part series
December 13 | 3 p.m. to 4:30 p.m.
Hosted by VNAs of Vermont

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