Missouri Nurse - January 2022

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2 Missouri Nursing News January, February, March 2022 Non-Physician Certification in Home Health Care Blocked by State-Level Barrier Existing Missouri law requires orders for home health services to be written by a physician; however, many Missourians, particularly those in rural areas, see an advanced practice registered nurse (APRN) or physician assistant (PA) for their primary care needs. For these patients, orders for home health services must be written by a physician provider regardless of whether the physician has an existing relationship with the patient, has not been caring for the patient or has even met the patient. This administrative requirement is not necessary to achieve good clinical outcomes, can disrupt the continuity of care, and can result in denials or delay of available care for our seniors. Thankfully, the ''Coronavirus Aid, Relief, and Economic Security Act'' or the ''CARES Act,” which was signed into law on March 27, 2020, permanently changed federal law so that APRNs and PAs can now order home health services for their patients. It was a modernization to the Medicare program! Now that the federal law changed, it is necessary to update Missouri’s home health law by simply changing the definition of home health services to include APRNs and PAs in the list of providers who may order home health services for their patients. Sounds easy right? Unfortunately, the answer is NO! Legislation to update Missouri’s home health statute was filed during the 2021 Missouri legislative session (will be filed again in the upcoming 2022 session) and was met with strong opposition from various physician trade organizations. While the proposed legislation greatly benefits Missouri’s seniors, it would not expand the scope of practice for APNS or PAs and does not impact existing relationships between physicians and their patients, however, it seems the decades long “turf war” continues on in Missouri. In April of 2020, the state of Missouri implemented a COVID-19 waiver mirroring the new federal law. During these past 19 months, thousands of patients, under the sole care of a nurse practitioner or physician assistant, have been admitted for home health services. In a recent survey of home health providers, 90% responded that the process for ordering and approving home health services under a APRN or PA was more efficient and allowed the patient a timely admission. Data from the care provided during the waiver period clearly demonstrates that this benefits physician workload and patient outcomes and satisfaction. COVID-19 continues to present challenges, and even when we emerge from the pandemic, we face a permanently changed healthcare market. A 2021 Mercer study, US Healthcare Labor Market, found that “by 2026, it is estimated that 23,000 primary care physicians will permanently leave the profession, leaving a vacuum of demand for primary care providers. More and more often, physician assistants (PAs) and nurse practitioners (NPs) will step in to fill that demand. About 40,000 new PAs and NPs enter the workforce annually, providing a steady stream of new entrants who are qualified and ready to fill the extra demand resulting from retiring physicians.” This data only reinforces the recent permanent change in federal law and further highlights the need for Missouri lawmakers to follow suit. We must take this opportunity where we can make decisions now that will help address the coming physician workforce issue and put a process in place that will not only improve the continuity of care but will continue and enhance the home health benefit for patients. The federal government, through bi-partisan efforts, recognized APRNs and PAs inability to sign home health orders as a potential delay in care, increased risk of poor outcomes and increases in the cost of care and took the steps to permanently make the change in federal law. It is time Missouri lawmakers put patients over politics and allow Missouri’s home health statute to include APRNs and PAs ability to certify home health services. Respectfully Submitted, Carol Hudspeth, Executive Director Missouri Alliance for Home Care MONA’s Mission, Vision, Purpose Our Mission Registered Professional Nurses advancing the profession to improve health for all Missourians Our Vision Missouri nurses are a powerful, unified force engaging consumers and transforming health and health care. Our Purpose To act and speak for the nursing profession and Missouri’s professional nurses and to promote and enhance safe and accountable professional nursing practice. MONA’s Official Publication: The Missouri Nursing News is an official publication of the Missouri Nurses Association (MONA) (a constituent member of the American Nurses Association), published quarterly every January, April, July and October. The MONA provides education, networking opportunities, publications and other products and services to its members and extends its mission to all nurses in Missouri. Phone: (573) 636-4623 Email: director@missourinursess.org Web site: www.MissouriNurses.org Mail: c/o Midwest Multistate Division 3340 American Avenue, Suite F Jefferson City, MO 65109 Questions about your nursing license? Contact the Missouri State Board of Nursing at: (573) 751-0681. This newsletter is a service of the Missouri Nurses Association and your receipt of it does not mean you are automatically a member. Your membership in support of this work is encouraged; please visit www.missourinurses.org. Writer’s Guidelines: • Any topic related to nursing will be considered for publication in the Missouri Nursing News. • Authors are not required to be members of the MONA; however, when space is limited, preference will be given to MONA members. • Photos are welcome, digital is preferred. MONA does not assume responsibility for lost or damaged photos. • Use current APA formatting for any article requiring citation. • Provide a brief author biography indicating the author’s nursing experience and/or expertise with the paper’s content. o Limit the author’s biography to 4-sentences. • Submitted material is due by the 10th of the month in March, June, September and December of each year. • The peer-review is blinded; submit the title page separately from the article • Submit the title page and article as Word documents to info@missourinurses.org For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa 50613, (800) 626–4081, sales@aldpub.com. MONA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement. We are looking for LPNs in Springfield and Bolivar $20/hr for part time + $1 Weekend Shift Differential For more information and to apply visit https://easylivinginc.org Acceptance of advertising does not imply endorsement or approval by the Missouri Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. MONA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of MONA or those of the national or local associations.
January, February, March 2022 Missouri Nursing News 3 What is Value-Based Purchasing? Sarah Oerther, Ph.D., RN, ANEF Since 2019, in the United States, people older than 65 years of age have outnumbered those younger than five years of age, and this trend is true in Missouri (United States Census Bureau, 2021). As Missouri residents live longer and age, more of them will develop multiple chronic conditions, such as heart disease, dementia. Many also will develop functional limitations, including difficulty with the activities of daily living such as managing one’s household due to a lack of mobility. Researchers have found that patients who can remain in their home with support services benefit in multiple ways (Landers et al., 2016; Pozniak et al., 2021). For example, often they receive more personalized care, maintain greater independence, are safer and more comfortable, and have a decrease in unnecessary trips to the hospital. Collectively, these benefits may delay or even prevent admission to assisted living and nursing home facilities, which often are more expensive forms of care as compared to the provision of support services in the home. On the other hand, the provision of support services in the home may be subject to fewer quality controls because healthcare providers traveling to homes may have less support from and supervision from peers as compared to facility-based care (Landers et al., 2016; Pozniak et al., 2021). To help ensure the quality of the provision of support services in the home, in 2016 several states began to implement the Home Health Value-Based Purchasing (HHVBP) Model developed by the Centers for Medicare & Medicaid Services (CMS) (The Centers for Medicare & Medicaid Services, 2021). "Valuebased purchasing," also known as pay for performance (P4P), is a model of payment that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures (Chee et al, 2016; Landers et al., 2016). Clinical outcomes, such as longer survival, are difficult to measure. Therefore, pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. In addition, this model penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care (Chee et al, 2016; The Centers for Medicare & Medicaid Services, 2021). The HHVBP Model was designed to give Medicarecertified home health organizations incentives to deliver high quality and efficient care (The Centers for Medicare & Medicaid Services, 2021). By adjusting payments based on the quality of care, rather than the quantity of services provided, the HHVBP Model enables CMS to tie home health organizations’ payment to their performance. To support the efforts of the Department of Health and Human Services, the HHVBP Model helps to spend healthcare dollars wisely. This includes supporting efforts to deliver better overall care, which contributes to healthier people and communities (Landers et al., 2016; The Centers for Medicare & Medicaid Services, 2021). In November 2021, the CMS acted to improve home health care for older adults and people with disabilities through a final rule, which aims to shift payments from a volume-based system to a value-based system for Medicare sponsored home health services. Nationwide, the HHVBP Model provides a critical update to the Home Health Prospective Payment System (PPS). This includes updates to the payments rates for home infusion therapy services for Calendar Year (2022). All these changes have been designed to harmonize with existing statutory and regulatory requirements, nationwide (The Centers for Medicare & Medicaid Services, 2021). One of the greatest health care challenges facing the State of Missouri is making sure that aging adults with multiple chronic illnesses can remain as independent as possible. Nurses need to understand these changes to reimbursements for the provision of home health services and respond accordingly. As nursing continues to meet the challenge of providing affordable health care to aging adults in their homes, nurse educators should look to the guidance offered in the Future of Nursing 2030 Report and expanding the training of future nurses to continue to work effectively at the clinical bedside and beyond. References Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current state of value-based purchasing programs. Circulation, 133(22), 2197–2205. https://doi. org/10.1161/CIRCULATIONAHA.115.010268 Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., MacMillan, R., Jones, K., Bowles, K., Dowding, D., Lee, T., Moorhead, T., Rodriguez, S., & Breese, E. (2016). The future of home health care. Home Health Care Management & Practice, 28(4), 262–278. https://doi.org/10.1177/1084822316666368 Pozniak, A., Lammers, E., Mukhopadhyay, P., Cogan, C., Ding, Z., Hanslits, K., Ji, N., Jin, Y., Repeck, K., Schrager, J., & Turenne, M. (2021). Impacts of the home health value-based purchasing ( HHVBP ) model after the first payment adjustment year. Health Services Research, 56(S2), 72–72. https://doi.org/10.1111/1475-6773.13799 The Centers for Medicare & Medicaid Services. (2021). Home health value-based purchasing model: CMS Innovation Center. Innovation Center. Retrieved from https:// innovation.cms.gov/innovation-models/home-healthvalue-based-purchasing-model. United States Census Bureau. (2021). U.S. Census Bureau quickfacts: Missouri. Retrieved from https://www. census.gov/quickfacts/MO.
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