We Appreciate, and Need, Nurses More than Ever

National Nurses Week

National Nurses Week celebrated nurses nationwide earlier in May, and nurses at Liberty HomeCare & Hospice Services make a major difference in their patients’ lives, in the care and compassion that they provide.

Patients and their families have complimented our nurses for their care, and we always want to continue to provide that kind of exceptional care for our patients. But an increasing shortage of nurses in the coming years may make maintaining that kind of care for our home care and hospice patients more challenging.

Nurse Shortage

The shortage of nurses in the three states Liberty serves – North Carolina, South Carolina, and Virginia – continues to grow. Between the three states, there is a shortage approaching 25,000 nurses. As sobering as that statistic is, the shortage is expected to grow in the next 10 years. In fact, one of every five jobs created in 2012 has been from the health care field, including nurses.

We need to encourage more people to consider the nursing industry, as our population continues to age. But how can it be done? Liberty offers an Educational Assistance Program that has aided some employees.

Capital grants can also aid nursing schools, as can the Nurse Education, Expansion, and Development Act. This federal act would give grants to nursing schools to increase the number of nursing faculty and students.  State legislation can also help improve opportunities for future nurses, and relieve some of the expected shortage.

Liberty HomeCare & Hospice Services aggressively recruits the top nurses in our coverage area. We know how vital they are to our patients’ care. We hope that these suggested measures and others can help make a difference, so all patients get the kind of care they deserve.

Maintaining Patient Trust Remains Home Care’s Goal

A disturbing news story out of Texas has made myself and everyone else associated with Liberty HomeCare & Hospice Services feel overwhelming shock and disappointment.

A doctor in Texas is allegedly the leader of the biggest Medicare fraud in U.S. history, involving more than $375 million from the Dallas, Texas area.

This incident is unacceptable, plain and simple, and doesn’t reflect the important work done by the home care industry. There are hundreds of thousands of home care workers in the Carolinas, Virginia, and the rest of the U.S. who do passionate and caring work. Indeed, these workers represent the highest moral and ethical standards in serving some of our communities’ most dependent and vulnerable seniors.

Liberty HomeCare & Hospice Services, as well as hundreds of other home care agencies, supports any effort to confront doctors or agencies that are abusing the Medicare and Medicaid systems and the patients we serve. If you are aware of any kind of abuse, or want more information, I urge you to take action by calling me directly at 1-910-815-3122 if it is related to Liberty or by visiting medicare.gov.

Expert Home Care is Vital for Seniors

The report from Texas is unsettling, but the staff of Liberty HomeCare & Hospice Services remains committed to enhancing the quality of life of our patients. We know that home care is a vital part of the health care industry, and won’t let the regrettable actions of a few taint the positive impact of so many others.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

HELP Hospice Act Vital Legislation Congress Should Approve

At Liberty HomeCare & Hospice Services, we hear all the time from the families of hospice patients, who tell us how our hospice care significantly helped them through the final stages of a loved one’s life. Studies have shown that hospice care can improve quality of life and reduce health costs. Indeed, it's not surprising that the utilization of hospice care continues to grow.

Affordable Care Act's Impact on Hospice Care

The Center for Medicare and Medicaid Services (CMS) has promoted Hospice Services for the last two decades.  That growth could face challenges in the coming years as a result of the Affordable Care Act, which recommends changes to hospice payment authority and a new face-to-face requirement for Medicare hospice patients.

HELP Hospice Act

But the proposed HELP Hospice Act can help patients adjust to those changes, while making the transition easier. The HELP Hospice Act, which has already received bipartisan support in the U.S. House of Representatives, features three core segments.

  • Any new payment methodology must first go through a two-year, 15-site demonstration program. This pilot program can help develop the reliable, evidence based, comprehensive data needed to determine which payment reform approach is best.
  • The HELP Hospice Act would increase hospice survey frequency, on average, to once every three years. This increase from the current average of 6 to 8 years would provide a better certification process, and allow for improved and appropriate regulatory oversight.
  • The HELP Hospice Act would modify the face-to-face encounter requirement by allowing clinical nurse specialists and physician assistants to also conduct the encounter, and allow hospice agencies seven days after the initial election of services to complete the requirement. These changes would help all agencies and particularly help small and rural hospices, which face operational constraints and may have to turn down patients who are most in need.

Many of the HELP Hospice Act’s principles do not cost any additional money, while still making a big difference for hospice organizations and their patients. All hospice patients and their families deserve the opportunity for the best care possible, and the HELP Hospice Act is a major step in that direction.


Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Medicare Change Resolution Needed Before New Year

Physicians who accept patients with Medicare could face a dark choice in 2012. On January 1, the Centers for Medicare & Medicare Services are scheduled to start paying Medicare claims at a 27 percent reduction from 2011 rates.

Issues for Physicians

Congress’s “super committee” has been meeting for weeks to determine ways to address the federal deficit. Health care leaders, including the American Medical Association, had hoped that Medicare reduction would be taken out of budget revisions. However, nothing has been accomplished yet.

That could mean that doctors will refuse to see new Medicare patients after the New Year. A recent article stated that more than half of the physicians in Texas would likely stop seeing patients if the cuts take place.

Unfortunately, those kinds of tough choices were already happening locally, even before the latest round of cuts. WRAL-TV in Raleigh, NC reported that in 2010 more than 80 physicians in N.C. stopped seeing Medicare patients, and more than 100 stopped in 2009.

Seniors Need Proper Care

The cost for physicians is often more than the payment that they receive from Medicare, which is even before this latest cut was proposed. So, it is understandable why a doctor might want to stop seeing those patients.

These latest cuts could trigger an even bigger decline in available physicians for local seniors. All patients need proper care, and these cuts will affect millions of seniors both locally and nationwide. AMA President Peter W. Carmel, MD, said this in regards to the budget stalemate:

“The deficit committee had a unique opportunity to stabilize the Medicare program for America’s seniors now and for generations to come,” he said. “Once again, Congress failed to stop the annual charade of scheduled Medicare physician payment cuts and short-term patches, which spends more taxpayer money to perpetuate a policy everyone agrees is fatally flawed.”

As Dr. Carmel mentioned, these cuts have been pushed off before. Delaying cuts isn’t the answer, finding a better solution is. Congressional leaders still have time, although the window is closing, to do just that. Let’s hope they can come up with a plan that serves everyone.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Home Care: The Best Way to End Hospital Readmission Trend

Recent media coverage of the Occupy movement from Wall Street to Wilmington illustrates the growing disenchantment with the status quo in America.

That kind of discord is also evident in the health care system, as skyrocketing costs continue to sap consumers and have detrimental effects on the economy. The new Affordable Care Act was signed as a way to curtail that, but no one can guarantee that it will stop the surge of health care expenses.

Hospital Readmission Issue

One thing we must curtail now is the rehospitalization of patients. Readmissions are a major drain on our economic system. The Wall Street Journal reports that 4.4 million hospital stays are from potentially preventable readmissions. Those readmissions are costing $30 billion a year, or roughly 10 percent of all money spent on hospital care.

One in five Medicare patients will be readmitted within 30 days after an initial visit, and in many instances, those repeat visits can be avoided.

In half of those cases, patients did not see a doctor before being readmitted. Many patients do not follow up with a doctor once they leave a hospital because they are fearful of ending up readmitted again or don’t understand the risks of missing a follow-up appointment. Patricia Rutherford, vice president of the Institute for Healthcare Improvement, acknowledged the problem to the Washington Post earlier this year.

“We don’t do a good job of coordinating care,” Rutherford said. “For very sick patients being discharged, 30 days is way too late to see a doctor.”

A Better Approach

Home care agencies such as Liberty HomeCare & Hospice Services can help better coordinate care for discharged patients and ease their concerns. Home care offers patients the option to be treated in the comfort of their own home. Home care saves millions of dollars each year, and can create faster recovery times for patients.

Recovery time at home increases even more with proper planning of care. Follow-up with patients is vital, including self-management programs, counseling, and developing exercise programs for recovery.

November is National Home Care Month

November is National Home Care Month, giving us all an opportunity to appreciate the valuable services that home care provides. But the benefits of home care aren’t just reserved for one month – home care can make a big difference year round.

That’s the message that patients and everyone else needs to understand. No one wants them to return to hospital rooms. Instead, those patients can get the care they need in the place they want – their home. Let’s get that movement started now.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Reducing Specialized Therapy Opportunities is the Wrong Idea for N.C.

October is National Physical Therapy Month

October is National Physical Therapy Month, and there’s a lot to celebrate. Physical therapy provides numerous benefits for patients. Physical therapy boosts patient recovery times, limits the risk of falls in the home, gives patients needed exercise, and improves independence.

At Liberty HomeCare and Hospice Services, we know these benefits have a direct, positive effect on our healthcare system. However, new guidelines being discussed in North Carolina would dramatically limit the amount of physical therapy that would be available to Medicaid recipients.

Latest Proposal by the NC Department of Health and Human Services

According to the latest proposal by the North Carolina Department of Health and Human Services, Medicaid recipients would only be eligible for a total of three home health therapy visits per year. This includes physical therapy, speech therapy, and occupational therapy combined.

That is a dramatic decrease from current standards. Currently, patients receive physician ordered therapy according to the patient’s individual needs.  Giving them the opportunity to achieve optimal outcomes and avoid the costly complication of re-hospitalization.

There are also several serious issues that need to be addressed about the proposal. How will a doctor know whether a patient has used up their three visits for the year (no such database currently exists for them), and how will the new limitations affect physicians’ recommendations? Limiting the patient to only three visits would dramatically reduce any benefit they can receive from such services. In fact, allowing only three visits is not much better than eliminating their availability entirely.

All of that is potentially bad news for Medicaid patients in North Carolina.  This was the result when the legislature passed the new state budget.  This reduction doesn’t benefit anyone.  This new policy doesn’t help the patient, and it doesn’t help the Medicaid system, because less therapy will create more re-hospitalizations. That will further strain the system and cause costs to continue to rise.

Why push for a plan where nobody wins? There has to be a better way.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Doctors’ Prognosis: New Face to Face Rule Hinders Home Care

A new Medicare rule is only a few months old, but it is already having a detrimental effect on home care in the Carolinas, Virginia, and even nationwide.

New Medicare Rule

The National Association for Home Care & Hospice conducted a survey of physicians recently to see what kind of impact the new face to face requirement has had since it was instituted April 1. The results of that survey illustrated just how much the new rules have impacted home health care:

• 62% of physicians say patients are less likely to be referred to home health care due to the new documentation requirements
• 73% of the physicians say the documentation requirements will result in a negative impact on the health of Medicare
• 93% consider the face-to-face documentation requirements more difficult than previous certification requirements and thus, want them simplified

Those findings illustrate why the new rule, while developed with good intentions, is not in the best interest of people who are affected the most. The extensive documentation requirements are a barrier to many patients, who may be intimidated by the need to provide such thorough information. Physicians also suffer from the new rule, as they must also provide unprecedented details about why a particular patient is eligible under Medicare coverage.

Less Patient Referrals

The most troublesome news is that the vast majority of physicians believe that the new rule will result in fewer patients referred to home care, which will negatively impact the health of thousands. Home care is a vital part of health care in this country. In fact, this article states that America needs to take advantage of all the benefits that home health care provides. This new rule was designed to increase a physician’s involvement in patient care. However, with patient numbers declining, it has had the opposite effect.

Liberty HomeCare & Hospice Services

Liberty HomeCare & Hospice Services is hopeful that new, less stringent requirements are created soon. In the meantime, we will remain dedicated to educating patients and physicians about the new rule and helping patients receive the care they need and deserve.

Tony Zizzamia
President, Liberty HomeCare & Hospice Services

Home Care: A Health Care Idea We Can All Support

Finding a common cause in America can prove as challenging as balancing the federal budget. Citizens throughout North Carolina have differing views on politics, and particularly about health care. However, there is one health care ideal that crosses property lines and party lines, which is the importance of home care.

November is National Home Care Month

November is National Home Care Month. No matter what Americans think of the recent health care reform law, they believe in the importance of home care. A recent study by Genworth Financial showed that 80 percent of respondents preferred receiving treatment in the home instead of outside surroundings. Another in-depth study by Avalere Health concluded that patients receiving Medicare home health services soon after a hospital discharge saved Medicare almost $2 billion over those who did not receive such care. Those receiving home care get better faster at a significantly diminished cost compared to those who are treated in hospital rooms.

Need for Home Care

The need for home care continues to increase. The Detroit Free Press reported earlier this year that one in four households in the U.S. cares for someone 50 or older. Furthermore, more than 7.6 million Americans receive home care. The U.S. Department of Labor reports that from 2000 to 2007, the industry saw an increase of almost 300,000 workers, a surge of almost 150 percent.

In addition to a new focus on chronically ill elderly patients with multiple diagnoses, new advances, such as telemonitoring and other medical treatments now available in the home could also increase that demand. Of course, those advances and the needs of home care patients, face challenges because of proposed cuts to Medicare and Medicaid. Those two programs fund a combined 57 percent of home health costs, Medicare alone has already cut home health reimbursement by more than 8% since 2008 and will cut another 5% in 2011. The proposed cuts could limit the availability of those advances and give home care patients fewer choices.

NC Residents Care

North Carolina residents won’t let those changes happen without a fight. Almost 1,000 letters have been sent to Congress members from the state, urging lawmakers to pass the Home Health Care Access Protection Act. The Home Health Care Access Protection Act would stop those cuts from happening and maintain the full range of services that home care provides.

Liberty HomeCare & Hospice Services believes in the future of home care, and we aren’t alone. Millions of people choose to receive care in the home. We have seen patients make remarkable recoveries in homes we visit, and there are thousands of other success stories throughout North Carolina.

That’s why supporting the Home Health Care Access Protection Act is the first step in helping keep home health care an affordable option in the health care continuum. We want the best for patients and caregivers, and that legislation is a good way to start.

Anthony Zizzamia is the president of Liberty HomeCare & Hospice Services, which has 25 offices throughout North Carolina and serves more than 19,000 patients annually.