WMHS leads charge for new home health care regulations

WMHS leads charge for new home health care regulations

More About WMHS leads charge for new home health care regulations

From left to right, nurse practitioners Linda Krause, Lisa Moreland and Jenny Barlow, WMHS President and CEO Barry P. Ronan, WMHS Senior Vice President and Chief Operating Officer Nancy Adams, WMHS Senior Vice President and Chief Medical Officer Gerald Goldstein, M.D., nurse practitioners Lynn Metcalf, Tiffany Bennett, Allison Rexrode and Ashley Preston.

WMHS leads charge for new home health care regulations

Now that the calendar has turned to 2020, a historic change has taken place across the state of Maryland in relation to the authorization for home health care.
In October, The Centers for Medicare and Medicaid Services announced an adjustment in policy that enables all Medicare-enrolled nurse practitioners in Maryland to certify home health care services for Medicare beneficiaries as part of the Maryland Total Cost of Care Model.
Under the previous Medicare regulations, a nurse practitioner could provide primary care services, but only a physician could order the patient to receive home health care services.
The push to change the existing policy was championed by Western Maryland Health System President and CEO Barry Ronan. “When I learned that the 5,300 nurse practitioners who had full practice authority in Maryland were not permitted by CMS to write orders for home care services, I realized that something had to be done,” Ronan said. “I am extremely grateful that the leadership at both the Centers for Medicare and Medicaid Innovations, the Maryland Hospital Association and Bobby Neal, Maryland’s Secretary of Health, were receptive to the recommendation that a demonstration project be created for NPs in Maryland being permitted to write orders for home care. This action no longer interrupts the continuum of care for NPs in the treatment of their patients.”
Maryland will become the only state to allow NPs to write these orders. “The previous policy excluded nurse practitioners and was completely antithetical to the mission of this state, which is value-based care and care in the most appropriate location,” said Gerald Goldstein, M.D., WMHS Senior Vice President and Chief Medical Officer.
“We have been carefully decreasing unnecessary length of stay and utilization. We place patients in the correct location, but because a patient’s primary care provider happens to be a nurse practitioner, the patient is unable to receive home care while under their care.”
Sharon Mason, WMHS Director of Home Health & Hospice Services, called the change a “historic victory” for home health care, nurse practitioners and patients in the community alike. “Our goal to keep patients out of the hospital,” she said.
“This opens the patients’ doors to us. We are now able to get to them as soon as possible. Previously, their care was being delayed, and sometimes, after surgery or a hospital stay, they ended up back in the emergency department. Home health care is so important. It is one of the leading ways to reduce readmissions.”
Jennifer Barlow, a Nurse Practitioner at WMHS LaVale Primary Care Center, said she treated many patients who were turning down home health care services because they did not want to go through the process that was in place.
“Patients would often refuse to seek home health services because it was difficult to get authorized,” she said. “At their sickest and most vulnerable points, they were forced to go see a new provider who they did not know in order to get the services started. It was very hard to overcome.”
Mason said that WMHS Home Health Care will now be able to touch 15-20 percent more patients than they have in the past. “We were hoping for this,” she said, “and now we are making a plan to reach our local nurse practitioners to educate them about some of the regulatory pieces and orders so that we can provide seamless care. That’s the whole goal.
“The community is going to benefit greatly from this welcomed change in the regulation. So many patients struggle to get the care they need after they leave the hospital. They can take comfort in knowing there are now no barriers to home health care, regardless of who their provider may be. There are no limitations and that’s just huge.”

About Western Maryland Health System

Western Maryland Health System was formed in 1996 to strengthen the healthcare services in Western Maryland and the surrounding communities in Pennsylvania and West Virginia. In November 2009, WMHS opened a new state-of-the-art hospital on Willowbrook Road in Cumberland, Maryland.

The Western Maryland Regional Medical Center has over 200 beds and offers a comprehensive range of general and specialty services for medical, surgical, and obstetrical patients. In addition to hospital-based services, WMHS has a network of diagnostic centers, urgent care centers, physician practices, a skilled nursing facility, home care, and other outpatient specialty services.

WMHS has been at the forefront of value-based care and is continuously working to improve the overall health of the community with a variety of health initiatives, including: health screenings, classes on adopting healthy lifestyles, community education, and exercise programs. WMHS has also addressed the issue of underserved populations by opening Community Outreach Clinics that aim to help at-risk populations make more informed healthcare decisions.

As of February 2018, WMHS and UPMC (University of Pittsburgh Medical Center) joined together in a clinical affiliation to work cooperatively to enhance healthcare services for local residents. The partnership enables WMHS to build upon its success in providing value-based care and to strengthen its ability to deliver quality care, transform care delivery and reduce the total cost of providing care in the community.

To learn more about Western Maryland Health System, visit click for details. Find us on social media at facebook.com/westernmdhealth, youtube.com/WMHSCumberland, Twitter @westernmdhealth, and Instagram @westernmarylandhealthsystem.

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Posted By: UPMC Western Maryland

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Date: January 29, 2020

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More About this Event Poster: UPMC Western Maryland

In 2018, WMHS and UPMC joined together in a clinical affiliation to work cooperatively to enhance healthcare services and to strengthen the delivery of quality care, transform care delivery and reduce the total cost of providing care in the community. In March 2019, the Boards of Directors of both WMHS and UPMC signed a non-binding letter of intent to negotiate an affiliation agreement. Following a nine-month regulatory review and due diligence process by WMHS and UPMC, the Boards co-signed a binding integration and affiliation agreement on January 15, 2020, setting February 1, as the target date for finalizing the affiliation.

“Throughout our research and discussions with UPMC, we became increasingly confident and excited about becoming part of a world-class academic medical center which shares our vision for providing quality patient care,” said Rolf Haarstad, chair of the WMHS Board of Directors. “Our mutual mission is to continue to bring cutting-edge, evidence-based medicine to patients close to home.”

“UPMC has a long, successful track record of affiliations with like-minded hospitals. We know how much this hospital means to the region, and we are thrilled that WMHS has chosen to join UPMC,” said Leslie C. Davis, senior vice president, UPMC, and executive vice president and chief operating officer, UPMC Health Services Division.

UPMC has committed to make certain capital investments to enhance services and upgrade facilities in the Western Maryland region. These investments by UPMC, along with investments that the WMHS Foundation has made and continues to make, will help ensure that UPMC Western Maryland will continue to provide state-of-the-art, quality healthcare for residents as well as maintaining its position as one of the largest employers in the region for years to come.

The new affiliation does not affect patients’ insurance coverage. UPMC Western Maryland will continue to honor the contracts it has in place with regional and national insurers and has reaffirmed its commitment to continue working with multiple payors in the future.

The board of UPMC Western Maryland consists of 12 directors, including 8 appointed by the current WMHS board and 4 designated by the UPMC board.

About UPMC
A $20 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates 89,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a nearly 3.6 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.2 billion in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution, and paid $587 million in federal, state and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America’s Best Hospitals and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. For more information, go to UPMC.com.

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