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2012 Annual Meeting
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Bringing Home the Care Continuum:
Harnessing High Tech, High Touch Home Care Medicine
 

May 3-4, 2012
Seattle Convention Center/Sheraton Seattle Hotel
Seattle, WA

2012 Annual Meeting Best Ever: Content Terrific, Networking Reception Added

by Jessica E. Quintilian, Assistant Executive Director

The Academy thanks our members, whose attendance and enthusiastic participation contributed to the success of our Annual Meeting in Seattle!

Members ranging from solo practitioners through national practices to academic program leaders told us, as reflected by Academy President Dr. Bruce Leff during his closing comments, that this was the best annual meeting ever. Academy staff thanks Dr. Steven Landers, Program Chair, and the members of the Annual Meeting Planning Committee whose time and efforts were most appreciated in developing the successful meeting. Thanks also goes to our speakers for their participation and presentations, and to our sponsors and exhibitors - Amedisys, Banyan International Corporation, Bayer Healthcare Viterion Telehealthcare, Cleveland Clinic, Gentiva Health Services, Gerontological Advanced Practice Nurses Association, Harden Healthcare, Home Care Assistance, The Home Doctor, Hopkins Medical Products, Intel/GE Care Innovations, Invacare Corporation, National Association for Home Care and Hospice, SafeVisits and Sterling Medical Services - whose support provided us with the ability to offer thought provoking presentations, breaks and our first evening networking reception that enhanced collegiality, collaboration, and raised the level of the meeting.

The content of this year’s meeting reflected the challenges, opportunities and increasing interest in the field of home care medicine. We are already using members’ comments, questions and observations to ensure that next year’s meeting in Texas is as relevant and successful as the just concluded 2012 meeting. If you weren’t able to attend the meeting, go to aahcp.org > Meetings and Programs > 2012 Annual Meeting to view the agenda with presentation links. The Academy also thanks Dr. Wen Dombrowski for live tweeting!

Day One Sessions

Independence at Home Act Policy and Implementation Update for Medicare, Medicaid and Managed Care
Dr. Steven Landers moderated a panel of speakers including Jim Pyles, Esq., Dr. Peter Boling, Pam Coleman and Dr. Bruce Kinosian. Described as both a clinical and a business model, IAH is now viewed by some as one of the principal drivers in health care reform because of its potential for shared savings. Over 130 organizations applied for the IAH demo, far exceeding the 10,000 beneficiary cap. Having organizations ready and able to participate in IAH makes the Academy well positioned to get the demo expanded, and our goal is to have the cap lifted by the end of this year. Members who were not selected for IAH were encouraged not to lose heart! Those who have been selected were urged to do their very best work, as the Academy is committed to IAH’s success. Implementation strategies were discussed, as were business structures for working with managed care and the need to demonstrate value.

Special Update on Medicare Payment Policy, Patient Protection and Affordable Care Act and What it Means for Home Care Medicine Providers
Dr. Debra Bakerjian and Kathy Kemle, MS, PA-C, discussed scope of practice for NPs and PAs and the issues to consider with interdisciplinary teams, such as billing, regulatory environment challenges and NP/PA collaboration with physicians. IAH will require an "all hands on deck” approach to meet the needs of chronic care patients. Home care medicine is one place where care coordination can – and needs – to happen. Mr. Pyles followed by discussing opportunities and threats under health reform for physicians, nurse practitioners, physician assistants and advanced practices nurses. Delivery models such as IAH and other models under ACA were presented. Dr. Landers then led the audience in a question and answer session with the panelists.

Measuring Success in Home Care Medicine: Tracking, Benchmarking and Improving Productivity, Efficiency, Quality and Patient Experience
Associate Executive Director Gary Swartz moderated a panel including Drs. Eric DeJonge, Adam Groff and William Zafirau. Dr. DeJonge began by discussing success in a fee for service health system, under which the majority of Academy members are operating. Using patient cases, success was presented from three perspectives: patients/families, providers and the health system. Value impact, appealing to a traditional hospital system, health plan or HMO, contracting with an ACO, and the need for financial measurement, benchmarking and improvement were among the topics presented. The session included a live poll with interactive data from the audience, conducted by Dr. Groff, and a question and answer session.

Morning Breakout Sessions
Concurrent breakout sessions featured Employer/Managed Care Contracting for Small/Medium Home Care Medical Groups, presented by Brent Feorene and Dr. Steven Phillips, and The Concierge Alternative, presented by Thomas Reed and Chip Measells. Both sessions were well attended and included comparison of similarities of IAH to MCO contracting and concierge models.

Practice Management Keynote - Home Health Transformation: Complexity, Connectivity and Consumerism
Dr. Mike Magee presented the practice management keynote address, beginning with how we define "health” today and the three megatrends of aging, the internet and consumerism. As society moves toward health as a human right, home care medicine providers are well positioned to lead this movement. Dr. Magee described the concept of "techmanity,” technology to advance humanity and how virtual services can be targeted to vulnerable populations. He presented measures of success such as family connectivity, engineering health into the home and promoting strategic health planning. Few concepts are as supported in America as home-centered health care, and Academy members were motivated by Dr. Magee to think boldly and act broadly: "The challenge is to manage chronic disease while pursing the parallel track of a preventive health care system. House call providers have the power and positioning to make this happen.”

Afternoon Breakout Sessions
Meeting attendees were offered two sets of afternoon breakout sessions, with two tracks from which to choose. Integration of Ancillary Testing in the House Call Practice/Health Value of Ancillary Diagnostics in Home Care Medicine, presented by Drs. C. Gresham Bayne and Thomas Parker, and Elder Abuse in the Blind Spot: The Critical Role of Home Care Physicians and Teams, presented by Dr. Edward Ratner and Marie-Therese Connolly, JD, were offered concurrently. Next, Gary Swartz, Brent Feorene and Dr. Bayne presented Starting My Home Care Practice, while Drs. Edward Ratner, Rebecca Conant, Cindy Pinson and George Kikano presented Medical Director and Community Relations Issues: The Intersection of Home Care Medicine with Skilled Home Health, Private Duty and Hospice. All sessions were well attended and well received, with ample audience participation.

Networking Reception

Following the educational sessions on May 3, the Academy’s first ever networking reception was held at the Sheraton Seattle. A resounding success, the reception was attended by more than 100 people and sponsored by Cleveland Clinic, Harden Healthcare, Invacare Corporation and National Association for Home Care & Hospice. Sponsor representatives Dr. Steven Landers, Julie Vandre and Barbara Woolley are pictured Members have consistently asked for more chances to meet and collaborate with one another at the meeting, and the reception provided just such an opportunity.

Day Two Sessions

The State of Mobile Communications Technology for Home Care Medicine

Dr. Gresham Bayne discussed the role of mobile communications technology and the biggest challenge our members face - making wireless communication work for them. He answered the questions of how to handle the tsunami of information coming and what members can do now to prepare. Members were encouraged to know their bandwidth, allow scripting of care plans and trend charts, allow seamless transitions to offline, use single sign-ons and benchmark office phone calls/house calls. Dr. Bayne reminded members that a decision point is coming soon, as the 1.5% e-prescribing penalty begins on January 1, 2013. Following Dr. Bayne’s presentation, Dr. Landers moderated a question and answer session. (Also see Dr. Bayne’s article "Technology and the Home Care Medicine Provider: An Update” in our April issue).

Morning Breakout Sessions

Education and clinical sessions were offered concurrently. Beyond "Nice Job”: Giving Effective Feedback to Medical Trainees on House Calls – Using Structured Clinical Observations was presented by Drs. Rebecca Conant, Jennifer Hayashi, Robert Jayes and Robert Kaiser. Dr. Thomas Parker presented Pharmacology Pearls for the Home Care Provider, and Dr. William Mills presented Clinical Needs of Assisted Living Residents. All sessions were well attended and well received.

Annual Meeting Features Awards, Election of New Board Members, Bylaws Modification and Tribute to Eric Baron

Dr. Bruce Leff began his address by celebrating our Academy members, who are helping define and execute the models of care that are gradually defining the field of home care medicine. Our members were commended for the gradual growth in house calls despite a challenging Medicare fee schedule, growing participation of nurse practitioners and physician assistants, growth of the VA Home-Based Primary Care Program and the Hospital at Home model.

Dr. Leff highlighted just a few of the Academy’s many accomplishments during the past year, including the official beginning of the IAH demonstration, a decade-long effort of the Academy! Thanks to support from The Retirement Research Foundation (RRF), the Field Guide was produced along with on-site meetings and webinars. Grant funding from VPA also made possible the production of the Laboratory Study, newly incorporated into the Field Guide, along with other new chapters also funded by RRF. Dr. Tom Cornwell and many Academy volunteers were thanked for their work on updating the Medical Management of the Home Care Patient this year. The Academy’s practice management effort has been substantially expanded, with response to individual questions, webinars, new materials, expanded regulatory representation, victories in the form of audits turned off, reimbursement for services turned on, expanded fee-based technical assistance and additional information communicated through our weekly e-Newsletter. We are gradually evolving toward a broader definition of who we are, looking toward our name change to American Academy of Home Care Medicine in 2014.

Dr. Leff encouraged members to get involved in any of our committees: Annual Meeting, Public Policy, Education, Research or other Academy work groups. Remember, volunteers are our lifeblood, so please let us know if you are interested in getting involved!

Members were asked to elect new Board members and to vote on a Bylaws change to bring them into compliance with those of other professional organizations with regard to removal of members when necessary. All measures passed.

Before presenting the awards, Dr. Leff paid tribute to Dr. Eric Baron for whom the House Call Doctor of the Year award was named. Dr. Baron, a former Board member, visionary and great contributor to the Academy, died this year of ALS. We will all remember Eric, as will his many friends and family.

This year’s Awards Committee Chair, Dr. Theresa Soriano, presented two Academy members with our highest honor. The 2012 Eric Baron House Call Doctor of the Year was awarded to Dr. Linda DeCherrie, Associate Director and Primary Care Residency Program Director at Mount Sinai Visiting Doctors Program. As former Director of Education at the Visiting Doctors Program, Dr. DeCherrie embodies the multi-faceted vision of a person who both provides direct care and works to create a generation of medical students, residents and fellows who will appreciate and provide community based care to vulnerable populations. She has integrated home visits and interdisciplinary care into the curriculum in all three years of primary care resident training and has increased the interest in geriatrics and home-based primary care. The development of a stronger interdisciplinary primary care presence both in the hospital and community is a timely and needed development to improve healthcare in our country, and Dr. DeCherrie actively makes this happen at Mount Sinai. In her role as Associate Director, Dr. DeCherrie works with program leadership to bring systems of care coordination and population management of vulnerable groups to an institutional level. An outstanding member of the house call profession, she represents excellence in her hands-on work as a physician and a role model in leading the integration of home based primary care into the education of many levels of medical trainees and other disciplines.

Unable to attend the ceremony in person, Dr. DeCherrie asked Dr. Leff to read her remarks. She expressed gratitude to the Academy, the team at Mt. Sinai and her family. "What makes me particularly excited about work every day is the opportunity to introduce trainees to house calls and to teach them about home care, geriatrics and primary care in general. I hope to spark a passion similar to mine, but if not a passion, then a realization of the benefits of home health care and an interest in supporting and encouraging it,” wrote Dr. DeCherrie.

The 2012 House Call Clinician of the Year was awarded to Nurse Practitioner Nancy Reyes, Ms. Reyes qualified as a Nurse Practitioner in 2003 after realizing, as a visiting home nurse, that her frail, home-limited older patients were not receiving the primary care they needed in the home. She encouraged her physician collaborator to start a house call program, now called Community Housecall Physicians, based in Hudson County, New Jersey. The program has grown from a few patients to over 600, cared for by a team of nurse practitioners. As part of the geriatrics curriculum at Jersey City Medical Center, she takes medical residents into the home, teaching them the value and need for house calls. Internal Medicine residents rank this experience as one of the best and most valuable rotations in their three years of Internal Medicine residency training. Ms. Reyes also mentors Nurse Practitioner students from Seton Hall University during their primary care rotations and encourages fellow NPs to specialize in geriatrics and home care medicine. Her work has been presented in numerous articles and at the annual meeting of the American Geriatrics Society. In 2007, she was invited to present the house call concept to the Agency of Health Care Research and Quality in Washington, D.C. Whether coordinating care with local agencies or advocating for quality end of life care, Ms. Reyes is a Nurse Practitioner that goes above and beyond, not stopping until her patients have the services they need. She is described by both her colleagues and the people of Hudson County as a role model and miracle worker with a heart of gold.

The 2012 Poster of the Year was awarded to Dr. Ina Li for "Christiana Care’s Home Visit Program: Further Success in House Call Medicine.”

This year, the Academy also presented a few special awards. Dr. Bruce Kinosian was awarded the President’s Award for Outstanding Contributions to the American Academy of Home Care Physicians. Board members who were rotating off the Board were honored. Dr. Wayne McCormick and Dr. Joe Ramsdell were each given awards for appreciation of their long service, leadership and many contributions as President and Board member of the Academy. Jim Pyles was given an award for appreciation of his outstanding service as advocacy leader and Board member. The Academy congratulates all of this year’s winners!

Keynote Address: Why Coordinated Care Matters to Patients and Families

The Academy was pleased to have Jonathan Rauch, Writer in Residence at The Brookings Institution and Opinion Columnist for National Journal, present our keynote address. Mr. Rauch included an entertaining, but telling, video in his address which demonstrated the challenges families face when trying to coordinate care for their loved ones. He brought his own personal caregiving experience to the audience relating how, without warning, he became one of the millions who learned firsthand why coordinated care matters. Mr. Rauch described how, from a caregivers point of view, our health system is like an obstacle course. "We want a smooth journey from where we are to where we’re destined to go,” explained Mr. Rauch. "Your (Academy) members will make a difference, integrating care with life,” he concluded.

Afternoon Features Breakouts and New Care Models Panel

Concurrent afternoon breakouts included An Introduction to a New Home-Based Episode of Care, presented by Richard Rakowski, which focused on the Clinically Home model. Mara Benner, Julie Vandre, RN and Dr. Rahul Koranne presented Washington Legislative and Policy Update: Home Care Agency Perspective, Showing the Value of Home Health in Health Care Reform and Home Care Policy-Opportunity Knocks? Sessions were well received with enthusiastic participation by attendees.

Dr. Steven Landers moderated the day’s final session, a grand finale of presenters discussing New Care Models and Their Intersection with Home Care Medicine, Dr. John Mach opened by discussing care management challenges and solutions. Dr. Allen Dobson followed with a presentation highlighting the need to re-establish communication among providers and the huge need for meaningful data. Dr. Brad Stuart presented Advanced Illness Management with a focus on "people-centered care” versus patient-centered care and the need for care coordination. Yale Sage presented an overview of American Physician Housecalls’ health services and the uniqueness of their transitional care program model. Finally, Jim Pyles responded to the aforementioned presentations and how they connect with the efforts of the Academy and the global movement of health care into the home.

Optional luncheon sessions on telemonitoring and on hospital readmissions were well attended. A paper for members to use in presenting to hospitals will be forthcoming soon. Below is a picture of Dr. George Margelis, General Manager, Care Innovations Australia presenting.

Dr. Leff’s closing remarks reflected the increased optimism and enthusiasm of this year’s meeting attendees.

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