COVID-19 Innovation: PACE Organizations Thriving by Shifting More Care into the Home

Amid the COVID-19 outbreak, post-acute care organizations have had to pivot.

For Philadelphia-based Mercy LIFE — a Program of All-Inclusive Care for the Elderly (PACE) organization within the Trinity Health Mid-Atlantic system — that has meant closing its adult day centers and shifting care into the home for its 800-plus participants. Buses usually used for senior transportation have been turned into meal delivery vehicles, while normally in-person therapy services have been largely shifted to a virtual model.

Despite all the changes, Mercy LIFE has seen no meaningful disruptions to reimbursement. That’s unlike most of the post-acute care world, which has been dealing with rapidly changing and — not always adequate — reimbursement rules amid the ongoing national emergency.

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That’s one reason PACE organizations like Mercy LIFE are so well-positioned to handle the coronavirus chaos. Built-in flexibilities allow PACE organizations to relatively easily shift care into the home — the setting in-home care providers have been pushing for years, with the rest of the world finally catching on amid the COVID-19 emergency.

“I think [the PACE program] is really showing its strength,” Shawn Bloom, president and CEO of the National PACE Association (NPA), told Home Health Care News. “We’ve got comprehensive, good data on 66 programs, and our rate of confirmed positive cases is only 2.2% [as of Friday, May 1].”

PACE is a Medicare and Medicaid program designed to keep seniors out of institutional settings like nursing homes. PACE programs offer comprehensive, interdisciplinary care to program participants, who must be 55 or older and certified by the state to need nursing home-level care.

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Under normal circumstances, the model is largely center-based. Seniors usually go to day centers multiple times per week for activities, meals, personal care, various forms therapy and more.

Additionally, PACE programs often have primary care. But the beauty of PACE is that organizations have the ability to flex their models as needed.

PACE programs get per member per month capitated payments from Medicare, Medicaid and private-pay sources, for which they assume full financial risk. That hasn’t changed amid the COVID-19 virus.

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“It’s a static amount that we get each month, and that amount is used to pay for any services that a PACE participant may need, whether it’s in the center, in the home or if they’re hospitalized, if they need a respite stay or if they need a sub-acute stay,” Carrie Hays McElroy, clinical operations and chief nursing officer at Trinity Health PACE, told HHCN.

Mercy LIFE is a specific program under Trinity Health PACE.

Meanwhile, home health providers don’t have that kind of flexibility. While many agencies have transitioned to delivering telehealth care when appropriate, those virtual visits aren’t reimbursable and don’t count toward low utilization payment adjustment (LUPA) thresholds. That means providers’ reimbursement has taken a hit at the expense of keeping home health patients safe.

Meanwhile, for the most part, PACE organizations aren’t struggling financially amid the coronavirus.

While some costs have shifted, many of the actual expenses — such as the amount of money required for staffing and transportation — have remained the same since the coronavirus took hold in mid-March, McElroy said.

“By reassigning caseload and the rearranging schedules, we’ve pretty much been able to manage [providing in-home care] with our current staffing,” said McElroy, who also serves as chief integrity and compliance officer. “Then we reassigned some of the duties — things like meal preparation or meal delivery or laundry.”

Trinity Health PACE’s organizations — of which there are 11 across nine states, according to McElroy — aren’t the only ones getting creative. NPA represents more than 130 PACE programs across the country, and Bloom said all of them have debuted creative new home- and community-based services to cut down on possible COVID-19 transmission while continuing to care for patients.

“Some programs have repurposed their PACE vans to be mobile medical clinics, where they literally are pulling up in front of the home, donning personal protective equipment (PPE) and bringing individuals out for primary care encounters,” he said. “We just featured two programs that have transitioned their day centers into overnight care centers. And they’ve done this with approval [from] the Centers for Medicare & Medicaid Services (CMS).”

Trinity Health PACE is exploring similar overnight care centers for participants who might need a higher level of care but are unable to access nursing homes due to the virus. However, the organization is still seeking input from CMS, which McElroy says has been very reasonable and understanding in giving PACE organizations flexibilities amid the coronavirus.

CMS has issued some new guidance for PACE organizations, but there’s been little regulatory change for programs.

“CMS has essentially said, ‘We will cut you some slack when we come to survey you,’” Bloom said. “That’s essentially what we’ve gotten. And quite honestly, that’s perfect.”

Bloom has taken the guidance to mean CMS is giving PACE organizations the freedom to do what they need to do to care for patients amid COVID. However, PACE programs like McElroy’s are still trying to be conservative.

“Pace is very heavily regulated under normal circumstances, and we have to be very careful that we’re not stepping too far away from those regulations,” McElroy said. “Flexibility is only so flexible.”

Still, the everyday flexibilities PACE organizations have are coming in handy amid the coronavirus — and they’re leaps and bounds beyond what home health providers have access to. Yet ironically, adopting home-based care models has been a central part of PACE organizations’ COVID-19 success, potentially inspiring lasting change for the program.

“[I think we’ll continue to see] reduced reliance on the data center, supporting individuals more proportionally in their homes,” Bloom said. “Another one, I think, is the adoption of telehealth.”

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