Home Health & Hospice Week

CMS could streamline the requirement without a legislative change.

The F2F burden is crushing many home care providers, and the feds could significantly lighten the burden -- if they want to.

The 130+ commenters on the 2013 proposed rule for the home health prospective payment system update are exhorting the Centers for Medicare & Medicaid Services to make a host of changes to improve the physician face-to-face encounter requirement. Here are some of the most popular:

1. Rescind the documentation portion. Many commenters asked CMS to simply chuck the narrative part of the requirement as duplicative of other information in the plan of care. Congress did not direct CMS to create such a requirement, they say (see related story, p. 270).

"Home care agencies agree with the need for the patient to be seen by a physician 90 days prior to or 30 days after admission to home health," says the Texas Association for Home Care & Hos-pice in its comment letter on the proposed rule. "It is the documentation requirements that have made compliance difficult in many cases for physicians."

Eliminating the narrative would "simplify the F2F regulatory requirements so that they more appropriately conform to Congressional intent," the Visiting Nurse Associations of America says.

2. Allow a checkbox form. If CMS won't repeal the F2F narrative altogether, TAHCH wants to see the agency allow a standard form with checkboxes for physicians to use to make documentation easier. Such a form would "eliminate the subjectivity by both physicians and reviewers," the trade group says.

3. Widen use of NPPs. Multiple commenters, particularly hospital and health system representatives, urge CMS to increase the use of non-physician practitioners to complete F2F requirements. "The current regulation remains costly and burdensome as it continues to hinder Medicare re-cipients from receiving the care that is needed due to physician reluctance to complete the form," ob-serves Mercy Health in St. Louis, which owns and manages 31 hospitals.

"This manner in which CMS has interpreted the implementation of this requirement contained in the Affordable Care Act deters the referral of patients to skilled home care services, which may result in more costly and frequent hospital readmissions," warns the Hospital & Health System Association of Pennsylvania.

Do this: "Consider additional expansion of the types of qualified health care personnel who are able to perform the face-to-face certification under the supervision of a physician," urges the California Hospital Association in its comment letter. "A registered nurse case manager working in the hospital setting has the essential clinical skills necessary to assess a patient's medical care needs, identify if he/she qualifies for home health services, and communicate this information to the certifying physician. The physician will then be able to review the information and make a determination regarding the patient's need for home health services and document the certification as indicated.

The result: "This practice would ensure phy-sician oversight while also facilitating the patient's timely access to home health services and smooth transition to post-hospital care," CHA says.

4. Relax the F2F timeline. "Extend the window of time during which the face to face encounter can occur to 60 days after the admission to home health" from the current 30 days, urges the Home Care Alliance of Massachusetts. "Because home health patients must be homebound to qualify for Medicare coverage, it is often burdensome and medically contraindicated for them to leave the home in order to have a physician encounter simply for the purpose of complying with the face to face requirement."

5. Tweak the NPP proposal. To make sure HHAs don't have to do extra work related to the non-physician practitioner proposal for 2013, CMS should make some changes to it, suggests national chain Amedisys Inc. in its comment letter. For ex-ample, make sure that agencies won't have to double-check that the NPP's supervising physician is the one co-signing the F2F documentation.

Timeline: CMS says it expects to issue the 2013 PPS final rule in November.