Home Health & Hospice Week

Changes in your therapy visit patterns under prospective payment system revisions may land you in hot water, just like it has for four publicly held companies.

Senate Finance Committee Chair Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa) on May 12 requested documentation from four for-profit home health agency chains related to therapy provision and PPS payment incentives. The request letters went to Amedisys Inc., Gentiva Health Services Inc., LHC Group Inc., and Almost Family Inc.

The request came on the heels of a Wall Street Journal article that claimed that HHA therapy practice patterns had changed in response to PPS payment revisions that took place in 2008 (see Eli's HCW, Vol. XIX, No. 18, p. 143). Agencies manipulated visit numbers to increase profits, the article charged.

For example: The number of patients receiving 10 therapy visits from Baton Rouge, La.- based Amedisys dropped 50 percent after the new six-, 14-, and 20-visit therapy thresholds took effect in 2008, the Journal reported. At the same time,Amedisys patients receiving 14 visits rose 33 percent, and patients receiving 20 visits increased 41 percent, the newspaper said.

"Too many Americans count on Medicare to provide quality health care to allow the program to be manipulated for somebody else's profit," Baucus says in a release. "If for-profit companies want to work with the Medicare program, we have to hold them to a very high standard."

The Medicare Payment Advisory Commission has pointed out the large ratio of for-profits that have started up in the HHA and hospice industries in the last five years.

Are you next? "I intend to closely review the practices of these and all companies working with the Medicare program to stop fraud, waste and abuse and ensure every dollar is used appropriately," Baucus pledges in the release.

"So far, it appears that either the home health care reimbursement policy is flawed, some companies are gaming the system, or both," Grassley says. "As the Senate committee of jurisdiction, we're working to figure out what's going on."

Companies Stand Their Ground

All four companies, whose stock prices dipped after news of the inquiry, have promised to cooperate fully with the investigation. "We also look forward to discussing with the Senators the many benefits and advantages home health care provides for the millions of Americans our industry serves, Amedisys CEO William Borne says in a release. "We are proud to be an organization that leads by putting our patients first and are proud of the work we do on their behalf," the company says.

The Journal article "told an incomplete story about the value of home health to patients, their families, and the overall healthcare system," Amedisys adds.

"We welcome this opportunity to better inform the members of the Committee and broader audiences about the important role that home care plays in addressing the needs of our nation's growing senior population," Gentiva CEO Tony Strange says in a release. "I am proud of the care that our thousands of home healthcare clinicians provide to patients each and every day, as well as the measures that Gentiva takes to ensure its appropriateness."

"Our Senior Advocacy mission calls for our caregivers to provide care based solely on patients' needs and clinical conditions and we are confident that when our data is thoroughly reviewed, it will provide a much clearer picture than was portrayed in The Wall Street Journal article," Almost Family CEO William Yarmuth says in a release.

LHC offers the most substantial rebuttal in its statement about the Senate inquiry. "As a company, therapy represents a much lower portion of our episodes than the national average," the Lafayette, La.-based chain says. "In 2007, 36.6 percent of our total Medicare episodes received therapy versus the national average of 49.8 percent, and only 38.2 percent of our total Medicare episodes in 2008 received therapy versus the national average of 50.2 percent."

LHC also points out that physicians write the orders for therapy; therapy visit numbers for 2007's top 20 diagnoses stayed the same in 2008 for the company; LHC therapy visit numbers increased due to total patient population growth; and LHC has a compliance program and third-party-manned compliance hotline.

Meanwhile, industry veterans hope the congressional probe helps put a stop to some abusive therapy practices they've seen lately. For example, in some therapist shortage areas, independent contractor therapists are running up visit numbers in order to secure higher reimbursement for themselves, one source charges.

Watch out: This inquiry may be just the start to a big regulatory and compliance assault on the home care industry, experts warn.

HHAs would do well to remember Operation Restore Trust-era tactics that lawmakers used to confront fraud and abuse issues in 1997, says Tom Boyd with Rohnert Park, Calif.-based Boyd & Nicholas. The interim payment system put nearly one-third of agencies out of business at that time.

"We are back in 1997," Boyd fears. The government believes "there are too many agencies and too many [that are] doing things wrong or illegal." The current number of Medicare agencies and Medicare home health expenditures were about the same in 2009 and 1997, Boyd tells Eli -- nearly 11,000 agencies and $17 billion spent. Instead of potentially shutting down a slew of existing agencies, Boyd wishes the government would stop certifying new providers and provide education and training to the agencies already in the program.