Home Health & Hospice Week

Home health agencies top list of best falls prevention programs.

If you're looking for ways to cut your patients' risk of falling, you may want to check out the latest Falls Free Coalition Home Safety Workgroup report.

The Oct. 2 report spotlights 10 creative practices in home assessment and modification that "can reduce home hazards through replication in community based organizations," according to a press release from the Coalition.

The Creative Practices in Home Safety Assessment and Modification Study offers these observations about falls programs:

* Home assessments and subsequent modifications are complex activities that require careful planning, oversight, and follow-up at all stages.

* Strategically established partnerships with organizations such as schools of nursing or home builders associations served as a common element across the selected programs.

* Some programs need specialized people to implement them effectively such as occupational therapists, and in some communities it may be difficult to access them.

The report also identified several creative strategies such as collaborating with first responders and other key partners, making use of trained volunteers, and integrating a fall risk assessment program into a larger safety program aimed at keeping older adults in their homes, the Coalition noted.

Three home care agencies made the Coalition's best-of list for falls prevention programs: Saint Elizabeth Home Care Services in Lincoln, NE; VNA of Care New England in Warwick, RI; and Holy Redeemer Home Care in Philadelphia, PA.

A link to the report is at www.homesafetycouncil.org/policy_makers/policy_fallsfree_w003.aspx.

• The fight is on over home care payments for 2008. The Senate Finance Committee met Oct. 17 to discuss ways to pay for a fix to physician payment rates in 2008 and 2009, according to press reports.

Senators were casting about for the $30 billion in cuts needed to avert the doc pay cut and make other Medicare changes, and home care once again landed on the chopping block. Home health agencies, wheelchair suppliers and oxygen providers are under discussion for reimbursement reductions to pay for the fix.

Alternative: But there is a way for home care to avoid cuts. Democrats want to finance the physician pay hike by cutting payments to Medicare managed care plans. Republicans, however, insist that rural patients depend on Medicare HMOs.

Timeline: Democratic leaders would like to mark up a Medicare bill by the end of October, but "they're dreaming," Sen. Trent Lott (R-MO) has told reporters.

The same day as the Senate Finance meeting, legislation launched to head off the HHA rate cuts for supposed case-mix creep. Sen. Susan Collins (R-ME) and three other senators co-sponsored a bill to eliminate the 10.91 percent in cuts and revamp the way the Centers for Medicare & Medicaid Services can formulate such cuts in the future.

The bill is the Home Health Care Access Protection Act of 2007 (S. 2181). Reps. Jim Mc-Govern (D-MA) and Walter Jones, Jr. (R-NC) introduced a companion bill in the House (H.R. 3865).

"These proposed administrative cuts would be just devastating," Collins says in a release. "Home care, as a share of Medicare spending, has dropped from 8.7 percent in 1997 to only 3.2 percent today. And it's projected to decline to just 2.6 percent of Medicare spending in 2015," she says.

"Making further, deep cuts in home health care services is not just wrong, it's bad fiscal policy," McGovern says in the release. "The CMS proposal makes no sense."

• Legislators may have an easier time cutting Medicare managed care plan rates after a congressional hearing critical about the plans. Democrats from the House Ways and Means Health and Oversight subcommittees slammed the way CMS has handled the Medicare Advantage plans, according to press reports. They referred to a July Government Accountability Office report that said CMS hasn't audited the MA plans as required.

CMS found millions of dollars in Medicare overpayments to MA plans during the audits it did do, but doesn't have the authority to recover the funds, a CMS official said in the hearing.

• Keep an eye out for new risk adjustment models for your Home Health Compare measures.

CMS is working on updated models for all of the outcome-based quality improvement (OBQI) measures displayed on the Web site, Henry Goldberg with Abt Associates said at an Oct. 9 session of the National Association for Home Care & Hospice's annual meeting in Denver.

But don't celebrate quite yet. CMS has not yet decided whether to adopt new models for all the measures, Goldberg told attendees.

• Chronic disease costs Americans $1.1 trillion in lost productivity every year, and $277 billion in treatment costs, according to a new study from the Milken Institute called "An Unhealthy America: The Economic Burden of Chronic Disease." That figure could reach $6 trillion by mid-century, the Institute says.

The report is available for a fee online at www.milkeninstitute.org.

• Now may be the time to invest in a snappy new Web site.

A growing number of people with chronic illnesses are going online to research their health problems, according to a recent study by the Pew Internet & American Life Project. About 51 percent of people with a disability or chronic illness use the Internet, compared with 74 percent of the general population, according to the study. But once people with illnesses get online, they become more frequent users.

The report is online at www.pewinternet.org/PPF/r/222/report_display.asp.

• If you have a COPD disease management program, you have a new option for accreditation. The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) is now offering a certification program for chronic obstructive pulmonary disease management, the Oakbrook Terrace, IL-based accrediting body says.

The Joint Commission is partnering with the American Lung Association for the certification program. COPD is the fourth-leading cause of death in the United States, the Joint Commission notes.

More than 11 million U.S. adults are estimated to have COPD, which is a major cause of hospitalization in the older population, according to the Amer-ican Lung Association.

• Durable medical equipment kickbacks are in the enforcement spotlight again.

A $21 million fraud scam landed Houston physician Jayshree Patel a 78-month prison sentence, says the U.S. Attorney's office. Prosecutors say Patel received kickbacks from DME companies. She and a colleague routinely approved wheelchairs for 30 to 80 patients a day without examining them or ordering tests. Patel allegedly certified 1,900 Medicare beneficiaries for motorized wheelchairs they didn't need.

Harold Iyalla, owner of 1st Choice Medical Equipment and Supplies, admitted paying Patel kickbacks last year, according to a U.S. Department of Justice release.