Home Health & Hospice Week

Patients' adherence to medication, diet and exercise regimens same as control group. Patients with chronic illnesses eat up Medicare dollars, but recent study findings may put the kibosh on any regular disease management program - at least until more data is available.

The Centers for Medicare & Medicaid Services contracted with 15 providers, including Hospice of the Valley in Phoenix, AZ, to furnish disease management services under the Medicare Coordinated Care Demonstration starting in January 2002.

Most of the programs focused on patients with heart conditions and diabetes, CMS contractor Mathematica Policy Research Inc. says in a report submitted to Congress this month. Hospice of the Valley also addressed COPD, cancer and neurological conditions.

While the DM programs were popular with patients and physicians, surveys found adherence to medication, diet and exercise regimens was the same for DM patients as for control groups that didn't receive DM.

"The absence of large effects on the patient adherence measures may be somewhat discouraging, but it does not necessarily imply that the programs are not having any effect on patient behavior," Mathematica cautions in the report. "Relative to the control group, program patients reported better access to information and appointments, better communication among their providers, and greater understanding of their health condition."

The report also noted that DM providers had a hard time enrolling enough patients and doubted that low-paid providers would recover their DM costs. The full 144-page report is at www.mathematicampr.com/publications/PDFs/bestpraccongressional.pdf. A second, fuller report on the four-year demo is due in October.  Don't pitch that letter from Abt Associates as junk mail. Abt is CMS' contractor for an OASIS survey that was sent out this month to 1,200 HHAs, the National Association for Home Care & Hospice notes.

"NAHC is urging all agencies that receive the survey to take the time to research the information requested and complete it," the trade group says. Survey findings will go into a congressional report on whether OASIS data should be collected for non-Medicare, non-Medicaid patients.
  The Department of Health & Human Services has decided to challenge a court ruling that the certificate of medical necessity should constitute sufficient proof for Medicare reimbursement.

HHS has filed an appeal with the 9th U.S. Circuit Court of Appeals in Maximum Comfort v. Tommy Thompson, a case involving a Redding, CA-based durable medical equipment supplier who sued HHS in 1999 after its Medicare claims were rejected for lack of documentation beyond the CMN (see HCW, Vol. 14, No. 14). In March, a federal judge in the Eastern District of California ruled in the supplier's favor.

The case could be heard as soon as early next year, Maximum Comfort owner Tom Lambert tells Eli.
  If you want to get your reconsideration request to Palmetto [...]