Home Health & Hospice Week

Pilot project cut rehospitalizations by half.

Home care will play a vital role in Medi-care's hospital readmission reduction project in Texas.

The three-year project will recruit home health agencies, among other providers, as "transition coaches" for patients being discharged from the hospital, reports The (McAllen, Texas) Monitor. The coaches will meet with patients before discharge and again within 48 hours after discharge.

"The coach helps the patient put together a list of questions for the doctor, discusses questions the patient might have about medications and helps the patient put together a plan for self care," the newspaper says. The coach also reconciles the physician's discharge summary with the patient's goals and helps the patient put together a health record.

Transition coaches helped cut hospital readmissions by half in a Denver-based pilot project run by the Quality Improvement Organization Colorado Foundation for Medical Care, a CFMC official told The Monitor. QIO TMF Health Quality  Institute is running the current project in the Browns-ville-Harlingen-Weslaco area.

Medicare currently is funding 14 such projects in as many states as part of the QIOs' 9th Scope of Work (see Eli's HCW, Vol. XVII, No. 30, p. 238). They are known under the "Care Transitions" name.

• Don't bank on the wage index values contained in the PPS rate notice for 2009, if you operate in certain East Coast states.

The Centers for Medicare & Medicaid Services has issued some technical corrections to its Nov. 3 Federal Register notice of home health prospective payment system rates for next year. CMS should have designated Litchfield County, Conn. and Merrimack County, N.H. as rural instead of listing them under CBSA 25540 and CBSA 31700, respectively, CMS says in a post to its Web site.

Manatee and Sarasota counties in Florida also were mis-categorized, CMS says. The agency will publish an official correction notice, it says.

• Medicare will have to find another way to save money rather than limiting COPD drug payments, according to a new court ruling.

Last month, a federal judge ruled that Med-icare can no longer use the "least costly alternative" to set payment rates for certain drugs, reports the New York Times. In this case, the judge found that certain Medicare carriers slashed payments for nebulizer drug DuoNeb. However, the judge ruled, Medicare should heed the payment rate methodology set by Congress.

• Your hospice payments could look a lot different if Congress heeds the advice of an influential advisory body.

The Medicare Payment Advisory Com-mission is considering recommending a payment revamp that would reimburse hospices at higher rates for days at the beginning and ending of hospice stays and at lower rates for days in the middle.

MedPAC will likely vote on the measure, as well as other hospice proposals, in its January meeting. If passed, the recommendation would go in the commission's March report to Congress.

The National Association for Home Care & Hospice and the National Hospice and Pallia-tive Care Organization are coming up with their own recommendations for reimbursement modifications to present to law- and policymakers, they say.

• A state ballot proposition to create the Missouri Quality Homecare Council passed Nov. 4. The Council will recruit home care workers and recommend their wages and economic benefits rates to the state legislature, notes the Fort Mill Times.

The proposition allows aides to unionize and bargain for benefits, but not to strike, the newspaper says. The Service Employees International Union helped fund the petition initiative.

• If you furnish Part B therapy in the home, you don't have to worry about the therapy cap exception expiring for another year.

The extension is now on the books. "The Medicare Improvements for Patients and Providers Act of 2008 extended the cap exceptions process for services furnished through December 31, 2009," CMS says in Nov. 7 CR 6222 (Transmittal No. 1631).

• The feds shouldn't be surprised that hospice spending is growing. In 2007, 39 percent of all deaths in the U.S. were under the care of hospice, up from 35 percent in 2006, NHPCO says in newly released data. Average length of service increased to 67 days, up from 60 days in 2006. But 31 percent of those served by hospice died or were discharged in seven days or less, NHPCO points out.

The ratio of non-cancer patients served by hospice continues to grow. In 2007 the figure was 41 percent, while in 2006 it was 59 percent, NHPCO says. More hospice statistics are in NHPCO's Facts and Figures report at http://www.nhpco.org.

• CMS has added one code and dropped one code from the list of supplies bundled under PPS. Home health agencies are now responsible for covering A6545 (Gradient compression wrap, non-elastic, below knee, 30-50 mmHg, each) under their PPS payments. "This is a new code that does not replace any prior code on the list," CMS notes in Nov. 7 CR 6262 (Transmittal No. 1633).

Agencies don't have to worry about A6413 (Adhesive bandage, first-aid type, any size, each), however. "This code is being removed because it is non-covered by Medicare statute," the transmittal says. The changes take effect Jan. 1.

• The Department of Health and Human Services is putting more money into keeping seniors at home -- especially veterans. HHS has announced $36 million in new home care-related grants to 28 states.

About $19 million of the funding involves a new collaboration with the U.S. Department of Veterans Affairs, HHS said. This is a joint effort to provide "consumer-directed home and community-based services to older Americans and veterans of all ages, as part of a Nursing Home Diversion grants program," HHS Secretary Mike Leavitt and VA Secretary James Peake say in a release.

The joint program will enable many people who would otherwise have been placed in nursing homes to remain at home, Leavitt continues.

Another $17 million in grants will go to Ad-ministration on Aging Alzheimer's disease demonstration programs. The programs will aim to im-prove the delivery of home and community-based services to people with Alzheimer's disease and their family caregivers, Leavitt says.

• Home health agencies furnishing Medi-caid waiver services may have to step up their documentation or risk repayments. The HHS Office of Inspector General recently cracked down on Illinois, shooting down $70,000 in waiver reimbursement for one of its largest waiver service providers, Search Developmental Center in Chicago.

In 2004 and 2005, the state incorrectly paid SDC for services that weren't provided or weren't documented, the OIG says in a new report (A-05-08-00060). For example, the OIG denied 38 services because the beneficiaries were in medical  facilities or attending medical appointments elsewhere.

The state should refund $35,000, the federal matching share, to the federal government, the OIG urges. The report is at http://www.oig.hhs.gov/oas/reportsregion5/50800060.pdf.

• A former Ohio HHA owner has pled guilty to Medicaid fraud and awaits sentencing, while his co-conspirator has already received a year in prison and $272,000 in restitution. Melee Ker-mue of Reynoldsburg-based Hope Home Health Care Inc. has pled guilty to health care fraud, reports newspaper Business First of Columbus. Wil-ma Bailey pled guilty to the same charge in January and received her sentence in August.

The pair submitted Medicaid claims with fictitious times and dates of service, including times when the patients were actually in the hospital, the Columbus Dispatch notes.

Kermue and Bailey fled to their home country of Liberia in 2005 (see Eli's HCW, Vol. XIV, No. 43, p. 348). Bailey and Kermue returned under ex-tradition, the newspapers say.