Home Health & Hospice Week

If you're wondering whether you'll have trouble with exceeding the per beneficiary cap this year, you shouldn't have to wonder much longer.

The Centers for Medicare & Medicaid Services issued the 2009 cap amount early "to assist the hospice industry in planning and budgeting," it says on its Web site. The cap amount is $23,014.50.

CMS also includes its methodology for the cap calculation "so that hospices can compute the amount themselves in the future if they so desire."

That calculation methodology could be changing, however. In its proposed rule in the April 24 Federal Register, CMS floats the idea of revamping how it determines the cap amount.

"Until recently, hospices rarely exceeded the aggregate cap," CMS notes in the rule. But now hospices have more patients with longer lengths of stay and exceed the cap more often.

The Medicare Payment Advisory Commission "found that for-profit ownership, smaller patient loads, and being a freestanding facility were correlated with longer lengths of stay and the consequent likelihood of exceeding the aggregate cap,"

CMS points out in the rule.

CMS is considering changes to how it counts the unduplicated census number for the cap and requiring hospices to calculate and report their own cap. Comments on the rule are due June 22.

Resources: The 2009 cap notice is at www.cms.hhs.gov/center/hospice.asp. CMS will issue the amount officially in its 2010 rate notice this summer, it says. The proposed rule is at http://edocket.access.gpo.gov/2009/pdf/E9-9417.pdf.

• Early use of home care services following a hospital stay by patients with at least one chronic disease saved Medicare $1.71 billion in the two-year 2005 to 2006 period, according to a study by Avalere Health. The study, sponsored by the Alliance for Home Health Quality and Innovation, also found that an additional $1.77 billion would have been saved in the same period if all Medicare beneficiaries with similar chronic diseases had accessed home care services.

Medicare could save $31.1 billion over the next 10 years if it expanded access to home care for chronic care patients, the study contends. The savings come from reduced hospitalizations and other reduced institutional costs.

AHHQI is an advocacy group founded by six for-profit home care chains.

• If you're switching to Home Health Medicare Administrative Contractor NHIC, don't panic if you can't get into the claims system on May 18. The system will experience a "dark day" on that date during the cutover from current regional home health intermediary National Government Services, NHIC explains in an e-mail message to providers.

"We expect the system to be available again on Tuesday, May 19," NHIC says. Home care providers can still submit claims electronically that day, the HH MAC adds.

• Home health agencies aren't the only ones getting hit with case mix creep cuts. Skilled nursing facilities, long-term care hospitals, and inpatient acute care hospitals are seeing the same treatment from CMS.

CMS has proposed cutting SNF payments 3.3 percent in 2010, with a 2.1 percent offset for inflation, the agency says. The agency wants to cut inpatient hospital rates 1.9 percent, offset by a 2.1 percent inflation update. And CMS has proposed cutting LTCH rates 2.4 percent, minus a 1.8 percent inflation increase.

• More chronic conditions translates to longer home care stays for patients, says a new study by the VNSNYCenter for Home Care Policy & Research.

For example: Patients who had hypertension plus three or more other chronic conditions,such as diabetes, heart disease, and arthritis, had nearly 22 days more (78 days total) of home care on average than patients with only hypertension (56 days total), says the study published in the Journal for Healthcare Quality.

Adding cognitive impairments to chronic conditions also increases the length of stay, the study found. Patients with hypertension and cognitive impairment used home health care for 20 days longer than patients without cognitive impairment.

Bottom line: The OASIS assessment needs to more accurately assess chronic conditions and cognitive impairments, the study authors suggest.

• The home medical equipment industry and its representatives will have a chance to give CMS a piece of their mind about competitive bidding next month.

CMS is holding a Program Advisory and Oversight Committee meeting June 4 in Baltimore.

"CMS expects that the feedback received from the PAOC committee members and the public will assist the Agency as it moves forward with the Round 1 Rebid," the agency says.

• Home health agencies accredited by the Accreditation Commission for Health Care Inc. can rest easy that they won't have to switch surveyors anytime soon. CMS has renewed ACHC's accrediting deemed status authority for HHAs, the Raleigh, N.C.-based organization notes in a release.

ACHC also has deemed status for its HME accreditation program, it says. It has applied for deemed status for its hospice program. The accrediting body has 10 accreditation programs altogether.

• If you use the current 4010 form for HME billing, you'll have to get used to a new HIPAA 5010 form as a prerequisite to submitting ICD-10 codes, CMS says in MLN Matters article SE0904. CMS advises suppliers that they "must be ready to submit claims electronically using the X12 version 5010" effective Jan. 1, 2012. CMS published the final rule for implementing the 5010 transaction standard on Jan. 15.

The big news regarding the 5010 is that it will allow you to report ICD-10 codes (ICD-10 will take effect on Oct. 1, 2013).

• HHA chain LHC Group Inc. reported another quarter of positive earnings. The Lafayette, La.-based company reported net income of $15.0 million based on revenues of $124.6 million for the quarter ended March 31. That's compared to a $7.8 million profit on $83.5 million in revenues for the same period in 2008.

LHC whittled its days sales outstanding (DSO) significantly from 74 days to 47 days in the time period.

LHC also announced a joint HHA venture with Methodist Hospital in Henderson, Ky. The venture will cover three counties in the certificate of need (CON) state, LHC says in a release. The HHA has annual revenues of $3 million.

• Gentiva Health Services Inc.'s revenues dipped but profits increased in the latest quarter.

The Melville, N.Y.-based chain reported net income of $18.0 million on revenues of $288.9 million for the quarter ended March 29. That profit figure includes the sale of some branch offices specializing in pediatrics, the company notes in a release.

The figures compare to a $7.7 million profit on $321.6 million in revenues for the same period in 2008. Nearly $78 million of the revenue difference was due to Gentiva's sale of its managed care Carecentrix business line, it says.

• Covenant Care at Home has completed the purchase of Home Care Services of Emanuel from Emanuel Medical Center in Turlock, Calif., reports the Turlock Journal. The new agency will target patients who live in retirement communities, the newspaper says. Covenant is owned by chain Covenant Retirement Communities, a ministry of the Evangelical Covenant Church.