Home Health & Hospice Week

Congress one step closer to finalizing Medicare budget for 2006.

As the House and Senate prepare to enter negotiations over their budget packages, home care providers wait anxiously to see if lawmakers will take their final opportunity to make big cuts to Medicare home care spending in 2006.

The House passed its budget reconciliation package by only two votes Nov. 18, delivering legislation that contained no Medicare cuts but about $12 billion in Medicaid cuts. The budget package passed Nov. 3 by the Senate contains no cuts to home care spending either (see Eli's HCW, Vol. XIV, No. 40).

Despite the two positive budget bills, home health agencies still may be in for trouble when the Senate and House head to conference to work out the differences in their budget reconciliation packages. "I don't think we're out of the woods yet," the Visiting Nurse Associations of America's Kathy Thompson tells Eli.

Congress is under intense pressure to correct the physician payment formula for Medicare to the tune of about $20 billion, the American Association for Homecare warns. Centers for Medicare & Medicaid Services Administrator Mark McClellan says CMS supports a physician payment fix, which will head off a 4 percent reduction in physician payments next year.

"This leaves home care at great risk of cuts to pay for the physician [sustainable growth rate] fix," AAH warns.

Providers should stress to lawmakers that home care is cost effective, clinically effective, and patient-preferred, AAH urges. "Home care is not the problem, it's the solution."

The conference committee is expected to be announced and start negotiating by mid-December when Congress reconvenes, observers say.

• A survey that's making its way to home oxygen providers may be used to support future cuts to their reimbursement rates. So warns AAHomecare about the survey being conducted by the HHS Office of Inspector General.

The survey may not fully capture all of the services that accompany home oxygen therapy--especially those services that do not routinely require documentation, AAH says. The trade group is asking providers who do receive the survey to return it promptly, as the OIG may not grant extensions.

• The influential Medicare Payment Advisory Commission may give therapy visits a hard look over the next year. As part of its study of the prospective payment system's payment adequacy, Med-PAC is looking at the OIG's three audit reports that denied a large percentage of therapy visits.

The audits "suggest that the same quality of care could have been achieved with the use of fewer resources," MedPAC staffer Sharon Cheng said in the commission's November meeting. "The Commission may wish to take into account this indication about payments and costs."

Medicare spending on home health has risen 40 percent since PPS began in 2000, while the number of Medicare-certified agencies is up 14 percent to about 8,000, Cheng reported. Home care spending is expected to rise another 16 percent between 2005 and 2010.

• CMS wants to know whether providers are satisfied with its contractors. The agency soon will send invitations to a random sample of about 25,000 providers, asking them to participate in its contractor satisfaction survey. The survey focuses on communication, inquiries, claims processing, appeals, enrollment, medical review, and audit and reimbursement.

Selected providers will receive their invitation in the mail during the third week of January and will have until Jan. 25 to respond.

• CMS just got some more ammunition in its case for pay for performance for all provider types.

Hospitals participating in the P4P demonstration reported improved quality scores for certain heart, pneumonia and knee and hip replacement patients in the first year, CMS has announced. And preliminary information from the second year of the demo shows quality scores are continuing to improve.

"We are seeing that pay-for-performance works," CMS Administrator Mark McClellan says in a release.

Medicare is awarding $8.85 million to hospitals that showed measurable improvements in care during the first year of the program. In the third year of the demo, CMS will start to reduce payments for the lowest-performing providers.

Members of the P4P task force formed by the  National Association for Home Care & Hospice, VNAA and AAH met with CMS staff Nov. 29 to begin collaboration on a home health P4P initiative, the trade groups report.

• The United States recovered more than $1.4 billion for fraud and false claims last fiscal year--including a case involving a fake DME company.

The U.S. subsidiary of dialysis provider Gambro Healthcare of Sweden paid $310 million to resolve civil and criminal allegations of fraud for a scheme that provided patients with equipment and supplies through a sham DME company. DaVita Inc. of El Segundo, CA has since acquired Gambro's U.S. operations.

• The monetary threshold for Administrative Law Judge and federal district court reviews will go up Jan. 1, as required by the Medicare Modern-ization Act. The dollar amount in controversy for an ALJ hearing will increase from $100 to $110, contractor Palmetto GBA notes on its Web site. The amount for court appeals will go from $1,050 to $1,090.

 • The 2006 calendar to help you figure out OASIS follow-up schedules is now out. You can download the tool by going to www.qtso.com, clicking on "OASIS" in the left-hand column and scrolling down to the follow-up scheduling calendar.