Home Health & Hospice Week

Finding: Home care costs Medicare less for these patients.

A new study commissioned by the Medicare Payment Advisory Commission could give a boost to home care for lucrative hip and knee replacement patients.

According to a study conducted by RAND Corp., patients discharged to skilled nursing or inpatient rehab facilities were more likely to be reinstitutionalized within 120 days after acute care discharge when compared to patients discharged to home care.

Mortality rates were the same for the groups, RAND researcher Melinda Beeuwkes Buntin told MedPAC at its April 21 meeting.

In addition, SNF and IRF care cost significantly more than home care - an average of $3,500 more for SNFs and $8,000 more for IRFs, RAND found.


MedPAC also conducted a panel study of 11 physicians specializing in joint replacement. The physicians recommended that patients recuperate at home instead of in an IRF or SNF unless extenuating conditions called for facility care, reported MedPAC staffer Sally Kaplan.

Because of changes to IRFs' 75 percent rule governing Medicare payment, more joint replacement patients are going to other post-acute settings for post-operative rehab, Kaplan noted.

More information on the study findings, which will be included in MedPAC's June report to Congress, is at www.medpac.gov/public_meetings/transcripts/0405_transcript_full.pdf (starting on p. 201).   Durable medical equipment suppliers get another chance to share their national competitive bidding concerns.

Bidding contractor Research Triangle Institute of Research Triangle Park, NC. will be holding four focus groups with suppliers to assess the potential impact bidding will have on their businesses.

The sessions will be held in Dallas on May 4 and Chicago on May 5. CMS held its first focus groups with suppliers earlier this month at the Medtrade show in Las Vegas.

More details on the focus groups are at www.cms.hhs.gov/suppliers/DMEPOS. 
  CMS still doesn't have a firm date for when it will publish its final national coverage determination for wheelchairs.

When the agency announced it was proposing new coverage criteria in February, it expected to publish the criteria by the end of March. At press time, the coverage determination still had not been published. At the April 21 Open Door Forum, Eric Sokol of the Power Mobility Coalition asked when suppliers might see the NCD.

"I can't say that, because it's a complicated issue no matter how you look at it," a CMS official responded. "It is still in the clearance process." 
  The Home Care Association of New Hampshire has taken the state to court over not paying enough for home care services.

The state is failing to comply with a law requiring annual updates of home health rates, the Association says in a release. New Hampshire hasn't updated rates since 1999, according to the trade group.

Some visiting nurse associations already have discontinued Medicaid homemaker programs [...]