Home Health & Hospice Week

The National Labor Relations Board ruled Oct. 3 that nurses with full-time responsibility for assigning fellow hospital workers to particular tasks are supervisors under federal labor law and thus not eligible to be represented by unions.

With a 3-2 vote, the board held that the permanent charge nurses employed by Oakwood Heritage Hospital, an acute care hospital, exercised supervisory authority in assigning employees within the meaning of Section 2(11) of the National Labor Relations Act.

The decision, long awaited by unions and businesses, sets a new standard for determining who is a supervisor and could have significant implications for efforts by labor unions to organize nurses. Under federal law, supervisors do not have the right to belong to unions.

Labor leaders decried the ruling, with AFL-CIO President John Sweeney saying it "welcomes employers to strip millions of workers of their right to have a union by reclassifying them as 'supervisors' in name only," according to the Washington Post.

Note: For more information, go to www.nlrb.gov/nlrb/press/releases/r2603.pdf.

• Durable medical equipment manufacturers must be wary of partnering too closely with suppliers, says the HHS Office of Inspector General in a new advisory opinion.

A durable medical equipment manufacturer  whose identity was not disclosed planned to underwrite advertising and provide free consulting services for suppliers of its products, explains the OIG in an Oct. 10 advisory opinion (No. 6-16). Such an arrangement poses substantial risk of generating disguised kickbacks for referrals for federally reimbursed products, the agency concludes.

The proposed arrangement clearly would constitute remuneration to DME suppliers,  said the OIG in its report.  That's because the suppliers are in the position to generate federal health care business for the wheelchair manufacturer who requested the advisory opinion, said the OIG.

The availability and value of the advertising assistance to suppliers would be determined in a way that considered volume and value of the suppliers' past and expected future purchases, the OIG said. Combined, those elements raise substantial anti-kickback concerns.

Risk: The OIG noted that it could, in such a case, impose administrative penalties in connection with the program.

Note: The advisory opinion is available at www.oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-16A.pdf. 

• Amedisys Inc., has announced the acquisition of Jefferson County Patient Care Services, Inc., a home health agency in Hillsboro, MO. The acquisition is effective as of Oct. 1, and is expected to contribute approximately $3.5 million in annualized revenues.

The acquisition represents the Baton Rouge, LA-based company's entry into Missouri and includes two locations: Hillsboro, MO, and St. Louis, MO.

• National Home Health Care Corp., a provider of home health care and staffing services in the Northeast, announced recently that its board of directors has declared a regular quarterly cash dividend of 75 cents per share on its common stock. The dividend will be payable on Nov. 6 to holders of record of its outstanding common stock on Oct. 19.

• A federal district court dismissed a complaint filed by a home health agency seeking relief from the collection of Medicare overpayment totalling $4 million.

The court's conclusion: The HHA failed to exhaust administrative remedies.

The U.S. District Court for the Northern District of Texas concluded Sept. 29 that M&F Home Health Care Inc. and its owner, Arthur Fleming, failed to appeal a Notice of Program Reimbursement for the Jan. 31, 1999, cost report, despite having ample opportunity to do so.

Because the HHA failed to exhaust the administrative remedies under Medicare, the district court found that it lacked jurisdiction.

"While [M&F and Fleming] allege that there are no administrative remedies under the Medicare Act to address their concerns, this conclusory statement is simply incorrect, and [Fleming and the HHA] have failed to allege exhaustion of the administrative remedies detailed in 42 U.S.C. §§405 and 1395," Judge Irma Carrillo Ramirez wrote.

• The Centers for Medicare & Medicaid Services should develop a new approach for allocating funds to the Medicare Integrity Program to ensure the money goes toward the most effective activities, the Government Accountability Office said in an Oct. 6 report.

Funding for each of the five MIP activities--which look at payments to and activities of home health agencies and other health care providers--has increased each year since 1997.

The GAO notes, however, the size of the increases varied by activity. CMS told the GAO that Medicare Integrity Program funds historically have been allocated based on past funding levels, and GAO found that CMS had no qualitative data by which to compare activities' effectiveness relative to funding.

Furthermore, the GAO found that CMS had not assessed whether MIP funds were distributed adequately to MIP contractors for each of the five program areas--audit, medical review, secondary payer, benefit integrity and provider education.

Recommendation: The GAO is calling on CMS to base future MIP funding allocations on the effectiveness of each of the five MIP activities, on contractors' workload and on Medicare program vulnerabilities.

Note: The GAO's full report report is available online at www.gao.gov/new.items/d06813.pdf.

• Americans are poorly prepared to meet an inevitable "caregiving crisis" coming as a result of population aging, according to a new report, Caregiving In America.

The report was released Sept. 28 by The Caregiving Project for Older Americans, a joint collaboration of the International Longevity Center-USA and the Schmieding Center for Senior Health & Education.

Caregiving in America reports that demographic and social trends are reducing the available pool of family caregivers, who by far are the greatest source of care to impaired older adults.

The so-called sandwich generation, those responsible for raising children and caring for aging parents, have been especially hard-hit by these trends. At the same time, the caregiving industry is experiencing a severe and worsening shortage of paid professionals, the report notes.

More than 15 million people use caregiver services in the United States, and with the aging of baby boomers, that number is expected to nearly double by 2050.

Note: To read the report, go to www.ilcusa.org/pub/books.htm.

• Texas Home Health has moved its corporate headquarters from Silsbee, TX to Brentwood, TN.

The company, which provides a slate of in-home health services, has 9,000 employees and serves 14,000 clients in Texas, Tennessee and Georgia and had 2005 revenue of $170 million.

"The Nashville area's central location is important as we look to expand our existing business and make acquisitions in the region," said company president and CEO Judy Bishop in a press release.

Texas Home Health provides in-home nursing, counseling, physical therapy, speech therapy, occupational therapy, hospice services and non-medical services that support daily living.

The company is owned by private equity firm Friedman Fleischer & Lowe.

• American HomePatient announced recently that the U.S. Supreme Court has denied the petition for writ of certiorari filed by the holders of the company's senior debt.

The Supreme Court's denial of the petition effectively concludes the debt holders' efforts to overturn the orders confirming the company's plan of reorganization.

The plan was originally confirmed by the bankruptcy court in 2003. American HomePatient is one of the nation's largest home health care providers with 262 centers in 34 states.

The company's product and service offerings include respiratory services, infusion therapy, parenteral and enteral nutrition, and medical equipment for patients in their home.