Home Health & Hospice Week

 The House of Representatives passed its budget resolution March 29, but the lack of home care cuts does not mean the industry's 2008 Medicare rates are safe.

Like the Senate, the House passed a budget blueprint that does not include President Bush's proposal to cut home health agency, hospice and durable medical equipment Medicare payment rates. The House voted down an alternative Republican resolution that called for $142 billion in Medicare cuts and $97 billion in Medicaid cuts over five years, according to press reports.

But lawmakers are still intent on rounding up budget savings to pay for two big projects--reauthorizing the State Children's Health Insurance Program (SCHIP) and avoiding a 10 percent cut to Medicare physician payments next year (see Eli's HCW, Vol. XVI, No. 11). Providers "are bracing for a fight later this year over how the costs of [the] two large items ...will be offset," notes the National Association for Home Care & Hospice.

Another target: To cover the cost of these changes, Democrats seem eager to reduce Medicare managed care plans'rates. The government pays 12 percent more for senior citizens enrolled in managed care plans than seniors who go through fee for service Medicare, according to managed care-cutting proponent Rep. Pete Stark (D-CA).

But reducing managed care payments won't yield enough savings to pay for both big-ticket budget items, experts say. That leaves home health agencies, with their relatively high average profit margins under Medicare, on the budget chopping block.

Beware: Lawmakers may look for even more Medicare and Medicaid cuts to reduce the deficit, NAHC warns.

The House and Senate hope to work out the differences in their budget resolutions by May 1. The resolutions act as a guide to lawmakers in crafting budget bills later this year.

• Home Health Compare's scores saw more movement than usual when CMS updated the patient outcomes data March 22. Three of the 10 measures saw an increase of 1 percentage point. The percentage of patients whose ambulation improved increased from 40 to 41; the percentage of patients who had less pain went from 62 to 63; and percentage of patients who have improved bladder control rose from 49 to 50.

The hot-button outcomes of acute hospitalization and emergent care stayed the same, however, at 28 percent and 21 percent respectively.

• One of main objectives of the new competitive bidding program for durable medical equipment, orthotics and supplies will be deterring fraud, according to CMS Acting Administrator Leslie Norwalk.

And on March 30, the HHS Office of Inspector General called attention to the DME fraud issue again, with a report on more than 1,500 DME suppliers in southern Florida.

Working in collaboration with the Centers for Medicare & Medicaid Services and the National Supplier Clearinghouse, the OIG inspected 1,581 suppliers to assess their compliance with selected Medicare supplier standards.

The OIG focused on five specific requirements, which state that suppliers must: (1) maintain a physical facility; (2) be open and staffed during business hours; (3) have a visible sign; (4) post hours of operation; and (5) maintain listed telephone numbers.

Though the criteria were basic, site visits by OIG inspectors found that 45 percent of DMEPOS suppliers in the three South Florida counties surveyed did not comply with at least one of the five standards.

Shocker: Nearly a third (31 percent) of the suppliers did not comply with the first two requirements of maintaining a facility at the business addresses that they provided to Medicare and being open for business during posted hours.

Another 14 percent of the Florida suppliers were open but failed to meet at least one of the three remaining requirements that the OIG reviewed. "It is clear that Medicare continues to be highly vulnerable to DMEPOS fraud and abuse," said Inspector General Daniel Levinson.