Home Health & Hospice Week

SNF rating system and hospital P4P show what home care has in store.

Your OASIS data will be more important than ever when two new initiatives for other provider types hit home health agencies.

The Centers for Medicare & Medicaid Services will start rating skilled nursing homes on a five-star scale, the agency has announced. The "ground-breaking ranking system" will "provide patients and their families an easy to understand assessment of nursing home quality, making meaningful distinctions between high performing and low performing homes," CMS explains in a release.

CMS will post the ratings on Nursing Home Compare by the end of the year. "Nursing Home Compare's new rating system will ... provide an incentive for nursing homes to strive toward earning a five-star rating by providing an environment of better quality care," CMS Acting Administrator Kerry Weems says in the release.

Similar ratings for HHAs on Home Health Compare may not be far behind, predict industry veterans.

P4P: Some of the political excitement for pay for performance seems to have died down, but that doesn't mean it's going away.

The third year of Medicare's "value-based purchasing" demonstration for hospitals shows that P4P incentives seem to increase care quality. Scores for quality standards have improved remarkably over the three years of the program.

For example: The composite quality score for patients with heart failure increased from 64 to 89 percent over the course of the demonstration. Patients with pneumonia saw a jump from 69 percent to 90 percent.

The top-performing 112 hospitals earned $7 million in incentive payments for "substantial and continual advancement in quality of care," CMS notes. The agency is now calling for the P4P program to apply to all hospitals paid by Medicare.

Once that is achieved, the agency is likely to call for the same for other providers like HHAs, experts forecast.

• Get ready for hospitals' post acute transfer rule to take an even bigger bite out of your post-hospital referrals. CMS wants to expand the transfer timeframe from the current three days to seven days, the agency says in its inpatient prospective payment system rule for hospitals published in the April 30 Federal Register.

That means if the hospital discharges a patient before the average length of stay for that patient's DRG, Medicare will pay a prorated per diem amount instead of the entire DRG payment. Currently that proration applies only when the patient begins home care within three days of hospital discharge, but CMS will now make that within a week.

Background: Starting in 1999, when CMS cut hospitals' payment rates for certain patients referred to home care upon discharge, home health agencies saw physicians reduce their referrals for those patients. And then when CMS expanded the proration from 30 to 182 DRGs in 2005, the referral reduction increased dramatically for some agencies (see Eli's HCW, Vol. XIV, No. 44). The number of affected DRGs went up to 273 this year.

"[Seven] days is currently an appropriate timeframe because ... it is sufficiently long enough to lessen the likelihood that providers would delay the initiation of necessary home health services," CMS contends in the rule.

The National Association for Home Care & Hospice submitted comments on the rule arguing against the increased seven-day timeframe, the trade group says in its newsletter for members. The change would result in longer than necessary hospital stays; further delay of HHA referrals with negative consequences for patients; and unmet needs at home resulting in preventable emergent care visits and re-hospitalizations, NAHC contends.

• HHAs are having a tough enough time reconciling claims payments under PPS refinements, and now they have more claims curveballs to field. A Medicare claims system update in April has caused remittance advice errors and prevented regional home health intermediary Cahaba GBA from making withholdings, the RHHI notes in a message to providers.

Now the problem is fixed and Cahaba will begin recouping the money--but will you be able to tell what the recoupments are for?

"To balance claims withholding, it is imperative for providers to research their past RAs beginning on April 7, 2008, through June 13, 2008," Cahaba instructs. "When reviewing RAs, providers will need to add the dollar amount of any outstanding balance for each RA to discover where money was owed and recoupment failed to occur."

Another RA problem: And RHHI National Government Services reports that starting June 2, some of the remarks codes on RAs were ones that were terminated or no longer valid.

The fix for that problem is being tested, NGS reports. Meanwhile, "we will not reproduce June remittance advice with corrected codes," the intermediary says.

• If your claims are rejecting due to NPI problems, it's probably for one of two reasons, CMS says. First, you could be submitting your legacy number instead of or in addition to your National Provider Identifier, which CMS began requiring as the only number May 28. "Legacy provider numbers are no longer allowed on ANY Medicare claim or transaction," CMS stresses in a message to providers.

Or your social security number or employer ID number may not match the taxpayer ID number information in the Medicare crosswalk. If that's the case, Medicare doesn't require SSNs or EINs on claims, so you can just drop those numbers, CMS suggests. More information is at www.cms.hhs.gov/NationalProvIdentStand.

• Home care and durable medical equipment suppliers are in the HHS Office of Inspector General's spotlight once again.

Scam #1: In the OIG's report on state Medicaid Fraud Control Units for 2007, the agency profiles a Colorado woman who forged documents to submit false timesheets for visits never provided. She submitted them under the name of an acquaintance who had moved out of the country, forged her signature, and kept the money for herself.

The defendant was sentenced to 90 days' imprisonment and 4 years' probation, plus was ordered to undergo a mental health evaluation, complete 200 hours of community service, write letters of apology, and to pay restitution of more than $20,000, the OIG reports.

Scam #2: A Washington, DC-based DME supplier agreed to pay $1.5 million to settle False Claims Act charges, the report says. The supplier billed for items not ordered by a physician, not medically necessary and not delivered to residents in group homes as claimed.

Scam #3: A Colorado supplier submitted more than $1 million in claims for power wheelchair repairs that weren't made or took much less time than stated, the report adds. The supplier also billed for items that were never provided or that cost much less than claimed.

The supplier received five years in state pri-son followed by five years' parole and was ordered to pay restitution of more than $728,000, the OIG says.

• Don't overlook hearing loss in your diabetic patients. Hearing loss is about twice as common in adults with diabetes compared to those who do not have the disease, says a new study funded by the National Institutes of Health.

"Hearing loss may be an under-recognized complication of diabetes," senior author Catherine Cowie of the National Institute of Diabetes and Digestive and Kidney Diseases says in a release.

• Odyssey Healthcare Inc. won't be getting a fresh crack at the Washington market any time soon. A state of Washington Court of Appeals shot down Odyssey's request to overturn a Department of Health ruling denying the for-profit chain certificates of need for three counties in the state, according to a June 17 opinion (No. 36489-1).

"Odyssey argued that the Department had misinterpreted its own methodology and had improperly forecast the three counties' hospice need," the opinion notes. But a health law judge, lower courts and finally the appeals court disagreed.

Franciscan Health Services, Providence Hospice and Home Care of Snohomish County, and Evergreen Hospice intervened in the case to oppose Odyssey's petition. Much of the testimony at a public hearing also disputed the chain's arguments, the opinion notes.

• For-profit hospice chain VITAS has inked a deal with CIGNA to provide hospice services for its members in 16 states, the Miami-based company says in a release.

The deal will cover all four levels of hospice care and a range of services and items from prescription drugs to medical equipment.

• Murky Medicare reimbursement for oxygen in 2009 hasn't kept a private investment firm from offering $1.6 billion to buy Apria Healthcare Group Inc. and take it private.

New York City-based Blackstone Group will buy Lake Forest, CA-based Apria for $21 a share, which was about 33 percent more than shares were trading at before the announcement. The stock price increased nearly 30 percent to $19.90 per share at press time, following the news.

Apria's board has approved the deal and the transaction is expected to close in 2008.

Apria has an opportunity to solicit other offers until July 24, notes the Daily Deal newspaper. But it would have to pay an undisclosed "breakup fee" to go with another buyer.

• Regional chain Almost Family Inc. is expanding its presence in the Northeast. The Louisville, KY-based company will buy the stock of Patient Care Inc. for $45.2 million. Patient Care has eight locations in New Jersey, Pennsylvania, and Connecticut, the chain says.

"With this acquisition, Almost Family will operate almost 90 branches across 11 states," the provider says in a release. It will mark the company's entry into Pennsylvania.

Patient Care had 2007 annual revenues of $47 million, according to the release. The acquisition is expected to close in the third quarter.