Home Health & Hospice Week

Medicare package begins to take shape in the Senate.

The clock is ticking down to physicians' Medicare reimbursement cut slated for July 1, but it's home care providers who could see payment pain.

The Senate is taking the lead on putting together a Medicare package that will avert docs' looming 10 percent cut. Senate Finance Committee Chair Max Baucus (D-MT) now indicates the committee will issue a Medicare bill that will put off physician rate cuts for 18 months.

Some observers thought legislators would opt for a short six-month fix, which would be significantly less expensive. The 18-month version will require lawmakers to come up with more funding for the fix, which makes the threat to home care providers' payment rates even more dire.

Ray of hope: Baucus has indicated he could pay for the fix by making physicians' payment cuts down the road even steeper, then fixing those when their time comes. This could take the pressure off members of Congress to tap other providers' payments to pay for the physician increase.

But the American Medical Association and other physician trade groups are not fans of the idea. They'd rather eliminate the problem now than ask lawmakers to fix a problem that is twice as big later.

Even if Congress does adopt the so-called balloon financing approach for doctors, the fix will still require more funding, which is likely to come from providers such as home health agencies, hospices and durable medical equipment suppliers.

Stay tuned: Baucus hopes to have Medicare legislation on the Senate floor by mid-May.

• The Medicare Payment Advisory Commission isn't going to make formal recommendations about hospice payment rates in its June report to Congress about the industry, but its findings could likely lead to congressional action anyway.

In last month's MedPAC meeting, the commission looked at hospice profitability, margins and length of stay. Several commissioners suggested making big cuts to hospice payment rates (see Eli's HCW, Vol. XVII, No. 11).

But in its April 10 meeting, MedPAC commissioners were more positive about hospices. "We're all going to leave this world and it's an excellent program," said physician and commissioner Ronald Castellanos. "It's a societal benefit. It's a family benefit."

States have a wide range of Medicare beneficiaries who use hospice before their deaths. For example, only 25 percent of District of Columbia Medicare decedents use hospice before dying, while that figure is 70 percent in Utah, noted MedPAC staffer Jim Mathews in the meeting.

The 70 percent figure is "actually not by accident, it's by design," Utah physician Perry Fine said in the meeting's public comment period. Hospice providers and allies have done "extraordinary work at changing the culture and the valuing of hospice by mainstream medicine," said Fine, a practicing physician with the University of Utah in Salt Lake City and a longtime hospice medical director.

Everyone should strive for 100 percent hospice use, Castellanos urged. "We should encourage that this program is available ... for those who qualify and want it."

Growth in hospice programs and utilization, "even dramatic levels of growth, is not necessarily a bad thing," added departing MedPAC Commissioner Nancy-Ann DeParle.

DeParle, a former Health Care Financing Administration head, also picked up on the issue of hospice surveys, insisting that a survey every eight years or more for hospices is not adequate.

Hospice Compare coming? The April 10 presentation by MedPAC staffers focused on quality of care and utilization. CMS and the quality improvement organization from North Carolina are currently generating hospice quality measures, Mathews noted.

Don Shumacher with the National Hospice and Palliative Care Organization again slammed CMS' new data collection requirements for hospice claims. "The data that they are asking us to collect is almost impossible," he stressed to the commission.

• Home health agencies may get a pretty substantial sneak peek at pay for performance. About 570 agencies are participating in the P4P demonstration that began Jan. 1, a CMS official reported in the April 2 Open Door Forum for home care providers.

• Don't be surprised if you're experiencing remittance advice confusion, if National Government Services is your intermediary. After the April 5 claims system update, providers began receiving two RAs for some claims--one with the old OSCAR number and one with the new National Provider Identifier number, NGS explains in an email to providers. The problem took place only for contractors who transferred to HIGLAS, the intermediary notes.

And sometimes no electronic RAs are delivered, NGS adds in another email. NGS and the system maintainer are working to correct the problem.

• Watch for CMS to issue final supplier standards in coming months now that the comment period for the proposed standards is closed. The American Association for Homecare urged CMS to implement a one-year transition to the new standards in its comments on the proposed rule.

And AAHomecare wants CMS to grant suppliers more flexibility in subcontracting for certain services, the trade group said in its comments.

CMS issued five new proposed standards and proposed revisions to existing standards in a Jan. 25 Federal Register notice (see Eli's HCW, Vol. XVII, No. 5).

• Don't expect relief at the gas pump any time soon. The high price of crude oil is keeping gasoline prices high, notes the federal Energy Information Administration. While the supply of gas seems better than last spring, "record crude oil prices are nonetheless pushing current and expected gasoline prices to record levels," the EIA notes on its Web site.

The U.S. average price of gas is $3.30 per gallon as of April 14, the EIA notes. That's up nearly 6 cents per gallon from the previous week and about 50 cents from the same time last year.

The gas price Web site www.gasbuddy.com puts that figure even higher, at $3.43 per gallon.

The West Coast has the highest average gas price at $3.66 per gallon while the Gulf Coast is the lowest at $3.28, the EIA says.

• Need help figuring out CMS' confusing manual system? Now you can consult an online brochure that provides an overview of the online manuals, including the claims processing and benefit integrity manuals. The two-page brochure is at www.cms.hhs.gov/MLNProducts/downloads/onlinebrochure.pdf.

• CMS' contractor for the Medicare Contractor Provider Satisfaction Survey is taking providers' feedback until the end of April, a CMS staffer noted in the April 2 Open Door Forum for home care providers.

So far 56 percent of HHAs, 53 percent of hospices, and 65 percent of suppliers have responded to the survey from Westat soliciting feedback on intermediaries and carriers. CMS' overall goal is a 65 percent response rate. CMS will publish the survey results in July.

More information on the survey is at www.cms.hhs.gov/mcpss.

• The HHS Office of Inspector General has loosened up its penalties when providers self-disclose compliance problems, but home care providers should still think twice about self-reporting problems to the OIG.

Inspector General Daniel Levinson issued an Open Letter to Health Care Providers on April 15. "Providers who disclose in good faith, fully cooperate with OIG, and provide requested information in a timely manner will generally not be required to enter into Corporate Integrity or Certification of Compli-ance Agreements with OIG," Levinson says in the Open Letter.

Previously, the OIG usually at least required a certification of compliance agreement.

But legal experts still advise providers to get good advice from counsel before deciding where to disclose compliance issues. Home care organizations generally should disclose to the OIG only for intentional wrongdoing, some suggest (see Eli's HCW, Vol. XV, No. 18).

• Palmetto GBA ranked among the nation's top government contractors in a recent ratings report. The Ethisphere Institute rated Palmetto No. 10 nationally in the "10 Best Private Company Ethics Programs" category, and No. 33 in the "Best Ethics Programs Overall," Palmetto notes in a release.

Researchers from the Ethisphere Institute analyzed more than 1,000 federal government contractors as part of the 2008 ratings, says Palmetto, which serves as a regional home health intermediary, DME MAC, competitive bidding implementation contractor and program safeguard contractor, among other roles.