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Home Health & Hospice Week

Industry Notes:

OBQI RISK ADJUSTMENT ADJUSTED

Published on Tue May 13, 2003

No, it's not your fuzzy math that's making your OBQI numbers jump around - they really might have changed.

The Centers for Medicare & Medicaid Services has refined the risk adjustment model for outcome-based quality improvement outcome reports, which contain 41 patient outcomes. National reference values for all outcomes in both the risk-adjusted and descriptive reports, the number of cases in the national reference sample at the top of both reports, and the number of eligible cases for each outcome will change as a result of a refinement implemented April 11.

CMS also put in place a new risk-adjustment model in early March, so "national reference values on Risk-Adjusted reports requested before and after March 8 will not necessarily match," CMS advises on its OASIS Web site.

Another item that might alter numbers is a monthly program "that incorporates late submissions, corrections and inactivations in the OBQM/I calculations," CMS explains. An agency with any of those items might see their calculations altered by them in subsequent reports.

More information on the risk-adjustment changes is at www.cms.hhs.gov/oasis/obqi.asp.

  • The U.S. Supreme Court refused April 28 to hear an appeal in a case in which a home health agency is suing an Internet company for "grading" it on its Web site, reports the Associated Press. That means the suit Northwest Healthcare Alliance, also known as Assured Home Health, brought against Healthgrades.com finally should proceed in Washington federal court.

    Jurisdictional wrangling has kept the case tied up since October 2000, with Assured seeking a Washington court venue and Healthgrades.com insisting upon a Colorado venue based on a user agreement on its Web site (see Eli's HCW, Vol. XI, No. 41, p. 332). Assured is suing the Internet company for defamation.

    The case is likely to set a precedent in In-ternet-based jurisdiction law, say legal experts.

  • The 1st U.S. Circuit Court of Appeals has shot down an appeal from a former home health aide who claims she was fired in 1992 based on age and national origin. A few questionable remarks from co-workers and/or supervisors that weren't related to the disciplinary reason St. Lukes Home Care Program in Puerto Rico fired Maria Zukowski don't prove the discrimination claim, the appeals court says in Zukowski vs. St. Luke's Home Care Program (No. 02-1887).

    Zukowski argued that a favorable decision on the matter from a local court, which St. Luke's allegedly concealed in federal court, should win her a reconsideration. The appeals court disagreed, noting the HHA cited the decision in its defense, and affirmed the lower court's ruling against Zukowski.

  • In a letter to Health and Human Services Secretary Tommy Thompson and Attorney General John Ashcroft, Sen. Charles Grassley (R-IA) raises fears that the $880 million tentative settlement between the government and HCA is letting the hospital chain off easy. Citing whistle-blower assertions that CMS analysts have suggested the former Columbia/HCA is responsible for up to $1.8 billion in single damages, the Senator argues the HCA settlement "has been crafted in the dark for apparently a fraction of the damages" the Nashville, TN-based company actually owes.

    Fuming that three previous letters to the agencies have been "brushed aside," Grassley referred his concerns to the Inspectors General of both HHS and the Department of Justice.

  • HHS has approved a Louisiana Medicaid waiver that will offer home care services such as skilled nursing and respite care to 4,200 beneficiaries with disabilities. The waiver also will allow for some consumer-directed care, where participants coordinate their own care, starting with 100 beneficiaries the first year, HHS says.

  • Publicly announced mergers and acquisitions in home health grew 22 percent to 11 deals from the last quarter of 2002 to the first quarter of 2003, and leaped 450 percent from 2 deals in the year-ago quarter, reports New Canaan, CT-based Irving Levin Associates. "The home health care sector, after floundering for several years, is seeing renewed interest from investors and companies seeking to expand," says the M&A information firm in a health care market report.

    Most other health care sectors saw significant downturns in M&A activity for the quarter.

  • O2 Science has purchased Aspen Oxygen Equipment of Pinetop, AZ, says the Tempe-based respiratory therapy company with 17 locations. The acquisition expands O2 Science's area into Northern Arizona, the company says.

  • Long-term care companies with significant home care divisions saw slight increases to revenues this quarter. Murfreesboro, TN-based National Healthcare Corp., with 32 home care programs, reported earnings of $3.4 million on revenues of $113.2 million for the quarter ended March 31, compared to a $3.1 million profit on revenues of $111.2 million for the same period in 2002.

    Manor Care, with 88 home health offices, saw about 10 percent growth in home care and hospice revenues to about $300 million for the quarter, said Manor Care CFO Geoffrey Meyers in an April 25 conference call with investors and analysts. The company overall saw its profits dip from $32.4 million a year ago to $31.1 million in the quarter ended March 31, but saw revenues increase from $716 million to $730.5 million in the same period.

  • Matria Healthcare Inc. reported net income of $1.1 million on revenues of $78.2 million for the quarter ended March 31, compared to a $1.6 million profit on revenues of $65.2 million in the year-ago quarter. New disease management arrangements with employers and health plans contributed to the 20 percent increase in revenues, the Marietta, GA-based DM company says.

  • Hospices should submit their claims in chronological order the first time around, or they will have to sort out the mess themselves, regional home health intermediary Palmetto GBA says in its April advisory to providers.

    If hospices fail to submit bills sequentially for patients with multiple admissions, the claims system can lock out certain claims. Hospices then have to cancel claims in the later admission, void the subsequent admission, and post the first revocation to correct the problem.

    The problem often occurs when hospices bill in one big batch that includes multiple admissions, Palmetto warns. "It is imperative that these notice of elections and claims are billed sequentially," the RHHI says.

     

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