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Home Health & Hospice Week

Industry Notes:

P4P BILL GAINS STEAM UNDER AARP BACKING

Published on Tue Jun 14, 2005

Information technology another topic likely to see legislative action.

The powerful American Association for Retired Persons has come out in support of pay-for-performance legislation. If overwhelming support in the House and Senate wasn't enough to guarantee passage of a P4P bill, then the AARP's boost could seal the deal.

Senate Finance Committee Chair Charles Grassley (R-IA) introduced the Medicare Value Purchasing (MVP) Act of 2005 with co-sponsor Sen. Max Baucus (D-MT) (see Eli's HCW, Vol. XIV, No. 24).

The Grassley-Baucus bill is "an idea whose time has come," says John Rother, the AARP's executive officer for policy and strategy. Using payment incentives to improve performance will spell better care for older and disabled Americans, he adds.

Many lawmakers believe P4P is "the next step in introducing market-based reform and incentives into the Medicare program," says attorney William Sarraille with Sidley Austin Brown & Wood in Washington. "Pay for performance is an idea that will take root," despite resistance from providers, predicts Sarraille.

P4P legislation is likely to open the door to other Medicare-related measures, experts predict. Legislation aimed at boosting information technology seems likely to have a place in any Medicare reform bill, say Washington insiders.

Sen. Mike Enzi (R-WY), chairman of the Health Education Labor and Pensions (HELP) committee, has introduced the "Healthcare Information Technology Quality and Improvement Act of 2005," with ranking member Sen. Edward Kennedy (D-MA). The bill would require health IT systems to work with all other systems, and authorize a national health IT contractor and a "Best Practices Center." The Enzi-Kennedy bill also would provide grants to help providers move to health IT systems.
The Grassley-Baucus P4P bill also calls for a three-year, six-site demonstration project on health IT, aimed at determining the "threshold" amount of IT that providers need in order to collect quality data and use it to improve care for Medicare beneficiaries.  

  • Talking with a nursing home resident's doctor about hospice can boost hospice utilization, says a new study in the Journal of the American Medical Association. Researchers identified a group of residents in three U.S. nursing homes who were appropriate for palliative care, then contacted half of their physicians to authorize a hospice information visit, the JAMA study says.

    Residents whose physicians were contacted were more likely to elect hospice care, had fewer acute care admissions and spent fewer days in an acute care setting, according to the study. And those residents' families "rated the resident's care more highly than did families of usual care residents," the study says.

    More information is in the July 13 issue of JAMA at     http://jama.ama-assn.org.
     
  • If you've been experiencing epoetin claims denials, a durable medical equipment regional carrierhas some advice. The Region B DMERC is seeing many EPO claims deny, Adminastar Federal said in a recent listserv message. The primary reason is that the beneficiary is not on Method II dialysis, as required. In addition, the supplier who provides the patient's dialysis supplies under Method II must also supply the EPO.
     
  • The Centers for Medicare & Medicaid Services has corrected errors in its Medicare appeals rule, saying that providing extra evidence after an appeal is submitted may extend the time frame by up to 14 days, but the extension may not necessarily be the full 14 days.

    Also, requesting an in-person hearing with an administrative law judge doesn't automatically cancel the 90-day timeframe to respond. But if the ALJ grants the request, the 90-day timeframe is considered waived, according to the June 30 Federal Register.
     
  • Quality Improvement Organizations' effectiveness in actually improving your Medicare beneficiaries' quality of care is under fire.

    Hospitals participating in QIO programs showed no statistically significant differences in quality-of-care improvements than non-participating hospitals, according to a recent Journal of the American Medical Association study. Although participating and non-participating hospitals began with many differences, a followup study revealed their rates of change over two to three years were nearly the same. The study collected data from four QIOs and compared baseline data from 1998 to followup data from 2000 and 2001.

    More information is in the June 15 issue of JAMA at     http://jama.ama-assn.org.
  • If you're experiencing a claims delay from Palmetto GBA, you're not alone. The regional home health intermediary is working to fix a delay with claims held in status/location (s/loc) SM95HG, it says.

    "We anticipate [the Fiscal Intermediary Shared System] to correct this situation by the end of July," Palmetto says in a Web site posting. Once Palmetto receives and tests the corrections, "these claims will be sent back to the Healthcare Integrated General Ledger Accounting System (HIGLAS) and moved from SM95HG to the payment floor PB9997," the RHHI says.
     
  • Apria Healthcare has inhaled another competitor. The Lake Forest, CA-based home respiratory provider is purchasing VitalAire, the U.S. home care subsidiary of the Paris-based Air Liquide Group. VitalAire recorded sales of about $20 million in 2004.

    Apria's own possible sale apparently has not knocked the breath out of its acquisition strategy. The company has confirmed that it's hired Morgan Stanley to help it consider potential offers, which observers have speculated could be as high as $2.5 billion.
     
  • It's official: Amedisys Inc. is ready to grow by more than 50 percent. The Baton Rouge, LA-based regional powerhouse has finalized its acquisition of Housecall Medical Resources Inc. for $106 million, Amedisys says.

    Amedisys, which reported 124 locations as of March of this year, will integrate Housecall's 66 home health agency and hospice locations that generate $103 million in revenue annually. Amedisys financed the deal with cash on hand and through $75 million in senior secured credit facilities provided by Wachovia Bank and GE Healthcare Financial Services.
     
  • Invacare Corp. is warning of lower-than-expected earnings in the second quarter and the full year, due to rising freight costs from high oil prices. Net sales will be 2 to 4 percentage points lower than forecast, the Elyria, OH-based company says.

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