Advanced Search

Home Health & Hospice Week

Industry Notes:

Quality Of Care Could Shape Medicare Reimbursement

Published on Sun Jul 20, 2003

Home care providers' Medicare reimbursement will directly depend on the quality of the services they provide if the Medicare Payment Advisory Commission gets its way.

MedPAC makes a strong call for a payment-quality nexus in the Medicare program in its June 3 report to Congress. "Medicare's beneficiaries and the nation's taxpayers cannot afford for the Medicare payment system to remain neutral toward quality," the influential advisory panel says.

MedPAC recommends providers be paid differently based on quality and that the Centers for Medicare & Medicaid Services "implement other payment structures to promote [quality] across settings, where some of the most important quality problems occur."

If the commission does succeed in pushing the measure, home health agencies probably would be low on the implementation list. Medi-care+Choice plans and inpatient rehabilitation facilities should be first in line for payment differentials, since data and quality measures are relatively readily available, the report says.

CMS also should take aggressive action in the hospital and physician sectors, since that's where most care is provided, the report says.

But home care quality information is easily available through OASIS, the report notes. That could make agencies more susceptible for quality-related changes to payment. "Home health agencies may be appropriate candidates for financial incentives," MedPAC says.

The commission praises CMS for implementing the home health quality initiative for HHAs earlier this year.

  • The General Accounting Office gave former HHS Office of Inspector General chief Janet Rehnquist a farewell kick in the pants June 11, publishing a scathing account of her oversight of the agency. The GAO criticizes Rehnquist for "serious lapses in judgment" and drastic personnel shifts that "fostered an atmosphere of anxiety and distrust" (GAO-03-685).

    The 50-page reports chronicles numerous high-profile "lapses in judgment" - from her purported delay of a Florida pension audit during Gov. Jeb Bush's gubernatorial run to her brief possession of a firearm at OIG headquarters. Rehnquist left the OIG June 1.

  • HHAs have a new online tool for information from CMS, the "Home Health Information Resource for Medicare" at www.cms.hhs. gov/providers/hha/. "There are many features on the page including an alphabetical listing of topics, an OASIS section, listserv access and a highlight section to emphasize current home health activities," CMS says.

  • The Joint Commission on Accreditation of Healthcare Organizations has posted substantially revised accreditation standards for home care organizations. They will go into effect Jan. 1. "The new standards are the result of nearly two years of work to substantially consolidate JCAHO requirements to reduce the paperwork and documentation burden of the accreditation process and increase its focus on patient safety and health care quality," the Oakbrook Terrace, IL-based accrediting body says in a release.

    The new standards, part of JCAHO's Shared Visions - New Pathways Initiative, are at www.jcaho.org/accredited+organizations/2004+standards.htm.

  • About 100 people involved with the home care industry showed up June 13 at the New Jersey statehouse to protest a change that would give control of home health aides to the state.

    A bill proposed by Assembly Speaker Albio Sires (D-Hudson) would set up four Quality Home Care Councils run by New Jersey to employ aides and assign them to patients who receive state-funded home care services, reports the Associated Press.

    The system, based on one in California, would eliminate choice for Medicaid patients, force aides into the state system and cost millions in administrative expenses, the protesters said.

    Proponents of the bill say it would keep private companies from profiting off Medicaid and would reduce aide turnover by offering aides higher salaries, according to AP.

  • National Home Health Corp. saw healthy earnings for the quarter ended April 30, but those may not last. Scarsdale, NY-based NHHC reports net income of $1.49 million on revenues of $25.12 million for the quarter, compared to a $1.36 million profit on $20.62 million in revenues for the same period in 2002.

    But Connecticut has significantly cut its Medicaid reimbursement rates for certain visits effective May 1. That reduction will slice about $8 million in revenues and $2.7 million in profit from the home nursing company's earnings, it expects.

  • Action Stocks Inc. has acquired Michigan-based Classic Health Systems Inc., which appears to have big ambitions in the durable medical equipment industry. Publicly traded Action Stocks helps companies go public and provides marketing services to health care companies.

    Classic's management team "will assume control of Action .... and transform it into one of this nation's leading home health care equipment companies," Classic President John Laga Jr. says in a release. "Over the next few months our growth plan will become apparent as we increase shareholder equity and improve the quality of life for our valued patients."

  • O2 Science has shed its California locations but picked up one in Oklahoma City. The respiratory therapy company sold its Long Beach and San Diego branches to Apria Healthcare Group and aims to capture market share in more underserved markets, it says. Tempe, AZ-based O2 Science will retain Accucare Medical Inc.'s management team in Oklahoma City.

  • Oklahoma City-based Breathing Disorders Inc. hopes to build its business on sleep apnea products with an infusion of capital from investment banking firm Council Oak, reports the Daily Oklahoman.

    Breathing Disorders, which describes itself as a national home medical equipment provider, aims to drum up $20 million a year in business by the end of three years.

    In March, the company, founded in 1995, opened three branches in Colorado, California and Arizona, it says.

  • Home care providers in some areas might have to add another group to their marketing lists: those who answer 211 calls.

    Florida's Palm Beach and Broward counties are among the 81 communities through the nation that offer information on senior services through the number, reports the Fort Lauderdale Sun-Sentinel. Connecticut is the only state with statewide 211 coverage.

    Among calls from seniors 80 years and older, finding home health and rehab services was the number-one request, the paper says.

  • Paying patients for their Medicare information and illegally compounding nebulizer drugs has culminated in lengthy prison terms for five Floridians.

    Idania Arias will spend 10 years in jail, while Dr. Pedro Sarduy, Marco Burgos, Grisel Arias and Suzanne Burgos will serve out five years each for participating in what prosecutors are calling the biggest Medicare pharmaceutical fraud conspiracy ever in south Florida.

    According to U.S. Attorney Marcos Jim-nez, the plot was masterminded by Idania Arias, and involved paying beneficiaries $50 for the use of their Medicare cards, then using the information to trump up claims for medically unnecessary nebulizer drugs.

    The case also involved pharmacies that compounded drugs such as albuterol to supply the conspirators with cut-price products with which to fulfill the prescriptions.

    Twenty-six individuals have already been convicted in connection with the $25 million scheme; the five sentenced May 21 are the "lead" defendants, Jimnez says.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All