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Home Health & Hospice Week

Industry Notes:

YOUR QUALITY REVIEWS JUST GOT LESS PRIVATE

Published on Tue Jul 22, 2003

QIOs To Disclose More to Patients


Health care providers should be aware that patients will now be able to extract potentially damaging information from QIOs.

If a patient ever complains to a quality improvement organization, the Medicare QIO must tell her, at a minimum, whether the QIO believes the beneficiary's treatment met "professionally recognized standards of health care," the U.S. Court of Appeals for the D.C. Circuit ruled June 23 in Public Citizen Inc. v. Dep't of Health and Human Services (No. 01-5294).

The appellate panel was construing a provision of the Social Security Act stating that a QIO - previously known as a peer review organization - "shall inform the individual (or representative) of the organization's final disposition of the complaint." Following the Centers for Medicare & Medicaid Services manual, QIOs currently tell beneficiaries only that their complaint has been received and examined and that the QIO will take unspecified appropriate action if warranted.

"To single people out, to make it more likely that they will be sued or punished, to damage the relationship that they have with their patients and their peers, is an antiquated notion that doesn't hold water anymore," says American Health Quality Association Executive Vice President David Schulke.

  • Home health agencies must cover three additional codes under the prospective payment system's bundling of supplies, but the Centers for Medicare & Medicaid Services also is taking two codes off the list. Beginning Oct. 1, agencies and suppliers will not be paid separately for codes K0614 (chem/antiseptic solution, 8oz), K0620 (tubular elastic dressing), or K0621 (gauze, non-impreg pack strip) when patients are under a home health plan of care, CMS says in July 3 program memorandum AB-03-096.

    Coming off the bundling list are A4421 (Ostomy Supply misc) and 97014 (Electric stimulation therapy). The updates are due to changes in the coding system, not changes to what items are covered, CMS insists.

  • Hospices now will experience the same sharing of information that home health agencies already have when overlapping claims occur. Regional home health intermediaries can share hospice contact information with other hospices and/or institutional providers to resolve billing conflicts for overlapping claims, CMS says in June 27 program memo A-03-055.

  • Health care providers got another reprieve on a much maligned reimbursement policy June 30. The implementation of the $1,590 cap on Part B outpatient therapy services is postponed from July 1 to Sept. 1, CMS advised fiscal intermediaries and carriers in July 3 program memorandum AB-03-097. The move was sparked by a lawsuit filed by the American Parkinson Disease Association, Easter Seals and the Medicare Rights Center, all of whom oppose the cap.

    Providers are now looking to Congress to pass legislation eliminating the cap, which affects home health agencies furnishing therapy services only under the Part B benefit, usually to non-homebound patients. The cap doesn't affect therapy that is bundled into the home health prospective payment system. Even if the cap does go into effect, providers can still bill for the full $1,590 amount between Sept. 1 and Dec. 31 - it won't be prorated or retroactively applied.

  • House Energy and Commerce Committee leaders June 26 sent letters to 26 drug companies, three drug wholesalers and Houston-based cancer care services company U.S. Oncology, asking the organizations to cough up information on pricing, sales volume and revenue connected with  the drugs. The probe into possible Medicaid fraud focuses on pharmaceutical reimbursement and Medicaid rebates.

  • A long-simmering probe of sales and marketing practices relating to enteral nutrition products should soon wind down for a division of Abbott Park, IL-based Abbott Laboratories - most likely at a hefty price. The company said June 26 it was putting aside $622 million in anticipation of the settlement of an investigation of its Ross Products Division's enteral nutrition business.

  • Home care giant American HomePatient Inc. emerged from bankruptcy July 1, over protests from its secured lenders. Under the reorganization plan, shareholders will retain their equity in the company and AHP will pay off lenders now or over time with interest, the Brentwood, TN-based company says.

    The U.S. Bankruptcy Court for the Middle District of Tennessee and the U.S. District Court for the Middle District of Tennessee both rejected requests for a stay from the lenders. Before AHP filed for bankruptcy, a group of distressed debt investors bought the company's loans, reports The Daily Deal. The investors wanted control of the company through acquiring equity rather than new debt. They also wanted higher interest rates on new debt, the Deal says.

    The lenders are appealing the Court's order confirming the reorganization plan, says AHP, which furnishes respiratory services, infusion, nutrition products and medical equipment from 287 locations in 35 states.

  • Med Diversified Inc. is in the process of formulating its bankruptcy reorganization plan, the Andover, MA-based home care consolidator says in its most recent earnings statement. Med and its subsidiary Tender Loving Care Health Care Services Inc. - formerly StaffBuilders - filed bankruptcy last November (see pdf of Eli's HCW, Vol. XI, No. 41, p. 333).

    Med reports a loss of $71.3 million for the year ending March 31, 2003 on sales of $369.5 million, compared to a $326.8 million loss on sales of $207.4 million in 2002.

  • Private duty company Maxim Health-care Services Inc. has purchased a chain of 20 home health agencies from Ft. Smith, AR-based nursing home giant Beverly Enterprises Inc. The chain of licensed, private duty agencies, called CareFocus, generated $22 million in revenues in 2002, Beverly says.

    Terms of the cash sale were not disclosed. Columbia, MD-based Maxim has 223 branches throughout the U.S.

  • The Phoenix Group Corp. has submitted a filing to the U.S. Bankruptcy Court for the Northern District of Texas Ft. Worth Division that would allow the Dallas-based home care company to exit bankruptcy with a clean balance sheet, Phoenix says. The reorganization's business plan involves targeted acquisitions in the home care industry.

    Phoenix entered into bankruptcy last August after Edina, MN-based Intrepid USA Health Care Services tried to take control of Phoenix subsidiary InterLink Home Health Care Inc. (see pdf of Eli's HCW, Vol. XI, No. 29, p. 239).

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