Home Health & Hospice Week

Getting physicians on board for the new face-to-face encounter requirement is like herding cats, and it will be home care providers who have to fill the corral.

"This issue is sending some folks over the edge," exclaims Casey Blumenthal with the Montana Hospital Association's home care division. "It is really quite absurd and impractical, especially in our more remote areas."

Home care providers are all over the board in their FFE implementation efforts, reports Marcia Tetterton with the Virginia Association for Home Care & Hospice. Usually larger institutional providers are quicker to come into compliance with new requirements. But "surprisingly, those that are in larger health systems are receiving a lot of push back from their own organization's physician groups," which is delaying compliance, Tetterton tells Eli.

The Centers for Medicare & Medicaid Services' announcement that enforcement of the requirement would be delayed until April 1 gave providers some much-needed breathing room. But the enforcement delay has caused some confusion over the FFE start date, says Kathleen Anderson with the Ohio Council for Home Care and Hospice. "Some agencies thought that that April 1st was the start date."

And HHAs have many other reimbursement, regulatory, and operational issues on their plates, so coming into compliance before the enforcement date may not be a priority. In some cases, those other issues include some serious state budget threats, observes Joie Glenn with the New Mexico Association for Home and Hospice Care.

But CMS said in the latest Open Door Forum that it expects HHAs and physicians to be getting into compliance with the FFE requirement now (see Eli's HCW, Vol. XX, No. 5, p. 34).

By far, dealing with physicians is agencies' biggest FFE challenge, industry representatives agree. "It's the physician's responsibility to complete the FFE appropriately, but we essentially have to babysit the process through its entirety," says Brad Garpestad of Spectrum Medical Inc. in Great Falls, Mont.

HHAs are having to spend a lot of time just educating docs about the requirement. "Most of the physicians have had no clue about this new requirement," says Keith Ballenger with Adventist Home Care Services in Silver Spring, Md. That's despite CMS insisting at the last Open Door Forum that it was conducting a comprehensive physician education campaign.

Spectrum Medical has been holding many meetings with physicians and other referral-related sources, Garpestad says.

Because agencies are having to educate physicians on their own, the docs are receiving an "inconsistent message" about the requirement, Tetterton points out.

For example: "Physicians have gotten mixed messages about when the rule actually took effect," says Peter Cobb with the Vermont Assembly of Home Health Agencies. "We contend despite the delay, the rule started Jan. 1. It is just enforcement that starts in April." Some agencies are telling physicians that they don't have to do FFE documentation until April 1, which is making it difficult for agencies who have already implemented their FFE processes to get physicians to comply.

"Getting out a consistent message has been a problem," Cobb laments.

The time and resources spent on education is a significant part of the administrative cost burden this requirement pushes onto HHAs, notes Kim Foltz with Iowa Alliance in Home Care.

High physician and non-physician practitioner turnover is just going to compound the ongoing need for -- and cost of -- referral source education, Blumenthal points out.

Once physicians hear about the new FFE requirement, agencies are getting serious pushback from them, industry reps agree. "Many have commented that this is just another piece of paper and/or process that takes even more of their time," Garpestad says.

The FFE requirement mandates duplicative documentation, Foltz maintains. "The vast majority of the information required in the FFE documentation also exists in the plan of care," she tells Eli.

The requirement "adds additional and unnecessary steps to the process and access of care," Garpestad claims. "This regulation adds steps and roadblocks to a simplified process. It confuses all who are involved in the delivery and coordination of care, adds burden to physicians and beneficiaries, and ultimately the accountability is placed solely on the home health provider for adherence to this regulation."

But the requirement is largely out of HHAs' hands. "The home health provider has little recourse in the assurance that this eligibility requirement will be met by both the beneficiary and the physician," Garpestad says.

"This is not something that home care created, it is yet another burden on all providers that just continues to drive up the cost of care," Tetterton concludes.