Healthcare at Home: The Rowan Report

by Jeffrey Grossman, Esq.

In January 2016, the Department of Labor (DOL) officially extended federal wage protections to  home care workers under the Fair Labor Standards Act, entitling them to the federal minimum wage, time-and-a-half pay for overtime, and pay for time spent traveling between clients. Predictably, lobbyist groups working on behalf of home care agencies petitioned the Supreme Court to upend the new regulation. On Monday, the Court decided it will not hear the case challenging the January DOL rule.

While on the surface this unfunded government mandate hurts home health agencies struggling to offer care within already slim Medicaid reimbursement margins, there is also a business case for increasing wages. [The author provides details on a range of benefits accruing to healthcare at home agencies, the service providers, and the agencies’ patients. Among these benefits of the increased wages are  ability to attract service providers capable of providing more versatile services and higher quality of care; and  helping to reduce costly turnover of service providers.]

Specifically, these are the benefits that Grossman identifies to make the business case for increasing wages to healthcare at home service providers:

First, increased wages will help entice new workers to the field, enabling agencies to care for more patients. Presently the median hourly wage for home care workers is $9.38¹, compared to the median for refuse collectors at $15.52 and parking enforcement workers at $16.99. While caregivers are often driven by a passion for their work, relatively low wages force many to look elsewhere. With higher pay, agencies should see an immediate impact on their ability to recruit new employees and increase revenue through improved bandwidth.

Second, better compensation will also impact the quality and scope of candidates who might consider home health work, helping agencies provide better care. Quality caregiving is a nuanced endeavor requiring technical skills and emotional intelligence; the ability to, for example, clean a patient after a bout of incontinence and then accompany them to an important meeting with their accountant. Often those with this unique pairing of skills are found outside of the traditional “system” of home care workers. Higher wages can help attract these nontraditional, but well aligned candidates onto the caregiver landscape.

Finally, better wages reduce costly turnover for agencies. While the full cost of employee turnover is difficult to measure, direct costs are conservatively estimated at $2,500 per front line employee.² There are also heavy indirect costs to consider. A lack of caregiver consistency is disengaging to the patient and often results in the use of another provider.

In addition to the immediate benefits of a larger, more qualified and more consistent employment base for their clients, the impact of more tenured staff and additional revenue may also allow agencies the luxury of incorporating technology platforms to help eliminate antiquated and costly operational practices, better preparing them for future increases in volume due to demographic shifts.

Each of these potential impacts of the DOL’s recent actions should contribute to the regaining of profit margins lost. While these countervailing measures may still fall short of fully insulating agencies from the pain of this regulation, they should be considered alongside any reasoned criticism of Monday’s ruling.

Jeffrey Grossman is a graduate of Emory Law School and the owner of Commonwealth Care Group, a concierge home health service provider which pays caregivers wages double the Federal minimum.

¹ http://phinational.org/sites/phinational.org/files/phi-facts-5.pdf

² https://www.leadingage.org

As we continue to keep readers informed about the impact of CMS’s Pre-Claim Review pilot, we spoke this week with two software vendors, a CMS connection service provider, and two consultants, one a financial advisor and the other an appeals resolution specialist. We believe we are getting a handle on the pros and cons of the new rule but reserve the right to update our analysis as more details come to light, especially after we interview HHAs in the first pilot state, Illinois, when the rule kicks in sometime in August.[The author focuses on the key dilemma to be handled by software vendors–namely, their knowing that significant changes in their software products will need to be undertaken to have it readied for CMS’s pre-claim review pilot program but CMS is not forthcoming about the needed changes. Similarly, providers of CMS connection services notes a lack of communications about providing up-to-date and concise information on, in particular, forms 835 and 837. Additional  lack of information provided by CMS representatives to healthcare at home agencies is indicated, and the article closes with a summary about  the pre-claim review rule pilot program . by Michael McGowan (former OASIS coordinator for CMS Region IX and designer of OperaCare software). He offers his views on chronic recertification of patients home health agencies in the past.]   Software leads off EMR software vendors are the first to be affected, whether they have a hundred. Software updates must be made across the board even if they only have a few customers in the five states in the pilot. The basic framework of the changes they need to deliver to the customers are in place but CMS will not tell them until June 28 what the final details will be. For example, in their June 14 conference call, CMS representatives were taken aback when a questioner pointed out to them that the 837 field they want to use to hold the pre-claim approval number when submitting the final claim is a field that is already used for another purpose. “We’ll get back to you on June 28 about that,” they sputtered, unable to disguise the embarrassed tone in their voices. “Here’s what you have to understand about how vendors handle regulatory upgrades,” explained Delta Health Technologies’ Bill Bassett. “There are always going to be changes, whether it’s the Comprehensive Joint Replacement payment bundling that was announced six months before its implementation date or this one, which only gave us a six week warning. You have to read the tea leaves and be prepared for anything. If you are light on your feet, by which I mean you have SaaS or web-based software, you make the change and all your customers have it that day. The vendors who will struggle with getting the details on June 28 and having them ready for Illinois customers by August 1 are the ones with legacy, client/server systems on 20 year-old database technology.” Connectivity up second Providers of CMS connection services have to make August 1 changes as well and are anxiously awaiting the rest of the story CMS promised to deliver on June 28. We spoke with Ellie Robison, CEO of MedTranDirect, who told us it will make a big difference whether an unused field can be found on the 837 form to insert the pre-claim approval number or whether the form will have to be redesigned. “We are ready to update our product that transmits and receives 837 and 835 documents,” she said, “and we would like to be able to transmit the stack of pre-claim documents. There are a few questions that have to be answered before we can do that though.” She is referring to the way the CMS representatives dodged the answer to a question during their June 14 Open Door forum. When informed that the field on the 837 form they told HHAs to use is already used for another purpose, they muttered, “We’ll let you know about that on June 28,” failing to disguise the embarrassment evident in their tone of voice. When asked whether plans of care have to be signed by the physician in time for the pre-claim submission or can wait until the final claim, as is the rule now, the answer was again profoundly unclear. “No other rules are changed,” was the best they could do when confronted with the unexpected question. No one we spoke with is sure exactly what that means. Batting third, HHAs themselves Nothing made it more clear that CMS is unfamiliar with the day-to-day challenges of operating a home health agency than their cavalier non-answer to the signed plan of care question. Every agency administrator knows the fiasco that occurred when physicians were required to certify homebound status under the Face-to-Face rule. Failure to get it done, signed, and correctly worded caused a phenomenal number of payment denials that could not be avoided or repaired by the agency itself. The same resentment regarding perceived unnecessary encroachment on their time crops up among physicians when asked to review and sign plan of care documents. Most providers have difficulty getting them signed by the end of a 60-day payment episode so that they can submit a final claim. If MACs interpret the new rule as meaning they can deny a pre-claim review over a missing signature, which is possible if CMS leaves the question unanswered, HHAs will have to bug physicians to sign the document at the beginning of an episode. “They are not going to like that,” asserted Deanna Loftus, Director of Regulatory Compliance for HEALTHCAREfirst. “We provide outsource billing services and electronic document signing as well as EMR software and we know firsthand that the primary billing delay is the physician signature. Getting it 50 days sooner than they do now will be extremely difficult.” Cleanup: the consultant’s overview “What took them so long?” was Michael McGowan’s surprising reaction. “Over the years, I have seen so many fourth, fifth, and sixth consecutive episodes for low-acuity patients, I finally got to the point where I wondered why CMS wasn’t seeing the same thing. This new rule forces agencies to play by the rules. It will be good for the patients, good for the tax payers, and good for the high-performing HHAs.” The former OASIS coordinator for CMS Region IX and now a payment denial consultant and designer of OperaCare, a new software tool designed to produce perfect, audit-proof episode documentation, McGowan offered this bird’s eye view of the environment the Pre-claim approval rule is trying to improve: “There are more HHAs than the population numbers require. With supply outstripping demand, many HHAs are suffering with census numbers too small to sustain payroll and overhead. There are two ways to keep census numbers up: find new patients or keep the current ones. With every sales rep finding his or herself one of ten or twenty hitting physician offices every day, winning new patients is hard. Recertifying patients, no matter how unjustifiable in terms of medical necessity and homebound status, is much easier.” This cause-and-effect logic string that McGowan describes is coming to an end, at least in the five pilot states, and is becoming the primary focus of attention for MAC auditors in every state. “These are the states that are the worst offenders,” he told us, “so controlling the problem in 10% of the states will solve much more than 10% of the problem. “Here is how it will happen. Agencies that have been surviving on recerts will see most of them disapproved in the new pre-claim process. They will perceive this as MAC overreach but that will mostly not be the case. These are episodes that should not be paid. Unable to be paid anymore to care for relatively healthy patients, their census will shrink and they will either figure out a way to improve their sales results or they will close or be acquired. The ethical agencies that have been discharging patients when they should will see few if any of their episodes disapproved for lack of medical necessity through the new pre-approval process. They will be the survivors. They will pick up patients from the agencies that close or from the struggling agencies they acquire. In the end, the smaller number of HHAs will match the population demand and everyone left will have enough census to stay afloat.” This consultant is not alone in his analysis that there could be an upside to the rule. We recruited an Illinois agency to keep us informed through the August launch. Susan Platt’s opinion of the new rule mirrors Mr. McGowan’s. “We agencies who are working to do it right, to get the face to face documentation correct and signed, to ensure our clients are truly homebound and have a skilled need, we abhor this rampant fraud and abuse. So we understand the idea behind this new rule. I am sick to death of trying to compete against agencies who see patients forever, sign them up for med set ups, etc. Since this new rule isn’t supposed to create a barrier or delay in starting care, the concept of stopping agencies who sign up inappropriate patients is great.” ©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

 

Santa Monica, CA – June 23, 2016 –Cedars-Sinai hospital in Los Angeles will announce today that it is launching “Safe Transition Home,” a partnership with HomeHero, a Santa Monica-based, non-medical home care provider. The program is designed to smoothly transition patients from the hospital to their homes with the goal of reducing inpatient readmissions, raising patient satisfaction and improving health outcomes. We spoke with Mike Townsend, co-founder of HomeHero about the new program.

“We are essentially expanding our non-medical home care services to include transporting people who have no available family or friends on the day of discharge from a hospital stay,” Townsend told us. “We will dispatch a caregiver, who will go into the hospital room, accompany the patient out the door, help the patient into his or her vehicle, and drive the patient home. Once home, the caregiver will help the person inside and conduct a safety inspection, based on the patient’s condition and needs.” After providing transition services, Townsend expects that his agency will be hired to continue to provide non-medical in-home care.

HomeHero is one of 11 startups participating in the 2016 Techstars Healthcare Accelerator, in partnership with Cedars-Sinai, to develop healthcare innovations. The accelerator is a partnership between Cedars-Sinai and Techstars, a global ecosystem for entrepreneurs to bring new technologies to market. [More details about the planned work between Cedars-Sinai hospital and other innovative partners like HealthHero to assist discharged patients return home and reduce hospital readmissions are provided in this article.]

“We are truly excited to be working with HomeHero, both at the operational level and within the Cedars-Sinai and Techstars Healthcare Accelerator program,” says Bradley T. Rosen, MD, MBA, FHM, Director of Care Transitions and Complex Medical Management at Cedars-Sinai. “They are a mature team with impressive individuals on both the healthcare and tech sides, and they are thinking creatively about how best to tackle fundamental challenges in patient care. I believe the Safe Transition Home program is the first of many initiatives that will effectively improve the quality of care our patients receive.”

The Safe Transition Home program aims to address long-standing transitional care challenges by providing licensed and trained home care professionals as a post-acute extension of Cedars-Sinai’s healthcare continuum. Townsend told us he will be looking for other partner hospitals if the Cedars-Sinai pilot proves successful.

The program also helps Cedars-Sinai address comprehensive regulatory changes set in place by the Affordable Care Act and CMS, such as steep fines for 30-day hospital readmissions and bundled payment systems emphasizing value-based care. HomeHero’s caregivers, referred to by the company as “Heroes,” provide assistance with activities of daily living such as personal care, housekeeping and medication management. Safe Transition Home covers additional services such as transportation to and from follow-up appointments with the patient’s physicians.

Caregivers also become the eyes and ears of the hospital in the home with the aid of a mobile app. The “Heroes” conduct guided safety checks in the home, record patient health information, monitor social determinants and deliver critical real-time data back to families and hospital case managers.

“The first six weeks of our time at Cedars-Sinai has been spent learning about the deep inner-workings of hospitals and identifying the biggest areas of need,” said Kyle Hill, Townsend’s partner and co-founder and CEO of HomeHero. “We felt Safe Transition Home was the best program to build first due to its low cost and risk, broad impact across multiple units and speed to implement.”

The program is funded through a combination of private clients and Cedars-Sinai.

About HomeHero

HomeHero is a non-medical home care provider based in Santa Monica, California, offering post-acute services such as personal care and companionship, transitional care, postoperative recovery, medication management, transportation and assistance with activities of daily living through hundreds of licensed and trained caregivers. Launched in May 2013 by Kyle Hill and Mike Townsend, originally as a service for their own families, HomeHero has grown to be one of the largest home care providers in California. Recently, the company made the decision to transition all of its field staff from 1099 to W-2 employees. The company has raised $23 million in venture funding from Graham Holdings, Social+Capital Partnership, Science Inc, The Launch Fund, Tencent Holdings, Techstars and Cedars-Sinai Medical Center. homehero.org

About Cedars-Sinai

Cedars-Sinai, the largest nonprofit academic medical center in the western United States, is known internationally for providing the highest-quality, most advanced patient care. Over its 113-year history, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Cedars-Sinai has a long history of transforming healthcare — at the bedside, in the clinic and in the community. Innovations from Cedars-Sinai include the invention of the Swan-Ganz catheter to measure blood pressure inside the heart, the start-up of a company that developed one of the world’s top evidence-based clinical decision-support systems for physicians, and the first experimental use of stem cells to cure heart disease.

About Techstars

Techstars is a global ecosystem that empowers entrepreneurs to bring new technologies to market wherever they choose to build their business. With 18 mentorship-driven accelerator programs worldwide, Techstars exists to support the world’s most promising entrepreneurs throughout their lifelong journey. Techstars provides access to over 3,000 founders, mentor investors, and corporate partners, allowing entrepreneurs to accelerate the pace of innovation and do more faster. Techstars makes entrepreneurship more accessible by providing access to capital, guidance, marketing, business development, customer acquisition, and recruitment. techstars.com

©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

Personally speaking as my own “medical supervisor,” I have learned ways to reduce my own out of pocket costs and try to begin to break down silos of information, bringing my health data together so I can keep track of current conditions and ways to stay healthy. Blood tests at an outsourced facility are actually much less expensive than having blood drawn at a clinic or my provider’s office. I still cannot believe I did the tests at the latter two, before finding out that if I eliminate the insurer from the equation my personal out of pocket costs are less than if the insurer “helps” with my care.

It seems stupid but it’s true. As long as I get the results, and the quality of the service is good, why would I want to pay more? If I stay healthy, I am never going to meet my annual deductible, so let’s use the private paid services for what I need to get done. I am not saying I don’t visit my doctor each year for an annual physical. What I am saying is there are alternatives to going there each and every time I think something may be wrong. Maybe I just need a “maintenance test” to make sure I am on track with my goals and objectives, why go to the higher cost provider when the alternative, that works is less costly. At least my wallet feels better.

What I’m getting at is that you can help yourself get better (if you really want to) by maybe taking the reins and being your own patient advocate, personally engaged in your care with your care team. I think anyone can and should be the #1 cheerleader for themselves when you need care. Maybe some technology can help with that and that’s what we should look at to help ourselves.

The care fragmentation experienced by patients today is rooted in ineffective transitions of care due to the lack of a shared “patient story and medical records.” Plus, we may have a long term plan of care that can be shared among providers when the patient transitions from one care setting to another. But is it? Or am I in charge of making sure it is. I think it does fall to ourselves to manage the details amongst the different care setting and providers we use. This is speaking to all transitions of care, from hospital to home, to primary care, to specialized practitioners for specific needs in chronic illness. No matter who is taking care of me, do they have “all the info?”

So if there is not “good care coordination” amongst these care teams, and they do not or cannot share information, or the long term care plan, then how can “the plan” be managed to lower the cost of care, and gain a better outcome? It will only happen with ourselves managing the process, until the day of interoperability when all the vendors of medical technology get together and make it happen.

Although it may seem that no one is minding the store when it comes to coordinated long term care planning and interoperability, many groups have been pressing to promote effective communication and coordination across all settings. They include in no particular order, the U.S. Department of Health and Human Services’ National Quality Strategy, the Institute of Healthcare Improvement and the ‘triple aim’ framework. More “industry experts and associations” could be included – but what’s the point of recreating the list?

So as we see more “virtual health platforms” being built by all kinds of companies, the problem remains the same for the actual providers of care: no money to fund the technology and not enough evidence that proves “Virtual Care” will save time, money and of course gain that better outcome. Although the theory of “virtual care” does claim to save time and money and improve outcomes, but without funding or getting paid for virtual visits, it’s hard for providers to justify the expense.

Patients or consumers were once seen as the ones who were not willing to use this type of medical care technology, but I think that has changed. People of all ages are counting steps and managing what they are eating with smart devices or wearables. They are even taking pills and proving they did with applications that show them swallowing them. So consumers are ready today, it’s just that providers have to find time (which they don’t have much of) to make the decision whether this type of care is required and can help them reach their goals and objectives. It will, but we are not seeing enough movement towards a virtual visit world. Not yet, but I think that worm is turning.

So where that leaves us this summer is that we need to get physicians, health plans and technology companies working together so we may move healthcare forward, improving public health for everyone. If the conversation is only between payers and providers to deliver on value based care, then how will they fix the issue without technologists at the table? We will still have too many silos if everyone does not start to realize that data is needed across platforms to gain the care coordination that will be required, not only with chronic care patients but with the increasing aging population and with the increase in the total global population. Fewer professional caregivers are coming out of universities today (due to costs?), and more population means better coordination of care (especially chronic care) will be required. We can all use technology to monitor and help guide us with what is happening with our own treatments and care. Applications can help but we will also need access to the many silos of personal medical data that exist about each of us for the care team to gain the better outcome.

Telehealth technology and virtual care is ready to roll. I feel consumers are ready too. Let’s make sure the message is clear with your own providers and payers of care. The insurers certainly could pay for technology to help lower the costs of care for their populations but, in my opinion, they are not moving quickly enough to help their insured populations with technology options. Maybe we as the people who pay insurance premiums can get them to listen if we all rally together. We need to have everyone focused on the future of health care, and using technology that can reduce costs and provide better outcomes. Our providers will appreciate that as much as we will.

Scott R. Herrmann is the Director of Strategic Solutions at Medocity (Salt Lake City, UT and Alpharetta, GA). He can be reached at sherrmann@medocity.com.

©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

By Tim Rowan, Editor & Publisher,  Home Care Technology Report

In a June 14 Open Door Forum, CMS representatives answered questions about the new Home Health documentation rule they will soon begin to test in five states. The “Pre-Claim Review” rule, as it is now called by the department that manages payments to Medicare home health providers, is being couched as an opportunity for those providers to “better manage their cash flow.”

“Now, you will know in advance whether your documentation is correct and your claim will be paid when submitted,” the CMS spokesperson read from a prepared script.[Additional details are provided  about documentation required from healthcare at home agencies by CMS under the “Pre-Claim Review” rule,  the expected advantages for healthcare at home providers using the “Pre-Claim Review” rule, and questions and answers about CMS’s “Pre-Claim Review” rule–with details on claim submissions for pre-approval and on funds available for agencies’ hiring additional staff.]

Here is how CMS anticipates the new system will help providers when it begins in Illinois on August 1, Florida on October 1, Texas on December 1, and Michigan and Massachusetts on January 1, 2017. (All dates are designated as “no earlier than.”) Most of the following information was delivered in a brief summary and clarified during the Q&A section of the June 14 conference call.

• HHAs may begin patient services the same way they do today, typically within 24-48 hours of referral or hospital discharge.
• HHAs may submit a Request for Anticipated Payment as they do now, as soon as the usual documentation and signatures are in place.
• Any time before the final claim is submitted, the HHA may submit documentation to its Medicare Administrative Contractor for pre-approval of that future claim. If any deficiencies are found in the Face-to-Face document, OASIS, plan or care, certification of homebound status or medical necessity for skilled services, deficiencies that would cause the final claim to be denied, the HHA is informed, ideally within 8 to 10 days.
• Corrections to disapproved documentation can be resubmitted an unlimited number of times, up until the final claim is submitted, until the HHA receives approval from the MAC.
• Pre-approval documents can be submitted by U.S. Mail, fax, or electronically via the CMS esMD system. MACs will notify HHAs if they have established their own electronic submission system. Replies will be sent via the same method through which they were received (mail, fax, electronic, etc.).
• When the MAC finally approves the documentation, the HHA is notified that its claim will be paid when submitted. A pre-approved claim cannot be denied by the MAC. “It is immune from further review,” in the language of the Open Door Forum hosts.
• HOWEVER, other contractors, including ZPIC, CERT, and RAC auditors, “are free to do whatever they want,” the CMS spokesperson stated. Even pre-approved PPS episodes can be subjected to further scrutiny by any or all of these other auditors.
• If a patient condition requires adding or increasing services during an episode of care, including unanticipated therapy services, no further pre-approval is required. “We are not assessing the plan of care,” it was explained, “only the correctness of the documentation that asserts the patient qualifies for the Medicare home health benefit. After that, we assume the episode will continue under physician supervision and that services will be added as necessary.”
• In the event that the HHA does not submit documentation for pre-approval and the claim is later determined to be proper and payable, it will be paid at 75% of the claim value. “This 25% penalty is in there to encourage HHAs to participate in the pre-approval process,” the forum host stated.
• MACs are being given supplemental funds to hire the additional staff to process the expected influx of hundreds of thousands of admission documents.
• HHAs are not being given supplemental funds to hire the additional staff to gather and submit admission documents at the beginning of each episode. “We see that all the pre-approval documents we are requiring are documents that you are gathering and getting signed anyway. There will be little extra work to submit them one additional time.” The implication was clearly that, while there may be additional staff hours required if admission documents must be submitted multiple times until a MAC finds them acceptable, that is essentially your fault and you should get better at submitting correct documentation the first time.

There were questions that were not answered during the call, or were answered in a way that did not satisfy the questioner.

Q: If an HHA receives a disapproval that says the need for skilled services is not verified, won’t they be motivated to discontinue services before their unpayable visits mount up to unacceptable losses?

A: “We expect that Home Health Agencies are oriented toward patient care and would not abandon a patient simply because they are not going to be paid for the services provided.”

Q: Does the plan of care have to be signed before the pre-claim review documents can be submitted?

A: Normal requirements apply. (We interpret this to mean the plan of care has to be signed before the final claim is submitted but the CMS spokespeople would not confirm that this is how your MACs will interpret it.) 

Q: Looking at recent MAC and ZPIC historical evidence, we know that quick hiring and training of new staff leads to problems. Training is often superficial, knowledge of home health regulations on the part of the trainees is inadequate, new auditors with insufficient understanding of Medicare Home Health regulations often improperly deny payments and demand ADRs. In the past, this problem has resulted in 80% to 90% overturn of denials by the ALJ, when that department was available. How are we to be assured that this history will not be repeated when MACs rapidly staff up and superficially train newcomers once again to meet this massive increase in documents arriving as soon as six weeks from now?

A: “We met with the MACs and told them to be ready.”

Q: You know who the bad actors are. We reluctantly accept that you were unable to figure out a way to target the criminals and leave the rest of us alone, but is there a way for a high-performing agency to be excused from the pre-approval requirement, for example if they receive no disapprovals for a year?

A: “This is a three-year trial. All HHAs in these five states will be on the program for the full three years regardless of their performance.”

Editor’s comment: While it is a relief that it has been clarified that in-home patient care services will not have to be delayed until pre-approval is received, indicating less fear of putting patients in danger than once thought, this regulation continues to disappoint on two levels. CMS has found extra money in the budget to defray the added costs the regulation imposes on MACs but refuses to acknowledge that HHA costs will rise as well. The hope that “cash flow will be more predictable” is little condolence. This reinforces the long-suspected CMS attitude that MACs are the police, the “good guys,” while all home health agencies, not just the tiny percentage of fraudulent players, will cheat if not constantly watched.

Secondly, to the extent this regulation is a punishment, as it has been described by the Partnership for Quality Home Healthcare (last week’s issue, Partnership Expresses Disappointment with Medicare Home Health “Pre-Claim Review” Demonstration), it will be a most ineffective one. It imposes equal burdens on criminals and legitimate providers. What is worse, as Bill Dombi has been making clear during his round of visits to state association meetings this spring, the bad guys will find a way around it. The rule ensures that documentation indicates homebound status and medical necessity, but it does not guarantee that there is an actual patient behind the documentation, a living human being receiving home health services.

As CMS continues to push the total number of HHAs from 12,000 to 6,000, we can only hope that the criminals will be the ones eliminated. Current efforts do not seem to be leading in that direction.

©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com