News From HomeCare

Study: IPS cuts HH access

Sixty-eight percent of all hospital discharge planners surveyed by George Washington University (GWU) researchers reported increased difficulty in initially obtaining home health services for Medicare patients since the implementation of the interim payment system (IPS).

In addition, respondents to the GWU Center for Health Services Research & Policy survey show that only 22% of them reported no change in difficulty finding home health services for their Medicare patients.

The latest findings of the study were included in the second phase of the two-part study that is measuring the impact of payment changes mandated by the Balanced Budget Act of 1997.

Home health industry advocates said the results were further evidence that Medicare patients have decreased access to home health services for the sickest patients. The study’s authors shared their opinion.

"There is compelling evidence of differential treatment of sicker beneficiaries in response to financial incentives of IPS that suggest problems with access to and quality of home care services for this population, the study concluded. "These findings raise significant policy questions that should be addressed in evaluating IPS and any other payment system that may be developed."

Risk areas for hospice, durable medical equipment outlined

Federal investigators still have their fraud and abuse sights set on durable medical equipment (DME) suppliers and hospice providers, a health care attorney told her colleagues during a January meeting of the American Health Lawyers Association.

There are a number of risk areas that hospices and DME providers need to be concerned with, says Deborah Randall of Arent Fox in Washington, DC. Specifically, hospices have 28 risk areas, while DME providers must be concerned with 47. So many, Randall says, hospices and DME supplier have difficulty keeping up with what investigators are taking aim at.

"When you look at the risk area, I think it is daunting to know what to pay attention to," Randall says.

Randall categorizes the risk areas:

1. basic billing mistakes;

2. industry-specific risk areas;

3. certification and operational issues;

4. failure to self-report.

It is the last item that Randall paid particular attention to. With the number of risk areas facing both industries, she says one common theme runs in them both is the Office of the Inspector General’s compliance guidelines.

The guidelines say there is a duty to self-report violations or suspected fraud, a notion that she challenges. "I think every single case has to be examined on its own merits, she says.

HH experts still fear Labor’s opinion despite withdrawal

Although the Department of Labor has withdrawn its opinion that would have extended health and safety standards and record keeping to workers furnishing services in private homes, home health officials fear the issue is not dead.

In January, Department of Labor officials issued an opinion letter that extended Occupational Safety and Health Administration (OSHA) record-keeping and standardized requirements to workers providing services in a private home, sending a shock wave through the home health industry. Industry officials immediately spoke out against the letter, saying the opinion would impose OSHA requirements on home health work sites that were out of employees’ control.

"While the letter opinion has been withdrawn, the notice of the withdrawal notes that the policy will be considered further and may be reissued in the future," says Jim Pyles, counsel for the Home Health Services and Staffing Association (HHSSA) in Washington, DC. "The policy seems to be in conflict with the ruling we obtained on behalf of HHSSA in a 1993 Seventh Circuit decision, which held that OSHA work site-related requirements cannot be imposed on work sites that are not under the employee’s control."

Pyles said the advisory would have had a devastating impact on the home care industry if it had been allowed to stand. It would have required home health providers to assume responsibility for all potential of safety hazards in homes of any employees who take work home with them and in the homes of patients receiving care there.