Proposed cuts hit home care for $20 billion

It appears that home health will account for a goodly chunk of the $138 billion President Clinton has proposed to save by slowing the growth of Medicare spending over the next six years.

If those numbers stand in the final bill Congress will consider, home care’s contribution will amount to about 14% of the total savings.

According to the Health Care Financing Administration, the president’s proposal would save Medicare about $15 billion over 5 years and $20 billion over six years in home care benefits through the transition to a prospective payment system (PPS), as well as through anti-fraud and anti-abuse initiatives.

The president’s proposal restores the original split of home health care payments between Parts A and B of Medicare. The first 100 home health visits follow a three-day hospitalization would be reimbursed by part A. All other visits, including those not following hospitalization, would be reimbursed by Part B.

However, HCFA says home health beneficiaries will not be affected by the restoration of the original policy, nor will the move count toward the $100 billion savings in the president’s plan.

According to HCFA, the policy "avoids the need for excess reductions in payments to hospitals, physicians, and other health care providers."

EEOC sues provider for language policy

It’s not only patient care issues that can cause legal trouble for home health providers. Sometimes, personnel conflicts end up in court.

Last December, the federal Equal Employment Opportunity Commission (EEOC) filed suit against a home health care agency for its policy requiring employees to speak only English, and for allegedly firing Hispanic-American workers who objected to the policy.

The suit, filed in Manhattan federal court, was brought on behalf of two women who alleged that New York City-based Long Life Home Care Service fired them shortly after a supervisor met with them to discuss "speaking Spanish on the job."

Long Life, which employs some 1,500 workers, does not dispute the existence of its policy prohibiting speaking a language other than English during working hours, the EEOC said.

However, the two plaintiffs alleged that the policy even prohibited employees from speaking Spanish during breaks, lunch in the cafeteria, and with one city block of Long Life’s building.

The company could not be reached for comment.

Woonsocket VNS merges with Landmark

Formalizing a decades-long bond between their two nonprofit organizations, the Visiting Nurse Service of Greater Woonsocket, RI, became a corporate affiliate of Landmark Medical Center in January.

Landmark Medical Center and Landmark Health Foundation come under the umbrella of parent organization Landmark Health Systems.

The 89-year-old VNS of Greater Woonsocket, based in Lincoln, RI, serves some 6,000 patients, making 210,000 home care visits a year. The agency employs 400 people, including 80 full-time nurses and 120 home care aides. The VNS is a licensed, Medicare-certified, comprehensive home care provider. The agency also is one of the state’s largest home psychiatric health-care providers. The VNS has specialty programs such as hospice care, respite care, Lifeline, and community-based clinics for blood pressure screening and flu immunization.

Landmark Medical Center is a 233-bed hospital with facilities in both Woonsocket and in North Smithfield, RI, that provide comprehensive emergency, diagnostic, medical, surgical, psychiatric, pediatric, and obstetrical services.

The hospital and the Visiting Nurses have a long history of collaboration dating back to at least 1933, notes Elaine Stephens, VNS president.

The purpose of the merger is to form an integrated health system that can deliver all possible kinds of care a patient might need.

"There’s been a lot of integration in our region," says Stephens, "and we thought it was important to make the affiliation formal.

"Our goal, besides further improving our services, is to look at patients from a systems approach as comprehensively as possible. Home care should be totally integrated [within a health system]."

MCOs get low marks in efficiency, cost control

In January, internists and neurologists in Central Florida who rated up to four managed care organizations (MCOs) in which they participate say some procedures required by MCOs may be increasing costs.

According to the Washington, DC-based American Society of Internal Medicine (ASIM), the organization conducting the survey, "Managed care organizations . . . as a whole, do not always live up to their marketing claims that they provide more preventive services or services that are higher in quality, more efficient or cost-effective. Instead, some MC policies — such as preauthorization or prior notification of services and redundant requirements for credentialing, referral and encounter data collection — may increase the costs of providing care.

"Such requirements can create barriers to the efficient delivery of healthcare and, many internists worry, could potentially lead to denials of medically necessary care in some instances."

"There is not a smoking gun of doctors reporting that patients were being denied access to care or being hurt by HMOs’ [policies], and I think that’s a positive thing from the physician point of view," says Bob Doherty, vice president for governmental affairs and public policy at ASIM. "Even though everyone has concerns about that happening, it hasn’t resulted in doctors taking action to deny care to patients."

None of the five Central Florida managed care organizations received overall high ratings from the physicians, and most survey participants said they would not recommend any of those MCOs to a family member.

According to ASIM, the respondents disagreed with the view that precertification requirements reduced unnecessary care, that profiling systems provided useful information that improved quality, or that physicians had adequate involvement in profiling. Respondents also said plans don’t give patients adequate information about capitation and medical services provided under financial risk arrangements, especially for patients with complex diseases.

"The overall message from the survey," Doherty says, "is that there are a lot of concerns from physicians about the impact of HMOs on efficiency and the quality of care and no great enthusiasm for them, though there weren’t any horror stories reported. Doctors ultimately make sure patients get the care they need."

Joint venture expands home care services

Thomas Memorial Hospital of South Charleston, WV, and Option Care have signed a joint venture agreement whereby Option Care’s Charleston office will provide infusion, respiratory, and durable medical equipment (DME) services for its hospital-based home health agency.

The hospital’s decision was driven by the current health care market, says Robert J. Gray, vice president of Thomas Memorial, a 309-bed not-for-profit facility. Thomas Memorial’s home care organization makes about 30,000 visits a year. The venture will allow them to offer more home services.

"Hospitals cannot be everything to everybody anymore. The market is dictating that we don’t do that. We probably wouldn’t have thought of this partnership two years ago," he says.

Gray acknowledges that another aim of the joint venture is to make home health services more attractive to managed care and other third-party payers.

"We also wanted to make our discharge planning function more comprehensive. We always give patients a choice [of home care], but with us, they don’t have to shop for it."

Gray says the decision had support from the hospital’s medical staff as well.

Option Care is a full-service home health provider with a national network of 184 franchised and company-owned locations, representing more than $250 million in annual billings.