Home care industry says HCFA’s OASIS change just small step

HHBR Washington Correspondent

WASHINGTON – Just as the Health Care Financing Administration (HCFA; Baltimore) was forced to scale back its Outcome and Assessment Information Set (OASIS) program (see related story above), home care groups across the country filed their comments, which were due last month, on the program’s reporting requirements. These comments show that the home care industry considers HCFA’s recent decision to exclude non-Medicare and non-Medicaid patients from this program only one step in the right direction.

"In the short term, this policy modification resolves some of the more esoteric privacy and agency liability issues associated with data submission," the National Association for Home Care (NAHC; Washington) stated on Friday. "However, the bulk of OASIS data collection and submission burdens remain."

In its comments to HCFA, the American Federation of Home Health Agencies (AFHHA; Silver Spring, MD) summed it up this way: "As currently conceived, the timing of OASIS is wrong, the burden on home health providers is unsustainable, and the consequences are as predictable as they are disturbing."

AFFHA contended that implementing OASIS at a time when home health agencies are already under "severe financial hardship" as a result of changes mandated by the Balanced Budget Act of 1997 (BBA) "will further destabilize the home health industry infrastructure." However, given its intention to proceed with the program, AFHHA urged the agency to consider ways to make the OASIS burden "more rational and sustainable."

Home Health Service and Staffing Association (HHSSA; Washington) attorney Jim Pyles agreed with this assessment. "They were just premature with this," said Pyles. "What we have pointed out to HCFA is that it is very simple for them to take an approach that will work for them and yet not eliminate access to care.

"All I know so far is that they have decided to not require information about non-Medicare patients to be reported in identifiable form," added Pyles. "That is totally inadequate." He said Medicare-certified home health agencies are still faced between now and April 26 with the elimination of all home health services to patients who refuse to give permission for the collection of the voluminous personal information included in OASIS.

"It is approximately a 30-foot document end-to-end, and it is 450 data elements, and patients don’t want to provide the information," added Pyles, a partner with the Washington, DC, law firm of Powers Pyles Sutter and Verville. In its comments, HHSSA also noted the findings of a study completed by the HCFA OASIS contractor, which found that many patients refused to answer some or all of the OASIS questions. HHSSA said this refusal would result in the elimination of services on a broad scale.

HHSSA called on HCFA to narrow the OASIS data set down to "just the core data that are essential for the establishment of a case mix adjuster for prospective payment" and to collect this information in "a non-identifiable form or in some other manner that does not force patients to choose between healthcare and medical privacy."

HHSA added that HCFA is already laboring under an "ambitious" schedule for the implementation of a prospective payment system (PPS) for Medicare home health services just 18 months from now while at the same time faced with Y2K computer modifications. To top it all off, Congress plans to adopt privacy standards this summer as required by the Health Insurance Portability and Accountability Act of 1996.

AFHHA argued that there are currently "far fewer" agencies participating in the Medicare program than HCFA suggested in its notice in the Federal Register. "Our research indicates that approximately 25% of the 10,492 figure indicated by HCFA are now gone or are no longer accepting Medicare patients," asserted AFHHA. "In addition, the OASIS burden on the remaining HHAs in terms of cost and administrative change will be far greater than HCFA acknowledges. Only 30% of providers, as indicated in the notice, stand to benefit from what is in any case an inadequate add-on to the per-beneficiary limits. For the majority of agencies – those who exceed their per-beneficiary limits – there will be no financial compensation for a significant new cost."

The Home Care Association of America (HCAA; Jacksonville, FL) echoed this theme. With the possible exception of the interim payment system (IPS), HCAA termed OASIS "one of the most visible examples of an unfunded mandate" on home health agencies. HCAA argued that although HCFA has maintained that funding is included to help agencies cover the cost of implementing OASIS, the "meager" funding provided does not take into account the time it takes to educate staff, survey patients and record and transmit the data. The association also pointed out that HCFA’s own final rule noted concern on the part of the agency that it "may not have captured all relevant costs, particularly ongoing and automation costs."

After learning about HCFA’s decision to eliminate non-Medicare and non-Medicaid patients from OASIS last week, NAHC outlined its remaining priorities concerning OASIS. In addition to its failure to fully reimburse agencies for the costs associated with OASIS, NAHC said HCFA has thus far failed to correct problems with the free HAVEN software that agencies must use to submit OASIS data.

In addition, it charged that HCFA has not provided agencies protection against liability for breach of confidentiality once patient-specific data have been transmitted over public telephone lines. "This concern applies to tansmission of data for all patients [including] Medicare, Medicaid, and private pay," NAHC added.

NAHC also announced that it is currently in discussion with several Congressional offices regarding introduction of a resolution that disapproves of the OASIS collection and reporting requirements.

"If approved in the Senate and House, a resolution of disapproval would force HCFA to withdraw the pending requirements and issue new regulations that both fully consider the burdens OASIS places on small businesses and provide justification for imposition of that burden," NAHC stated.

The association was quick to point out that it was a similar resolution introduced in the Senate last year by Sen. Kit Bond (R-MO) that prompted HCFA to withdraw its contentious home health surety bond regulations.