(February 6, 2012) Reimbursement/Compliance Actions
Across the U.S., individual states are working to keep home care and hospice rates from experiencing further cuts. In Texas, the Texas Association for Home Care and Hospice (TAHC&H) has had mixed success but overall is pleased with the outcomes. While the Texas evaluation visit code rates decrease slightly, the state association was successful in keeping the home health therapy rates on a visit methodology rather then the 15-minute increment methodology proposed (TAHC&H Successful in HHSC Negotiations! TAHC&H Up to the Minute!) National associations such as the National Association for Home Care and Hospice and the National Hospice and Palliative Care Organization, are actively involved in advocating in opposition to home care and hospice reimbursement cuts.
One avenue available for providers to keep current with what is happening at a  federal level is to participate in or follow the agenda items at the Centers for Medicare and Medicaid Services Home Health, Hospice and DME Open Door Forum. Open Door Forums are scheduled on a monthly basis and, for example, recent activities provided information regarding:
- Round two registration for DME competitive bidding process (online), documents needed and time frames that must be met
- Hospice quality data submission, including information on the newly approved submission form, as well as how to voluntarily participate via CMS’s Hospice Quality Reporting Site
- The scheduled Healthcare Common Procedure Coding System (HCPCS) code set modifications release
Innovations and New Opportunities
As the traditional home care and hospice requirements continue to increase and/or change and reimbursement continues to be cut back, providers find an increasing need to consider other opportunities for developing new income service lines. To this end, Medicare demonstration projects and clinical trials might be found to yield opportunities beyond the traditional home care and hospice mind set.
The CMS Innovation Center Program is focused on testing and establishing new service models that are designed to drive health care reform. The plan for the development of leaders’ skills in the areas of innovation is through the Innovation Center’s Innovation Advisors Programs. Individuals selected to be part of the CMS Innovation Advisors Program participate in a six-month fellowship program that includes orientation and applied research experiences. Participants dedicate a minimum of 10 hours per week to implement an innovative project that was submitted along with their application for selection. The participants have also committed time for seminars and instructional activities, with the intent of sharing information and results across geographic regions. Innovation advisors select five, which represent the home care and hospice industry. View the complete listing of individuals currently selected to participate in the Innovation Advisors Programs, along with their geographic location and practice setting.
Medicare Demonstration Projects
Independence At Home Demonstration is just getting underway and is intended to evaluate the effectiveness of delivering primary care services for Medicare beneficiaries with multiple chronic conditions in a home setting. Medical practices led by physicians or nurse practitioners will provide primary care home visits tailored to the needs of individual patients with multiple chronic conditions and functional limitations and their families. This demonstration project is being established as part of the Affordable Care Act (ACA).
Home-based primary care provides patients more time with healthcare providers to utilize in performing assessments in a patient’s home living setting, resulting in a greater accountability for all patient care aspects. It is intended that this approach will provide timely and appropriate care resulting in an overall improvement in quality of care and quality of life along with a concurrent lowering of health care costs by delaying the need for care in institutional settings.
Home care and hospice providers, with nurse practitioner staff, should consider collaborating with medical offices to participate in this demonstration project. The participation by home care and hospice staff to augment medical staff services could result in opening new service line opportunities. Find complete details on this demonstration project.
Government Clinical Trials
Government clinical trials are another avenue for home care and hospice providers to integrate their services into future care programs and service lines. Overall, ClinicalTrials.gov has 119,516 trials with locations in 178 countries that are currently underway. In order to determine if there are open studies in an area of interest or clinical expertise, providers can conduct a search. For example, by searching for open studies on accidental falls, a total of 17 open studies focused on accidental falls were located. Of these open studies, six studies are currently recruiting participants and five studies have not yet gotten into the participant recruiting stage.
As home care and hospice providers develop care programs focused on specific diagnoses or concerns existing within the practice setting, leaders should consider registering a clinical trial themselves or offering to participate in a previously approved clinical trial. Find the listing of government clinical trials in progress at this time.
Resources:
Clinical Trials. Open Studies: Accidental Falls. Retrieved here on Jan. 22, 2012
Medicare: Independence at Home Demonstration Project.. Retrieved here on Jan. 22, 2012
Texas Association for Home Care and Hospice. TAHC&H Successful in HHSC Negotiations! Up to the Minute! Jan. 13, 2012/Jan. 17, 2012. |
