The Hidden Cost of Free Software

Sure, times are hard.  Recent changes to Medicare regulations and a unco-operative economy are causing many agencies and related home health businesses to seriously consider their futures.  And there is a big trap, out there, ready to snare unsuspecting agency owners and make their jobs even harder for them.

That trap is Free Software.

It must be understood that there are vendors of home health care software that are credible, reliable, and reputable.  But, healthcare is seen as a potential source of profitable business and there are many players that have arrived on the scene, looking for short-term profits, whatever the cost.  These players will develop a product that offers agencies the bare essentials to run a home health care business.  When a customer starts billing, then the software vendor will start to charge for their product. This is OK for start-ups and early-stage agencies.  But what happens is that an agency will lock itself in to a poorly designed system, potentially for a multi-year contract.  They will enter data, train their staff, and incorporate the product in to their agency workflow.  And when that agency is starting to really rock-and-roll with plenty of patient referrals, they find that their software choice is incapable of supporting their business volume.  At that point, it is a hard, and potentially costly decision to change to a different product and so the agency struggles on, with their software choice holding up their business growth.

What is worse is when software companies that essentially give their product away in order to secure longer term revenue, fail to be able to fund on-going research and development.  The product stagnates.  New features and functions quickly become basic expectations.  And that software company's lack of cash to invest in their systems means that their customers suffer - slow and incomplete development, skimpy customer support, mediocre training resources, and, potentially, a company that is forced to go out of business.

Where does that leave its customers?  High and dry with all their patient information stored on the remote servers of a bankrupt software vendor.

So, don't thing that free software is always good software.  Vendors have a business to run, costs to cover, and investments to make in the on-going development of a product for you, the customer, as well as a trained and talented team of customer support staff and trainers, also for you, the customer.

If you are offered a deal that is too good to be true, it probably is.  You are running your business - you know what it takes.  Software vendors have to do the same thing.  No income means a poorly run business that will probably fail.  If you are paying your software vendor for their product, you are helping to guarantee your future success.

CMS ANNOUNCES POLICY AND PAYMENT UPDATES

News that is generating a lot of questions was posted by CMS on October 30, 2009.  Indura Systems customers can be sure that our top-rated customer support team is ready and available to answer your questions on this topic.

A link to the rule can be found below:
http://www.cms.hhs.gov/HomeHealthPPS/HHPPSRN/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=ascending&itemID=CMS1230142&intNumPerPage=10

The Centers for Medicare & Medicaid Services (CMS) today announces a 2.0 percent market basket update to Medicare’s calendar year (CY) 2010 home health prospective payment system (HH PPS) rates and modifications to the home health outlier policy. These improvements are evidence of CMS’ continued efforts to ensure appropriate payments, to prevent fraud and abuse, and to protect beneficiaries in the Medicare home health program. Home health agencies (HHAs) receive additional payments (outlier payments) for 60-day home health episodes of care that carry unusually high costs. For CY 2010, CMS will cap home health outlier payments at 10 percent per HHA and target total aggregate outlier payments at 2.5 percent of all HH PPS payments. The current (2009) target for aggregate outlier payments is 5 percent of total HH PPS expenditures. By lowering the total outlier payment target to 2.5 percent, this final rule increases home health base rates by 2.5 percent for CY 2010.

“This final regulation builds on Medicare’s efforts to refine its payment systems while working to reduce waste, fraud and abuse,” said Jonathan Blum, director of CMS’s Center for Medicare Management. “Through the use of up-to-date home health data, it also provides a clearer focus for oversight of the program while encouraging better coordination of Medicare’s home health benefits.”

In this final rule, CMS continues its current policy of a 2.75 percent reduction to national standardized 60-day episode payment rates and non-medical supply factors in CY 2010. Retention of this policy will help offset the increase in the home health case-mix that is not associated with any underlying change in the actual clinical conditions of home health patients. This CY 2010 reduction is the third year of a four-year phase-in of HH PPS rate adjustments, which were made final in the HH PPS Refinement and Rate Update for the CY 2008 final rule.

Historically, home health payment rates have been updated annually by either the full home health market basket index or by an adjustment to the home health market basket index by Congress. CMS uses the home health market basket index – an inflation measurement of the costs of the mix of goods and services offered by home health agencies. The Deficit Reduction Act of 2005 (DRA) provided for an adjustment to the home health market basket percentage update for CY 2007 and subsequent years depending on quality data submissions by HHAs.

Through implementation of new payment and enrollment safeguards, this final rule will reduce Medicare’s vulnerability to fraud, abuse and improper payments. HHAs currently submit Outcome and Assessment Information Set (OASIS) data as a condition of participation in Medicare. Beginning Jan. 1, 2010, the final rule will require HHAs to submit OASIS data as a condition of payment under HH PPS.

CMS is implementing an improved version of OASIS, called OASIS-C, to collect data on all episodes of care beginning Jan. 1, 2010. This data will document important aspects of the patient’s health status including clinical condition, functional abilities, and service needs. As a result, a clinician will be able to capture a clear and accurate picture of the patient which will assist in development of an appropriate plan of care. Documentation provided through OASIS-C also could be used to signal concerns about patient health, encourage preventive care, identify needs for additional patient treatment, and record patient immunizations and vaccinations.

In CY 2010, CMS will publicly report 12 nationally accepted and approved quality measures plus 13 new process measures on its CMS Home Health Compare Web site (http://www.Medicare.gov/HHCompare) HHAs that submit required quality data will receive payments based on the full home health market basket update of 2.0 percent for CY 2010. The home health market basket index percentage will be reduced by 2 percentage points to 0.0 percent for CY 2010 for those HHAs that do not submit the required quality data. For CY 2012, CMS will require HHAs to report, as part of the required home health quality measures, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Home Health Care Survey for Medicare and/or Medicaid beneficiaries.

To qualify for the Medicare home health benefit, a Medicare beneficiary must be under the care of a physician and: have an intermittent need for skilled nursing care; need physical or speech therapy; or, have a continuing need for occupational therapy. The beneficiary also must be homebound and receive home health services from a Medicare approved HHA.

Medicare reimbursement for H1N1 vaccine vs. seasonal influenza

The Influenza vaccine for 2009 is reimbursed on reasonable cost, while the Influenza administration rate is reimbursed on the wage adjusted outpatient prospective payment system (OPPS) reimbursement rate.

The OPPS reimbursement rate for 2009 is $24.89. The rate is wage adjusted where the labor portion is 60% and non-labor portion is 40%.

The H1N1 vaccine is to be provided at no charge to providers therefore, there will be no provider reimbursement for the H1N1 vaccine. Medicare will reimburse providers for the administration of the H1N1 vaccine at the same rate as the influenza vaccine administration rate. Home health providers will be reimbursed at the wage adjusted amount for $24.89.

For example, in 2009, the national unadjusted payment rate is $24.89.  If the wage index for the applicable CBSA is .99, then the payment to the HHA would be $24.74

$24.89*.6=$14.934 (the portion to be wage adjusted);

$14.934*.99 (the wage index) =$14.78466 (the wage adjusted portion of the payment)

$14.78466+$9.956 (the 40% of the national unadjusted payment that is not wage adjusted) = $24.74 (after rounding)).