Will Your Agency Sink or Swim?

Back in the 1970's, Sir Richard Branson, the founder and chairman of Virgin Atlantic, had opened up his first record stores in London, with the profits he had made from selling used records in the back of his university newsletter.  He was ambitious, and a few record stores in and around London was not his idea of success.  But sales were not where they needed to be.  He could do one of two things - liquidate everything, and declare bankruptcy, or get a loan and overcome his financial obstacles to growth.

With a new injection of approximately $45,000, he bought his first recording studio, put out records of the Sex Pistols and Boy George, and then bought his first Boeing 747 to start Virgin Atlantic Airlines.  Branson is now listed as one of the richest people in the world and has interests in more than 360 companies.

What does this mean to you?

With so many changes to regulations and funding, it can be a tough time for home health care agencies.  It is not uncommon to be completely distracted by the need to cut costs in order to stay in business.  But those agencies that WILL be successful are those that take a broader view.  They understand that they need to "manage" costs more than cutting them. This is most effectively achieved when a business can do more with less, and can re-assign skilled resources to tasks that are more directly profitable.

One of the easiest ways for an agency to manage their costs more effectively is to review the tools that they use to run their business.  Almost every agency has some form of software.  Some applications have been developed to run entire hospitals, doctor's offices, and everything in between.  These are big, expensive, and overkill for most agencies.  Other applications have been developed to do just the essential tasks that an agency would need to perform - 485, OASIS, scheduling, billing.  Many of these have been created and are sold by very small companies with questionable longevity.

There has never been a better time to look at Igea HHC from Indura Systems. A full-service, fully featured home health care solution, Igea HHC is used by hundreds of agencies throughout the United States. Happy customers tell us of their ability to manage more patients with less staff, and, at the same time, make their billing more accurate and cost-effective.

Igea HHC is a professional-grade product with a reputation for high performance, ease of use, and on-going compliance. Indura Systems is dedicated to home health care, at the industry level, and in partnership with every one of our agency customers.

With regular system updates that deliver critical features that touch on all parts of an agency's workflow, Igea HHC customers can be sure of always getting the home health care system they need, to run their business smoothly, efficiently, and profitably.

For a limited time, we are offering some very special payment options to make it as easy as possible for agencies to benefit from Igea HHC. There really is no better time than right now.

Contact Indura Systems today for your no obligation demonstration, and discover why Igea HHC customers are looking forward to 2010!

Valuable Source of Free Training

We are always looking for ways to reduce costs while improving effectiveness, and getting something that is truly valuable, for free, is becoming increasingly rare.

So for those of you who need to recap or train employees on claim/billing-related topics, CAHABA offers a valuable source of free training available for anybody:

https://www.cahabagba.com/rhhi/education/online_courses/index.htm

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.

28th Annual Home Care and Hospice Conference and Exposition

We were delighted to attend the 28th Annual Home Care and Hospice Conference and Exposition in Los Angeles this year.  Our new booth was on display and we enjoyed talking with many visitors about our point of care system, iPOC, and introducing our new EMR product, Igea EMR, due for release in Q1 2010.

Many existing Igea customers visited us to share their delight with Igea HHC, and to offer us valuable feedback on features and functions they would like to see in future releases.  All this information is carefully documented and passed to our research and development team.

A number of visitors asked us about OASIS-C and ICD10 and we were happy to reassure them that our entire product line will remain compliant through all future changes to these standards.

Janet Rosta from the Baptist Memorial Health Care Corporation in Tennessee was the lucky winner of our Dell Mini 10 Netbook, a special prize awarded to all those who visited our booth and could answer 5 questions about Indura Systems and Igea HHC.  Congratulations to Janet.

A new newsletter will be distributed soon and will include some exciting updates and screen shots of our trade show attendance, and our Igea EMR beta release.

ENSURE APPROPRIATE PAY FOR HEALTH SERVICES

ENSURE ADEQUATE AND APPROPRIATE PAYMENT
FOR MEDICARE HOME HEALTH SERVICES

ISSUE: The Centers for Medicare & Medicaid Services (CMS) administratively has promulgated a 2.75 percent across-the-board rate reduction for home health services for 2008, 2009, and 2010, as well as a 2.71 percent cut for 2011. The 2.75 percent cuts scheduled for 2008 and 2009 have been implemented. Over the next five years (2009- 2013) these cuts will reduce outlays for home health by $7.59 billion unless Congress blocks them. These reductions are based on an unfounded allegation by CMS that case mix weights have increased without attendant changes in patient characteristics, referred to by CMS as “case mix creep” or “upcoding.”

In its 2009 report to Congress, the Medicare Payment Advisory Commission(MedPAC) recommended that Congress eliminate the home health market basket update for 2010 and accelerate the application of the 2011 coding creep adjustment proposed for 2011 (2.71 percent) to 2010—reducing current rates in 2010 by 5.46 percent. MedPAC also recommended that Congress direct CMS to rebase home health payments in 2011, using 2007 costs as a base.

A 5 percent rural payment differential or “rural add-on” for home health services delivered in rural areas expired on December 31, 2006. This has resulted in rural home health agency closures and threatened access to home health care for beneficiaries living in rural areas.

In February 2009, the Obama Administration included MedPAC’s 2009 recommendations for deep cuts to home health as part of its proposed FY 2010 budget. Over five years these harmful cuts would take more than $13 billion from the Medicare home health program. The administration’s budget also calls for the bundling of hospital and post acute care payments beginning in 2013.

RECOMMENDATION: Congress should: 1) Reform the Medicare home health payment model to achieve a more reliable payment distribution that reflects varying resource uses and costs incurred in providing care to individual patients; 2) Reject any proposals to cut the home health market basket inflation update or impose additional rate reductions for home health agencies; 3) Reinstate the 5 percent add-on payment for home health services in rural areas; 4) Block the home health case mix rate reductions and reform the regulatory process for evaluating case mix changes; and 5) Reject proposals to bundle home health payments into hospital or other provider payments.

RATIONALE:
• MedPAC’s proposed freeze in home health payments, coupled with the CMS regulatory payment reductions and rebased payment rates, would reduce home health payments by $550 million in 2010, by 2.5 billion in 2011, and by $13 billion from 2010 through 2014. These cuts would come from a benefit that is about $15.5 billion per year ($2 billion less than in 1997) and under control in terms of expenditure growth.

• Currently, about one third of Medicare home health agencies (HHAs) have negative Medicare profit margins. The National Association for Home Care & Hospice (NAHC)as calculated that by 2011, nearly two-thirds of home health agencies will have negative Medicare profit margins if MedPAC’s proposed freeze, accelerated CMS regulatory cuts,and rebasing of payment rates are implemented.

• MedPAC fails to evaluate the impact on care access that occurs with the current wide ranging financial situation of HHAs. Regardless of average margins, there is a wide range in agency margins and thus a wide range in impact that the proposed across-the board cuts in payments would have. There is no evaluation to date of the completely reformed home health payment model put in place in 2008. In the event that the wide range in margins continues, a more sophisticated payment model connecting payments to resource use should be developed.

• MedPAC’s proposal to reduce home health payments is based on claims that home health agencies are making excessive profit margins on Medicare services. MedPAC’s financial analysis of Medicare HHAs, projecting a 12.2 percent margin for 2009, is unreliable. First, it does not include any consideration of the 1,626 agencies (21 percent)that are part of a hospital or skilled nursing facility. In some states, hospital-based HHAs make up the majority of the providers (ND 85.0 percent; SD 76.5 percent; MT 66.7 percent; OR 63.0 percent). Facility-based HHAs have an average Medicare profit margin of negative 6.19 percent. Second, the MedPAC analysis uses a weighted average,combining all HHAs into a single unit, rather than recognizing the individual existence and local nature of each provider. It sees a single national profit margin for freestanding agencies as representative of over 9,700 very diverse HHAs. When all agencies’ margins are included and given equal weight, the true Medicare margin would be closer to 5 percent. About one third of home health agencies currently have negative margins. Third, MedPAC margin data fails to recognize many agency costs, including the cost of telehealth equipment, increasing costs for labor, emergency and bioterrorism preparedness, and system changes to adapt to the new home health payment changes.

• Home health agencies are already in financial jeopardy as a result of Medicaid cuts and inadequate Medicare Advantage and private pay rates. Ongoing study of home health cost reports by the National Association for Home Care & Hospice indicates that the overall financial strength of Medicare home health agencies is weak. The average allpayor profit margin for freestanding HHAs is reduced to 4 percent when taking into account losses from non Medicare payors.

• Recent cost reports reveal that the average Medicare margin for rural agencies is negative 3.52 percent. The loss of the 5 percent rural add-on payment for home health services in rural areas has resulted in reductions in service areas, agency closures, and reports that some agencies had to turn away high resource use patients who are more expensive for agencies to serve. In many rural areas home health agencies can be the primary caregivers for homebound beneficiaries with limited access to transportation.

• The “case mix creep” adjustment ignores increases in patient acuity, particularly a significant increase in orthopedic and neurologically impaired patients requiring restorative therapy. These changes in patient characteristics are documented in a report from the Lewin Group and directly correlate with changes in case mix weights.

• CMS alleges that the entire change in the average case mix weights between 1999 and 2005 is the result of provider upcoding or factors unrelated to changes in patient characteristics. If this had occurred one would expect to see a big increase in Medicare home health expenditures. In fact, as the chart below indicates, Medicare home health expenditures are far lower than the Congressional Budget Office (CBO) had expected under the new Home Health Prospective Payment System and are $2 billion less than in 1997.

• Bundling home care payments into hospital or other provider payments would severely compromise both the quality and availability of home health care for Medicare beneficiaries. It would cause major disruption to the health care industry, be anticompetitive, increase the federal regulatory burden and erect a new and unnecessary barrier to beneficiaries’ access to quality care. Hospitals have no experience in the management of post acute care and no infrastructure to manage utilization review. Hospitals are the highest cost sector so this is not the place to locate efficiencies in post acute care. If bundled payments are considered, they should go to community-based providers that have a breadth of experience in providing post acute care and avoiding unnecessary hospitalizations.

TAKE ACTION NOW:

http://www.congressweb.com/cweb4/index.cfm?orgcode=nahc

President Obama Makes Health Care Reform a Top Priority

March 03, 2009 - by Lynn Shapiro, Writer

The Senate is pitched for battle, having heard the details of President Obama's plans for health care reform, laid out in the speech he delivered to Americans last week.

It is a certainty that every vested interest will lobby against it, especially pharmaceutical companies, which stand to lose huge sums of money now that the Obama administration plans to spend $1.1 billion for new reviews of generic drugs. The move is based on several recent studies showing that generics sometimes work as well or better than newer, more expensive medicines. The budget also calls for negotiations with drug makers to lower their prices, as Canada and Western European countries now do.

This initiative is a radical departure from President George W. Bush's Prescription Drug Plan of 2003 for Medicare beneficiaries (Medicare Part D), which refused to require drug makers to negotiate their prices downward.

Unlike Bush, Obama appears unafraid of impinging on the fortunes of industry. Neither is he averse to taxing Americans in the highest income bracket. The President said that most workers are unduly constrained by health care costs and that to ease this burden, he would derive $318 billion by raising the taxes on the top 20 percent of tax filers who earn more than $250,000 a year. These individuals would pay 90 percent of all taxes.

Obama's proposal would also eliminate subsidies now given to the private plans that provide care to more than 10 million of the 44 million Medicare beneficiaries. By forcing these plans, known as Medicare Advantage, into a competitive bidding process, the administration says it can save $175 billion over the next 10 years.

The President is counting on the economy to be thriving by 2011. Then, his plan for hiking taxes on high-income payers would make it possible for him to keep his promise to halve the deficit by 2013.

Deficits of almost $1.8 trillion in 2009 and $1.2 trillion in 2010 are frightening. But while Obama wants to extend tax cuts for the middle class, much of the health care package is intended to save the economy and create jobs. So, the massive amount of red ink Americans face should be temporary, the budget assumes.

Deciding when to go from stimulus spending to deficit reduction is the trickiest part of the equation, but doing it is essential, analysts say.

Other Provisions

Another avenue for health care savings would come from slashing Medicare's home health care programs, said to be excessive. What's more, ending rebates from drug companies for medicines sold to Medicaid patients would save the U.S. healthcare system almost $20 billion.

The budget also includes more than $1 billion to help the FDA fortify its food safety program because of the salmonella outcry; $6 billion for cancer research and a program to send nurses to new mothers' homes to check on babies. Another $76.8 billion would go to the Health and Human Services Department to fund electronic medical records to end costly duplication of diagnostic tests and allow doctors to share patient histories. This provision is not only cost-effective but potentially beneficial to the patient, experts say. Obama promises to preserve patients' privacy, even while doctors share patients' records.

White House budget director Peter Orszag projected in commentary over the weekend that the proposed spending would save $1.8 billion in 2010, $16.2 billion in 2011 and increasing amounts annually to create a $633.8 billion fund to pay for health care reform by 2018. Congress has already provided $25 billion to help laid-off workers pay for COBRA.

What's more, Obama says that spending to get coverage for more of America's 46 million uninsured will save money, if preventive care helps patients avoid expensive and chronic diseases.

Money will be also be saved, Obama said, by finding and eliminating overpayments in Medicare. "The Government Accountability Office has labeled Medicare as 'high-risk' due to billions of dollars lost to overpayments and fraud each year," the budget reads.

Better Care, Not More

In conclusion, the budget says "about $26 billion can be saved over 10 years by using a combination of incentives and penalties to prevent avoidable expensive readmission when patients go back into the hospital within a month after treatment. Reforming the way doctors are paid will also reduce costs, by paying them to provide better care rather than more expensive care, such as imaging scans and surgery that may not be necessary." For example, since Obama took office, Medicare has announced it will stop covering virtual colonoscopies, deciding they're too expensive.

None of this will be easy but one thing is for sure. President Obama has made health care reform a top priority.

Brought to you by Indura Systems.

House Call Physicians Ineligible for e-Prescribing Incentives

AAFP Efforts Fail to Reverse CMS Decision
By Sheri Porter 2/24/2009

The AAFP's efforts, in tandem with those of the American Academy of Home Care Physicians, or AAHCP, to correct an oversight in CMS' recently launched electronic-prescribing incentive program, recently resulted in a denial from the agency.

Rick Kellerman, M.D., of Wichita, Kan., an AAFP past president, is shown here checking on a nursing home patient.

In a Feb. 9 letter to CMS Acting Administrator Charlene Frizzera, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., pointed out that, as currently implemented by CMS, Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 "precludes physicians who practice predominantly, if not exclusively, as house call physicians from participation in the e-prescribing incentive program." On Feb. 23, however, AAFP News Now learned from AAHCP Executive Director Constance Row that CMS had declined to make the changes recommended by the two organizations.

Relevant CPT Codes Overlooked

The issue lies with the agency's choice of CPT codes that appear in the denominator of the e-prescribing legislation. As King pointed out in his letter to CMS, those CPT codes include services provided in the areas of psychotherapy, general ophthalmological services, health and behavior assessment and intervention, office and outpatient visits, and office consultations. However, CMS failed to include codes typically used by physicians who focus their practices on house call services, said King.

Those codes also include care provided to patients living in nursing homes. King argued that many house call physicians were early adopters of health information technology and e-prescribing. He said patients served by home care physicians usually have multiple comorbidities that call for an array of prescriptions that would be more efficiently handled electronically.According to Row, however, "CMS has decided definitively not to add these codes to the 2009 electronic-prescribing incentive program." She added that the letter from CMS indicated the agency may "consider changes for 2010 or beyond."

Statistics Reinforce Call for Inclusion

Row said that statistics provided by CMS only reinforce the argument that home health care physicians and other eligible providers should have the opportunity to benefit financially from the e-prescribing bonus program. She cited figures from CMS' Physician Supplier Procedure Summary Master Record that details Part B claims paid by Medicare carriers in 2007.According to those data, all Medicare providers combined logged 2,194,083 total house calls and 1,696,411 total domiciliary visits (i.e., house calls to patients residing in assisted living facilities) in 2007.

Family physicians alone logged 410,582 house call visits and 286,521 domiciliary visits in 2007. In his letter, King called on CMS to add home services CPT codes 99341 to 99350 and domiciliary/rest home visit CPT codes 99324 to 99337 to the denominator for eligibility in the e-prescribing incentive program.Row said that in light of CMS' rejection of that suggestion, her organization would continue to work closely with the AAFP for possible resolution of the issue in 2010.

Brought to you by Indura Systems.

Kaiser Daily Health Policy Report

Health Care Marketplace Health Care Spending Will Account for One-Fifth of GDP in 2018; Federal Government Will Pay More Than 50% of Those Costs, According to CMS Report [Feb 24, 2009]

Overall U.S. health care spending will reach $2.5 trillion in 2009, a 5.5% increase from 2008, when health care spending increased by 6.1%, according to a CMS report published Tuesday in the journal Health Affairs, the Wall Street Journal reports (Zhang, Wall Street Journal, 2/24).

Total health care spending will account for 17.6% of the gross domestic product in 2009, a full percentage point higher than 2008, marking the largest one-year increase since CMS began tracking health care spending in 1960 (Dunham, Reuters/Boston Globe, 2/24). The rate of health care spending growth is expected to decline over the next five years in part because people will lose their jobs and health coverage as the recession continues, and they will forgo medical treatment; however, the economy will be shrinking and growing at a slower rate, which will increase health care spending's share of GDP (Young, The Hill, 2/24).

The study found that in 2009, government health care spending is expected to increase by 7.4% to $1.19 trillion, while private health spending is expected to increase by 3.9% to $1.32 trillion (Wall Street Journal, 2/24). CMS projects that in 2018 overall U.S. health care spending will reach $4.35 trillion, accounting for 20.3% of the GDP (The Hill, 2/24). The study estimates that health care costs will average $8,160 per U.S. resident in 2009, up $356 from 2008, and will reach $13,100 per U.S. resident by 2018 (Alonso-Zaldivar, AP/Boston Globe, 2/24).

The report forecasts that the government will pay for more than 50% of total health care spending by 2016 and 51.3% by 2018, as Medicaid enrollment increases and baby boomers start enrolling in Medicare (Pugh, McClatchy/St. Paul Pioneer Press, 2/24). According to the study, Medicaid spending will increase from $352 billion in 2008 to $801 billion by 2018. The report estimates that Medicare enrollment increases will drive up the spending growth rate in the program from 6.2% in 2011 to 8.6% in 2018.

CMS predicts that final Medicare figures will show spending of $466 billion for 2008, 8.1% higher than in 2007 (Reichard, CQ HealthBeat, 2/24). According to the report, Medicare's hospital trust fund could become insolvent by 2016 -- three years earlier than previous estimates -- because of lower tax revenue caused by the recession (AP/Boston Globe, 2/24).

Additional Findings The study predicts that private health insurance enrollment will drop from 195.5 million in 2008 to 189.5 million in 2010 (CQ HealthBeat, 2/24). Private health spending is expected to increase as the economy improves, growing to 4.2% in 2010 and reaching 6.1% by 2018 (Reuters/Boston Globe, 2/24). The report also estimates spending growth rates for overall health spending in 2008 of 7.2% for hospitals, 6.2% for physician and clinical services, 9.1% for home health care, and 4.6% for nursing homes (CQ HealthBeat, 2/24). The rate of prescription drug spending increased by 3.5% in 2008, down from 4.9% in 2007, which study co-author Andrea Sisko attributes to U.S. residents' being more willing to use generics and less inclined to fill prescriptions as the economy declines.

The report projects that the recession would begin to improve in 2010 and health spending growth would surge again in 2011 (Reuters/Boston Globe, 2/24). The study did not examine the impact of the recently enacted stimulus package, which includes $87 billion in increased Medicaid aid, nor did the report take into account the expansion of CHIP (Wall Street Journal, 2/24). The estimate includes a scheduled 21% cut to Medicare physician payment rates, but Congress and President Obama are expected to block the cuts. The Congressional Budget Office has estimated that blocking the cut will cost at least $100 billion over 10 years (The Hill, 2/24).

The study is available online.

Brought to you by Indura Systems.

Obama releases $15 billion in Medicaid funding to states

President Obama, meeting with the nation's governors in Washington, D.C., this morning, announced a quick release to the states of $15 billion of federal Medicaid relief funding to help them cope with the rising health care costs brought on by the economic crisis. According to a White House press release, the money will be available in 48 hours--on Wednesday--in special Treasury accounts set up for the states to access.

"That means that by the time most of you get home," said President Obama, "money will be waiting to help 20 million vulnerable Americans in your states keep their health coverage. Children with asthma will be able to breathe easier, seniors won’t need to fear losing their doctors, and pregnant women with limited means won’t need to worry about the health of their babies.”

The funding is part of the designated moneys from the American Recovery and Reinvestment Act, and the temporary increase will be administered by the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS). The federal agency will coordinate with states to ensure they are properly meeting regulations and requirements about Medicaid.

The announcement of the funding release was made as President Obama and Vice President Biden hosted members of the National Governors Association at the White House.

A state-by-state grant award summary for the program can be found here.

SusanG@dailykos.com

Brought to you by Indura Systems.

Care Givers on Bikes!

Brought to you by Indura Systems.

Gentiva to divest six home healthcare branches to Loving Care Agency

By Datamonitor staff writer

Gentiva Health Services, a provider of comprehensive home health services, has entered into an asset purchase agreement with Andventure, doing business as Loving Care Agency and Links2Care, for the sale of six Gentiva branch offices in four cities that specialize in pediatric home healthcare and also provide adult home health aide services.

These offices comprise more than 80% of Gentiva's current pediatric care operations. Terms have not been disclosed. According to Gentiva, the transaction fits with its stated objective of increasing its focus on skilled home health services for geriatric patients.
Under the terms of the transaction that Gentiva has announced, Loving Care Agency will acquire existing Gentiva branches in Phoenix, Arizona; Springfield, Massachusetts; Pittsburgh and State College, Pennsylvania. The transaction is expected to close in the first quarter, subject to all customary approvals.

Tony Strange, CEO of Gentiva, said: "This agreement with Loving Care, a leader in pediatric homecare services, will build on the high quality of care that these branches have provided. Our decision to migrate away from pediatric home healthcare is in keeping with the company's strategy of focusing on geriatric specialties.

"We believe our emphasis on providing value-added services to this population will translate into higher margins and returns that we can leverage to continue to grow our core home health business."


Brought to you by Indura Systems.

Home health care benefits both taxpayers and patients

As Gov. David Paterson tries to make New York State's budget ends meet, he is met with cry after cry -- ''You can't cut my program!''

We've all seen the heart-rending ads on TV. There's one proposed cut, however, that doesn't make sense even for the people it least affects directly: home health care.

The governor wants to cut Medicaid reimbursement rates between 1.5 percent and 3.5 percent for certified home health agencies and long term home health care programs; he's also proposing an additional, across-the-board cut of 1 percent in all Medicaid rates, the elimination of an inflation-based increase in payments to home health providers for 2008 and 2009, and a 0.7 percent tax on revenues.

The Home Care Association of New York State says these actions likely will force many home care providers to drastically reduce services or go out of business. And without the option of home care, people who have depended on it are likely to end up back in hospitals and nursing homes, where taxpayers will pick up a much larger Medicaid bill.

The governor figures his proposal will save the state $184 million in Medicaid costs in 2009-10; since the federal government contributes toward Medicaid, it means a cut of about $347 million in federal home health funding. Does Gov. Paterson think the people who no longer can get home health care are just going to disappear? Too many will need to be moved into more expensive hospitals and nursing homes. Home health care is less expensive, and provides better care, most experts agree. Why would we want to end a program that does that?

New York State's Medicaid program has been described as the ''Cadillac'' of programs, offering more coverage than most other states do. It is better coverage than many people can afford from private insurers, and better than the coverage offered by many employers. Shouldn't this be an area that could be looked at for cuts before threatening programs that actually save taxpayers money while providing better care for patients?

Neither the taxpayers nor the patients will be better off under these proposed budget cuts. We urge Gov. Patterson to reconsider.

Brought to you by Indura Systems.

California is Ready for Obama HIE Stimulus

White Paper Describes “Shovel-Ready” Project

President Obama's economic stimulus package is an opportunity to accelerate health information exchange in California through a “shovel-ready” statewide HIE. As a result of the planning and activities accomplished by CalRHIO and its stakeholders, California has completed key requirements called for in the legislation and is ready to deploy and implement HIE across the state.

A new White Paper discusses achievements that demonstrate California's readiness:

1. A proven statewide HIE solution, selected through a rigorous competitive process, is ready to deploy; implementation plans are fully developed.

2. A statewide public-private HIE organization is already established, with fully operational governance and management, and support from a broad range of stakeholders.

3. The statewide HIE solution, embraced by many local RHIOs, offers an efficient, affordable way for providers and communities all over California to collaborate and participate in an interoperable HIE.

4. Privacy and security standards and policies, which either meet or exceed national recommendations, are tested and in place.

5. Clinical use cases have been defined and support the strategy for launching the statewide HIE in hospital emergency departments and then expanding into physician offices.

6. A sustainable business model has been created that ensures a statewide HIE network can be deployed, maintained, and continually improved over the long-term.

To view the full White Paper, click here.

Brought to you by Indura Systems.

What The Stimulus Plan Means to Healthcare

A comparison of the $838 billion economic recovery plan passed by the Senate with an $820 billion version passed by the House. Additional debt costs would add almost $350 billion over 10 years. Many provisions expire in two years.

From the Associated Press:

HEALTH CARE:

• Senate — $20 billion to subsidize health care insurance for the unemployed under the COBRA program; $87 billion to help states with Medicaid; $22 billion to modernize health information technology systems; $10 billion for health research and construction of National Institutes of Health facilities.


• House — $40 billion for more generous COBRA subsidies and to provide health care through Medicaid; $87 billion to help states with Medicaid; $20 billion to modernize health information technology systems; $4 billion for preventative care; $1.5 billion for community health centers; $420 million to combat avian flu; $335 million for programs that combat AIDS, sexually transmitted diseases and tuberculosis.

Brought to you by Indura Systems.

Good News from Palmetto - GBA RESOLUTION ACHIEVED

Claims Submitted through Direct Data Entry in Status/Location SM95HG

Palmetto GBA just announced that claims that were submitted through direct data entry (DDE) and are pending in FISS Status/Location SM95HG have been corrected and are being released for processing. These claims were submitted via DDE between November 3, 2008, and December 2, 2008 and received a duplicate document control number (DCN). PalmettoGBA is keenly aware this issue has affected sequential billing for some Home Health and Hospice providers. Once the affected claims begin to process to completion sequential billing can resume.

Previously issued accelerated payments are scheduled for recoupment beginning March 2, 2009.

To learn more about the resolution to this matter and others, we encourage you to visit the Palmetto GBA RHHI Claims Processing Issues Log located at this link.

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NGS Notification regarding debit/credit issue

National Government Services is experiencing an issue whereby some Part A debit/credit adjustments were assigned duplicate DCNs and are therefore being rejected by HIGLAS. This is primarily impacting home health and hospice providers, since home health final claims process as debit/credit adjustments if they are tied to a RAP. National Government Services is working with CMS, IBM, and FISS to resolve this issue and expects a resolution on April 6. No action is required by providers at this time.

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Revised Home Health Prospective Payment System Fact Sheet

See the latest information at http://www.cms.hhs.gov/MLNProducts/downloads/HomeHlthProspPymtfctsht09-508.pdf.
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Home Health Care - the business to start!

It's official - Home Health Care is one of few businesses that can survive the current economic crisis. Here is what the blog biziki.com has to say about Home Health Care:

While employment in the health service industry is projected to grow 28% by 2012, employment in the specialized home health care industry is expected to be
nearly twice that, or 54.5%. Each year, over 7.6 million people are provided with home health care services.

Thanks to science and medicine, people are living to a ripe old age more and more. This means, however, that more people are needed assistance at home. And that is where home health care comes into the picture.

Just think, 7.6 million people, 6 episodes per year, $3000 per episode - that is potentially a $136,800,000,000/year industry.
Want a bigger slice of that pie?
Find out why Igea HHC from Indura Systems is THE PREFERRED home health care agency management system for more customers throughout the United States.
Read the whole blog at http://www.biziki.com/biz/top-industries-to-start-a-business/.
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Benefits for Veterans in New Jersey

A very useful and detailed blog posting that covers information about benefits for Veterans in New Jersey:

http://www.dvanarelli.com/blog/2009/01/27/the-basics-of-va-pension-benefits/
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NAHC Regulatory Affairs Update

The Department of Homeland Security (DHS) developed a brief emergency preparedness guide for home health providers and patients. They have asked NAHC to help disseminate the guide and seek feedback on its utility.

The developers are also interested in any general comments providers have. http://www.dhs.gov/xlibrary/assets/oha-home-health-care-preparedness.pdf

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