The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule.  HHS will announce a new compliance date at some point in the future.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius.  “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

The full text 0f this ICD-10 news is on the HHS.gov website.

February

Association of Home Care and Hospice of NC
April 30 – May 1
Durham, NC

See you soon!

Patients who are assigned or “aligned” with physicians who participate in ACOs are not required to receive services from such physicians or from any other participants in ACOs.  Patients who are aligned with physicians in ACOs still have the right to freedom of choice of all types of providers.  The Centers for Medicare and Medicaid Services (CMS) emphasizes this fact in commentary to the final regulations governing ACO’s as follows:

• “We have also been vigilant in protecting the rights and benefits of FFS beneficiaries under traditional Medicare to maintain the same access to care and freedom of choice…”

• “An ACO will not receive an assignment of those beneficiaries that choose not to receive care from ACO providers.”

• “We also noted that the strategies employed by an ACO to optimize care coordination should not impede the ability of a beneficiary to seek care from providers that are not participating in the ACO, or place any restrictions that are not legally required on the exchange of medical records with providers who are not part of the ACO.  We proposed to prohibit the ACO from developing any policies that would restrict a beneficiary’s freedom to seek care from providers and suppliers outside of the ACO.”

• “It is important to note that the term ‘assignment’ for purposes of this provision in no way implies any limits, restrictions, or diminishment of the rights of Medicare FFS beneficiaries to exercise complete freedom of choice in the physicians and other health care practitioners and suppliers from whom they receive their services.  Thus, while the statute refers to the assignment of beneficiaries to an ACO, we would characterize the process more as an ‘alignment’ of beneficiaries with an ACO, that is, the exercise of free choice by beneficiaries in the physicians and other health care providers and suppliers from whom they receive their services is a presupposition of the Shared Saving Program.”

• “…the Shared Savings program is certainly not intended to be a managed care program in a new guise.  One important distinction between an ACO and many MA organizations is that beneficiaries are not locked into receiving services from the ACO to which they are assigned, and may continue to seek care from any provider they choose.”

• “Beneficiaries who are assigned to ACOs under the Shared Savings Program remain Medicare fee-for-service beneficiaries, retaining their full freedom of choice regarding where to receive services. We therefore take this opportunity, as requested by a number of commenters, to confirm and emphasize that basic beneficiary rights are maintained under the Shared Savings Program, most especially (but not exclusively) the right to receive care from physicians and other medical practitioners of their choice outside the ACO at no penalty to the patient.”

• “The ACO model does not include the use of networks or any restrictions on where beneficiaries can receive care.”

It remains to be seen how ACOs will work in practice, but the final regulations are quite clear that patients in ACOs retain their right to freedom of choice of providers

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

ACOs seem to be the next “big thing.”  Doctors and hospitals clearly have a role to play in ACOs.  Many post-acute providers, however; including home health agencies, hospices, and HME companies; would like to know if they can also be part of ACOs.  Section 1899(a)(1)(A) of the Affordable Care Act defines ACOs as “groups of providers of services and suppliers” that work together to manage and coordinate care for Medicare fee-for-services beneficiaries.  The statute lists the following groups of providers of services and suppliers that are eligible to participate as an ACO

-          ACO professionals, i.e. physicians in group practice arrangements

-          Networks of individual practices of ACO professionals

-          Partnerships or joints venture arrangements between hospitals and ACO professionals

-          Hospitals employing ACO professionals

-          Such other groups of providers of services and suppliers as the Secretary of the U.S. Department of Health and Human Services (HHS) determines appropriate [Emphasis added]

It is also important for post-acute providers to know that Section 425.20 of final regulations published by the Centers for Medicare and Medicaid Services (CMS), which govern the establishment and operations of ACOs, defines “participant” a

…an individual or group of ACO provider(s)/supplier(s), that is identified by a Medicare-enrolled TIN, that alone or together with one or more other ACO participants comprise(s) an ACO, and that is included on the list of ACO participants that is required under Section 425.204(c)(5)

The final regulations go on to define ACO providers and suppliers as follows

ACO provider/supplier means an individual or entity that–

(1)    Is a provider (as defined at Section 400.202 of this chapter) or a supplier (as defined at Section 400.202 of this chapter);

(2)    Is enrolled in Medicare;

(3)    Bills for items and services it furnished to Medicare fee-for-service beneficiaries under a Medicare billing number assigned to the TIN of an ACO participant in accordance with applicable Medicare regulations; and

(4)    Is included on the list of ACO providers/suppliers that is required under Section 425.204(c)(5).

The commentary to the final regulations governing ACOs makes it even clearer that post-acute providers can participate in ACOs:

We do not believe that we should be prescriptive in setting any requirements for the number, types and location of providers/suppliers that are included as ACO participants…In addition, any Medicare enrolled entities not specified in the statutory definition of eligible entities in Section 1899(b)(1)(A)-(D) of the Act can participate in the Shared Savings Program as ACO participants by joining an ACO containing one or more of the organizations eligible to form an ACO.

The commentary also states that ACO participants are defined as any Medicare-enrolled provider or supplier, including pharmacists.

Consequently, based upon the statute, the final regulations, and commentary to the final regulations, it is clear that post-acute providers may join doctors to form ACOs.

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Join Kristin Stricker and Stan Massey of Transcend Hospice Marketing Group to learn:

• How to effectively gather and apply market research to identify and prioritize opportunities for increasing length of stay in your service area.
• How to spark earlier admissions using marketing strategies targeted to the specific needs and interests of the public, physicians, nursing homes and other referral sources.

Event Date: Feburary 16th 3 pm ET

This is a FREE educational webinar

We look forward to having you join us!

Sponsored by CareAnyware Hospice Software and presented by Transcend Hospice Marketing Group

Welcome to the new CareAnyware.com. Our goal was to put valuable home health and hospice educational resources at your fingertips and bring you the most up-to-date news to help you provide better care, ease the burden of compliance and grow your organization:

• Access to our most useful educational content for home health and hospice providers, including whitepapers, articles, case studies and webinars is just two clicks away, under the “resources” tab.
• The CareAnyware blog explores important topics in hospice and home health point-of-care, regulatory compliance and business operations twice per week.
• Our valued customers will find the “client login” link  in the top right hand area of the site, as before.

We hope you find the site easier to navigate and provides easy access to valuable information regarding  best practices in both home health and hospice software as well as insights on providing the best patient care possible.

Let us know what you think in the comments!  We welcome your feedback!

Many of our best ideas have been developed and brought to life with customer input and participation – the clinical content built into our CareTouch Logic point-of-care system, industry-leading compliance safeguards and reports and the powerful reporting tools including Performance Lab Analytics have been collective efforts building off customer insights, needs and requirements for running an efficient home health or hospice organization and serving patients with the best possible care.

Our plan for 2012 is to accelerate our collaborative development efforts and continue to improve our home health and hospice software available as a web-based, SaaS solution. Some of the more exciting enhancements include powerful care planning diagnostic tools, ROI and benchmarking reports, clinical content, mobile applications and more.  Web-based home health software and web-based hospice software gives organizations actionable data and intelligence to enable growth and to provide great care.

As we plan for the future with our customers, we also want to accelerate our learnings by conducting more research and formally seeking input on topics ranging from support, training and implementation, educational webinars and more.

We always welcome feedback and comments from the home health and hospice community.  Please feel free to share your thoughts in the comments.

Most dog owners love Rex and Fido because they are sources of warmth and unconditional love. That warmth and love is now being put to work in one New York hospital, where dogs are being trained to provide therapeutic care to hospice patients.

In a recent Huffington Post article, hospice industry advocate Jeanne Dennis points our attention to Tug, a French Water Dog with an exceptionally unique skill set. Tug and his fellow non-human volunteers are the first graduates of a specialized volunteer training program that prepares dogs to act – in tandem with their owners – as palliative caregivers.  The training program (the result of a partnership between The Good Dog Foundation and Visiting Nurse Services of New York) is currently in full swing at the Haven House Specialty Care Unit of New York’s Bellevue Hospital.

Studies have shown that visits from a pet can contribute to increases in both the mood and the physical health of patients in their last stages of life. Animal visits boost hospice patients’ psychological health by bringing back happy memories of past times with beloved pets. The presence of a dog can also soothe a family’s sadness, contributing to more satisfying interactions between patients and their family members. The program is also worthwhile from a physical health perspective: the CDC has reported that people with pets have lower blood pressure and lower cholesterol and triglyceride levels than their pet-free counterparts.

For more information about hospice volunteer training for dogs, check out the website for The Good Dog Foundation. You can read more about VNSNY’s Hospice and Palliative Care services on their website. Another great piece about a North Carolina couple who volunteer, along with their three dogs, at hospitals and hospices all over the state, recently ran in the Wilmington Star-News.

How hard would it be for you to implement something like this in your agency? Is this one of those programs that looks good on paper but would be impossible to run? Has anyone had success integrating pet therapy into their menu of hospice services? Opinions and thoughts are welcome in the comments!

Those of you working in hospice may cringe when you hear about the latest media takedown of “for-profit” hospice. We’ve covered this topic on the CareAnyware blog before, and if you’re a hospice provider, chances are it’s been on your radar for quite some time. The journalistic trend – ever since MedPAC launched an investigation into for-profit hospices several years ago – has been to publish pieces that question the motives of for-profit hospice providers.

If all of the negative hospice sentiment has frustrated you, you might want to take a look at this piece by Joanne Kenen of the Association of Health Care Journalists. Kenan advocates for temperance over hysteria and she encourages journalists to examine misconceptions and gray areas that can lead to unwarranted biases in their coverage of hospice.

Kenen says that although the sales and marketing practices of the for-profit hospices are the topic du jour, they are certainly not the only thing worth writing about. She suggests that journalists keep the following things in mind when approaching hospice coverage:

• Don’t mix up quantity and quality – just because the for-profits may be accused of admitting high numbers of patients, don’t assume the care they’re giving is sub-par.
• There’s a difference between the big guys and the little guys – don’t let the tax status of a hospice organization bias coverage of quality of care issues.
• Prognosis isn’t easy – accurately diagnosing the length of time a patient has left to live is not an exact science. Don’t always assume fraud when a patient lives longer – and stays in hospice longer – than expected.

Read the rest of Kenen’s insights.

Read a good post on GeriPal about the for-profit “problem” in hospice and palliative care – “Should For-Profit Hospices Be Banned?”

We’d love to hear what you think about how journalists cover hospice. What would you like journalists to know? What do you think it’s important for them to keep in mind to give a more accurate picture of the current state of the hospice industry? Share some of your wisdom with us in the comments!

The videos and podcasts – all free, and all clocking in at around four minutes – are part of OIG’s Compliance Training Initiative. The topics covered include:

• Major health care fraud and abuse laws
• The basics of health care compliance programs
• What to do when a compliance issue arises
• Health care reform questions for compliance professionals

Also available (and free) on OIG’s site are the sixteen training modules that were used for the May 18, 2011 “HEAT” (Health Care Fraud Enforcement and Prevention Action Team) Provider Compliance Training Webcast.

These easily digestible resources are perfect for busy hospice and home care administrators: they’re short, to-the-point, and up-to-date. And this year, with fraud looming large in the realm of regulatory concerns, it’ll be more important than ever to proactively educate yourself and your staff about compliance best practices. Here at CareAnyware, we’re focused on helping post-acute providers be 100% in compliance — our CareTouch Logic feature, built into our web-based home health and hospice software helps clinicians create and maintain defendable documentation that keeps your agency in the clear.

Check out OIG’s videos, podcasts, and other home health and hospice fraud prevention resources. Once you’ve watched a video or two, come back and do your best Roger Ebert impression in the comments!