Tuesday, August 27, 2013

Two’s Company, Three’s a Crowd:
Compliance Officers, In-House and Outside Counsel

Large scale healthcare providers often have not only one, but three, places to turn when faced with a legal or compliance issue.  They can rely on in-house counsel, outside counsel, or a compliance officer for the right answer.  It is important that each of these entities knows and understands the role they play for the healthcare provider. As the saying goes, two’s company, and three’s a crowd.  Tasks can overlap, and responsibilities can be muddled if roles are not clearly delineated among the three.  At McBrayer, McGinnis, Leslie & Kirkland, PLLC, two of our healthcare attorneys have first-hand knowledge of how these roles intersect because they have served in a capacity other than outside counsel for healthcare providers. The knowledge and experience they gained from these past positions have served them, and their clients, well.

Monday, August 26, 2013

Licensure Requirements for Home Medical
Equipment Providers, Personal Service Agencies

Given the current health care climate, it is no surprise that providers who were unregulated just a few years ago are now subject to certification and licensure requirements.

In April 2012, Kentucky House Bill 282 passed the legislature and was signed into law. The law requires that all home medical equipment providers who sell or distribute home medical equipment products to patients in Kentucky obtain a Home Medical Equipment License from the Kentucky Board of Pharmacy. Home medical equipment providers, which are durable medical equipment companies, provide individuals necessary items such as wheelchairs, hospital beds, and nebulizers.

The bill provides the Board of Pharmacy with the authority to grant reciprocity to out-of-state suppliers with licensing requirements in bordering states under certain circumstances.

Final Rule for Long-Term Care Facilities and
Hospice Providers Takes Effect August 26th

On June 27, 2013, CMS published its final rule for hospice agreements with long-term care providers. LTC facilities are now required to have written agreements specifying what services the hospice and LTC provider will provide to nursing home residents receiving hospice care. This new Condition of Participation aims to improve the quality and consistency of care between LTC and hospice providers by specifically defining responsibilities and roles. The agreement must be signed by authorized representatives for both the LTC facility and hospice before hospice care can be provided to patients. The effective date is August 26, 2013.

Friday, August 16, 2013

Beyond Making the Rounds: Hospitalists
& Quality of Care Under ACA: Part II

In an earlier post, I discussed how hospitalists play a vital role in meeting ACA’s quality of care standards for the inpatient setting. Now, let’s take a look at how PCPs must also work to meet these same standards.

A PCP’s Evolving Role for Inpatient Care
Of course, the industry cannot rely on hospitalists alone to meet ACA standards. It takes a village. PCPs still play a key role in establishing quality inpatient care. When a patient is admitted to the hospital, the PCP’s role in the patient’s care has not ended. Instead, PCPs should see the inpatient stay as a momentary transition in care for which they are responsible for retaining oversight. PCPs should step up, not step back, to ensure continuity of care.

Thursday, August 15, 2013

Beyond Making the Rounds: Hospitalists
& Quality of Care under the ACA

By now, everyone knows the Affordable Care Act’s motto is “increase quality, decrease costs.” As providers transition from the fee-for-service payment model to new payment systems that are tied to quality, one subset of providers will play a pivotal role in bringing health care into a new era: hospitalists.

Hospitalists (physicians who provide care solely to hospital inpatients) are poised to lead the way in ensuring that patient care is no longer a series of disconnected dots, but rather a continuum of ongoing service. As primary care providers and subspecialists increasingly limit time set aside for hospital visits, it is up to hospitalists to improve inpatient efficiency, manage patient expectations and coordinate the overall inpatient experience. The unique nature of hospitalists, still a recently new specialty, makes meeting the lofty expectations of the ACA more attainable.

Monday, August 12, 2013

Kentucky Selected To Participate in ER “Super-users” Program

If you have ever been to an emergency room in the Commonwealth, chances are you have seen a “super-user” – a person who uses emergency rooms for regular health care instead of lower-cost alternatives such as a primary care physician.  Whether they are Medicaid recipients or uninsured, super-users (also known as “super-utilizers” or “frequent flyers”) increase Medicaid expenditures and drive up the overall costs of health care. In 2012, 4,400 Medicaid recipients used an emergency room ten or more times, and Kentucky Medicaid spent more than $219 million on emergency room use.  Super-users do not just waste money.  As anyone who has visited the ER can tell you, they also waste the valuable time and resources of emergency room providers, creating longer wait times for those experiencing true emergencies.

The Pioneer Program Report Card

In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization program created through the Affordable Care Act. The program’s goal was to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity.

ACOs are a centerpiece of the ACA. In an ACO, physicians and health systems coordinate care to patients in an effort to reduce duplication of services or costs. The Pioneer program awarded bonuses to providers offering quality care at reduced costs. If certain quality targets were not met, or costs were not reduced, providers suffered a consequence. ACOs were projected to save Medicare as much as $940 million through 2015 and result in over a billion dollars in bonus payments to providers.

Thursday, August 1, 2013

More About Proposed Payment Changes
for Medicare Home Health Agencies

Earlier this week, I discussed CMS’ proposal to rebase the payment rates for home health services. Here I will discuss CMS’ other proposed changes to home health payment.

Coding Changes
According to CMS, there are several ICD-9 codes that are resulting in “inaccurate overpayments” through their inclusion in the home health prospective payment system. CMS is suggesting removal of two specific ICD-9-CM codes:

(1) those that are too acute for the home health setting; and
(2) diagnosis codes for health conditions that do not require home health intervention, do not impact home health plan of care, and/or would not result in the use of additional home health resources.

ICD-10-CM codes will be included in the payment system starting in October 2014.