Guest guest Posted October 4, 2011 Report Share Posted October 4, 2011 Your Daily Posterous Spaces Update October 4th, 2011 Home-Health Firms Blasted <http://ptmanagerblog.com/73747760> Posted about 23 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73747760> Home-Health Firms Blasted Senate Panel Alleges Big Providers Abused Medicare by Tailoring Patient Care to Maximize Profits - - smaller<http://online.wsj.com/article_email/SB1000142405297020461250457660679170\ 8892886-lMyQjAxMTAxMDAwMzEwNDMyWj.html?mod=wsj_share_email#> - Larger<http://online.wsj.com/article_email/SB10001424052970204612504576606791708\ 892886-lMyQjAxMTAxMDAwMzEwNDMyWj.html?mod=wsj_share_email#> By JOHN CARREYROU<http://online.wsj.com/search/term.html?KEYWORDS=JOHN+CARREYROU & bylines\ earch=true> An inquiry by the Senate Finance Committee has found that the nation's three largest home-health companies tailored the care they provided to Medicare patients to maximize their reimbursements from the federal program. Read the Report - *Staff Report on Home Health and the Medicare Therapy Threshold<http://online.wsj.com/documents/Home_Health_Report_Final2.pdf> * The committee launched its investigation following an article last year in The Wall Street Journal that used Medicare-claims data to analyze the companies' patterns of dispensing care. The article described how the companies' Medicare patients received a high number of the most profitable home-therapy visits but few of the least profitable ones. The three companies, Amedisys<http://online.wsj.com/public/quotes/main.html?type=djn & symbol=AMED> Inc., LHC Group<http://online.wsj.com/public/quotes/main.html?type=djn & symbol=LHCG> Inc. and Gentiva Health Services<http://online.wsj.com/public/quotes/main.html?type=djn & symbol=GTIV> Inc., get most of their revenues from Medicare. Home-health care, which involves sending nurses to patients' homes in an effort to cut down on costly hospitalizations, is one of the fastest-growing areas of spending for the $524 billion-a-year health plan for the elderly and disabled. The Senate committee, citing emails and other internal documents obtained from the companies, alleges that they encouraged employees to make enough home-therapy visits to reach thresholds that triggered bonus payments, whether or not the visits were medically necessary. The panel's report said those alleged practices, at best, " represent abuses " of the Medicare program. " At worst, " it said, " they may be examples of for-profit companies defrauding " the program at taxpayers' expense. The report concludes that the Centers for Medicare and Medicaid Services should stop using the number of therapy visits as a payment gauge and instead rely on measures of " patient well-being and health characteristics. " We are disappointed with the committee's conclusions, and we stand by our company's integrity, ethics, and patient-care practices, " Amedisys said in an emailed statement. A spokesperson for Gentiva said it " cooperated fully with the committee's inquiry, providing all materials requested. " The company declined to elaborate because it hadn't seen the committee's full findings. Pete November, LHC Group's general counsel, said his company provided the committee with an independent analysis showing that LHC Group's " therapy utilization and reimbursement per episode " were " both 13% below the national average. " He added, " Our business operations focus on providing cost-effective care based upon the individualized needs of the patients we serve. " In a case unrelated to the Senate inquiry, LHC Group reached a $65 million settlement with the Justice Department last week to settle civil allegations that between 2006 and 2008 it improperly billed for services that weren't medically necessary and for care provided to patients who weren't homebound. The department said Judy Master, whose lawsuit prompted the government investigation of the matter, will receive $12 million of the settlement. Ms. Master worked for a consulting firm that LHC Group had hired. Crossing Thresholds The industry's pattern of visits altered in 2008, after Medicare started to pay home-health firms bonuses for 6, 14 and 20 therapy visits to a patient, rather than only at 10 visits. 6 visits: up 19% 10 visits: down 43% 14 visits: up 42% 20 visits: up 30% --Centers for Medicare and Medicaid Services As part of the settlement, in which it didn't admit any wrongdoing, LHC Group entered into a corporate integrity agreement with the inspector general of the Department of Health and Human Services. In a report summarizing the findings of its inquiry, which it plans to release Monday, the Senate committee said LHC Group, Amedisys and Gentiva " encouraged therapists to target the most-profitable number of therapy visits, even when patient need alone may not have justified such patterns. " Medicare reimbursements for home-health care are determined in part by the number of therapy visits each patient receives, with an extra fee kicking in as soon as a patient hits a certain number of visits. The bonus was designed to ensure providers didn't stint on therapy visits. In 2008 Medicare altered the number of visits required to trigger bonus payments. Instead of offering companies a bonus of a few thousand dollars after they reached a 10-visit threshold, it instead offered smaller bonuses at thresholds of six, 14 and 20 visits. After it did so, Amedisys, the largest of the three home-health companies, altered its clinical protocols to match the change, the committee alleges. " We need to work immediately to adjust our '10 therapy threshold' mind-set, " one Amedisys executive in Florida wrote to subordinates in a Feb. 27, 2008, email cited by the committee's report, referring to the number of home visits that used to, but now no longer, triggered a Medicare bonus. By increasing the number of visits its nurses made to patients' homes to 14 to match Medicare's new reimbursement system, Amedisys stood to earn $880 more per patient, the executive wrote in the email. After the 2008 reimbursement change, the number of Medicare patients treated by Amedisys who received 10 home visits dropped by 46%, while the number of patients who received 14 visits rose 22.5%. Meanwhile, the committee's report said, the number of Amedisys patients who received either six or 20 visits, the two other new bonus thresholds, rose 16% and 32%, respectively, according to the report. During a conference call Amedisys held on June 13, 2007, the report said, a document was passed around to participants that proposed substituting more lucrative physical-therapy visits for less-lucrative skilled-nursing visits in a company program to treat patients with wounds. The switch would bring " added revenue " of $1.4 million, the document stated. At Gentiva, the report said, a spreadsheet analyzing Medicare's 2008 reimbursement changes showed that the company would earn $11 million more from the federal program if " therapy visits provided increased 2 to 4 visits to reach 6- and 14-visit plateaus. " Another internal analysis of the coming reimbursement changes emailed to Gentiva Chief Executive Tony Strange on Sept. 7, 2007 stated that " increasing therapy visits by an average of 2 visits " per patient " will increase revenue by approximately $350 to $550 per episode " of care. After the 2008 reimbursement change, the number of Gentiva patients who received 10 visits declined by 24%, while the number of patients who received either 14 or 20 visits rose by 21% and 29%, respectively, according to the report. At LHC Group, a company physical therapist said in a July 8, 2007, email to another LHC employee that he had coached a colleague on how to meet the 10-visit threshold under Medicare's old reimbursement system. " There are several old tricks up my sleeve that I told him about from a clinical standpoint that he should feel better about using to get to 10 visits, " he wrote. Sen. Max Baucus (D., Mont.), the Senate Finance Committee's chairman, said " the gaming of Medicare by these companies represents serious abuse of the home-health program. " Elderly patients " should not be used as pawns to increase a company's profits, " and " in these tough economic times, taxpayers simply cannot afford for their dollars to be wasted on unnecessary care, " he added. " The reimbursement policy encourages gaming, and gaming is what's occurred, " said Sen. Grassley, the committee's senior Republican member. " The federal government needs to fix the policy that lets Medicare money flow down the drain. " Medicare fraud indictments include two Dot-based companies | Dorchester Reporter<http://ptmanagerblog.com/medicare-fraud-indictments-include-two-dot-ba> Posted about 21 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73764005> Medicare fraud indictments include two Dot-based companies By *Andy Metzger, STATE HOUSE NEWS SERVICE* *Oct. 3, 2011* Three health care companies and ten individuals allegedly bilked the state Medicaid Program out of $10 million, Attorney General Martha Coakley said Friday, announcing 118 criminal indictments returned Thursday by a statewide grand jury and grand juries in Suffolk and Bristol counties. “Medicare is one of the single largest budget items for the commonwealth,” Coakley said at a press conference Friday morning. “Every one of those dollars for health care should be going to our most vulnerable.” Describing four unrelated cases, prosecutors said Adlife Healthcare, of Framingham, allegedly billed the state for medical treatment to people who were deceased. Preventive Medicine Associates, and its owner Dr. Punyamurtula Kishore, of Brookline, allegedly ran a “kickback scheme” with sober houses throughout the state. Benson, of New Bedford, allegedly over-billed the state by making it seem as though his psychotherapy patients had more dire medical needs. Pond View Nursing Facility, in Jamaica Plain, was shut down in June 2008 for bad service, Coakley said, and its owner Carolyn Wetterberg was indicted for allegedly inflating the supposed medical needs of Pond View patients. “They may as well be walking over to MassHealth and taking money out of the Treasury,” said Coakley about the four companies and the “separate but very serious violations of public trust.” Asked about the extent of fraud in the massive program, Coakley said she was unable to provide a specific estimate but said, “Obviously there’s a lot.” Adlife, an adult foster care program, is accused of the biggest fraud, amounting to $5.5 million in which the company claimed adults, who would visit during the day, were round-the-clock patients and billed the state for patients who are actually dead. Adlife had offices in West Springfield, Dorchester and Hyannis, but Adlife and the other accused companies are “not in business,” according to Coakley. Preventive Medicine Associates was the next largest, accused of $3.8 million in unnecessary drug tests as part of a kickback scheme with sober houses in Dorchester, Malden, New Bedford and elsewhere that would contract with PMA to perform the unnecessary drug screens. Kishore, 61, was arrested at his home on Tuesday, Sept. 20. The indictment charges he and his companies with eight counts each of Medicaid kickbacks and false claims. Benson, who ran Counseling Services out of New Bedford, allegedly filed $160,000 in false claims with Medicaid, billing the state for “acute care” for patients receiving little if any therapy. After the state shut down Pond View and the patients were moved to other nursing homes, many who had reportedly needed help eating and walking were able to perform both those activities without any assistance, according to Coakley, who explained the allegations of inflated levels of care. “We do not believe there were miracles performed after those patients left that nursing home,” Coakley said. Two suspects – Sharon , the 55-year-old owner of Adlife, and Carl , the 65-year-old manager of New Horizon House in Dorchester, accused of participating in the drug-screen kickback – were arrested Thursday night. The other suspects – -Miles, a 36-year-old Adlife employee and Framingham resident; Kali Geddes, a 31-year-old Brighton resident who worked for Adlife; Coughlin, a 31-year-old Carver man who operates ’s house sober homes in Wareham, New Bedford and Sandwich; Leonard, a 56-year-old Malden man who co-owns and manages Marshall House sober home in that city; Wetterberg, Benson, and Kishore – will all be summonsed to court to face their charges. MassHealth, which runs the state’s Medicaid program, was budgeted at $10.3 billion, or about a third of the state’s budget. The 118 indictments, which Coakley described as difficult and expensive to achieve, accuse the four companies of defrauding about a tenth of 1 percent of the total MassHealth budget. Coakley said the investigation was the product of tips, some of them through her office’s Medicare Fraud Tip Line, and an investigation that followed the closure of Pond View. The investigation was conducted by Coakley’s office, State Police, the FBI and the federal Inspector General. was scheduled to be arraigned Friday in Framingham District Court and was also scheduled to be arraigned in Suffolk Superior Court. The AG’s tip line is . via dotnews.com<http://www.dotnews.com/2011/medicare-fraud-indictments-includes-dot-\ based-companies> Universal board certification can solve the Doctor Nurse controversy<http://ptmanagerblog.com/universal-board-certification-can-solve-the\ -d> Posted about 21 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73764669> Universal board certification can solve the Doctor Nurse controversy by Pho, MD <http://www.kevinmd.com/blog/post-author/kevin-pho> | in Pho <http://www.kevinmd.com/blog/category/pho> | I’m going take on the Doctor Nurse controversy<http://www.nytimes.com/2011/10/02/health/policy/02docs.html?_r=1 & par\ tner=rss & emc=rss & pagewanted=all> .. This isn’t a new issue, as the doctorate in nursing degree has been around for awhile. But a recent piece in the *New York Times* gave it new life. The topic is a ripe invitation to “doctor bash,” with the predictable arguments about physicians protecting their turf, elitism, and the like. Yawn. To sample the representative comments, consider those in the *Times’* health blog, *Well*<http://well.blogs.nytimes.com/2011/10/01/who-gets-to-be-called-a-doctor/> .. To recap, doctors are worried that diluting the doctorate pool would confuse patients, and accuse Doctor Nurses of ulterior motives: But many physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point? Dr. Roland Goertz, the board chairman of the American Academy of Family Physicians, says that physicians are worried that losing control over “doctor,” a word that has defined their profession for centuries, will be followed by the loss of control over the profession itself. He said that patients could be confused about the roles of various health professionals who all call themselves doctors. “There is real concern that the use of the word ‘doctor’ will not be clear to patients,” he said. Physicians, as always, are being reactionary and playing from behind the public relations curve. Those who earn a doctorate degree, whether it be in nursing, pharmacology, or psychology, deserve to be called “doctor.” Period. What medical doctors need to do is to differentiate themselves and emphasize their more extensive training. The answer? Universal board certification. Have all doctorate-level clinical providers take the same board certification exam. It should be as rigorous as the ones currently provided by the American Board of Internal Medicine or the American Academy of Family Physicians. Those that pass truly deserve to be called “doctor,” no matter what their background. Another, admittedly more realistic, option is to educate the public about the different “doctors” who may be treating them. Let them know that not all board certifications are alike. Physicians certified by the American Board of Internal Medicine, for instance, have different training requirements from those who obtained a doctorate in nursing. It is up to physicians and their professional to emphasize and publicize that. Trying to monopolizing the doctorate degree is a losing public relations strategy. What differentiates physicians is their more extensive training, symbolized by board certification status. We need to proactively capitalize on the strength, instead of reacting to the current trend of doctorate creep. * Pho <http://www.kevinmd.com/blog/about-kevin-md> is a**n internal medicine physician and on **the Board of Contributors at *USA Today via kevinmd.com<http://www.kevinmd.com/blog/2011/10/universal-board-certification-so\ lve-doctor-nurse-controversy.html> [image: Posterous] <http://posterous.com> Want your own?<http://posterous.com> Change your email settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\ xkgmH> Quote Link to comment Share on other sites More sharing options...
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