The Senate Finance Committee has released a report on the provision of Medicare home health care services based on an investigation prompted by 2 Wall Street Journal (WSJ) articles published in 2010 that analyzed the therapy utilization patterns of the 4 largest publicly traded home health companies—Amedisys, LHC Group, Gentiva, and Almost Family.
The report contains a review of internal documents and communications provided to the committee by each of the providers. It also describes the practices the providers used to maximize reimbursement. In its conclusion, the committee recommends that the Centers for Medicare and Medicaid Services (CMS) closely examine new reimbursement approaches that focus on patient well-being and health characteristics, rather than the numerical utilization measures. It also encourages CMS to continue efforts to assess the efficiency and effectiveness of various postacute care settings and the services they provide.
Following the publication of the WSJ articles and the Senate's announcement to investigate the industry, APTA and the Home Health Section issued a statement on the challenges facing physical therapists in home health. The statement highlighted APTA's objectives related to (1) educating members to ensure that all physical therapy services are delivered in a clinically appropriate, ethical, and professional manner in compliance with all federal and state regulations and policies; and (2) monitoring all activity to ensure that any discussions regarding the practice of physical therapy and utilization of services are accurate, comprehensive, and unbiased. APTA has made extensive efforts over the past year to meet these objectives and has other activities planned in the coming months.
With the release of the Senate's report, APTA remains steadfast in its opposition to waste, fraud, and abuse within the Medicare program. The association also will continue to work to ensure that Congress, MedPAC, and CMS have a clear understanding of the critical importance of the physical therapist's (PT) clinical decision making, and that PTs are not unduly penalized as a result of the negative findings in this report. Additionally, APTA has recommended in its comments on the home health prospective payment system rate update for Calendar Year 2012 that CMS move from a reimbursement system based on the number of visits to a system that is based on the clinical condition of the patient.
Perhaps the Senate Finance committee should look at SNFs as well. Now THERE is some real fraud going on in these facilities. And frankly its not driven by PTs, or really any of the clinical departments. It comes from administrators above these departments; the push to keep patients as long as possible and/or to drive up RUG categories to optimize reimbursement. I am sorry, but there are plenty of ill individuals out there in need.
Posted by David Ravnikar
on 10/8/2011 10:01 AM
Home health agencies are businesses, the goal of which is to make a profit. Obviously the business manager will pressure the providers to document care plans to maximize reimbursement, if the business is to succeed. Just as obviously, it is the therapist's responsibility to use her professional judgement to provide what the patient needs. But as long as government is involved in health care, the rules will only get more and more particular, stifling professional judgment and forcing businesses into "fraud" just to survive...eventually leading to government-run everything! This is where we are heading and the push for DPT by our "union" is part of the problem.
Posted by Melanie Welch
on 10/11/2011 9:48 AM
AMEN to the comment re: fraud at SNFs! It originates with the administrators and is perpetuated by the "social workers" who will overule the PT recommendations for discharge in order to keep patients against their will over weekends when they are receiving no services. Because of this fact, I will no longer work in SNFs.
Posted by Patricia Crean
on 10/15/2011 11:01 PM