HEADLINES Worth A Clinician’s Look – October, 2009
- Two new guides on Premixed Insulin Analogues available from AHRQ
- Healthcare industry still posting job growth – especially in home care
- Have you decided about CAHPS?
- Surgical masks proven as effective as N95 respirators in safeguarding healthcare workers – implications for home health clinicians and organizations
- 2010 OIG Work Plan shows major focus on Medicare & Medicaid home health; hospice issues also included
Two new guides on Premixed Insulin Analogues available from AHRQ
Two new free publications are now available through the AHRQ Effective Health Care Program.
The Clinician’s Guide on premixed insulin analogues for treating adults with Type 2 diabetes, titled, “Premixed Insulin Analogues: A Comparison with Other Treatments for Type 2 Diabetes,” is available at: http://effectivehealthcare.ahrq.gov/repFiles/Insulin_Clinician5.pdf
A free Companion Guide for consumers, “Premixed Insulin for Type 2 Diabetes: A Guide for Adults” – AHRQ Pub Number 08(09)-EHC017-A is available at: http://www.effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&DocID=125&ProcessID=18
For free printed copies, call 800-358-9295 and ask for the documents by their AHRQ publication number.
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Healthcare industry still posting job growth – especially in home care
An October 2, 2009 article in Modern Healthcare reported that an estimated 19,200 jobs were added to the healthcare industry in September while unemployment in the economy as a whole pushed to a 26-year-high of 9.8%. The industry has added 195,400 jobs during 2009, growing by 1.4%.
Most of the growth has been in outpatient settings such as physician offices and home healthcare. Home healthcare services grew by 0.4% in September, adding 4,400 workers to a total employment of 1 million, the same percentage as a year ago.
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Have you decided about CAHPS?
What is it? The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey, (Home Health Care CAHPS Survey) is designed to measure the experiences of people receiving home health care from Medicare-certified home health agencies. The Home Health Care CAHPS Survey will be conducted for home health agencies by approved Home Health Care CAHPS Survey vendors.
The survey is designed to meet the following goals:
- Produce comparable data on the patient’s perspective that will allow objective and meaningful comparisons between home health agencies on domains that are important to consumers.
- Public reporting of survey results are designed to create incentives for agencies to improve their quality of care.
- Public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of care provided in return for public investment.
Is it Mandatory? Home Health CAHPS is a voluntary process in which home health agencies may choose to participate through approved vendors. For now, CMS only intends to use the survey data for public reporting but there could be a future tie to Prospective Pay and Pay-for-Performance. That the data would be publicly posted can be a great marketing tool, or not, depending on results.
What is the Timeline?
- Voluntary HH-CAHPS participation time period is from October to December 2009.
- Another option is for an agency to begin with the “dry run” period between January and March 2010.
NOTE: Agencies must complete a dry run or participate in the voluntary implementation to be eligible for national implementation.
CMS proposes that participating home health agencies conduct a dry run of the survey for at least one month in the first quarter of 2010 (January, and/or February, and/or March 2010) and submit the dry run data to the Home Health CAHPS Data Center by 11:59 P.M. EST on June 23, 2010. The dry run data would not be publicly reported on Home Health Compare.
CMS proposes that all Medicare-certified HHAs continuously collect HH-CAHPS survey data every quarter beginning in the second quarter (April, May and June) of 2010 and submit these data for the second quarter of 2010 to the Home Health CAHPS Data Center by 11:59 EST on September 22, 2010. The proposed CMS rule requires agencies to participate in the April 2010 national implementation to be eligible for their full annual payment update.
From August 13, 2009 Federal Register, p. 40962 at http://www.gpo.gov/fdsys/pkg/FR-2009-08-13/pdf/R9-18587.pdf
A guidance manual that describes agency and vendor obligations and list of approved vendors as of September 14, 2009 is on the Home Health CAHPS website www.homehealthcaphs.org
Other vendors are in the approval process. A Spanish version of the interview script was posted to the site on October 2, 2009. You can download a copy of the questionnaire in MS-Word format from the Survey and Protocols tab on the CAHPS website.
What is the cost? The cost will be determined by the vendors, patient population and survey type (i.e. phone versus mail) that the individual agency chooses.
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Surgical masks proven as effective as N95 respirators in safeguarding healthcare workers – implications for home health clinicians and organizations
Increasingly, a variety of masks are available for purchase, from big box stores to medical supply companies. Although these products are likely not comparable to surgical masks developed for medical settings in how they are made or in materials, the effectiveness of surgical masks as compared to other protection methods is important to consider.
Scientific data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing how effective a surgical mask protects health care workers against influenza is very important.
A research study published in the Journal of the American Medical Association on October 1, 2009 found that using a surgical mask was comparable with using an N95 respirator. A randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in eight tertiary care Ontario, Canada hospitals was conducted by randomly assigning nurses to wear either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season.
Influenza infection occurred in 23.6% in the surgical mask group and 22.9% in the N95 respirator group and the results were found to be statistically significant. These findings are important to home care clinicians who are exposed to various home settings every day.
As the country prepares for the H1N1 and regular influenza season, home health agencies should be stocking an adequate number of masks for staff as well as establishing a relationship with a supplier who can quickly replenish stock.
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2010 OIG Work Plan shows major focus on Medicare & Medicaid home health; hospice issues also included
The Office of the Inspector General (OIG) of the Department of Health and Human Services has issued its Work Plan for Fiscal Year 2010. As in previous years, the Plan identifies many investigations of home health and hospice. Of the two services, the main focus by both Medicare and Medicaid is home health.
The bullets listed below each have further explanations in the Plan that can be accessed at http://oig.hhs.gov/08/Work_Plan_FY_2010.pdf
Medicare Home Health, the OIG will be investigating:
- Part B payments to outside suppliers for services and supplies that are included in home health agency (HHA) prospective payment and the adequacy of controls to prevent inappropriate Part B payments;
- HHA claims and medical records to assess the accuracy of home health resource groups (HHRG) listed on the claims and identify patterns of miscoded HHRGs;
- The incidence of Medicare home health services outlier payments for insulin injection and billing patterns in geographic areas with high rates of home health visits for insulin injections;
- The Centers for Medicare & Medicaid Services’(CMS) methodology for calculating outlier payments to determine whether the methodology reimburses HHAs as intended for high cost episodes;
- Compliance with billing for the appropriate location of services provided, and trends regarding the number of claims submitted to Medicare, of visits furnished to beneficiaries, arrangements with other facilities, and ownership information;
- Cost report data to analyze HHA profitability trends to see if the payment methodology should be adjusted, including profitability in Medicare and overall profitability trends for freestanding and hospital-based HHAs;
- Billing patterns in geographic areas with high utilization of diabetes self-management training services;
- CMS’ process for ensuring that Outcome and Assessment Information Set (OASIS) data submitted by HHAs is accurate and complete; and
- Contractor’s screening mechanisms and post-enrollment monitoring to identify HHA applicants that pose fraud risks to Medicare and the extent to which applicants omitted ownership information on enrollment applications.
Medicare Hospice, the OIG will be investigating:
- Part B billing for physician services furnished to hospice beneficiaries, including frequency and total expenditures for physician services under Parts A and B for hospice beneficiaries and whether physicians double billed these physician services to Parts A and B;
- Hospice claims to identify trends in hospice utilization, including the characteristics of hospice beneficiaries, geographical variations in utilization, and differences between for-profit and not-for-profit providers; and
- Whether Medicare is making duplicative payment for drugs to hospices under Part A and to individuals under Part D, and to identify controls to prevent duplicative payment.
Medicaid Home Health will include:
- Review of HHA claims to determine whether agencies have met applicable criteria to provide services and whether beneficiaries have met eligibility criteria;
- Review of Medicaid payments for personal care services to determine whether states have appropriately claimed federal financial participation;
- In selected states, review whether attendants furnishing personal care services met state qualifications;
- In selected states, review the extent to which Medicare and Medicaid have paid for the same home health services, and the controls these states have established to prevent duplicate payment; and
- Review states’ compliance with federal regulations for home- and community-based services (HCBS) waiver programs and CMS’ oversight of states’ compliance with these HCBS waiver programs.
