Jan’s church assigned her to a woman who regressed over a period of years and a series of strokes from complete independence in her own home to moving to an assisted living facility and finally to complete dependence in a skilled nursing facility. Unable to dress herself, she spent her day in thin pajamas, worn robes and unflattering hospital gowns.

“Finally,” Erickson told HCTR, “she was limited to transfers from bed to wheelchair and back again, nothing more. I visited her and looked in her closet for something she might wear that would be warmer and less institutional in appearance. But it was obvious to me that she could no longer get into any of the clothes in her closet. She was cold all the time and complained both about being uncomfortable and about how she looked like a sick person.”

That very night, as Jan Erickson tells the story, she had a dream. In it, she saw the design of a jacket that her friend might be able to get into. “I got up in the middle of the night and sketched the basic outline of the jacket,” she remembers. “It included a raglan sleeve* and a kangaroo pocket that doubles as a handwarmer.”

Most importantly, she continued, it goes on from the front and wraps around the back, held in place by overlapping or by the wheelchair itself. Even from a wheelchair, she hoped, her declining friend might be able to put it on and take it off without assistance. “Plus, at jacket length,” she added, “it did not include any of the well-known dangers of those dime-store blankets with sleeves that are so long people have reported serious injuries from tripping over them.”

From dream to national sales and distribution

Erickson’s hopes were realized. Six years later, Janska, LLC is exhibiting at healthcare and fashion trade shows and selling her designs through resellers that include Amazon.com and SkyMall magazine. She believes that one of the smartest things she did was to select Polartec® fabric, named by Time magazine as one of the top inventions of the 20th Century, because it is warm but lightweight, wicks away moisture, stretches, tends to be stain resistent and is machine washable. “A whole list of features just perfect for disabled people,” she said.

The company has added a full line of easy on, easy off accessories since jacket sales took off. Erickson studied the sociology and psychology of clothing and learned that people with mobility and other ADL issues are profoundly affected by being in real clothes rather than “sick people clothes” all day. So she specified that Janska clothing must always be colorful as well as functional as she expanded into leg warmers, mukluks, lap blankets and shawls.

“Research in the fields of both sociology and psychology has shown that, when people are dressed in bright colors, others tend to engage with them more,” she said, shifting easily into teaching mode. “People with dementia respond positively to soft things, even when they respond to little else.”

Vowing never to sacrifice style for the sake of comfort, not skimp on quality for the sake of ease of use, Erickson insists on using both male and female models in her display ads, emphasizing that neither gender has less of a right to look good while living with limitations. “We are as interested in dignity as we are in restoring someone’s ability to safely dress themselves or safely dress someone else,” she explained.

Explaining clothing and safety, she said, “Caregivers tend to lean over too far when dressing someone in a wheelchair, which can become a safety issue. If someone is unable to put on our jacket without help, it is easy for someone else to get them into it.”

Warmth and comfort are just as important as safety, ADL improvement and personal dignity, in Erickson’s opinion. Janska’s mukluks, lap blankets and shawls are sewn with seams on the outside to improve the wearer’s feeling of comfort.

These days, Jan Erickson spends as much time at fashion-oriented trade shows as she does at those focused on the elderly and infirm. “We must have done a good job when we decided to maintain style while adding functionality,” she laughs. “We have boutique resellers who made us develop separate marketing materials that do not mention the words elderly or infirm, so as not to scare of their perfectly able teen and young adult customers, who think the Janska clothing is simply “cool.”

janskawellnesswear.com/

*According to Wikipedia, a raglan sleeve is a type of sleeve whose distinguishing characteristic is to extend in one piece fully to the collar, leaving a diagonal seam from underarm to collarbone. It was named after the 1st Baron Raglan, probably because it was designed to fit his coat for the arm lost in the Battle of Waterloo.

TRISH TULLOCH

In the summer of 2008, we at RBC Limited were privileged to work with two home health demonstration agencies participating with the Centers for Medicare and Medicaid Services (CMS) and Abt Associates to field test the revised OASIS-C. Since that time we have supported dozens of agencies in their transition planning to OASIS-C through leadership, staff education and competencies. To help you plan and refine your agency’s transition processes to ensure success in 2010, this column shares some “Lessons Learned” from those experiences.

What are the Most Challenging OASIS-C Items?

M2400, a new process measure that is to be completed on transfer or discharge, surfaced as the most challenging item during the demonstration period. M2400 requires the clinician performing the assessment to “look back” at the care provided during this specific episode of care to determine if six specific care practices were included in the Plan of Care (POC, still called by some the 485) and if included, determine if these practices were implemented during this episode of care. You can find M2400 on page 24 of the final OASIS-C at http://www.cms.hhs.gov/HomeHealthQualityInits/Downloads/HHQIOASISCAllTimePoint.pdf

Things to remember about M2400

• The actual “look back” audit period includes a review of only the current episode in which the patient is receiving care and services.
• Subsequent OASIS-C field use indicates M2400 presents many challenges based on the documentation and/or software system used by the agency. Many agencies have developed a simple paper “look back” tool to be used during the episode of care that helps the clinician with accurate and timely completion of this item on transfer or discharge. Software vendors are challenged to consolidate this information during the episode of care on one screen, as a reference guide to clinicians completing this item as indicated.
• Agencies have also reviewed their transfer/discharge processes relative to completing OASIS-C and are considering a revised review/audit process focused on these six items to ensure accuracy prior to locking this final OASIS-C document.
• Since these items may be used in the revised Home Care Compare Report for agency Quality Outcomes and may ultimately impact agency reimbursement under a future Pay for Performance model, it is important to accurately and efficiently monitor the collection and analysis of these data elements.

M2100, the Care Management grid, directs clinicians to assess the types and sources of caregiver assistance for multiple activities, including medication administration, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) as well as medical treatments and advocacy for medical care. The level of caregiver ability and willingness is assessed and documented in the M2100 grid. You can find M2100 on page 21 of the final OASIS-C at
http://www.cms.hhs.gov/HomeHealthQualityInits/Downloads/HHQIOASISCAllTimePoint.pdf

Things to remember about M2100

• CMS defines caregiver abilities or willingness with grid columns for “needs training and/or support,” “not likely to provide assistance” and or “unclear if they will provide assistance.” It is critical that assessing clinicians have a comprehensive, working knowledge of these definitions.
• Agencies have found that a detailed item review with multiple realistic case scenarios provides and supports the clinician’s understanding and application of this new OASIS-C item in designating the assistance the patient needs.
• Assessing clinicians from the demonstration indicated frustration with the definitions of each level of assistance needed, as well as an inability within the restricted admission timeframe to accurately assess this item.
• Additionally, experienced home care clinicians know that caregiver availability and abilities is very difficult to fully determine during the initial start of care assessment. Agencies should develop policies and processes that support clinicians with the flexibility needed to comprehensively build a realistic POC. If this requires two admission visits to complete the POC, then clinicians should not fear recrimination or penalties if they can justify the need.

Tools to Support Accuracy on the Optional Best Practices

While CMS indicates that the newly integrated process items are optional practices, regulators and industry experts agree that identified clinical Best Practices are critical to providing quality clinical outcomes that save agencies and payers money. Furthermore, the decision to continue the optional approach with your staff may adversely impact your future patient and agency outcomes, community marketing initiatives and eventually reimbursement in a pay-for-performance payment structure.

Proactive agencies have reviewed and identified optional best practices they intend to perform when using the revised OASIS-C. A recent poll by Home Care Outcomes indicates that agencies are currently performing many of the identified best practices. In fact, current transition training by RBC indicates many agencies are already performing 70-80% of these Best Practices and that clinician training revolved around the revised documentation of these practices on specified OASIS-C assessment items.

What Best Practices has your agency selected, and what tools support clinician completion of these items?

• Software vendors have integrated a variety of Best Practice tools into their system to support clinician completion of these items.
• Demonstration and transition agencies have indicated that easy tool access for use by clinicians in the home is vital.
• Consider using available Best Practice tools to simplify assessment and documentation of these practices. CMS includes links to several Best Practices in Chapter 5 of the OASIS-C Guidance Manual, which can be found at http://www.cms.hhs.gov/HomeHealthQualityInits/14_HHQIOASISUserManual.asp#TopOfPage

Training and Leadership Processes to Support the Transition

Administrative and management leadership understands that any change in clinical practice needs ongoing support and close monitoring to ensure accurate and consistent implementation. Recognize that a learning curve will exist in the transition to the revised OASIS-C that will take a considerable amount of time. Hopefully you are in the middle of considering how your agency will support field clinicians during transition to OASIS-C. Consider the following questions when developing and revising your plans.

• How will your agency ensure consistent understanding of the revised and new OASIS-C elements?
• What have you done to provide the support to reinforce implementing the revised and new items in 2010?
• How will you support your clinicians to ensure optimal practices that enhance and refine care in the delivery of your home health services?
• Will you provide the incremental training and review time to discuss these new items to ensure accuracy and consistency throughout 2010?
• How will your clinicians learn common errors to avoid with the revised OASIS-C tool?

Consider these options:

• Mini staff meetings or regular in-service sessions to update staff on revised OASIS-C items. One demonstration agency has already initiated a weekly morning mini OASIS-C training session that provides a quick review and tool for each revised or new item in an incremental process throughout October, November and December.
• Bi-weekly team meetings that integrate the application of OASIS-C items into current case review. One agency indicates that the additional time for discussion and application supports clinician understanding of score variations beginning in 2010.
• Share your strategies with your colleagues. (see editor’s note, below)

Consider these options:

• Provide each clinician with the Final OASIS-C Guidance (Chapter 3)
• Provide each clinician with your updated Best Practice tools to complete the new OASIS-C items
• Ensure clinicians easy access to agency OASIS-C experts who can readily answer their questions when completing these documents in the New Year

From Editor Carolyn Humphrey: Look for articles in upcoming issues of The Informed Home Care Clinician detailing strategies and approaches we have learned from you and your colleagues to help you address these questions. We are here to provide you with the best and easiest-to-apply information for all the issues you face each day. Our commitment is to have a minimum of one OASIS-C column in every issue and other need-to-know OASIS-C material in each issue’s “News You Can Use” segment. Let us know what you think and what you want us to cover on the critically important topic of transitioning to OASIS-C.

Trisha Tulloch is a Senior Consultant with RBC Limited of Staatsburg, New York. A seasoned clinician with more than 30 years in health care practice, Trisha’s diverse experience includes leadership roles in both Home Health and Hospice.  A Registered Nurse with code credentials from the Board of Advanced Medical Coding, she is a nationally recognized speaker who provides both clinical and administrative expertise to agencies across the country.  Responsible for oversight of RBC Limited’s Health Care Division, she collaborates with industry experts and attorneys for Corporate Compliance, Fact Finding, Fraud and Abuse and Regulatory Standards.  Her specialty in coding and OASIS education and training, utilizing RBC Limited’s Integrated Oasis Solutions methodology, reflects her unique skill set to promote industry best practices. Contact the author through RBC Limited: www.rbclimited.com

TRISH TULLOCH

With less than three months until OASIS changes again, home health providers are proactively organizing and finalizing OASIS-C training initiatives to provide up-to-date information on critical new and revised assessment items based on the Centers for Medicare and Medicaid Services (CMS) Guidance. Additionally, agency leadership is assessing the impact of these changes to OASIS and revising agency processes to accommodate those requirements.

This article explains the leadership considerations that can have the biggest impact on home health providers and the decisions that need to be finalized to assure that OASIS-C staff training will enhance clinical practice consistency.

LEADERSHIP CONSIDERATIONS

Best Practices – Optional or Required?
Agency clinical leadership should first take the time necessary to compare the agency’s current comprehensive assessment format and content, which includes OASIS-B1, with the revised OASIS-C elements. CMS has created a helpful crosswalk that can form the foundation of the review. It can be found at http://www.cms.hhs.gov/OASIS/Downloads/OASISC3ColumnChangeTable.pdf .

While CMS indicates that the newly integrated OASIS-C process items are optional practices, regulators, industry and clinical experts agree that identified clinical Evidence Based Practices (EBP) — often called Best Practices (BP) — are critical to providing quality home health care. Furthermore, the decision to continue the optional approach with your staff may adversely impact agency outcomes, community marketing initiatives and eventually agency reimbursement.

It is recommended that agency leadership review OASIS-C best practice process items and plan to address agency required clinical Best Practices Standards. Written protocols for select agency best practices, as well as staff and patient education materials, may be distributed during fall training sessions. Staff competencies as well as job descriptions may need to be updated to reflect your agency decision regarding required clinical best practices.

Practice Change Considerations
Leadership knows that any change in clinical practice needs close monitoring and evaluation to ensure accurate and consistent implementation. Leadership must answer at least two difficult questions:

1. How will your agency ensure that staff is consistently implementing revised and new OASIS-C elements?
2. How will you support your clinicians to ensure optimal practices that enhance and refine care in the delivery of home health services?

Consider these options:

• Implement a revised agency, team and/or clinician scorecard on vital elements integral to the OASIS-C data set.
• Review weekly or monthly Case Mix updates for all Start of Care and Recertifications.
• Develop and use a monthly Process Report to identify how your clinicians are scoring the optional best practice items to determine the threshold your agency is achieving on these new, reportable parameters.

Keeping track of this from day one of OASIS-C implementation will arm you with data so you will not be surprised in late 2010 when process outcomes are posted to the CMS Home Care Compare web site.

Training Considerations
CMS has determined that four hours of staff training for each staff member on the new and revised assessment items will adequately meet the educational needs of home health clinicians. But seasoned educators know that practice changes, such as those evidenced in the OASIS-C, will require a longer time period to incrementally review and successfully transition from the current OASIS-B1 assessment to the revised OASIS-C document.

An incremental review of new and revised OASIS-C items using creative educational strategies beginning this fall will allow staff time to understand the changes and begin to see how to integrate the revised assessment items into their clinical practice. Begin with the best practice items and ensure your staff has the tools and knowledge to complete the screen tools and implement a relevant plan of care that addresses the screen outcomes (see list below). Offer frequent updates and the printed revised Chapter 3 Guidance to clinical staff for reference and review during and after item review sessions.

Best Practice Screens and Protocols include:

• Falls Risk Assessment
• Integument Assessment for Pressure Ulcer Risk
• Standardized Pain Assessment
• Depression Screen
• Medication Management
• Diabetic Foot Care
• Heart Failure Care
• Pressure Ulcer Treatments

Consider piloting priority OASIS-C training and field use with clinical experts and preceptors in your agency. First-hand use of new and revised items enhances lively education programs with realistic patient case scenarios to exemplify assessment variations and item scoring changes.

Clinical staff can present practice variations, as well as impact and process changes that support those field changes. Understand that dedicating time throughout the year for ongoing OASIS-C monitoring, training and individualizing clinician feedback will be critical in 2010.

Review and Update Processes that must be in place in 2010 to reinforce new education programming
Consider revising or refining your current:

• Staff updates
• Case Conference Applications
• Case Scenario presentations
• Board updates
• In-service education activities such as mini-newsletter and e-mail updates

Set the Tone for Success in 2010
Leadership sets the pace and tone for success with any agency change and home health managers are not strangers to working in a constantly changing culture. Focused energy and positive initiatives will reinforce fundamentals for success as assessments and practices change.

Clinicians need to see how revised assessments, EBP and valid and reliable tools will help them better assess and document what they have been practicing for many years. Systematizing and standardizing these practices not only enhances clinical practice but also ensures and validates that patients and caregivers will recognize organizations and clinicians who value and implement national best practice standards.

Trisha Tulloch is a Senior Consultant with RBC Limited of Staatsburg, New York. A seasoned clinician with more than 30 years in health care practice, Trisha’s diverse experience includes leadership roles in both Home Health and Hospice.  A Registered Nurse with code credentials from the Board of Advanced Medical Coding, she is a nationally recognized speaker who provides both clinical and administrative expertise to agencies across the country.  Responsible for oversight of RBC Limited’s Health Care Division, she collaborates with industry experts and attorneys for Corporate Compliance, Fact Finding, Fraud and Abuse and Regulatory Standards.  Her specialty in coding and OASIS education and training, utilizing RBC Limited’s Integrated Oasis Solutions methodology, reflects her unique skill set to promote industry best practices. She has extensive experience and expertise in:

• Clinical Best Practices;
• OASIS Assessment & Documentation;
• CHAP & Joint Commission Accreditation;
• On-site Management;
• Reimbursement issues;
• In-service and training of home care staff;
• Hospice clinical, administrative and financial management;
• ICD-9-CM Coding;
• Corporate compliance;
• Strategic planning; and
• PPS.

Contact the author through RBC Limited: www.rbclimited.com

Nevertheless, searching the literature and the web for those best practices can be both confusing and time consuming. The most important component when finding and using best practices, especially including research- and evidence-based practice, is being sure they are valid and reliable, knowing they can be used with confidence and are current and will help you direct patient care.

Over the past three years, the Collaboration for Homecare Advances in Management and Practice – CHAMP – has increasingly become a valuable resource for home care clinicians, clinical, quality improvement and educational managers, educators, as well as anyone else interested in advancing home care clinical practice and patient outcomes.

Administered by the Center for Home Care Policy & Research, a part of the Visiting Nurse Service of New York, you can be confident the information is reliable. Add the CHAMP program web site to your Internet Favorites. Use it as a go-to resource for agency policies and procedures. Have confidence in the support you will find there in the questions and answers from peers and consultants.

CHAMP’s web site http://www.champ-program.org/ provides:

• A broad, web-based community where members can interact with other home care professionals and experts and gain access to information on the latest performance improvement innovations and updates http://www.champ-program.org/page/57/champ-community

• Downloadable tools, presentations and guidelines in the Resources section http://www.champ-program.org/page/40/resources

• Affordable, self-paced online educational programs to enhance frontline manager and staff skills http://www.champ-program.org/page/39/programs-learning

• Evidence-based, best practice information provided by evidence briefs summarizing the nation’s first consistent geriatric practice framework for home care http://www.champ-program.org/page/56/framework

Many agencies have used CHAMP resources. A Clinical Nurse Specialist of a large home health agency commented, “I have to tell you it is fabulous…The amount of info, the quality of info is unbelievable…one terrific web site!”

Laurie Reische, CHAMP Program Manager, told an IHCC interviewer, “It is exciting to be able to bring CHAMP to home care organizations and stakeholders all over the country. Now home care organizations and staff have a place to easily access evidence-based resources and best practices that specifically address the complex needs of older home care patients.”

• 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.

**********

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.

**********

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.

by Carolyn J. Humphrey, Editor

Ann McCaughan, Chief Operating Officer and Chief Technology Officer of Noninvasive Medical Technologies, Inc. (NMT) is the 2009 Frost & Sullivan Lifetime Achievement Award winner in the category “North American Remote Patient Monitoring.”

ANN McCAUGHAN

The award, presented to a nurse for the first time, states:

“With thirty years of extensive experience in the field of cardiac and trauma nursing, Mrs. McCaughan has made invaluable contributions in nurturing the company into a leading research and development organization in the field of noninvasive hemodynamic monitoring. Widely acknowledged as one of the leading experts in Cardiac Home Care, Mrs. McCaughan has ably guided Noninvasive Technologies into inventing novel noninvasive hemodynamic monitors. By and large, her expertise in cardiac nursing, company leadership, research acumen, proclivity for innovation, and animal welfare activities have earned her an unparalleled reputation in the industry.”

Many readers may recognize Ann as an editorial board member and frequent author in Home Healthcare Nurse during the ten years I served as editor. Her professional, creative and practical approach to caring for cardiac patients in their homes is evident in everything she writes, the nurses she mentors and her fierce support of nursing in all settings. Frost & Sullivan could have chosen no better than nurse Ann as their lifetime achievement winner.

Ann has provided the clinical leadership and technological expertise to propel NMT to develop novel patient monitoring devices. For instance, the ZOE fluid status monitor is a simple, lightweight device that provides a new alternative to patients monitored at home by noninvasively measuring thoracic base impedance.

This patient monitoring solution is particularly useful and adds significant value in the event of heart failure and those problems associated with hemodynamic status. Presently, the ZOE monitoring system is being integrated into a wireless fluid status management system, further adding onto its functionality.

You can learn more about Ann and why she was chosen for the award at http://nmtinc.org/

For more information on the ZOE Monitor and the many other creative noninvasive monitoring devices created by NMT go to http://nmtinc.org/products_zoe.html

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To showcase resources that can support emergency preparedness planning within the home health care sector, particularly in the face of a potential H1N1 pandemic, AHRQ will host a Web conference, Planning for an Influenza Pandemic in the Home Health Care Sector, on September 23, 2009. Emergency preparedness planners and providers, as well as Federal, State, and local community health and home care planners, are all invited to attend.

This event will feature a panel discussion and insights from home health care emergency preparedness planners representing different perspectives: health system, Government, health policy, and industry. During the Web conference, participants will learn about AHRQ’s resources for emergency preparedness involving home health care, including:

• Home Health Care During an Influenza Pandemic: Issues and Resources

• Mass Casualty Events Models and Tools To Support Planning and Response for Pandemic and All Hazards Preparedness

Speakers:
• Barbara Citarella, RN, BSN, MS, RBC Limited
• Geraldine A. Coyle, RN, EdD, U.S. Department of Veterans Affairs
• Andrea Hassol, MSPH, Abt Associates
• Alexis Silver, Home Care Association of New York State
• Representative from the Centers for Disease Control and Prevention

To register, please visit: https://ahrq-kt.webex.com/ahrq-kt/onstage/g.php?t=a&d=750707782

To learn more about the event and speakers:
http://www.academyhealth.org/knowledgetransfer/EPWebcasts.htm

For more information, please e-mail: emergencypreparedness@academyhealth.org

This is the last event in a series of four Web conferences. The AHRQ Web site features slides, transcripts, and materials from the previous events:

● Lessons from the Field of Emergency Preparedness (November 6, 2008)
● Public Health Emergency Preparedness: Planning and Practicing for a Disaster (February 9, 2009)
● Planning and Preparedness for Children’s Needs in Public Health Emergencies (May 12, 2009)

Title: Information Exchange with HHS on H1N1 Healthcare System Preparedness and Response
Date: Thursday, August 20, 2009
Time: 1:30 -3:00 pm, EDT

Call-in Number: 800-837-1935
Conference ID: H1N1

Agenda

I. Opening Remarks
Chair: Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response
Co-Chairs: Capt. Clare Helminiak, Dr. Sally Phillips, and R.Adm. Ann Knebel
Moderator: Susie Butler, CMS Office of External Affairs

II. Discussion
The purpose of the dialogue is to engage the provider community in a discussion of H1N1 preparedness and response issues. High priority will be put on a discussion of the value and contribution of the primary care
provider networks. We will discuss strategies for:
* reducing the burden on emergency departments
* early identification and intervention with high risk patients
* work force protection

In addition we will discuss emerging issues on the healthcare system surge capacity, critical care planning and home health care preparedness and planning issues as of interest to the participants.

III. Open Q&A
Submit questions and innovative solutions in advance at: H1N1.listening@hhs.gov.
Note: CMS emphasizes that submitting questions prior to the call will allow them to address as many questions
as possible. If you choose, you may wait to speak your question during the call.

The CMS Office of External Affairs would like to hear from you:
* What are your plans to protect high risk patients from H1N1 infection in your clinics/professional settings?
* Have you initiated any early intervention strategies with high risk patients (e.g. home antivirals)?
* What strategies are you planning to prevent unnecessary trips to the Emergency Department?
* How are you addressing an anticipated increased patient volume?
* Could telehealth play a role in surge?
* Could call centers support hospital decompression?
* What can PCP do to help the hospitals and vice versa?

Mark your calendar! A follow-up call on the same topic is scheduled for Monday, September 14, 2009.

As this site develops over the summer of ‘09, you will find here a wealth of information about the things that concern you most as a clinician. Longtime editor of the magazine Home Health Nurse, Carolyn Humphrey, RN, will research and report on OASIS, coding, regulatory issues and patient care.

From time to time, we will introduce other writers, either as a guest or regular columnist, to explore chart documentation questions, ICD-10 news, physical therapy procedures and a growing list of important clinical issues.

Your input will be a major part of this service. Commenting on articles is as easy as registering on the site and clicking on the “comment” tag at the end of every article. We hope that the resulting dialog will be helpful for everyone.

If you are a writer with something to say beyond the scope of a comment, we always welcome article submissions and will try to publish as many as we can. Send them to the editor, Tim Rowan, at editor@homecaretechreport.com.