Guest guest Posted July 8, 1998 Report Share Posted July 8, 1998 Hello : I am wondering if I am doing something wrong on my computer??? I received this with no message or attachment. Since I am in Home Health Care, I know whatever went with it would be of interest to me. Can you re-send, or let me know what I missed? Thanks much!! Pike, PT. GCS DJPike@... ---------- > > To: ptmanager@... > Subject: Home Health Hit Hard > Date: Wednesday, July 08, 1998 7:03 AM > ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 1998 Report Share Posted July 9, 1998 Try this version - let me know if it makes it through This article was published in the Tampa Bay Health Care Journal 7/6/98 Looks like BBA is taking effect??? ******************************* by Shepherd Health Care Editor Nearly 50 of Florida's Medicare-certified home health care agencies have shut down in recent months in a trend that shows few signs of slowing. Officials say the shutdowns -- 43 from early April to mid-June, including 26 of about 400 Florida " parent " Medicare agencies -- are unprecedented. Industry spokespersons blame a congressional war on Medicare fraud, abuse and excessive profits, a war that has led to sharp cuts in reimbursement over the past nine months. The cuts have put the home health industry in turmoil nationwide, according to American City Business Journal reports from many markets. Perhaps 1,000 or more of Florida's Medicare home health workers have lost jobs over the past three months alone. In Florida, Columbia Homecare has shut down about 20 agencies statewide in recent weeks, one-third of them in the Tampa Bay area. With the closings came several hundred layoffs. To be sure, Columbia Homecare has been battered by an ongoing federal investigation into its business practices. Some doctors have stopped referring patients to Columbia, and sale plans for Columbia's home-health unit also had an impact. But Columbia blames the federal cuts. Meanwhile, other companies large and small agree federal cuts are the main problem. Besides Columbia, Housecall Home Health Care, Home Health Corp. of America, IHS Home Care, Shands Home Care, the Visiting Nurse Association and at least 10 other Florida companies have shut parent and/or branch agencies. Around Tampa Bay, 10 Medicare agencies -- including seven Columbia Homecare operations -- have closed since April. A spokesman for the dominant home health provider around Tampa Bay, BayCare Health System's Home Care Division, declined comment. State records for BayCare, which is owned by large not-for-profit hospitals, indicate no closings in recent weeks. BayCare, where leaders have long prepared for overall Medicare cuts, could thus be one of the few beneficiaries of the current upheaval. In any case, " what's unusual is the large, unprecedented number of parent agencies closing, " said Anne Menard, supervisor of the Florida Agency for Health Care Administration's Home Care Unit. " Typically, before the Medicare regulations changed, we used to see them selling the parent agencies when they got in financial trouble. We never saw them giving that Medicare number up, " Menard said. " We hear even more (closings) are coming, " Menard added. Also, some agencies are cutting staff and limiting services to clients in reaction to reimbursement cuts. Federal spending cuts in Medicare's budget for home health care became effective April 1, retroactive to Oct. 1, 1997. " It's a mess, " said Gene Tischer, executive director of the Association of Home Health Industries of Florida Inc. " The rates are lower than we thought -- and we thought they'd be bad. " A survey several months ago by Tischer's organization indicated that in 1998, Medicare reimbursements would go down by $300 million -- from $1.2 billion in 1997 to about $900 million in 1998. " And now it looks even worse than that, " said Tischer. " Now, you're starting to see blood on the table. We are in trouble. " The federal Health Care Financing Administration (HCFA), which oversees Medicare, has set up an interim payment system as a way to contain home health care costs under Medicare, the federal health insurance program for people age 65 and older. Under the interim payment system, the government rolled back rates paid to home care providers to fiscal 1993-1994 levels. The interim payment system is a prelude to HCFA's plan to implement a prospective payment system (PPS) in October 1999 for home health care. Under PPS, agencies will be reimbursed at fees set in advance for certain services. That's basically the same system under which hospitals currently are paid. Under the PPS system, agencies will know beforehand how much money they will have to work with -- but that's still more than a year away. The changes were part of the federal Balanced Budget Act of 1997. The act called for reducing overall Medicare spending by $115 billion over the next five years. Of that, $14 billion will come from reductions in spending on home health care. Another goal is to cut what some federal officials see as a history of wild profiteering on the backs of the elderly. Home care, available to home-bound Medicare beneficiaries who require skilled care, is the fastest-growing expense in the Medicare program, according to HCFA. Today, about 9,000 home health agencies serve Medicare beneficiaries. According to HCFA reports, Medicare spent only 2.9 percent of its funds on home health care in 1990. By 1996, that had grown to 8.7 percent, for a total of $16.7 billion. In that same time, the average number of visits per Medicare patient more than doubled from 33 to 76, even though non-Medicare home health patients receive an average of only four or five visits. At Columbia, for instance, employees were reportedly directed to generate as many home health visits as possible. Indeed, the old payment system had no limits or incentives to reduce the number of visits or types of care provided to patients. As a result, many patients were receiving services that were not medically necessary and thus not covered by Medicare, said HCFA reports. " Some providers were out of control, " admitted one industry executive who asked not to be identified. But, the official said, the interim payment system " penalizes those that were trying to run a tight ship, too. " The planned PPS system, meanwhile, is designed to control growth by creating incentives for home health agencies to provide only care that is medically necessary, and do so as efficiently as possible. But industry officials worry the new payment method will discourage agencies from accepting patients with expensive medical problems, such as quadriplegics and those needing bowel care. And in the short run, agencies state- and nationwide are suffering from Congress's good intentions. " We will see a lot more consolidation of home care, " said Pam Steinke, division vice president of Columbia Home Care in Central Florida. " We're trying to reduce costs by closing branch offices and consolidating overhead. " As are her competitors. At 06:20 PM 7/8/1998 -0700, you wrote: >Hello : > I am wondering if I am doing something wrong on my computer??? I received >this with no message or attachment. Since I am in Home Health Care, I know >whatever went with it would be of interest to me. Can you re-send, or let >me know what I missed? Thanks much!! > Pike, PT. GCS >DJPike@... > >---------- >> >> To: ptmanager@... >> Subject: Home Health Hit Hard >> Date: Wednesday, July 08, 1998 7:03 AM >> > > > >---- >Read this list on the Web at http://www.FindMail.com/list/ptmanager/ >To unsubscribe, email to ptmanager-unsubscribe@... >To subscribe, email to ptmanager-subscribe@... >-- >Start a FREE E-Mail List at http://makelist.com ! > R. Kovacek, MSA, PT KovacekManagementServices, Inc. The FOCUS Group, Inc. 20225 Danbury Lane Harper Woods, MI 48225 Fax Email Pkovacek@... <http://www.theFOCUSgroup.net> Join PT Manager list serv -- To subscribe, send an empty message to ptmanager-subscribe@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 1998 Report Share Posted July 9, 1998 Just in case the other version does not get through, the URL is http://www.amcity.com/journals/health_care/tampabay/1998-07-06/story6.html Good luck At 06:20 PM 7/8/1998 -0700, you wrote: >Hello : > I am wondering if I am doing something wrong on my computer??? I received >this with no message or attachment. Since I am in Home Health Care, I know >whatever went with it would be of interest to me. Can you re-send, or let >me know what I missed? Thanks much!! > Pike, PT. GCS >DJPike@... > >---------- >> >> To: ptmanager@... >> Subject: Home Health Hit Hard >> Date: Wednesday, July 08, 1998 7:03 AM >> > > > >---- >Read this list on the Web at http://www.FindMail.com/list/ptmanager/ >To unsubscribe, email to ptmanager-unsubscribe@... >To subscribe, email to ptmanager-subscribe@... >-- >Start a FREE E-Mail List at http://makelist.com ! > R. Kovacek, MSA, PT KovacekManagementServices, Inc. The FOCUS Group, Inc. 20225 Danbury Lane Harper Woods, MI 48225 Fax Email Pkovacek@... <http://www.theFOCUSgroup.net> Join PT Manager list serv -- To subscribe, send an empty message to ptmanager-subscribe@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 1998 Report Share Posted July 9, 1998 The fallout was predicted, with estimates of as much as 40% fewer HHA's stated last year. So far, most of the bailouts have seemed to be either those who realized their game of exploitations was up, or those unfortunate " good " providers whose costs were too high. Belt tightening is tough to administer, but not impossible. The real crisis will occur when needed services are denied the patients due to a HHA trying to match some financial formula instead of doing what is reasonable and necessary, and justifiable. To add to the list of dropouts, I heard that GranCare is dropping its certified Medicare entity because its per beneficiary limit came back at $3500 while their current practice is closer to $7,000. What I would give for a $3,500 PBL. Our VNA is at $2750. But fortunately our belt tightening is keeping us in business (at least this quarter) and the pain has been felt by employees and not patients, so far. One thing is for certain, more interesting changes will keep flowing our way. But now more than ever, it is critical for HHA's to have strong rehab influences, meaning strong advocates for PT, OT, ST & SW. Otherwise, the rehab care offered to patients will be the major casualty of PPS. W. , MS,PT Visiting Nurse Association of Southeast Michigan dperry@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 1998 Report Share Posted July 10, 1998 I am curious about the per beneficiary limits you mentioned. Are those for ALL care received (e.g., PT, OT, ST, nursing, e tc.) or is that per discipline? I do not work in home health but we send many of our inpatient rehab and SNF/Subacute patients to home health with the expecation that since we can progress patients only so far in the hospital setting (due to short LOS), it will get " finished " in home health. There is some concern now that home health will not be able to continue seeing patients for a long enough period of time since they (you!) are getting squeezed as much as inpatient and outpatient settings are. Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 1998 Report Share Posted July 10, 1998 I agree with Mark's concerns over decreased limits and decreased home health LOS. Couple this with the implementation of PPS in long term care area, we will see a lowering in the acquity of patients being admitted to home health and long term care. The net effect will be a worsening bed crunch in acute care because we will not be able to find HH agencies and LTC facilities who are willing to risk admitting a high acquity level of patients. Yow! >>> " Mark K. Dwyer " 07/10/98 11:54am >>> I am curious about the per beneficiary limits you mentioned. Are those for ALL care received (e.g., PT, OT, ST, nursing, e tc.) or is that per discipline? I do not work in home health but we send many of our inpatient rehab and SNF/Subacute patients to home health with the expecation that since we can progress patients only so far in the hospital setting (due to short LOS), it will get " finished " in home health. There is some concern now that home health will not be able to continue seeing patients for a long enough period of time since they (you!) are getting squeezed as much as inpatient and outpatient settings are. Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 1998 Report Share Posted July 10, 1998 I agree with Mark's concerns over decreased limits and decreased home health LOS. Couple this with the implementation of PPS in long term care area, we will see a lowering in the acquity of patients being admitted to home health and long term care. The net effect will be a worsening bed crunch in acute care because we will not be able to find HH agencies and LTC facilities who are willing to risk admitting a high acquity level of patients. Yow! Lane, MHS,MS,PT Orlando, FL >>> " Mark K. Dwyer " 07/10/98 11:54am >>> I am curious about the per beneficiary limits you mentioned. Are those for ALL care received (e.g., PT, OT, ST, nursing, e tc.) or is that per discipline? I do not work in home health but we send many of our inpatient rehab and SNF/Subacute patients to home health with the expecation that since we can progress patients only so far in the hospital setting (due to short LOS), it will get " finished " in home health. There is some concern now that home health will not be able to continue seeing patients for a long enough period of time since they (you!) are getting squeezed as much as inpatient and outpatient settings are. Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 1998 Report Share Posted July 11, 1998 The interim payment system home health is experiencing now levies 2 separate cost limits. The Per Benificiary Limit is a total dollar amount that each agency is assessed, based on pereformance in 1994 fiscal year. It applies to all disciplines combined, and is the average anticipated expense per patient that an agency will be reimbursed. A separate discipline cost limit also is in effect, which is the maximum per visit per discipline that an agency can collect. These limits have also been reduced. Thus the reason why many HHA are bailing out. You need to better two separate financial limits, just to break even. Wise agencies are reducing overhead costs as much as possible to keep within the discipline cost limits, and trying various methods to deliver optimum care while staying under the PBL on the average. Thus the incentive is to not keep folks on schedule any longer than necessary, and save extra visits for those who really need more. A good sound agency should be able to meet your patients needs, but won't be inclined to deliver any more visits than absolutely necessary. Don't stop referring to home care, please. We can still " finish " the work you started, but may just need to do it quicker and smarter than in the past. W. , MS, PT Visiting Nurse Association of Southeast Michigan Therapeutics dperry@... >>> Mark K. Dwyer 07/10/98 11:54am >>> I am curious about the per beneficiary limits you mentioned. Are those f= or ALL care received (e.g., PT, OT, ST, nursing, e tc.) or is that per discipline? I do not work in home health but we send many of our inpatie= nt rehab and SNF/Subacute patients to home health with the expecation that since we can progress patients only so far in the hospital setting (due t= o short LOS), it will get " finished " in home health. There is some concern= now that home health will not be able to continue seeing patients for a long enough period of time since they (you!) are getting squeezed as much= as inpatient and outpatient settings are. Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 1998 Report Share Posted July 12, 1998 The PPS for long term care units will hit everyone hard, but the one thing it lacks is any incentive to discharge early since there is no concommitant restriction on LOS (besides the usual 100 Medicare days). Therefore, while facilities will have to deal with a vastly different revenue stream (decreased!), there will be no incentive to discharge any earlier, since any other Medicare patient will pay the same (when averaged out). Now if they ever figure out that they need to have some form of LOS disincentive (e.g., DRG-like case rate) then the inpatient settings PLUS the outpatient/home health settings will have a problem since the acuity level of patients being discharged from ANY inpatient care setting will increase. With the limits in home health and the coming fee schedules in outpatient, who will handle it? Of course, the people who stand to lose the most are the patients, since what will likely be dropped is work geared toward community reentry and the like. That, coupled with research that shows patients regress significantly four to six months after therapy is completed, makes one wonder what will happen to our patients down the line when we are providing even less. Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 1998 Report Share Posted July 14, 1998 Thanks for the update on the payment mechanism for home health. I did not realize there were two separate limits. Also, regarding your comment about continuing to refer as you will " ' " finish' the work you started, but may just need to do it quicker and smarter than in the past. " Don't worry, there is no option for us in inpatient care. We are also doing it quicker and smarter, and since people are being discharged so fast, outpatient is becoming less and less of an option since the functional status of the patients is low enough that outpatient is not feasible for them or their families. Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 1998 Report Share Posted July 15, 1998 And much of our collective work will need to be finished by the patient and their families/caregivers. Effective patient education will become even more critical. The scariest part of that scenario is for those who don't have competant or compliant help. Or for those unwilling or incapable of paying (beyond their insurance) for help, whether professional or lay. W. , MS, PT Visiting Nurse Association of Southeast Michigan Therapeutics dperry@... >>> Mark K. Dwyer 07/14/98 11:13pm >>> Thanks for the update on the payment mechanism for home health. I did no= t realize there were two separate limits. Also, regarding your comment abo= ut continuing to refer as you will " ' " finish' the work you started, but may just need to do it quicker and smarter than in the past. " = Don't worry, there is no option for us in inpatient care. We are also doing it quicker and smarter, and since people are being discharged so fast, outpatient is becoming less and less of an option since the functional status of the patients is low enough that outpatient is not feasible for them or their families. = Mark Dwyer, MHA, PT Kansas City, Kansas ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 18, 1998 Report Share Posted July 18, 1998 Mark: For the high-acuity patient there is still the option of LTAC (long term acute care) as and intermediate step in the continuum of care. This provides a hospital level of care, is DRG exempt but capped at a dollar amount and the specialty hospital must have an average length of stay of 25 days or more. The flow in the continuum would be: acute diagnostic hospital to LTAC to rehab or SNU to home with obvious deviations based on patient recovery. LTAC will most probably be evaluated for PPS soon but at the present provides an appropriate level of care for the high acuity patient. Angie , PT Images Amarillo, TX 79118 At 09:22 PM 7/12/98 -0400, you wrote: >The PPS for long term care units will hit everyone hard, but the one thing >it lacks is any incentive to discharge early since there is no concommitant >restriction on LOS (besides the usual 100 Medicare days). Therefore, while >facilities will have to deal with a vastly different revenue stream >(decreased!), there will be no incentive to discharge any earlier, since >any other Medicare patient will pay the same (when averaged out). Now if >they ever figure out that they need to have some form of LOS disincentive >(e.g., DRG-like case rate) then the inpatient settings PLUS the >outpatient/home health settings will have a problem since the acuity level >of patients being discharged from ANY inpatient care setting will increase. > With the limits in home health and the coming fee schedules in outpatient, >who will handle it? > >Of course, the people who stand to lose the most are the patients, since >what will likely be dropped is work geared toward community reentry and the >like. That, coupled with research that shows patients regress >significantly four to six months after therapy is completed, makes one >wonder what will happen to our patients down the line when we are providing >even less. > >Mark Dwyer, MHA, PT >Kansas City, Kansas > > > >---- >Read this list on the Web at http://www.FindMail.com/list/ptmanager/ >To unsubscribe, email to ptmanager-unsubscribe@... >To subscribe, email to ptmanager-subscribe@... >-- >Start a FREE E-Mail List at http://makelist.com ! > > ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 1998 Report Share Posted July 19, 1998 Angie, I am very familiar with long term acute care (LTAC) since we have a facilitiy in our hospital that rents one of our floors. It was an adjustment at first knowing when to send patients there, but now that they have been there for almost two years, we are more comfortable with the criteria. At the time they came in we were just moving heavily into subacute rehab, so we had acute, subacute, LTAC, rehab, outpatient, and home health. Geez, talk about schizophrenia (and yeah, we have that floor also!! <grin>). The scenario I was alluding to, however, takes place a lot in our skilled and subacute units with patients returning home before we think they are ready. We are overruled, however, and the patients return home also. It would be interesting to see research on the readmission rates on those who go home before we think they are ready. That might be an interesting research project for someone... Mark Dwyer, MHA, PT Kansas City, Kansas mdwyer1@... ---- Read this list on the Web at http://www.FindMail.com/list/ptmanager/ To unsubscribe, email to ptmanager-unsubscribe@... To subscribe, email to ptmanager-subscribe@... -- Start a FREE E-Mail List at http://makelist.com ! Quote Link to comment Share on other sites More sharing options...
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