North Carolina Nursing Home Tragedy
March 29, 2009
It just came to my attention that a gunman entered a nursing home in North Carolina and opened fire. Eight people are dead including one nurse and seven elderly residents. It must take incredible strength and courage to back into the home and care for the remaining residents. I wonder if a card of encouragement or a note of acknowledgment might help these staff members even a little. The address of the home is as follows. A link to the fox news story is below that.
Pinelake Health & Rehab Rehabilitation and Health Center of Gastonia
801 Pinehurst Avenue
Carthage, NC 28327
What Happened to Providers Who Violated Requirements Applicable to Payment Arrangements with Referring Physicians?
March 25, 2009
What Happened to Providers Who Violated Requirements Applicable to Payment Arrangements with Referring Physicians?
Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739
E-mail: ElizabethHogue@ElizabethHogue.net
Many post-acute providers have established relationships with physicians who also make referrals to them. Such relationships may include payments for services provided as Medical Directors or consulting physicians. They may also include leases to rent space from referring physicians.
Generally, providers that establish such relationships must meet the requirements of:
- the federal anti-kickback statute, and applicable exceptions or “safe harbors;”
-the federal so-called Stark laws and applicable exceptions; and
-requirements of state statutes and regulations in all states in which they do business.
The Stark laws do not apply to hospices.
Failure to meet these requirements has resulted in enforcement actions against a number of providers. Below are some examples of such actions.
San Jacinto Methodist Hospital (SJMH), Texas, agreed to pay $21,025.62 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and physician self-referrals. The OIG alleged that SJMH entered into an arrangement with a physician for a Medical Director position, which included the physician occupying hospital space for private use and utilizing hospital personnel for clerical assistance related to the physician’s private practice patient visits without any contractual entitlement to do so.
MedCare Home Health and its owner Wilfred Braceras, Florida, agreed to pay $178,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that MedCare and Braceras paid kickbacks to a “coordinator” to induce the referral of home health care patients. The recipient of the kickbacks was not an employee, had no contract, and was paid based on the volume and value of the referrals. Braceras’ home health care chain; B&B Holdings Enterprises, Inc. d/b/a South Eastern Health Management Association, Inc.; also entered into an addendum to the existing corporate integrity agreement.
The King’s Daughters’ Hospital and Health Services, Indiana, agreed to pay $391,500 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that the Hospital’s compensation arrangements with employed physicians failed to comply fully with the Stark law’s restrictions on productivity bonuses. Specifically, the physicians were compensated for services that they did not personally perform.
Valerie Tolley d/b/a Health Care Medical (HCM), Mississippi, agreed to pay $100,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that HCM made payments and attempted to make payments of kickbacks in exchange for direct and indirect patient referrals.
Ivinson Hospital, Wyoming, agreed to pay $635,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Ivinson paid prohibited remuneration to physicians in the form of free rent, equipment and furnishings, leases at less-than-fair-market value, reimbursement for medical-director services in excess of fair-market value, and reimbursement in excess of the requirements of an income-guarantee agreement.
Bioscrip, Inc. and Bioscrip Pharmacy, Inc. (Bioscrip); agreed to pay $795,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and prohibited physician self-referrals. The OIG alleged that Bioscrip stationed a pharmacist from its West Hollywood, California pharmacy at two physician practices and that, while on-site at the physician practices, the pharmacist provided services for the pharmacy with the practices as well as services that benefitted the physician practices without a lease. These services included those that otherwise would have been provided to patients by the physician practices. Patients of the physician practices, including those counseled by the on-site Bioscrip pharmacist, were referred to and filled prescriptions paid for by the Medicare Part D program at a Bioscrip pharmacy.
Spartanburg Regional Healthcare System, South Carolina, agreed to pay $780,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that Spartanburg provided information technology (IT) resources to non-employee physician groups without written contracts in place. Specifically, Spartanburg reported that it failed to document IT agreements with ten different physician practices/groups and also failed to bill and collect for those IT resources.
Providers must be scrupulous about compliance with all applicable requirements when they establish relationships with referring physicians that involve payments to them. The costs of non-compliance may be high, as demonstrated above.
©2009. Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced by any means without the advance written permission of the author.
Getting Ready for OASIS-C
March 23, 2009
Anyone who has been in home care for any length of time knows better than to change all their processes for changes slated to occur in nine months. And yet, if you have been in home care that long, you know that waiting to the last minute is also not a viable option. The question I am facing with my clients currently is how to prepare for OASIS-C now so that when it is time for complete implementation it won’t be as painful. The answers I want to give are those that benefit the agency now and will ease the pain of OASIS-C implementation.
Below are five things that you can do now in order to prepare for OASIS-C. More than ever we want your comments so that we can add to the list for everyone’s benefit in the coming weeks and months.
- Implement a ‘real’ fall prevention program. Monitor results. Fall Precautions are about more than removing throw rugs! Get physical therapy and occupational therapy involved.
- Assign a staff member to begin preparing for next year’s flu season so that a plan exists to monitor the vaccination status of all patients. Prepare consent forms and order templates to ensure that your staff are ready to attack the flu head on in October.
- Call your wound care supply vendors. Ask for education. An abundance of programs are out there, free of charge to agencies. Wound care needs to be taken to the next level in home health.
- Run a list of all patients with heart failure as a diagnosis. See if your agency is weighing patients, monitoring electrolytes, and preventing hospitalizations. Design a program to meet your agency’s needs.
- Begin use of the PHQ-2© Pfizer Depression screen or determine the screen you will be using and implement now.
This list is just a beginning. But hopefully everything on this list will benefit patients beginning now. It is simple and can be fully completed within a month. Hopefully by then, we can publish another to do list.
Please comment below or send emails to Haydelconsulting@bellsouth.net.
Bundled Services and Outcomes
March 22, 2009
Bundling of Services
One legislative policy option for controlling postacute care costs is for Medicare to make a “bundled” payment to hospitals to cover episode costs.
This policy is being suggested by an economist Pete Welch in the Health and Human Services Division of the Congressional Budget Office. In short, bundled services would include all post acute care services for a period of thirty days to be included in the hospital DRG payment. If post acute care services were ineffective, the financial risk to the hospital would be considerable.
It is only a ‘suggestion’ at this time but there is a very real possibility that Congress will take this suggestion seriously as a means to reduce post acute costs to Medicare. Whether this is good or bad depends on where you are sitting. But, as a consultant, my job isn’t to determine the suitability of such a proposal but rather to get clients ready for the possibility of bundled services.
It stands to reason that if hospitals are going to be paying for the first thirty days of care following a hospitalization they will have serious motivation to choose the best post acute care option with the best potential to meet the needs of the patient thereby reducing costs. Furthermore, the hospitals would have to justify their decisions.
Therefore, if I owned any type of facility that rendered care to patients following an inpatient stay, I would start now to ensure that my reported outcomes were as pristine as possible. And the outcome I would focus the most attention on is Acute Care Hospitalizations. If and when this comes to pass, I cannot see a hospital deliberately choosing an agency or facility that had a high rate of hospitalizations.
And if this doesn’t come to pass, there are millions of other reasons why preventing hospitalizations is a good thing. Ask any patient or family member of a patient who has been hospitalized lately how their lives were disrupted by an inpatient stay.
Ten Things about OASIS-C
March 18, 2009
- Say Goodbye to MO numbers. We now have M numbers.
- Most of the assessment numbers have changed completely from what we are used to.
- The question that has replaced MO440 about the presence of a wound or lesion has been modified to specify skin lesions and open wounds receiving intervention by the home health agency.
- Those of you expecting the time for assessments to be increased may be pleasantly surprised. With the exception of the transfer assessment, other OASIS assessments have been increased by one or two questions only.
- The date of referral is now an OASIS item. Could it be that someone is interested in seeing if your agency admits patients within 48 hours of referral as mandated by the Conditions of Participation?
- MO660 assessing the frequency of disruptive behavior problems has been assessed with M1745. M17454 reads: Frequency of Disruptive Behavior Symptoms (reported or observed) Any physical, verbal, or other disruptive/dangerous symptoms that are injurious to self or others or jeopardizes personal safety.
- The OASIS-C dataset asks about ‘formal’ screens for depression, pain and pressure ulcer risk. This does not refer to attire.
- Vaccination status will be assessed. Note that the flu season is October 31 through March 31. If your agency does not have a flu vaccination program then many assessments in January will reflect that your patient has not received a flu vaccine.
- Actual wound measurements are included in the dataset
- A comprehensive Care Management Grid is included as part of the assessment that covers ADL/IADLs, meds, treatments, equipment manager, supervision and advocacy.
We are preparing education material for agencies to help them get ready for OASIS-C. Look for updates next week. As always we welcome your comments and questions below in the comments section or by email to haydelconsulting@bellsouth.net.
