The short title is the Medicare Fraud Reduction Act. This ‘act’ places caps on your aggregate number of episodes. Representative Jim Matheson, a democrat from Utah introduced a bill into congress on October 4th, and Representative Brett Guthrie, a republican from Kentucky co-sponsored the bill.
H.R. 3245 of the 113th congress (you have to state the 113th congress or web results will show cocaine sentencing laws) as I understand it, states:
- No episode will be paid for after the agency meets its caps.
- The cap is 3.3 episodes for agencies that reside in a rural area
- The cap is 2.7 episodes for all the rest of you.
- When more than one agency sees a patient, the episode credit is divided proportionately between the agencies on a percentage of episodes basis.
If this looks familiar to you, it reads exactly like the proposal The Partnership for Quality Home Health (click to see members) submitted to Congress signed by Eric Berger. Note the 4th paragraph of page four of the proposal.
And yet, both Eric Berger, CEO and paid lobbyist for The Partnership of Quality Home Healthcare, and Bill Dombi of NAHC deny having anything to do with this Bill. Eric Berger pointed out that the language was available on the internet for anyone to use and apparently somebody did.
My first response was that one of them was being less than truthful but their denials were direct and to the point. I do not believe that either man would commit to writing a falsehood.
You are obviously free to your own opinions about caps but I do not like this idea not one bit. However, the best I can do is make sure you know about it so you can act on it in the manner in which you see fit.
In researching the so called recommended targets for fraud reduction, I found some interesting facts which I am certain have no bearing on the length of stay required by a patient.
- In Bogalusa, Louisiana, 15 percent of residents have diabetes. This is twice the rate of the rest of the country.
- In East Carol Parish, a full 57 percent of children live in poverty which I assume is a fairly decent indicator of the overall economic status of the community.
- Hancock county in Tennessee doesn’t report on drug use or alcohol use but they have more than triple the number of deaths from motor vehicle accidents.
- Like the other hot spots, Hancock County has high unemployment (50% higher than the rest of the state) and very poor educational levels.
- There are three counties in Mississippi that hit the target list. Consider that in Mississippi taken as a whole, 32% of children grow up in poverty. For the three fraudulent counties, the percentages are 46%, 52% and 53%. If they are fraudulent, they aren’t very good at it. Someone should be getting the money stolen from Medicare.
- In one Mississippi county, a full 78 percent of people had water exceeding a violation in the past year.
- Perhaps the most tragic is the violent crime in these three counties. In Mississippi, 280 people out of every 100,000 is expected to become a victim of violent crime. The county with poisonous water (Sharkey) has a very low rate of 72 incidents. Jefferson County counted 443 victims per 100,000 but Claiborne county takes the prize with 770.
- In Madison Parish, Louisiana, you have a one in ten chance of being a victim of violent crime which is a shame because it is one of my favorite places. I had no idea I was in such danger.
Add it all together and you have a bill introduced to congress that will limit access to care to elderly people without resources. Their families are stressed and stretched thin. Neither the patients or their families have enough education or money to log on to a computer much less email their senator. They are the men and women who didn’t need an education to farm our land and feed us for fifty years before they retired.
They are disproportionately African American and disproportionately elderly in the counties where they reside as the younger people who could leave have left. For the most part they have outlived their usefulness and have no voice. If we don’t speak up for them, who will?
Of course, I have gone way off track. None of these tragic figures in any way contribute to longer lengths of stay. Rather, the home health agencies commit fraud.
Most of my data was obtained from the County Road Maps. It is a great site where you can find a plethora of information about your community and there is even grant money available if you can come up with a plan to address your data.
Its important that all of our voices are heard. Even if you disagree with me, contact your state representative. I am going to contact mine and I will also email and call Bill Matheson and Brett Guthrie every day for no other reason than I didn’t have any time off this weekend because of their ill advised nonsense. If you click their names, you will be taken to their contact forms.
If for some reason you are inclined to like the proposed reform, I would like to hear from you so I could begin to understand who would think this was a good idea.
Comments welcome.