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Posts tagged ‘Bill Dombi’


Priscilla Demonstrating a Proper Face-to-Face Encounter.  She continues to work on documentation skills.

Priscilla Demonstrating a Proper Face-to-Face Encounter. She continues to work on documentation skills.

I have never been a big fan of associations and organizations.  I am not a joiner in general.  Specifically, I have been very frank about my feelings towards the National Association of Home Care and Hospice.  I believe that in the past they took on causes that benefited some agencies at the expense of others.  In many ways, it is almost impossible to be an organization representative of all agencies of all sizes in all parts of the country.

As of June 5, that changed.  William A. Dombi, attorney for the plaintiff – your association – has filed suit against the US Department of Health and Human Services.  NACH is challenging the requirements regarding documentation of the Face-to-Face encounter.  They allege that Medicare is enforcing the Face to Face encounter requirements in ways that were never intended and are not legal.  They note that these retroactive denials are made outside of the consideration of the care needed by the patient or the quality of the care rendered to the patient.

This is good stuff, y’all.

Because I was so outspoken and passionately against the position NAHC took in the past regarding other issues, I owe it to the Association (and to myself) to be as outspoken and passionate in my support of this lawsuit.

If NAHC asks anything of its members, please cooperate to the best of your ability.  If nothing else, send the board at NAHC responsible for approving the filing of the claim a note of gratitude.  This is one position that NAHC has taken that benefits all agencies, patients, and the Medicare trusts.

I can respect that.

Homecare vs Homecare

There is much philosophical talk about being divisive in our healthcare.  I don’t have a problem with being divisive.  This is my website and I can write what I want.  I am the senior editor – make no mistake. 

I do hold myself to certain standards, though and I think I may have fallen short on Monday and understated NAHC’s position on the Caps Limitation bill.   What I wrote was that both NAHC and The Partnership denied involvement regarding the introduction of the bill. 

In a nutshell the facts are:

NAHC – The organization that represents home health care and hospice on a national level has spoken out against the caps.   This is exactly what Bill Dombi of NACH wrote to me:

We do not support the episode cap and, in fact, have actively conveyed our opposition to Senate and House members.

The Partnership – A group of publicly traded homecare companies, plus a few stragglers, originally drafted the language in the bill but denies knowledge of how it was introduced.  This is what Eric Berger of The Partnership wrote in an email to me:

Like others throughout our community, the Partnership views targeted program integrity reform as a preferable alternative to further across-the-board cuts or the reimposition of cost-sharing that would impact innocent beneficiaries and their compliant providers. 

There’s only one sentence but if it were clinical documentation it would result in a denial.  Here are just a few of the questions it raises:

  1. Who are the ‘others’ in our community?
  2. Targeted Program integrity reform is what exactly?  Capping episode limits based on an arbitrary number determined by people who have never laid hands on a patient? 
  3. If there are innocent patients and compliant providers, does that mean that there are guilty beneficiaries?  Is that where the problem lies? 

As I stated in a post last week, there are some people who simply cannot write.  I cannot dance, remember?  The next email I received late Sunday night left no doubt about the position of the Partnership.  Again, from Eric Berger:

As for the Partnership’s plans with respect to this bill, we will not be taking any action on it — our total focus is on the rebasing and face-to-face regulations that pose a significant threat to our community. 

Initially, I was not going to make a big deal about this.  My concern is the bill itself – not The Partnership.  The members of The Partnership pay serious money to be a part of the elite group of companies that pay for lobbying efforts designed to benefit their companies.  Whether you like it or not, I do not believe there is anything illegal about it.   

So while it is very true that both NAHC and The Partnership deny having anything to do with the introduction of the bill, their positions on the bill could not be further apart.  I think that my original post would have been better if I had highlighted these differences.

Because honestly,  while I believe Eric Berger when he says The Partnership had nothing to do with the introduction of the bill, I worry about  his documentation skills.  He’s like a nurse who leaves the vital signs section blank and states the patient is stable.  We assume the nurse forgot to document the vital signs but it may be that the patient is dead.

Urgent Call to Action

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:

  1. No episode will be paid for after the agency meets its caps.
  2. The cap is 3.3 episodes for agencies that reside in a rural area
  3. The cap is 2.7 episodes for all the rest of you.
  4. 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.

LHCG’s Keith Myers Responds

Wow.  What a day.  You take one little Fortune 500 CEO to task on his position regarding payment cuts and the sky falls in.

I believe that all of us have the not only the right but also the responsibility to question decisions and recommendations that may affect our ability to care for patients.  I cannot be polite or demur about something credible that concerns my clients and ultimately their patients because there are certain people who don’t want to hear it.  Mr. Bill Dombi, of NAHC has posted in a public forum that my post was factually false and potentially slanderous and derogatory.  I plead guilty only to the last one assuming we share the definition of derogatory:  expressive of a low opinion.  My post was not at all supportive of an idea that puts my clients in jeopardy.

In the interest of fairness, I have received emails from Keith Myers,   Bill Borne and Bill Dombi today.  I have permission to post Keith’s so it is below.   Bill Borne and I exchanged a couple of emails and he has promised to call me in the morning to clarify a few things.  Mr. Dombi sent a response back that will take time and effort to understand.

As promised, here is the response from LHC’s Keith Myers.

Dear Ms. Haydel,

I’m writing today to clarify LHC Group’s position relative to the recent article published by Reuters

regarding home health reimbursement cuts.

 The article states, “The Alliance for Home Health Quality and Innovation, which includes Amedisys and peers such as Gentiva Health Inc., Almost Family and LHC Group Inc., is lobbying Washington to accelerate the 2012 cuts that are spread out until 2017.”

 Let me clear. LHC Group does not support MedPAC’s proposed acceleration of rebasing and, in fact, is working diligently alongside other members of the National Association for Home Care and Hospice, as well as the Partnership for Quality Home Healthcare, to fight the imposition of co-payments and eliminate (or, at a minimum, lessen the impact of) any further across-the-board cuts to the Medicare home health benefit.

 While I’ll defer to the Alliance to speak on its own behalf, it’s important to note the Alliance is a research organization and is not involved in lobbying or any other legislative activity.

 At LHC Group, we do not support any policy that disproportionately impacts smaller providers. Our goal is to create a reimbursement system that is in the best interest of our entire industry and, most importantly, the patients we all serve.

With Warmest Regards, Keith G. Myers

Chairman and CEO

LHC Group Inc.

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