Barry Berger’s mother, Polly Berger, was recently featured in a Los Angeles Times article titled ‘Calmly Waiting to Die’.  Click the link to read this beautiful story -

http://www.latimes.com/news/local/la-me-0814-lopez-readytodie-20110812,0,4557581.column

Here’s the link to download and listen to Larry Mantle’s AirTalk Program regarding AB889 – The Domestic Workers Bill of Rights.  There are also public comments posted on the webpage.

http://www.scpr.org/programs/airtalk/2011/08/10/20219/california-labor-rights/

In 1996, it is estimated that patients who fail to take medications as prescribed cost the US over $25,000,000,000.  And that was 15 years ago!  The problems facing many older adults related to medication compliance include 1) lack of transportation for picking up prescriptions and 2) lack of medication regime for managing numerous prescriptions with varying frequencies.  An in-home caregiver can be one solution for these patients. In-home caregivers can assist with providing not only transportation, but also mobility assistance in and out of the home.  An in-home caregiver cannot set-up a medication pill box (a family member or Licensed Nurse is responsible for that, per California law).  But, the caregiver can provide medication reminders and document when the medication are taken. This is valuable information for family members living outside of the home and for the physicians to ensure medication compliance.  In-home caregivers are an inexpensive solution for preventing healthcare decline at home and preserving quality of life.

At 11:00am on Wednesday, August 10th, Accredited President Barry Berger will be the featured guest on the Larry Mantle Show (89.3 FM). The conversation today will surround AB889 – The Domestic Workers Bill of Rights.  This legislation could have terrible unintended consequences that will impact an agency’s ability to deliver cost-effective, quality home care services.  Tune in and get the update.

My weekend started as a quiet, mellow opportunity to sit back, relax, and get caught up on the world’s current events.  Yes, the USA’s Credit Rating Dip leaves me feeling a bit unnerved, but the media’s attack on healthcare is what put me over the edge and fueled my fire.  USA Today’s article  (http://www.wltx.com/news/national/article/146727/142/Medicare-Costs-for-Hospice-Up-70)about Hospice Costs Going Up 70% totally misses the mark.  The population is not only aging, but people are living longer with multiple illnesses.  So, hospice is a financial solution as it is much, much cheaper than hospital expense.  More importantly, it gives individuals and their families the opportunity to experience end of life with greater dignity. Ask any hospice company and they’ll tell you that hospice is still under-utilized and usually within the last 2 weeks of life.  An article like this is harmful to the public perception and it puts unnecessary questions in the minds of our legislatures.  Its a shame USA Today didn’t do more research to show how hospice is part of the greater solution and its not the problem.

Then, I read this article ( http://yourlife.usatoday.com/health/healthcare/hospitals/story/2011/08/Medicare-data-show-gap-in-hospital-performance-perception/49820754/1) and I can’t help but think that all healthcare providers are going to be set up to fail so Medicare and our legislators can justify their budget cuts.   As it is, our government is putting ridiculous policies in place that cost providers more money (which ultimately limits resources for patient care) and don’t do a darn thing to help patient care. More red tape, like home health’s Face to Face Requirement, which serves to find ways to deny payment for lack of compliance.  Instead, our government should support providers with solutions to enhance patient care.  Articles like this aren’t about accountability, which I would totally support, they are about manipulating the public to justify what’s coming next.  And beware because you won’t like what’s coming next when you or your family needs the support of healthcare providers.

For as many bad ideas as CMS and Congress have imposed on the HME industry, none has the potential to be as harmful on HME providers and our patients as the so-called “competitive” bidding program.

As such, we’re pleased to announce that U.S. Representative Kendrick Meek (D-FL) introduced a budget neutral, bi-partisan bill yesterday afternoon, HR 3790, to repeal the highly criticized DME competitive bidding program. 

CAMPS and other first-round states, along with the Accredited Medical Equipment Providers of America and the American Association for Homecare, have been working aggressively towards this goal for months and it’s now time to engage HME providers, consumers and advocates nationwide in gaining support for HR 3790.

What You Need to Do:

1) Make contact! Contact your Member(s) of Congress as soon as possible and ask that they support HR 3790 and join their colleagues to repeal this terrible program and avoid harming California’s Medicare beneficiaries and HME providers. (See listing below for resources.)

Your “Ask”… “Please co-sponsor HR 3790 to repeal so called “competitive bidding” for HME/DME services. This bill will give Congress the same savings that the bidding program was projected to give, without unnecessarily eliminating 90% of the local providers and without limiting a patient’s access to quality products and timely services.”

If your representative is listed below as one who has already signed on to the bill, please contact their office and thank them for the support!

2) Original co-sponsors – Be aware that there are 16 original co-sponsors who joined Rep. Meek and signed on to the bill before its introduction. One is from California:
Jason Altmire (D-PA)
John Boccieri (D-OH)  
JoAnn Emerson (D-MO)   
Sam Farr (D-CA)   
Marcia Fudge (D-OH)   
Alcee Hastings (D-FL) 
Eddie Bernice Johnson (D-TX) 
Rob Klein (D-FL)
Dan Maffei (D-NY)
John Murtha (D-PA)
Tim Ryan (D-OH)
Debbie Wasserman Schultz (D-FL)
Health Shuler (D-NC)
Glenn Thompson (R-PA)
Pat Tiberi (R-OH)
Robert Wexler (D-FL)
3) Review background information and resources – Several documents are linked below to assist you with your contacts:

• Draft of Bill
• Rep. Meek “Dear Colleague” letter to fellow representatives
• AAHomecare Issue Paper
• Contact information for California Congressional delegation health staff
• Latest information from economist Dr. Brian O’Roark on the Impact of Competitive Bidding on the DME Market – A One Year Update

4) Report feedback to CAMPS – As you’re making contacts with California’s Congressional offices, please share any information with Gloria Peterson, CAMPS asst. executive director at gpetersonamgroupus  (gpetersonamgroupus)   about their positions/concerns with HR 3790. Since bidding will be starting in just a matter of days, we know many of you will be extremely busy so please try to make contacts as soon as possible on this critical repeal legislation.

This program needs to be permanently stopped!

Understanding the Bill’s “Pay For”:

It’s important to note that in order to gain support from a Congress that is dealing with budget deficits and health care changes, budget neutrality is absolutely necessary. HR 3790 is budget neutral, calling for minor cuts (in all DME except Group 3 Complex Rehab) of 0.25% for three years and a single 0.5% cut two years later combined with a Consumer Price Index freeze.

AAHomecare reviewed the actuary figures, which added to the 9.5% cut HME providers took in January 2009 to delay the bidding program, is equal to 19.5%, the same savings projected from the bidding demonstration projects, which the program was based on. The following summation was provided by AAHomecare to explain the bill’s “pay-for” that establishes budget neutrality:

• Eliminate the CPI-U updates for all DME in 2010, 2011, and 2012 (i.e., no update in these years). Then, the DME fee schedule would be reduced by 0.25 percentage points in each of these three years.
• Complex rehabilitative power wheelchairs recognized by the Secretary as classified within group 3 or higher would receive a CPI-U update in 2010, 2011 and 2012.
• In 2013, all DME would receive a CPI-U update.
• In 2014, all DME would receive a CPI-U update. Complex rehabilitative power wheelchairs recognized by the Secretary as classified within group 3 or higher would receive a CPI-U update plus 2 percentage points. All other DME would receive the CPI-U only with no additional 2 percentage point increase.
• In 2015, complex rehabilitative power wheelchairs recognized by the Secretary as classified within group 3 or higher would receive a CPI-U update. All other DME would receive no CPI-U update as well as a 0.5 percentage point reduction in fee schedule payments.
• In 2016 and subsequent years, all DME would receive the CPI-U update annually.

With the expansion of Round Two bidding, the threat of Medicare implementing Round One prices nationwide, and the possibilty of other insurance carriers including Medi-Cal mimicking competitive bid prices, this is a bill that the entire industry can stand behind. CAMPS appreciates that even though you are working harder than ever to survive, and a majority of you will be preparing to re-bid soon, the time is now to stop this program and it will take the efforts from everyone, regardless of where they are located, to enact this into law.

Please do your part and engage your legislators today!

With the daily activity in Washington focused on health care reform, they need to hear from you…..a health care provider in their district. If you have any questions about the bill or need any assistance with your contacts, do not hesitate to contact CAMPS asst. executive director Gloria Peterson at gpetersonamgroupus  (gpetersonamgroupus)   or 916/443-2115 x104 directly.

For more information, visit www.campsone.org

As more Americans choose to remain in their homes while they age, finding the right type of at-home care for loved ones can be a challenge. Private duty home care provides a secure, quality, and affordable option for families.

A private duty home care company offers home care aides, companion care, homemaker services and in some cases nursing services within a client’s home or place of residence. The caregivers provide a wide variety and range of services that are needed by a senior or families in order to allow an aging person to remain at home.

Private duty home care offers many unique benefits and provides peace of mind and security to you and your loved ones. NPDA member agencies directly employ, screen, train and bond their caregivers. In addition, they handle all scheduling and payroll management. They offer the benefits of 24/7 on-call availability, caregiver monitoring and individualized care plans. Payments for care are paid privately, as opposed to through Medicare.

For more information, visit www.privatedutyhomecare.org

Care Plan Oversight Reimbursement

Care Plan Oversight (CPO) is physician supervision of patients under either the home health benefit where the patient requires complex or multi-disciplinary care modalities requiring ongoing physician involvement.

Conditions of Coverage

• The beneficiary must require complex or multi-disciplinary care modalities
• The beneficiary must be receiving Medicare covered home health or hospice services during the period in which the care plan oversight services are furnished;
• The physician who bills CPO must be the same physician who signed the home health plan of care and personally furnishes the care plan oversight services;
• The physician must furnish at least 30 minutes of care plan oversight (see details of countable services below) within the calendar month for which payment is claimed;
• The physician must have provided a covered physician service that required a face-to-face encounter with the beneficiary within the 6 months immediately preceding the provision of the first care plan oversight service (a face-to-face encounter does not include EKG, lab services or surgery);
• The care plan oversight billed must not be routine post-operative care provided in the global surgical period of a surgical procedure billed by the physician;
• For beneficiaries receiving Medicare covered home health services, the physician must not have a significant financial or contractual interest in the home health agency as defined in 42 CFR 424.22 (d);
• Services provided “incident to” a physician’s service do not qualify as CPO and do not count toward the 30-minute requirement.
• The physician billing for Care Plan Oversight must document in the patient’s record the services that were furnished and the date and length of time associated with those services.

Countable Services

The following activities rendered by a physician are countable services toward the 30-minute minimum requirement for care plan oversight:

• Development and/or revision of care plans
• Review reports and patient status
• Review labs and other studies
• Communication with health professionals (not employed in the same practice)
• Participation in Team Conference
• Add new information to care plan
• Reviewing/Signing orders from previous month
• Adjustment of medical therapy

NOTE: The above services are only “countable” if performed by the physician providing the CPO.

Non-countable Services

The following activities are services not countable toward the 30-minute minimum requirement:

• Services furnished by nurse practitioners, physician assistants, and other non-physicians
• The physician’s telephone call to patient, family or other responsible party
• Phone calls for prescriptions
• Travel time, time spent preparing claims and for claims processing.
• Initial interpretation or review of lab or study results that were ordered during or associated with a face-to-face encounter.
• Low intensity services included as part of other Evaluation and Management services.
• Informal consults with health professionals not involved in the patient’s care.
• The physician’s time spent on discussions with the nurse or therapist, at their own office or with the Home Health Agency staff.
• The work included in hospital discharge day management (99238-99239) and discharge from observation (99217).

CPO Billing

Documentation & Billing Tips

• Support need for ongoing complex medical management including integration of new information and adjustments to therapy
• Have more than just the signed treatment plan
• Services Furnished, Dates and Times, and Physician Signatures
• Actual signature (not stamp) required for CMS Form 485 or equivalent
• A copy of signed Plan of Care
• Billing Codes to Use

G0180                         Certification

G0179             Re-certification (once every 60 days after initial Certification)

For more information on Care Plan Oversight,

visit www.cms.gov