What Home Health Providers Can Learn From Hospice OIG Audits

Home Health Care News | By Patrick Filbin

The home health industry should keep its collective eye on the U.S. Department of Health & Human Services Office of the Inspector General’s (HHS-OIG) recent audits on the hospice industry, because it soon could be next.
 
As the home health space continues to grow, federal oversight and the scrutiny attached to the industry have grown with it.
 
Experts at Husch Blackwell have followed this trend through the hospice industry, and have gleaned knowledge from that.
 
“As we have been following and reporting on those hospice audits, the OIG has been looking at the home health space as well,” Bryan Nowicki said this week on a podcast episode of Hospice Insights. “They’re very similar in overall structure with what we have been working on with hospice. They’re looking for certain kinds of errors that they’ve identified as being recurring or ‘top of mind’ in the home health field.”
 
When the OIG first began its hospice audits in 2021, the office was looking for things like whether beneficiaries met the definition of being confined to a home; whether they were truly in need of skilled services; whether the OASIS information was being submitted in a timely fashion; and whether services were properly documented.
 
Those were the four priorities being reviewed by the OIG, Nowicki said. Now the OIG is cranking up those efforts and focus areas, this time for home health agencies.
 
“Frankly, those are pretty recurring issues in home health,” Nowicki said. “We would expect more of the same, but [the audit process] is going to be guided by what they actually find. Audits are happening now and the OIG’s goal is to begin issuing final audit reports and publishing them on their website in 2023.”
 
Unlike many audits, results from the OIG audits are made public, which creates even more anxiety from the industry, according to Husch Blackwell attorney Meg Pekarske.

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If I Stop Treatment Will I Start Dying

By Barbara Karnes

If I stop treatment does it mean I stop trying? If I stop trying does it mean I’ll start dying? I don’t want to die.

When faced with the above considerations, what decision do we make? How do we face the realization “I am going to die”?

Most of us go through life with the notion that other people die, not me or anyone close to me. Yet for all of us that bubble of illusion will someday break.

If we don’t die a fast death, by accident (no warning), we will die a gradual death from disease or old age. Either way someday all of us will die. How do we prepare for that day? Do we or should we prepare for that day?

I don’t have a one size fits all answer to those questions. Each of us will prepare for our eventual (assumed gradual) death in our own way, according to our personality. Doer personalities will have their advanced directives and Five Wishes completed and filed away. They will have talked with their family and significant others years before that information will be needed. A procrastinator personality may never address their advanced directives even though they may have given it some thought. An easy going personality ——it goes on and on. Think about who you are and how you are addressing your eventual death…

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CALL TO ACTION: 2023 Proposed Home Health Rule

HHAC stands with the National Association for Home Care and Hospice (NAHC) in combating several of the key provisions found in the 2023 Proposed Home Health Rule, and echoes the statement made by NAHC President, Bill Dombi, that: 

"With significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of the proposed rate cut. Reliable analyses proves that PDGM underpaid home health agencies. We will be taking all steps to protect the home health benefit as this proposed rule advances and have fully prepared for congressional action and more.” 

According to a recent analysis performed of available data, NAHC estimated that should the proposed rule pass in its current form, 37% of free-standing home health agencies and 50% of all non hospital-based agencies would be operating at <0% net margin. 

The best time to begin our grassroots efforts against the destructive proposed changes will be when Congress is at recess in August. In the meantime, please use this link to go to the Federal Register and submit a formal comment about the rule. Let CMS and Congress know what it would do to your agency and those you care for. Comments must be submitted by 08/16/2022 to be considered. 

Resources: 

• Summary of Previous and Newly Proposed Medicare Home Health Cuts
• Talking Points: Congress Must Act to Prevent Home Health Cuts that Will Devastate Access to Care 

Dems Want to Tax High Earners to Protect Medicare Solvency

Associated Press / By ALAN FRAM
 
WASHINGTON (AP) — Senate Democrats want to boost taxes on some high earners and use the money to extend the solvency of Medicare, the latest step in the party’s election-year attempt to craft a scaled-back version of the economic package that collapsed last year, Democratic aides told The Associated Press.
 
Democrats expect to submit legislative language on their Medicare plan to the Senate’s parliamentarian in the next few days, the aides said. It was the latest sign that Majority Leader Chuck Schumer, D-N.Y., and Sen. Joe Manchin, D-W.Va., could be edging toward a compromise the party hopes to push through Congress this summer over solid Republican opposition. Manchin scuttled last year’s bill.
 
Under the latest proposal, people earning more than $400,000 a year and couples making more than $500,000 would have to pay a 3.8% tax on their earnings from tax-advantaged businesses called pass throughs. Until now, many of them have been using a loophole to avoid paying that levy.
 
That would raise an estimated $203 billion over a decade, which Democrats say would be used to delay until 2031 a shortfall in the Medicare trust fund that pays for hospital care. That fund is currently projected to start running out of money in 2028, three years earlier.
 
Most U.S. businesses are pass throughs, which include partnerships and sole proprietorships and range from one-person law practices to some large companies. Owners count the profits as income when they pay individual income taxes, but such companies do not pay corporate taxes — meaning they avoid paying two levels of taxation.
 
Democrats this week also sent the parliamentarian a separate 190-page piece of the emerging Schumer-Manchin compromise that would lower prescription drug costs for patients and the government. Provisions include requiring Medicare to negotiate drug prices, limiting beneficiaries’ out-of-pocket costs to $2,000 annually and increasing federal subsidies for copays and premiums for some low-income people.

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