Many of you have been approached by or wish to approach hospitals to offer the support of your housecalls program to their effort to reduce readmissions. You have asked us for a basic briefing document you could take with you, something that would explain how house calls can help, and give some concrete examples of benefits.

 

An interested group met at the Annual Meeting to give the background needed and to describe their programs.Click here for a Policy Brief giving the argument and their examples. Consider this an Annual Meeting gift that we hope will keep on giving! And many thanks to those who participated!

 

Constance Row, LFACHE
Executive Director

IAH Expansion Efforts Underway

 

CMS officials have acknowledged the difficulty in initial practice selection due to the high number (130) of programs that applied as well as the statutory cap of 10,000 beneficiaries.  CMS followed the criteria in the posted application and specifications in selecting the initial IAH practices. CMS is also to announce the approved consortia practices in June.   The Academy is involved in efforts to expand IAH.  You can help by donating to the Homecare Medicine Action Fund. 

The kick-off meeting of the Academy grant funded learning collaborative took place on May 2 prior to the Annual Meeting in Seattle. The next meeting of the Learning Collaborative will be on through a June 19 call focusing on top concerns of practices as they begin service to eligible beneficiaries under the Demonstration.

The Patient-Centered Outcomes Research Institute (PCORI) recently announced it is accepting applicants for funding to support comparative effectiveness research projects that address PCORIs National Priorities for Research and Research Agenda.  There are four current areas of focus outlined in PCORI's National Priorities for Research and Research Agenda (PCORI Funding Announcements - PFA) and a fifth will be announced this summer.

• Assessment of Prevention, Diagnosis, and Treatment Options- for projects that address critical decisions that patients, their caregivers and clinicians face with too little information
• Improving Healthcare Systems - for projects that address critical decisions that face health care systems, the patients and caregivers who rely on them, and the clinicians who work within them
• Communication and Dissemination - for projects that address critical elements in the communication and dissemination process among patients, their caregivers and clinician
• Addressing Disparities - for projects that will inform the choice of strategies to eliminate disparities
• Accelerating Patient-Centered Outcomes Research and Methodological Research - This fifth area of focus/PFA will be announced this summer.

Research relating to homecare medicine fits with the areas of focus. The application process requires a rigorous description of the research that reflects an academic perspective. PCORI will award $120 million this year. Letters of Intent are due June 15. Application materials can be downloaded from the "Funding Opportunities" section of PCORI's website, www.pcori.org.

 

 

 

The Federal Communications Commission (FCC) adopted rules last week to advance care enabled by Medical Body Area Networks (MBANs), low-power wideband networks consisting of multiple body-worn sensors that transmit a variety of patient data to a control device. This ruling should enhance the growth of home care medicine by allocating underutilized radio spectrum to information transmitted by the patient body sensors over the MBANs. This has implications to support;

 

• Your patient care,
• Expansion of the home care medicine field in general,
• Opportunities for services not currently covered and paid by Medicare,
• Enhanced Academy relationship with and support by firms that participate in the mobile technology and telemonitoring fields. 

 

The FCC allocated spectrum for registration and restriction to indoor operation at health care facilities.  However, importantly the FCC also allocated spectrum and may be used in any location - including in-home residential settings. The FCC announcement can be found here. 

The FCC in the May 24 News Release notes;

 

"Wireless devices that operate on MBAN spectrum can be used to actively monitor a patient's health, including blood glucose and pressure monitoring, delivery of electrocardiogram readings, and even neonatal monitoring systems. MBAN devices will be designed to be deployed widely within a hospital setting and will make use of inexpensive disposable body-worn sensors. MBAN technology will also make it easier to move patients to different parts of the health care facility for treatment and can dramatically improve the quality of patient care by giving health care providers the chance to identify life-threatening problems or events before they reach critical levels." 

Saturday, June 30, 2012 is the last day to submit a hardship exemption request, or report at least 10 instances of e-prescribing on claims to CMS to avoid the 1.5 percent reduction on all Medicare claims in 2013.  The available hardship categories are; 

• Inability to electronically prescribe due to state, or federal law, or local law or regulation
• The eligible professional prescribes fewer than 100 prescriptions during a 6- month payment adjustment reporting period
• The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642)
• The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643)

Hardship exemption requests must be submitted annually and by June 30 to claim an exemption request to avoid next year's penalty. Additional information about thee-Prescribing incentive program and the hardship exemption process can be found on the CMS site here.

The MGMA-ACMPE, formerly the Medical Group Management Association, is urging CMS to rescind a rule that will reduce payments for physician office services if the patient is subsequently admitted to a hospital for reasons related to the office visit and the hospital wholly owns or operates the practice. 

 

The payment policy change, delayed from an originally planned January start to July 1, would have physicians paid the lower facility rate for services performed on patients that are subsequently admitted for an inpatient hospital stay when 1) performed in the three days prior to an inpatient admission; 2) related to the admission; and 3) performed in a physician practice (or other entity) that is wholly owned or operated by the hospital to which the patient was admitted.   

While we recognize that most Academy members do not have office practices, some do. And so the Academy voiced concerns about this provision when proposed in the Medicare Fee Schedule rulemaking process. We added the comment that "CMS does not want to create an incentive for these providers to not see the patient and let that patient be admitted". 

To view the letter click here. 

The MGMA also adds concerns that any delay or failure by hospitals to provide notification to practices that a Medicare beneficiary seen within the 3 days prior in the office would leave physician offices unaware that they were supposed to file an amended bill. Subsequent failure to file could than be construed as an overpayment from Medicare, which becomes a false claim after 60 days and subject to all the penalties of the False Claims Act. The Academy also submitted comments on this 60 day Repayment Rule.

The Academy is pleased to announce an updated and expanded Medical Management of the Home Care Patient (MMHCP) is Now Available. This important publication for care of your patients and operating a home care medicine practice is updated with the most current and relevant material.  This book is applicable to the practice and patients of all Academy members including physicians, nurse practitioners and physician assistants. Leaders of your Academy in conjunction with the AMA authored the MMHCP. Order you copy here.

 

This 4th edition, like the field of home care medicine, has grown across many aspects of care, organization and regulation and covers the changing landscape from care of special populations, relationships with community based long term care supportive services through skilled nursing and therapy services to the latest in acute hospital in the home programs.

 

Specific topics include:

• The basis for care of the home care medicine patient.
• Care transitions and the importance of care transitions in reducing hospital readmissions.
• Legal, compliance and ethical issues that arise or are present in practice of home care medicine.
• The Veterans Administration's Home Based Primary Care Program.
• Special home care medicine populations from neonatal through hospice and end of life care.
• A caregiver self-assessment tool.
• A comprehensive glossary.
• Listing of national, state and local resources.
• Case studies, tables, figures and easy-to-read text.
• A continuing medical education component for physicians interested in obtaining AMA PRA Category 1 Credits™

The MMHCP is a care delivery complement to the expanded Field Guide to Home Care Medicine  and both beginning and growing practices will want to have both references.   

  

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