- Medical community faces bacterial challenges. The Centers for Disease Control and Prevention recently reported that 19,000 people died in 2005 from MRSA (methicillin-resistant staphylococcus aureus) and about 95,000 were infected. The initial response has been to prevent bacterial spread and reduce antibiotic prescribing. According to Dr. Scott Gottlieb, a practicing physician and resident fellow at the American Enterprise Institute, we need to place emphasis on better diagnostic tests and new medicines. It can sometimes take days to discover that a patient is infected with a resistant bug. On the medication front, pharmaceutical companies do not obtain a high return on drugs targeted at infections, reducing the incentive to develop new ones. Dr. Gottlieb suggests that we need to take immediate action to encourage the development of better tests and new medicines to fight this growing health threat.
For more information:
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html
- Medical identity theft on the rise. According to the World Privacy Forum, more than a half-million Americans have experienced someone using his or her name and health insurance to obtain medical treatment or prescription drugs. According to Nils Frederiksen, a spokesman for the Pennsylvania attorney general's office, you need to treat your medical ID card as if it were a Visa card with a million-dollar credit limit. If you see a problem, contact your insurer immediately. Once alerted, insurers can remove information from your records that could affect payment for future treatment.
For more information: http://www.worldprivacyforum.org/medicalidentitytheft.html
- November is the best time to get flu vaccine. The ACIP recommends that certain people should get vaccinated each year, including people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. For more information: http://www.cdc.gov/flu/whatyoushouldknow.htm
- CMS releases update for OASIS manual. CMS recommends interested parties download the October 2007 revision of Part 1. The manual includes the upcoming changes effective Jan. 1, 2008. The download is available at: http://www.cms.hhs.gov/HomeHealthQualityInits/
- CMS posts grouper software and documentation.
The recently posted materials include the written grouper logic/pseudocode and associated tables. For agencies developing their own grouper software, CMS has made available the group program (.DLL) and test cases. For more information: http://www.cms.hhs.gov/HomeHealthPPS
- CMS posts updated version of select tables from the final rule. The tables include new versions of the wage index related addendums, Addendum A and Addendum B for non-urban and urban area. For more information: http://www.cms.hhs.gov/center/hha.asp
- CMS Hosts next Open Door Forum on Nov. 28. The Open Door Forum addresses the unique concerns of home health, hospice and DME. The next forum should include the latest information regarding the proposed PPS reform. For more information: http://www.cms.hhs.gov/
- November is National Home Care & Hospice Month.
NAHC develops themes for this monthly celebration. This year’s themes are "Preserving Health Independence and Freedom" and
"Love In Action"
NAHC has made available media resources and celebration ideas: http://www.nahc.org/HCHPCMonth/07/
- Home Care Aide week is November 11 – 17. This year’s theme is: "Honoring Those Who Honor Others"
NAHC has made available media resources and celebration ideas: http://www.nahc.org/HCHPCMonth/07/
- CMS Issues Final Rule to Refine and Update PPS for 2008. The final rule makes several changes from the original proposed rule. Some of the most significant changes in the final rule include:
Case Mix Creep
The most controversial part of the act became an even hotter item as CMS expanded the creep from three to four years. CMS adds a fourth year of rate cuts at 2.71 percent for 2011.
Medical Supplies
The final rule increases the number of severity levels from five to six, with payment ranging from $14.12 to $551.00.
Case Mix
The final rule makes point adjustments to the OASIS items used for scoring.
The entire final rule may be found at:http://www.cms.hhs.gov/HomeHealthPPS
- 3rd Annual Private Duty Home Care Leadership Summit to be held Jan. 27 – 29. This year’s summit will be held in Phoenix, Ariz. For more information: http://www.nahc.org/Meetings/pd/08/
Important Upcoming Dates for Home Health Community
- Nov. 2nd - The proposed 3.0% home health market basket increase for
CY 2008 for all assessments with an end date on January 1, 2008, or after.
- Jan. 1st - PPS Refinement Act goes into effect. The Act includes the most significant changes to PPS since its implementation in 2008. The OASIS, scoring calculations and payment rates are scheduled to be revised.
IRVEN – Production Version 1.7 (in effect Oct. 1, 2007) is available for download. The download may be found at: http://www.cms.hhs.gov/InpatientRehabFacPPS/
CMG 2.20 version 2.20 Grouper Package is available for download. The new grouper goes into effect Oct. 1. To download the new grouper:
http://www.cms.hhs.gov/InpatientRehabFacPPS
Data files to the IRF PPS Final Rule for 2008 FY are available for download.
- Rate Setting file
- Wage Index file
- Case-Mix Groups, Relative Weights and Average Length of Stay Used in the Final Rule
- Appendix C – List of Comorbidities (rev Aug 3, 2007)
These files may be found at: http://www.cms.hhs.gov/InpatientRehabFacPPS
- CMS Releases Final IRF Payment Rule for 2008 –
No Change to the 75 Percent Rule.
The 75 percent rule is used by CMS to classify a provider as an IRF. Currently, in addition to a patient’s principal diagnosis, a patient’s comorbidities may be used to determine whether a provider satisfied the 75 percent rule. Beginning with cost-reporting periods July 1, 2008, comorbidities can no longer be used. Other changes include an increase in IRF payments by 3.2 and an increase in the high cost outlier threshold to $7,362 (from $5,534 in FY 2007).
For more information:
http://www.cms.hhs.gov/inpatientrehabfacpps
- AHCA launches redesigned website. During the 58th Annual AHCA Convention last month, AHCA released a redesigned website to enhance navigation and provide easier access to the latest news impacting the industry. The updated website may be found at: http://www.ahcancal.org
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Countdown to PPS Refinement:
PPS PLUS SOFTWARE
WILL BE!
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Regina McNamara RN, MSN, MPH is a health care consultant with more than over two decades experience in health care organizations. She has a high level of expertise in operations, performance improvement, turnarounds and strategy development. She helps organizations to improve profitability, quality and customer satisfaction. She is president of Kelsco Consulting Group, LLC located in Cheshire, Conn. 
