CMS Delays Enforcement Of “Two Midnights” Rule

CMS is delaying enforcement of the “two midnight” payment policy for short hospital stays until the end of April. The delay allows Congress time to pass the package repealing Medicare’s sustainable growth-rate formula when it reconvenes on April 13. The legislation includes a six-month delay in enforcement of the payment rule. The “two midnight” rule assumes an admission was appropriate if a patient’s stay spanned two midnights and that outpatient observation status was appropriate if it did not.

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Tiptastic Tuesday: How To Spot Signs Of Elder Abuse

According to The Elder Justice Roadmap, a report by the U.S. Department of Justice and the Department of Health and Human Services, five million Americans are affected by elder abuse every year. Abuse of the elderly can be difficult to pinpoint as its signs could appear to be symptoms of dementia or the natural results of frailty that come with growing older. It is important to know that elder abuse is not always physical and  includes other categories, including sexual, psychological, and financial neglect.

Be on the lookout for the following common signs that abuse may be happening:

  • Frequent arguments between the caregiver and the patient
  • Changes in a senior’s personality or behavior
  • Unexplained injuries like burns, bruises, welts, cuts or scars
  • Broken bones, dislocations and sprains
  • Failure to take medication or overdose of medication
  • A caregiver’s refusal to let you see the patient alone
  • Appearing disheveled, in torn or soiled clothing, or not being appropriately dressed for the weather
  • Appearing hungry, malnourished, disorientated or confused
  • Unexplained charges or a suspicious drain of money
  • Unexplained weight loss

If you notice something strange, it is important to notify authorities or to report it to Adult Protective Services (APS).

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House Passes SGR Reform Bill

Yesterday, a majority passed Medicare legislation that reforms the physician payment formula also known as the Sustainable Growth Rate (SGR). H.R. 2 will now go to the Senate where it is expected to pass.

The bill includes the previously reported provisions that affect home health and hospice services:

  1. The annual payment rate update (Market Basket Index) is set at 1% in 2018. This represents an estimated 1 point reduction from what would otherwise be the update
  2. A two year extension of the home health rural add-on at 3%. Under the bill, the add-on would expire with episodes beginning January 1, 2018 and later.
  3. Modification of the home health surety bond requirements setting the bond minimum at $50,000 and allowing Medicare to scale the bond value up commensurate with the volume of Medicare revenue in the home health agency.

The Medicare beneficiary changes do not include a home health copay.

The bill “would institute a permanent fix in the physician payment methodology” which is good news for Medicare providers as there have been 17 previous “patches” that were financed by cutting provider payment rates.

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Medicare Providers Could Face Up To 100% Late Tax Penalties Under New Provision

Congress recently proposed a bill that would reset Medicare physician pay rates. However, details about the measure emerged that it would also include penalties as high as 100% for providers delinquent with income tax payments. According to the Government Accountability Office (GAO), thousands of Medicare providers are late paying their income taxes every year. Under the provision, the IRS would be allowed to impose late tax penalties as high as double the amount of the back taxes, reducing the offenders’ Medicare reimbursement checks. The current law sets the ceiling at 15%.

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CMS Extends Deadline For Long-Term & Post-Acute Care Health IT Survey

CMS is extending the deadline for its long-term and post-acute care (LTPAC) health IT survey. The survey applies to home health and hospice providers, and offers an opportunity to share the challenges and opportunities associated with health IT implementation. They survey period for the voluntary LTPAC EHR survey has been extended to April 3, 2015.

Click here to participate in the survey.

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Study: Behavioral Therapy More Beneficial To Dementia Patients Than Drugs

For caregivers serving those suffering from Alzheimer’s disease or other dementias, the biggest challenge is often coping with other behaviors common in dementia. Antipsychotic drugs to treat these symptoms has become increasingly common with approximately 1 in 3 dementia patients in nursing homes being prescribed them. Outside of nursing homes, 1 in 7 dementia patients are prescribed these drugs – all despite a warning from the Food and Drug Administration saying that antipsychotics increase the risk of death for people with dementia.

According to a recent study published in the British Medical Journal, antipsychotics are much less effective than non-drug treatments in controlling the symptoms of dementia. Researchers say the treatments that show the best results were ones that trained caregivers on how to communicate calmly and clearly, and those that introduced hobbies and other activities to the patient. Researchers believe caregiver interventions work because they train caregivers to look for the triggers of the symptoms. When a caregiver sees the triggers of the symptoms, they train patients on how to manage them.

Healthcare providers typically use antipsychotics because they have not been trained to use non-drug approaches and when they do know how to use them, they are rarely reimbursed for doing so by Medicare or private insurance.

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CMS: More Additions & Rebasings Of Nursing Home Ratings To Come

Last week, CMS released rebased Five Star ratings that caused approximately one-third of the nation’s skilled nursing facilities to lose a rating star due to administrative changes. Next year, more quality measures, including measures for rehospitalization and discharge rates, will be added. Although providers are unhappy with the changes, CMS officials say there have been big improvements, including an almost 20 percent reduction of antipsychotic use in two years. Changes that went into effect last week include the inclusion of quality measures pertaining to antipsychotics use by short-stay and long-stay residents, increased performance expectation, and adjusted staffing algorithms at verifying nurse staffing levels via payroll records. CMS also announced that it will be releasing results of pilot surveys that check “adequacy” of resident assessments and “accuracy” of provider information self-reported to help calculate quality measures. According to CMS officials, many nursing homes will see a decline in ratings until they make further improvements.

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