In an investigative report published Monday, The Wall Street Journal looks into home health care companies that appear to be taking advantage of the Medicare reimbursement system. The results of the WSJ’s analysis -- which centered on the nation’s largest home health agency, Baton Rouge-based Amedisys Inc., but also included data on Lafayette-based LHC Group Inc. -- show that the number of in-home therapy visits tracks Medicare financial incentives.

Home health agencies, the fastest-growing sector of the health care industry, derive most of their revenue from Medicare. The WSJ’s analysis was based on publicly available Medicare records and supported by comments from a former Amedisys nurse.
“I was told ‘we have to have ten visits to get paid,’” says Tracy Trusler, a former Amedisys nurse for two years in Tennessee, who has since left the company. Her supervisors, she says, asked her to look through patients’ files to find those who were just shy of the 10-visit mark and call their assigned therapists to remind them to make the extra appointment.

“The tenth visit was not always medically necessary,” Ms. Trusler says.
The paper enlisted Henry Dove, a professor at Yale University’s School of Public Health and an expert in analyzing Medicare data, to assist in its analysis. Dove studied Medicare’s database to determine how often between 2005 and 2008 various home-health companies sent therapists to patients’ homes during a 60-day period of care, and whether the number of visits coincided with Medicare financial incentives. The WSJ reported:
Mr. Dove found the pattern of clustering visits at reimbursement trigger points was industry wide. The three other publicly traded home-health companies saw similar movements from 2007 to 2008. LHC Group Inc., for instance, saw the percentage of patients getting 10 visits in 2008 drop by 64% from 2007. For Gentiva Health Services Inc., the 10-visit percentage fell 27%, and at Almost Family Inc., the percentage fell 39%.

A spokesman for LHC said the company agreed with The Journal’s analysis but noted that the majority of its patients didn’t receive therapy—and therefore the company didn’t qualify for the bonus payments. He added that “the shift in therapy visits noted in your data resulted from a change in the types of patients we cared for,” such as more orthopedic patients, “and not a change in treatment patterns.”
Read The WSJ story here.

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