WSJ investigates home health Medicare reimbursements
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 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:
“The tenth visit was not always medically necessary,” Ms. Trusler says.
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%.Read The WSJ story here.
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.”
Subscribe to this comment's feedwritten by WillNotPay , April 27, 2010 - 04:54 pm
written by Match U Peach U , April 27, 2010 - 05:25 pm
written by Amazing , April 27, 2010 - 06:03 pm
written by Jeff PA , April 27, 2010 - 10:15 pm
written by Self Ex-Communicated Catholic ! , April 28, 2010 - 02:48 am
Ponzi Scam Artists, Madoff and Stanford.......Beware those who come bearing gifts !
written by Great Article NOT , April 28, 2010 - 03:27 pm
written by Match U Peach U , April 28, 2010 - 07:32 pm
Ponzi Scam Artists, Madoff and Stanford.......
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Maybe so, but WSJ is not in the business of regulation, the government is, and the trusted government was busy watching porn.
written by Match U Peach U , April 28, 2010 - 07:35 pm
Home health care is the fastest growing sector but also it saves tax payers billions each year. For example, an average night at the hospital will cost around $3500 where an average HH visit is around $200 for Medicare.
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True, but the liberals are back in power. BTW, Did you get your check yet? Better hurry, the money will run out soon. Just ask those living in the People's Republic of California.
written by Good Time Charlie ! , April 29, 2010 - 03:15 am
Repent, saith the church, " TITHE your way to the Pearly Gates !
written by Morrow , April 29, 2010 - 12:24 pm
written by Former Amedisys Nurse , May 01, 2010 - 11:18 am
written by frustrated physical therapist , May 16, 2010 - 05:23 am
Also, there is a system in place to ensure the billing codes maximize payment. It's as if all of this is endemic.
I'd even go one step further. Therapists fool themselves into thinking they can make a significant difference in an older adult's ability to balance and function. I say this as even after 20 in-home visits, an older adult is still a "fall risk" and likely would be considered functionally unchanged as evaluated by a blinded, third party therapist assessment. The nature of aging severely limits the body's ability to functionally change.
Now, for the Classical Liberal statement: should the federal government be forcing "free" citizens to pay for health care that is questionable? Even for care that even is effective? When a socialized system exists, fraud, both overt and subtle, will develop.
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