Crisis escalates over interim payment system
The crisis swirling around the home care industry continues to escalate in Washington, DC, as reports from the field suggest that the number of home care agencies closing or planning to close is growing. Among recent developments:
· Following threats of action by Congress, the Health Care Financing Administration (HCFA) on June 26 announced that it would indefinitely suspend the effective date for its controversial rules on implementing new surety bond requirements for home health agencies. Many providers claimed that HCFA's rules for the bonds were impossible to meet, and some in Congress and in the Small Business Administration (SBA) of Washington, DC, appeared to agree.
· A hearing was scheduled for July 16 in the House Ways and Means Health Subcommittee to discuss postponing implementation of the home health prospective payment system (PPS) beyond its mandated October 1999 start-up date. HCFA administrator Nancy Ann Min DeParle requested the delay, apparently because PPS - along with a number of other mandated reforms - has gotten tangled in HCFA's Year 2000 computer problem.
· Home care representatives continue to label HCFA's rules for implementing the interim payment system (IPS), included in last year's Balanced Budget Act, as an even bigger threat to home health agencies' survival. The surety bond reprieve "enables home health agencies to enjoy their bankruptcy a little longer - IPS is such a disaster," quips Ann Howard, executive director of the American Federation of Home Health Agencies in Silver Spring, MD. Rallies outside the Capitol, sponsored by the home health trade associations, and comments emanating from within, suggest some sympathy for repealing or reforming IPS in Congress. A Senate bill to accomplish this aim was expected to be introduced in late July.
· The SBA has also announced a number of concerns with the final IPS rule published in the Federal Register. "Aside from its obvious impacts on the industry and patient care," the rule goes far beyond Congress' intent and violates provisions of the Administrative Procedure Act, the SBA finds.
· Lawsuits have been filed in Texas, Vermont, Oklahoma, and Washington, DC, by home care trade groups, seeking to overturn IPS.
· Closings of VNAs in a number of states were documented in American Health Consultants' June 22 Home Health Business Report, all blamed on implementation of IPS. A recent informal survey of state home care associations by the National Association for Home Care (NAHC) of Washington, DC, suggests that 800 home health agencies have already closed this year.
"We're doing everything we can in Congress to overturn IPS. Everything that is but working together as an industry," Howard observes. Each of the five major national home care trade associations has its own pet approach to the problem, but Howard says the industry must find a way to achieve unity around a single solution if it is to prevail.
The Hospice Association of America (HAA) has joined the NAHC, its parent organization, in asking Congress to repeal or fix IPS. HAA has gathered IPS petitions from 240 hospices. However, given that more than a third of American hospices are part of home health agencies, many of which may be threatened by IPS, and many others carry dual certification as home health agencies, it is worth asking why the hospice industry has been so quiet in this crisis.
Hospice can't bury head in the sand
"We've made some attempts to call on the hospice community," says Diane H. Jones, MSW, ACSW, HAA's executive director. "As I talk to hospices and state associations I try to make the point: 'There but the grace of God go I.' However, hospices have responded either by telling home care to "go stew in its own juices" or pleading that hospice is besieged by its own problems.
"I'd appeal to hospices to understand the issues, understand how this may impact on them, and start talking to home care providers in their neighborhood. Say: 'Let's together identify the patients that might meet hospice criteria. For those that do not, for whatever reason, let us help you figure out how to care for them,'" Jones suggests. "But there has to be some kind of basic empathy for the intrinsic unfairness of IPS. It's in hospice's best interest to make sure home care experiences its support at this time. We simply don't know what the future will hold, or when hospice will need home care's support."
While hospices and home health agencies haven't always enjoyed harmonious relationships, they remain close neighbors on the care continuum, and potentially important sources of referral and collaboration. What the projected upheavals in home care mean to the hospice industry, beyond the direct effects on dually certified hospices or those based on home health agencies, is likely to be immense. For more information on HAA's campaign to repeal IPS, contact Karen Woods at: (202) 546-4759.
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