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From Health Law Daily, October 1, 2015

Representatives listen in on proposed Medicare solutions at Health Subcommittee hearing

By Bryant Storm, J.D.

The House Committee on Energy and Commerce Subcommittee on Health held a hearing entitled “Examining Potential Ways to Improve the Medicare Program” to consider proposed legislation designed to improve Medicare by effectuating payment reform and lifting practice restrictions which limit the ability of providers to administer services. The hearing included the testimony of providers who were asked to offer “real world experiences” on the Medicare program’s limitations and the promise of the legislative solutions.

Legislation. Health Subcommittee chairman Rep. Joseph Pitts (R-Pa) explained the three pieces of legislation that were the focus of the hearing. The first piece of legislation, H.R. 556, known as the Prevent Interruptions in Physical Therapy Act would add therapists (physical, occupational, and speech) to the list of providers allowed to transfer care under locum tenens agreements for a Medicare patient in circumstances of illness, pregnancy, or vacation. Specifically, H.R. 556 would allow physical therapists to bring in other licensed professionals under their provider number to cover for certain absences. Another proposed law, H.R. 1934, the Cancer Care Payment Reform Act, would establish a national Oncology Medical Home Demonstration Project to improve Medicare payments for cancer care. Finally, a discussion draft proposed by Rep. Greg Walden (R-Ore) was considered which would make changes to the documentation and face-to-face requirements for home health providers under the Medicare program.

Opening statements. Rep. Fred Upton (R-Mich) warned that alarm bells concerning the potential insolvency of the Medicare programs “cannot be ignored.” Rep. Upton expressed hopefulness that the three legislative proposals could represent a turning of the tide with respect to the program’s solvency. Although Rep. Frank Pallone (D-NJ) favorably discussed the legislative attempts to improve patient care, Pallone admonished the committee for not inviting a member of HHS or another administrative official to testify as to whether any of the proposed laws were feasible.

Home health. Sarah Meyers, the executive director of the Oregon Association for Home Care testified as to the importance of skilled home health care. Meyers also testified that one of the greatest burdens facing home health providers is the implementation of the face-to-face requirement. While Meyers acknowledged the requirement “that no claim would be paid unless it was for services ordered by a physician as a result of a face-to-face encounter with the patient,” is good medicine, Meyers asserted that the rule has led to “impossible-to-meet” documentation requirements. The result of the overly stringent documentation rules is that thousands of claims have been denied based on “insufficient documentation even though a review of the full patient record reveals that the patient meets Medicare coverage criteria.”

Meyers praised the draft legislation proposed by Rep Walden, which would employ the use of a standardized form to identify the clinical condition for which home health is needed. She testified that by using a standardized system, home health providers would be able to avoid unnecessary documentation and reimbursement hurdles.

Cancer care. Bruce Gould, the Medical Director at Northwest Georgia Oncology Centers, P.C., testified in favor of H.R. 1934. In his testimony, Gould suggested that the payment reform model proposed in the bill would “lower the costs of cancer care while enhancing the quality of care for patients.” Gould explained that community oncology practices are struggling as a result of major Medicare reimbursement cuts. The result is a consolidation of cancer care. Gould explained that the cuts have forced 300 practices to close treatment sites and pushed 550 practices into merging with hospital systems. The consolidation is increasing costs and reducing access. Gould testified that H.R. 1934 is a solution for the problem because it builds upon prior successful demonstrations with the concept of an Oncology Medical Home model. He explained that Northwest Georgia Oncology has taken part in similar demonstrations that were successful in lowering costs while reducing hospitalizations, readmissions, and emergency department utilizations.

Physical Therapy. Sandra Norby, a physical therapist and the owner of HomeTown Physical Therapy, LLC, testified in support of H.R. 556. Norby testified that the locum tenens program has long been an important protector of patient access to care. However, she also said, “now that medicine has evolved to fully recognize physical therapy as part of a comprehensive care model, it is high time that access to physical therapy also receive the same protections against delays due to unavoidable absences by their standard provider.” By allowing physical therapists to participate in locum tenens arrangements, H.R. 556 would improve access to care by keeping clinics open. If physical therapists are permitted, like other Medicare providers, to bring in another qualified provider on a temporary basis in cases of “vacancy, illness, pregnancy, jury duty, or other temporary lack of adequate staffing in the clinic,” care can be administered without interruption. Norby also testified that H.R. 556 promises to lower Medicare costs and reduce delays in patient recovery.

Companies: Northwest Georgia Oncology Centers, P.C.; Oregon Association for Home Care; HomeTown Physical Therapy, LLC

MainStory: TopStory ReimbursementNews ComplianceNews FederalLegislationNews HouseNews CMSNews HomeNews PaymentNews PartANews PartBNews QualityNews RuralNews SafetyNews

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