Home Health & Hospice

Weekly roundup

Homecare Insider, May 23, 2016

Overtime laws could change the game for home health

The Department of Labor’s final rule on overtime requirements for salaried employees, issued last week, will have repercussions for home health agencies (HHA) and hospice providers, industry experts said. The final rule, which will take effect December 1, 2016, increases minimum salary requirements for overtime exemptions for salaried workers from its current level of $23,660 per year, or $455 per week, to $47,476 a year, or $913 per week.

HHAs with salaried employees under that new threshold will have to pay overtime—1.5 times an employee’s regular rate—for labor beyond 40 hours within a workweek. The rule change will cause a “significant administrative burden” for home care and hospice because the business is visit-based, William Dombi, vice president for law at the National Association of Home Care and Hospice (NAHC), told Home Health Care News. He predicted that tracking staff time would be a major task for HHAs.

Minimum wage and overtime protection for hourly homecare workers became the law of the land last fall, when the DoL extended a 2013 rule to the field of home health. The latest rule applies to salaried employees who previously made too much—i.e., more than $23,660 annually—to be eligible for overtime. HHAs are expected to respond to the rule by possibly cutting hours to avoid overtime situations, or by altering compensation—possibly by moving away from payment on a per-visit basis, Home Health Care News has reported.

Medicaid-funded homecare agencies that serve individuals with intellectual or development disabilities will have until March 2019 to implement the overtime rule, as will Medicaid-funded residential care facilities with 15 or fewer beds, according to the Labor Department.

Source: Home Health Care News, U.S. Department of Labor

Study finds prognosis ‘discordance’ between physicians, caregivers

Caregivers for critically ill patients often have a different outlook than the patients’ physician, according to a study that appeared in the Journal of the American Medical Association last week. Based on more than five years of data, the researchers found what a significant “physician-surrogate discordance” about prognosis of critically ill patients in more than half of the cases they studied.

The study consisted of quantitative surveys and qualitative interviews conducted in four ICUs at a major U.S. medical center involving 229 surrogate decision-makers and 99 physicians caring for 174 critically patients at high risk of death from January 2005 to July 2009.

Physician-surrogate discordance about prognosis occurred in 122 of the 229 instances (53%). In 65 instances (28%), the discordance was related to both misunderstandings by surrogates and differences in belief about the patient’s prognosis; 38 (17%) were related to misunderstandings by surrogates only; and seven (3%) were related to differences in belief, according to the study.

The study found other reasons for the discordance, including:
•    A need to maintain hope to benefit the patient
•    A belief that the patient had unique strengths unknown to the physician
•    Religious beliefs

Source: JAMA

Home health prior authorization: Public comments are unanimous

All of the public comments on the Federal Register blast the Medicare Probable Fraud Measurement Pilot (CMS-10406), announced in February, as an administrative burden and an impediment to delivering vital patient care rather than an effective way to cut waste fraud and abuse in Medicare-funded home health.
The pilot program, announced in February, would require HHAs to obtain prior authorization for patient services before delivering care. This would lower the risk of improper Medicare payments for these services, according to the proposed rule.

However, the proposal would result in increased costs, several commenters stated. For example, patients’ conditions could worsen and result in rehospitalization if care were delayed; HHAs would need to add administrative staff to manage the prior authorization process; and agencies could potentially end up providing care without securing payment.

In addition, several of the comments questioned the need for further waste fraud and abuse measures on top of the requirements already in place.

Source: Federal Register

Hospice doc urges dying patients to choose VSED

As more states begin to debate physician-assisted suicide legislation, one Arizona hospice physician explained why she and other hospice physicians would not honor dying patients’ requests if physician-assisted suicide becomes law.

In a Los Angeles Times editorial last week, Ann Marie Chiasson, MD, a hospice and palliative care specialist and the assistant fellowship director at the University of Arizona's Center for Integrative Medicine, wrote that assisting a patient suicide would violate physicians' Hippocratic Oath to “first, do no harm.” Instead, she stated, dying patients or their caretakers could opt for VSED (voluntary stopping of eating and drinking).

Chiasson stated that based on what she’s seen in her practice, “[VSED] is a pleasant way to go. Hunger is gone after the first three days. … And thirst can be managed by rinsing the mouth or taking ice chips. Patients drift off into a coma over the course of a few weeks,” she wrote. “I had to see such deaths in my practice many times to believe that not eating and drinking at the end of life was a good thing.”

Dying patients who choose VSED can still receive pain medication, she wrote.

Source: LA Times