by Michelle Boasten
Surely by now everyone has heard of the #BlackLivesMatter movement. It was started by three women (Alicia, Opal and Patrisse) who wanted to bring serious attention to the murder of 17 year old Trayvon Martin. These women truly understood that there is a devaluing of Black lives which is tied directly to racism. Racism, like any other -ism (i.e. sexism, classism) at its core is a deliberate and intentional design to separate people. One of the tools used to effectively continue this separation are constant and consistent negative messages about a group of people. These messages eventually become a stereotype.
I know many of you reading this are thinking… what on earth does #BlackLivesMatter have to do with Home Health Care? Interestingly enough, there are some strong parallels. Over the last 30 years, Home Health Care has developed a net negative image at the Office of the Inspector General (OIG). Though we insiders know it is undeserved, the OIG stereotype has been well supported by the fraud cases that seem to be in the news every day.
Nothing demonstrates this stereotype better than the video produced by the OIG itself.1 If you are not aware of the official opinion of who we are, you will miss the parallel and not understand the consequences and power of a reputation.
OIG is not alone
Home Health Care, as an industry, is viewed harshly and negatively by many people inside and outside the government. While the OIG may clearly know that there are thousands of good people working hard everyday to care for their patients, they focus on the crooks, thieves and swindlers. This might be difficult to digest when you run a good business and surround yourself with upstanding, hard working, honest people who are trying to serve sick and homebound patients. In fact, you may have been so busy doing that honest work that you missed the fact that there are some who are not doing this at all, who are instead busy stealing from Medicare and Medicaid coffers.
This systemic fraud, waste and abuse has led the OIG, CMS and the DOJ to respond with oversight measures such as moratoriums, targeted audits and now pre-claim reviews, not to mention occasional raids. These measures make it really difficult for the good guys to practice. But where did that come from?
It came from CMS and its contractors conflating criminal intent with sloppy clinical documentation as though both were the same act. Professional criminals may occupy only 4 percent of the industry, as some reports claim, but badly documented homebound status and medical necessity, side by side with multiple unjustifiable successive payment episodes, look like fraud even when the care provided is legitimate. This is what encourages the CMS and its OIG to believe 6 out of 10 of you, instead of 4 out of 100, are crooks. This is how our industry's reputation has been tainted. Home Health Care is caught up in a stereotype brought about by an unwitting collusion between CMS auditors and agency documentation failings and recertification practices that produce a consistent negative message.
So how do you prove you are one of the 4 out of 10 good guys?
The first thing to do is acknowledge that you are aware of the 6 out of 10. Then realize the Feds and their contractors have a low tolerance for sloppy clinical and administrative practices. Now, more than ever before, Home Health Care reimbursement is threatened because our nation’s healthcare budgets can no longer sustain paying for unnecessary -- or unprovided -- patient care.
Agency leadership has to be more alert, scrutinizing every admission, dotting every i and crossing every t. And it wouldn't be a bad idea to start a movement of your own. If you want to showcase your good work and the value Home Health Care brings to the patient, perhaps someone needs to create a #HomeHealthCareMatters movement. Otherwise you might find yourself suffering ever more heavy-handed oversight measures and greater reimbursement cuts.
A smart movement begins with rich, evidenced-based data using technology. The data needs to concentrate on how much Home Health Care keeps healthcare costs down by keeping people out of the hospital. Focus your efforts on successful outcomes and specific measures that can demonstrate evidenced-based practices that quantify your message of how much you really do matter to the payers' bottom line. Perhaps it is your State Association leadership who need to mimic the work of Alicia, Opal and Patrisse, because...
#HomeHealthCareMatters.
1 OIG: "Eye on Oversight: Home Health Fraud" (YouTube)
Michelle Boasten is a humanitarian and social entrepreneur. She is the Founder of "You Can Care, Inc." an IRS 501(c)3 non-profit. Michelle has invented and developed a web and mobile incentivized volunteer caregiving platform to tackle the twin issues of caregiving and student loan debt. www.OnlyOneNurse.com
Prior to "You Can Care," Ms. Boasten founded EVV (electronic visit verification) in 1996. By 1998 the product was patented and today more than 50% of all home health agencies are required and mandated by law to use an EVV system to evidence accountable caregiving activity.