State news: 5 states testing home health program, hallway beds draw complaints in N.Y.

State news: 5 states testing home health program, hallway beds draw complaints in N.Y.

Here’s a roundup of healthcare news from Florida, Illinois, Massachusetts, Michigan, New York, Maryland, Texas and New Hampshire.

CMS announces home health pre-claim review demo

Home health agencies in five states will have to submit required clinical documents before submitting Medicare claims under a three-year demonstration program announced by CMS.

“CMS is testing whether pre-claim review improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies providing services to people with Medicare benefits,” the agency’s statement said. “Additionally, CMS is also testing whether the demonstration helps reduce expenditures while maintaining or improving quality of care.”

While CMS said the program shouldn’t adversely affect care, the Partnership for Quality Home Health Care argued it would.

"[The] demonstration does not go far enough to protect patients from potential harms inherent with pre-claim review, including confusion, delays and service interruptions in care for a vulnerable patient population" said the Partnership’s Colin Roskey to POLITICO.

The demo begins in Illinois no earlier than Aug. 1, 2016; Florida no earlier than Oct. 1, 2016; Texas no earlier than Dec. 1, 2016; and Michigan and Massachusetts no earlier than Jan. 1, 2017.

N.Y. hospital staff complains about hallway beds

Several residents, a nurse and one attending physicians complained to POLITICO about the use of hallway beds and their effect on care at Montefiore Medical Center in New York.

The staff, who chose to remain anonymous for fear of retaliation, claimed the hospital has put up to seven beds in hallways on several floors. When they bring their concerns to management, they’re supposedly ignored.

In one example, a resident said the hospital has violated its own rules in the emergency department (ED) by putting patients who can’t walk or speak into an area where there’s no private bathrooms or call buttons.

“It’s horrifying to see patient who is incontinent—and a nurse is trying to change a patient behind a screen that offers no privacy,” said one resident. “It’s disgusting.”

Residents spoke of have to conduct breast and rectal exams on patients in hallway beds.

Montefiore administrators said patients have to consent to being placed in a hallway, and said the facility is taking steps to relieve overcrowding in its ED.

Maryland hospitals settle for lower-than-requested rate hike

Maryland’s Health Services Cost Review Commission approved an average 2.72 percent reimbursement rate for hospitals in the coming fiscal year, below the hospitals’ request for a 3.27 percent hike.

The Baltimore Sun reported the state regulators wouldn’t go that high because of a five-year agreement which began in 2014 allowing higher Medicare and Medicaid reimbursements for Maryland hospitals in exchange for keeping the annual healthcare spending growth in the state below 3.58 percent.

It also required Maryland to keep Medicare spending per beneficiary below the national average. Failing to meet that mark this year would trigger a review of the agreement.

Med groups, telehealth industry try for compromise on Texas telehealth rules

The Texas Tribune reported a potentially nasty fight over regulations on telemedicine in Texas may be averted thanks to cooperation between the industry and medical groups.

A law backed by physician groups passed last year required most physicians to meet face-to-face with patients before treating them remotely. Telehealth groups challenged the law in court, but now, the two sides have begun a negotiating a compromise to present to Texas legislators next year.

An e-mail obtained by the Tribune said lobbyists from both industries have been meeting to “discuss "modernizing our telemedicine statutes and reducing the regulatory footprint governing the provision of telemedicine services.”

The compromise would supposedly be modeled on Indiana’s telemedicine law, which doesn’t require an in-person visit.

New Hampshire suing maker of OxyContin

Purdue Pharma is being sued the state of New Hampshire over claims it distributes “misleading information” to physicians about its opioid painkiller OxyContin.

The Concord Monitor reported the company made 217 marketing visits to the state in 2014, the most recently available data, with the state’s attorney general’s office finding Purdue engaging in “deceptive marketing” which doesn’t disclose the risks of long-term opioid use.

“Purdue sales representatives continue to make sales visits to New Hampshire doctors during which they misleadingly portray or omit the risk of addiction,” wrote Assistant Attorney General James Boffetti.

Last year, Purdue was one of five pharmaceutical companies to refuse a subpoena to turn over documents related to their marketing practices to the attorney general’s office.