All posts by Anthony Fischer

Tony is Associate Producer of the successful podcast Conversations In Care and Executive Producer of The Fischer Report. As an Elder Care Advocate with over 20 years experience on multiple levels of the healthcare continuum, Tony brings caregivers news and analysis of the latest healthcare news so they can prepare for changes in the healthcare system. That said he has been known to have an opinion on politics from time to time.

Michigan’s Medicare Fraud Problem Caused By Lax Home Care Regulation

Michigan Lags Behind Other States In Home Care Regulation

Home Care services will play a key role in the ever-changing healthcare system.  With an avalanche of Baby Boomers nearing retirement age, the healthcare system is desperate for services that provide quality care cost efficiently while keeping patients from making costly emergency room visits.

Baby Boomers are also demanding more innovation and service improvements in healthcare just as they have of every other service they have consumed. Skilled Home Care, Hospice and Telemedicine have proliferated as a result.  So much so that lawmakers and policy wonks in Washington are expecting a dramatic increase in Home Care utilization over the next decade.

So what’s holding the rapidly growing home care industry back? Fraud.  New companies have sprung forth to meet demand with many founders having little to no experience in healthcare service delivery. Without the proper expertise to compete by providing quality service, owners turn to fraudulent schemes to make ends meet.

As a deterrent to fraudulent behavior the FBI has made a public spectacle of Medicare fraud busts.  The FBI press releases have had their intended effect but they have also had the unintended consequence of deterring patients form using the service.  That combined with the reluctance of doctors to refer to potentially fraudulent providers has slowed the development of this much needed service.

Falling Short

Most states have faced the fraud problem head-on by requiring companies to apply for a state license in addition to the federal Medicare license.  The extra requirements have served as their own deterrent to Medicare fraud.

Still there are four states in the union that don’t require any additional licensing to operate a home care company.  Michigan, Ohio, Iowa and Massachusetts all refrain from further regulating the home care industry. To their credit Ohio and Massachusetts require additional licensing for the professionals that work in the industry.  However Michigan Home Care Companies remain the least regulated and companies in the state remain a major target of the FBI’s Medicare fraud task force.

A Hot-Bed Of Activity

mcquade
Barbara MCquade, US District Attorney, Eastern District

Since 2013 the FBI’s Medicare Fraud Task force has indicted more than 70 Michigan healthcare professionals for medical fraud worth over $410 million. Even the FBI has noticed that southeast Michigan has become a hot bed for fraud activity.

“For whatever reason I think Southeast Michigan has become an opportune area to operate in,” said F.B.I. Special Agent in Charge Andy Arena. “That’s what this task force is trying to show. That this is not the place to be. Get out.”

The Reasons Fraud Runs Rampant In Michigan

Owners Lack Health Care Service Experience

The increase in fraud could have something to do how easily an entrepreneur can open a home care agency in Michigan. Even with little to no knowledge of the healthcare system.  Potential owners can also obtain a license to operate a home care at a relatively small cost. Normally expensive costs like labor can be purchased cheaply through contractual agreements with payment deferred until after the operator receives the license.

This year the federal agency overseeing Medicare and Medicaid reimbursement (CMS) finally issued a moratorium on new home care licenses. However the move comes after many fraudulent companies are already in operation in Michigan.

Infrequent Inspections

Another factor contributing to fraud is the infrequency of home care regulation provided in the current system.  Federal Medicare regulations require that licensed home care agencies be inspected

Photo Courtesy www.FreeDigital Photos.net David Castillo Dominici
Photo Courtesy www.FreeDigital Photos.net David Castillo Dominici

every two years. The Centers for Medicare and Medicaid Services (CMS) depend on third-party regulators to facilitate the survey process. Organizations like the Community Health Accreditation Partner (also known as CHAP) and the Joint Commission provide professionals to conducting inspections.  Although all inspectors receive training a shortage of inspectors often puts the process behind schedule.

The gap between inspections (known in the industry as surveys) opens a window of non-compliance with agencies able to ignore regulations without fear of inspection.  During this time agencies often go without key staff like Qualified Administrators, Clinical Directors, Medical Directors and key office staff to cut overhead cost and squeeze more profit out of the bottom line.  This practice adversely effects care and lowers the inter-agency accountability.  Without key healthcare professionals taking an active part in the company, owners often cut corners and open the door for fraud.

Not A Small Problem

The fraud problem isn’t limited to small companies or start-up companies.  Large companies with years of experience have also fallen into fraudulent habits either through malicious intent or negligent.

More regulation, especially in Michigan can help stem the tide of fraudulent behavior. Additional state licensing, requiring licensed administrators and an increase in inspection frequency can help fix a horribly flawed system.  For now consumers should make themselves aware of the warning signs of Medicare fraud as well as asking their lawmakers to increase home care regulations.

The cost efficiency of home care service can go along way to saving the healthcare system.  Until fraud is rooted out however the American taxpayers will have to foot the bill for billions of dollars in increased healthcare cost.

Presidential Candidates Should Look Beyond Obama Care Repeal

Like it or hate it, the Affordable Care Act (aka Obama Care) was the most significant legislation to be passed into law since the Patriot Act.  The sweeping reform of the healthcare system had the country in an uproar after along passing along party lines in a democrat controlled congress.  Now the uproar has been reduced to a murmur as more and more American’s seek to get coverage from the insurance marketplace.

That is of course unless you listen to the Republican Candidates who vow to “repeal and replace” a law that is set cost the federal government $2.76 Trillion over 20 years including over $270 billion in administrative costs.  

The GOP prefers an open market that will allow competition to lower cost for consumers and increase accessibility for consumers.

But the changes in how consumers buy insurance is nothing compared to the changes in the healthcare system at large since the ACA’s passage. The insurance reimbursement to Hospital systems and the physicians has changed drastically.  Quality Care Thresholds have also changed making reimbursement based on outcomes and not volume of patients treated.  Mountains of policy and regulations changes have occurred as a result.

It is the mountain of new rules that makes the notion of totally repealing Obama Care a false premise. It can only be tweaked but never rolled back completely.

This may be disconcerting for the one issue voters out their who hope a vote for a Tea Party Candidate can get them the type of healthcare reform they prefer.

So if the law can’t be repealed, how can we effect change?

The Affordable Care Act is so complex federal agencies are still working on the regulations that will enforce the spirit of the law.  Decisions on how healthcare organizations are funded, the availability of expensive treatments and quality of care indicators are all being discussed as you read this post.

The ACA gives government agencies more power over our healthcare decision then any other point in our American history. Now is the time for consumers to stay vigilant and voice concerns over the new policies and program being put into place.

The 2016 Presidential Candidates need to back away from sound bites full of empty rhetoric and educate the voters on how they can effect change moving forward. Adhering strictly to the talking points won’t accomplish this.

If the Republican field is truly serious about protecting the healthcare consumer from government overreach they should appoint a healthcare advisor to each of their campaigns to take a hard look the new regulations are having on real people. Otherwise any talk about improving the healthcare system is a waste of our time.

Baby Boomers Poised To Change Healthcare

The Baby Boomers have drastically changed nearly every industry over the last sixty years.  So it should be no surprise that they are having significant effect the healthcare industry as well.

In fact Baby Boomer’s present the single largest challenge the American healthcare industry has ever faced. The Boomers will be using the system at historic rates as the industry tries to meet demand with an aging  and depleting workforce.

This is the most powerful force operating in our health system right now, this generational change,” says Jeff Goldsmith, president of Health Futures Inc., Charlottesville, Va. So far, the growth in the number of senior citizen boomers has been incremental, and its impact on health care has been overshadowed by federal reform and budget battles. “People aren’t paying much attention,” via hhnmag.com

The Post World War II generation is also demanding changes in the healthcare system causing a shift to home-based services such as home care, visiting physician services and hospice.  That is a demand lawmakers believe America’s health care system can rise too.

In July, Senator Ron Wyden (D-ORE) told Medpage Today that he believes a Baby-Boomer inspired revolution is coming to healthcare.

“I believe Medicare and Medicaid are going to lead a revolution in caring for people at home,” Wyden said, especially for chronic illnesses such as cancer, diabetes, stroke, and Alzheimer’s, which account for 93% of Medicare’s costs.

Home Care can save the Medicare system money.  With technological advances in the Bio-med field and electronic medical records, the licensed healthcare professional can access medical information and order treatments just as efficiently than a hospital facility.  For patients who don’t need 24 hour monitoring by a Register Nurse or physician, home care can be a very cost effective service delivery system.

Hospital systems have already figured this out.  They are investing more time and resources into home care services as a way to boost patient outcomes and cut hospital readmission. Minimizing readmission is a key part to the new reimbursement system Medicare has put in place as a result of the affordable care act. By having some control over the patients healthcare delivery after discharge, hospitals hope to curb readmission and provide better outcomes.

With the healthcare industry already embracing the shift to home care and lawmakers willing to fund it.  Look for more innovation in the field of home health care over the next fifteen years.  Innovation that could save the Medicare system from financial collapse.

 

Obama Care Battle Continues After Federal Ruling

Just when you thought all the fuss about Obama Care was over.  Wednesday’s ruling  by Federal Court Judge Rosemary Collyer put the Obama Care fight back on the table and thrusting it into the political spotlight after years of battle.

At the core of the judges decision is funding for the monstrous trillion-dollar healthcare program which was allocated by executive order instead of the regular appropriations process.

“The House of Representatives as an institution would suffer a concrete, particularized injury if the Executive were able to draw funds from the Treasury without a valid appropriation,” Judge Collyer said in her 43-page decision.

Because congress was passed over in the appropriations they did not have the opportunity to excercise their constitutional duties.  Now according to the Judge they can sue for the right to fund (or defund) the program, a lawsuit that will likely land Obama Care on the steps of the supreme court once again.

“The president’s unilateral change to Obamacare was unprecedented and outside the powers granted to his office under our Constitution,” Mr. Boehner said in a statement after the ruling. “I am grateful to the court for ruling that this historic overreach can be challenged by the coequal branch of government with the sole power to create or change the law.”

What does the Republican lawsuit mean for consumers.  Not much considering Republicans are not likely to strip millions of American’s of health coverage during an elections cycle.  However if congressional republicans are success in the suit against the executive branch you may see some changes to the health insurance market place.

If you are hoping that the Collyer’s decision will be the beginning of the end of Obama Care keep hoping.  Reams of paper have already been used to write the regulations guiding the implementation of the wide-reaching health care law.  Consumers may see some tweaks but don’t expect the program to completely roll back.  But don’t expect that to stop the candidates from talking about it as Obama Care will become a hot campaign issue once again thanks to the ruling.

Listen to the Fischer Report during Conversations In Care on Wednesday’s at 8 pm.