Educational Session Descriptions

MONDAY, March 23, 2009
Concurrent Educational Sessions (100 series)
10:30 am to Noon

101-One Year Later: The Evolving Face of the Home Health PPS and Its Impact on the Practice of Home Health Care

In January 2008, Medicare-certified home health agencies began the difficult task of adapting to the first round of major programmatic changes since inception of the prospective payment system (PPS) in October 2000. This session will provide an in-depth look at what has happened since that time and how it has affected the practice of home health care.

Objectives:

• Identify organizational and operational impacts of PPS reform;
• Explain changes in clinical services triggered by the revised PPS; and
• Recognize emerging factors in the revised PPS that affect revenue and costs.

Faculty: Betty Gordon, Principal, Operational Consulting Division; William Simione III, Principal; both from Simione Consultants, LLC, Hamden, Conn.; Amanda Twiss, President, Outcome Concept systems, Inc., Seattle, Wash.

Course Level: Update; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

102-Answers from the Experts: CMS Panel on the Medicare Hospice Benefit

This popular annual program is a tradition for the NAHC March on Washington Conference as it provides attendees the opportunity to hear from and ask questions of a panel of top Centers for Medicare & Medicaid Services (CMS) hospice experts. CMS will address important issues of the day, leaving time for providers to focus attention on other topics of concern. Among the items discussed will be: interpretive guidelines for the new hospice conditions of participation (CoPs); survey and certification issues; hospice medical review; and other regulatory areas of interest.

Objectives:

• Explain CMS hospice interpretive guidelines;
• Discuss hospice conditions of participation; and
• Identify top survey deficiencies.

Faculty: Lori Anderson, Director, Division of Home Health, Hospice & HCPCS, Chronic Care Policy Group, CMS, Baltimore, Md.; Danielle N. Shearer, Health Insurance Specialist, Office of Clinical Standards & Quality, CMS, Baltimore, Md.; Capt. Mary Rossi-Coajou, MS,RN, Nurse Consultant, Office of Clinical Standards & Quality, CMS, Baltimore, Md.; Jan V. Tarantino, Director, Division of Continuing Care Providers, Survey & Certification Group, CMS, Baltimore, Md.

Course Level: CEs not available for this session.

103-The Future of Private Plans Under the Medicare Program

The Medicare program has had a private plan option for decades, but enrollment levels have waxed and waned depending on actions taken by Congress relative to reimbursement and regulatory requirements. Dubbed “Medicare Advantage” (MA) under the Medicare Modernization, Improvement and Prescription Drug Act of 2003, private plans saw dramatic enrollment increases beginning in 2006. As oversight during 2006 and 2007 revealed concerns about excess payments to plans, key players in Congress began to press for program reforms, and during 2008 some changes were made to the rules governing MA plans. This session will chart historic changes in the MA program and provide insight into recent regulatory and legislative activities expected to have an impact on the program’s future popularity and the effect on the delivery of home health services.

Objectives:

• Outline structure of the MA program;
• Describe recent regulatory and legislative changes to the MA program; and
• Discuss the potential impact these changes may have on plan participation, enrollment, and delivery of home health services to plan enrollees.

Invited Faculty: Vicki Gottlich, LLM, Senior Policy Attorney, Center for Medicare Advocacy, Washington, D.C.; Theresa M. Forster, Vice President for Policy, National Association for Home Care & Hospice, Washington, D.C.

Course Level: Update; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

104-Home Health Quality Improvement (HHQI) Campaign – Findings and Future Plans

More than one-half of the nation’s 9,000-plus Medicare-certified home health agencies volunteered to participate in the first phase of the Home Health Quality Improvement Campaign that was launched in January 2007, by the Centers for Medicare & Medicaid Services (CMS). A 12-month project aimed at reducing avoidable hospitalizations, the campaign issued 12 best practices packages by April 2008, and provided reports so participating agencies could assess their progress. This session will provide an evaluation of the campaign’s findings and results, CMS activities related to the second phase of this important campaign, and insight into what the project findings might have for the future of home care practice.

Objectives:

• Describe the HHQI Campaign;
• Discuss the results of the campaign’s efforts and the potential effect it will have on the future of home care practice; and
• Describe the role Quality Improvement Organizations (QIOs) play in the second phase of the HHQI campaign and home care quality in the future.

Faculty:Cynthia Pamon, Health Insurance Specialist, Office of Clinical Standards & Quality, CMS, Baltimore, Md.; Charles Schade, MD, Director, Scientific Support, Quality Insights of Pennsylvania, Harrisburg, Penn.

Course Level: Update; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

MONDAY, March 23, 2009
Concurrent Educational Sessions (200 series)
2 to 3:30 pm

201-CMS Panel on Home Health Regulatory & Policy Issues

Representatives from the Centers for Medicare & Medicaid Services (CMS) will discuss regulatory and policy initiatives for 2008 and beyond. In addition to the latest on vital topics like payment and survey and certification issues, panelists will discuss CMS’ quality initiatives and other efforts.

Objectives:

• Describe major regulatory and policy changes CMS is planning to make in the home health program;
• Discuss the rationale behind the changes; and
• Identify how these changes will impact your agency and how operations must be modified in order to comply with changes.

Faculty: Debra Terkay, Center for Medicaid and State Operations; Marie Casey, Office of Financial Management; Mark Zobel, Medicare Contractor Management Group (invited); Lori Anderson, Chronic Care Policy Group; Shannon Flood, Office of Research, Development & Information; All from the Centers for Medicare & Medicaid Services, Baltimore, Md. Integrity Group, Chronic Care Policy Group, Survey & Certification Group, and Office of Clinical Standards & Quality, all of the Centers for Medicare & Medicaid Services, Baltimore, Md.

Course Level: CEs not available for this session.

202-How to Meet the New Hospice CoPs – Clinical, Operations, Administrative and Legal Requirements

In June 2008, the Centers for Medicare & Medicaid Services issued the first overhaul of regulations governing Medicare hospice services since 1983. The new requirements include an array of changes that will affect virtually every aspect of hospice service delivery – clinical, operational, administrative and legal. This workshop will provide valuable insights into effective means for ensuring that your hospice meets its obligations under the new CoPs.

Objectives:

• Discuss new quality assessment and performance improvement requirements;
• Identify new requirements for initial and ongoing comprehensive assessments; and
• Identify new legal and operational requirements.

Faculty: Susan Bruno, LCSW, ACSW, The Hospice Institute of the Florida Suncoast, Clearwater, Fla.; Kenneth Burgess, J.D., and Michael Hale, JD, RN, Poyner & Spruill, LLP, Raleigh, NC; Hospice Provider TBA.

Course Level: Overview; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

203-Advocacy from A to Z – Lobby Your Member of Congress

This program will familiarize participants with the methods and techniques of lobbying to communicate successfully with members of Congress regarding home care and hospice priorities. Participants will learn how to conduct a lobbying visit, avoid common errors and do effective follow up. Workshop presenters have extensive experience working on Capitol Hill and knowledge of current home care and hospice legislative issues.

Objectives:

• Discuss how to successfully conduct a lobbying visit;
• Demonstrate what to do during the three most common types of legislative interviews and how to avoid the two most common mistakes; and
• Outline follow-up activities and describe the most effective means for communicating with members of Congress.

Faculty: Jeffrey Kincheloe, JD, Vice President for Government Affairs, U.S.Senate; National Association for Home Care & Hospice, Washington, D.C.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/SKA).

204-Accounting for Differences: Does Home Health P4P Risk Adjustment Adequately Account for Patient Variation?

In recent years private and public payers have increasingly focused on creating financial incentives for providers to improve care quality, and in some cases even assessing penalties for poor quality outcomes.  In order to ensure the appropriate payments based on outcomes, the patient's risk at admission must be fully assessed.  At this session, researchers will present data on the diversity of the home health population, and the extent to which risk adjustment adequately accounts for this diversity.  The Medicare Home Health Pay for Performance Demonstration Project, as well as future goals of pay for performance, will then be discussed.

Objectives:

• Discuss risk adjustment and diversity among home health patients
• Describe the current home health P4P demonstration project.
• Outline options for future home health payment strategies pay based on performance.

Faculty:  Henry B. Goldberg, Senior Associate, Health Policy & Clinical Research, Abt Associates Inc., Cambridge, Mass.; Christopher Murtaugh, Associate Director, Center for Home Care Policy and Research, Visiting Nurse Service of New York (presenting data from his work funded by ASPE), Amanda Thomas,r Director of Research, National Association for Home Care & Hospice, Washington, D.C.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/MAS).

MONDAY, March 23, 2009
Concurrent Educational Sessions (300 series)
3:45 to 5:15 pm

301-What Lies Beneath: Shedding Light on Variations through the Study of Home Health Claims Data

The practice of home health is becoming increasingly complex, and variation appears to be more the norm than the exception. What are the factors that contribute to these variations?  This workshop will provide findings of in-depth home health claims analysis of hospital-based and free-standing agencies conducted by the National Association for Home Care & Hospice with the goal of explaining the impact of organizational and patient differences on an agency’s practices and prospects. A panel of research experts will be on hand to provide their perspectives and insights on the data.

Objectives:

• Describe the differences between hospital-based and free-standing agencies regarding patient characteristics;
• Discuss differences in patient utilization and diagnoses among patients treated in these two settings;
• Suggest policy recommendations for the Medicare Payment Advisory Commission (MedPAC) in assessing hospital-based agencies in future studies of home health care.

Faculty: Richard Chesney, President, Healthcare Market Resources, Drescher, Penn.; Amanda A. Thomas, Director of Research, National Association for Home Care & Hospice, Washington, D.C.;

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/FIN).

302-Balancing Hospice Clinical Excellence and Financial Stability

As hospices adapt to the many changes under the new Conditions of Participation and Centers for Medicare & Medicaid Services (CMS) hospice data collection requirements, a special focus must be placed on the delicate balance of optimizing organization-wide operations and remaining within budgetary limitations through effective financial management. This workshop provides guidance on ensuring the new requirements are met while core structures of finance and operations are well grounded – even amid a sea of change.

Objectives:

• Identify operational approaches to meeting the new CoP requirements;
• Discuss methods to achieve cost efficiencies and stabilization techniques in the evolving new CMS regulatory demands; and
• Identify electronic applications to help hospice operational success.

Faculty: Robert Simione, Principal, Simione Consultants, LLC, Hamden, Conn.; Carla Braveman, BSN, RN, M.Ed., CHCE, President/CEO, Big Bend Hospice, Tallahassee, Fla.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/SEB).

303-Up Close and Personal: The OASIS-C Assessment Instrument

The Centers for Medicare & Medicaid Services (CMS) expects to complete testing and submit OASIS-C to the federal Office of Management and Budget for approval in late 2008, with plans to implement the new assessment instrument in January 2010. In addition to reviewing the testing results, this workshop will provide an in-depth view of the new assessment tool that will be used to measure quality and establish payments under the Medicare home health program.

Objectives:

• Describe the findings of CMS’ OASIS-C testing;
• Identify the major new components of the OASIS-C assessment instrument; and
• Outline the major implications of the new assessment instrument for measuring quality and establishing home health payment.

Faculty: Deborah Deitz, Nurse Researcher, Abt Associates, Inc., Cambridge, Mass.; Elizabeth Madigan, RN, PhD, FAAN, Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

Legal Symposium Workshops

WEDNESDAY, March 25, 2009
Concurrent Educational Sessions (400 series)
8:30 to 10 am

401-Back to Basics – Medicare’s Coverage of Home Health Services

Since 1997, the home health care world has focused on the myriad of program changes that shifted payment from cost reimbursement to a prospective payment method. As a result, there has been dramatic change in the nature of the home health patient and the services provided. However, there has been no substantive change in Medicare coverage criteria. This program provides a revitalized tour of Medicare coverage standards regarding therapy services, home health aide care, homebound status and intermittent care. Is your agency’s understanding of Medicare coverage on target?

Objectives:

• Discuss the scope and breadth of Medicare coverage of home health services;
• Identify detailed coverage criteria for homebound status and the intermittent care limitation; and
• Outline the standards to meet for coverage of skilled nursing and therapy services.

Faculty: Mary St. Pierre, Vice President for Regulatory Affairs, and William A. Dombi, Vice President for Law, National Association for Home Care & Hospice, Washington, D.C.

Course Level: Overview; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

402-Not Just Red Tape: Implications of the New Provider Enrollment Requirements for Compliance Action

The Centers for Medicare & Medicaid Services made major changes to the provider enrollment process in recent years that affect both new and existing home health agencies and hospices. But the new, more complex requirements represent more than a few additional “hoops” for agencies to jump through. This session will go beneath the surface of the new provider enrollment requirements to reveal some of the more complex motivations behind the new information collection efforts, and the implications they may have for your agency and potential compliance actions.

Objectives:

• Outline the new enrollment process and requirements for new and existing agencies;
• Describe the variety of uses that federal government has for the information required under the provider enrollment rules; and
• Discuss potential compliance-related issues that could arise from the new requirements.

Faculty: Denise Bonn, Esq., Deputy Director, Center for Health Care Law, National Association for Home Care & Hospice, Washington, D.C.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

WEDNESDAY, March 25, 2009
Concurrent Educational Sessions (500 series)
10:15 to 11:45 am

501-Hiring and Firing – Doing it Right the First Time!

Home care and hospice employers are constantly faced with issues related to employment law. These issues include matters of discriminatory employment actions, worker discipline, employee discharges and employee leave time. This program provides an overview of state and federal employment laws that are implicated in hiring and firing decisions, and offers practical recommendations on managing these legal responsibilities.

Objectives:

• Identify federal civil rights law standards in the recruitment and hiring of staff;
• Recognize risk areas in employee discipline actions; and
• Discuss best practices in employment policies regarding hiring and firing.

Faculty: Kerry Parker, Esq., Epstein Becker & Green, Newark, N.J.

Course Level: Overview; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/PHR).

502-Legal Issues in Competition

All is NOT fair in health care competition – there are legal restraints that should affect business conduct in the never-ending quest for success or survival. These legal considerations include federal and state anti-trust law, state unfair trade practices law and the use of non-compete clauses in business and employment contracts. In addition, concerns can arise that implicate slander/libel issues and tortious interference with business arrangements.

Objectives:

• Identify federal and state laws applicable to business competition;
• Describe the benefits and burdens of utilizing employee non-competition agreements; and
• Define the role of federal and state governments in enforcing anti-trust laws on behalf of private competition.

Invited Faculty: William A. Dombi, Vice President for Law, National Association for Home Care & Hospice, Washington, D.C.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

WEDNESDAY, March 25, 2009
Concurrent Educational Sessions (600 series)
1:30 to 3 pm

601-Legal Issues in Patient Freedom of Choice

The competition for patient referrals is as fierce as ever with the growth in numbers of home health agencies and hospices. Complaints of patient steering, directed hospital discharges and blocking of patients choice of provider are heard everyday. What really are the rights and responsibilities of patients, referral sources and home health agencies/hospices? This program offers both the standards that must be met to achieve compliance with patient choice and the steps to take when your competitor is missing the mark.

Objectives:

• Identify federal obligations of hospitals in discharge planning in relation to patient referrals;
• Explain options available to referral sources regarding the patient’s exercise of their freedom of choice; and
• Identify available remedial action including complaints to state survey units and Federal False Claims Act litigation.

Faculty: Denise Bonn, Esquire, Deputy Director, Center for Health Care Law, National Association for Home Care & Hospice, Washington D.C.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/RE).

602-The IRS and Home Care – Are you Compliant?

Whether you like it or not, tax laws impact your business on an everyday basis. The key is to understand the basics and know when to turn to the experts. There are a number of tax law areas that have particular application to the business of home care. This program addresses such issues as: classifying workers as independent contractors, the requirements of the new IRS Form 990 for non-profits, allowable business deductions and other relevant issues.

Objectives:

• Identify standards for distinguishing independent contractors and employees for tax purposes;
• Recognize new standards for completion of IRS 990; and
• Discuss home care specific tax law considerations.

Faculty: Mark Sharp, CPA, Partner, BKD, LLP, Springfield, Mo.; Brian Todd, CPA, Senior Manager, BKD, LLP, Springfield, Mo.

Course Level: Intermediate; 1.5 Nursing CEs; 1.0 Accounting CPE (NASBA/TAX).