After seven government settlements in 10 years, the Tenet Shareholder Committee says Tenet Healthcare Corp. is still no closer to true reform.
That's why the committee, which was formed four years ago to bring corporate governance reform to the hospital giant, asked the Department of Justice May 26 to include seven recommended provisions in any global settlement with Tenet. Without these provisions, allegations of Medicare fraud and patient abuse will continue to plague Tenet, the committee says.
Some of the alleged missteps made in the past include conducting secret settlement negotiations, poor enforcement of corporate integrity agreements, compliance reports shielded from public scrutiny, and settlements that have returned mere "pennies on the dollar" to federal healthcare programs, the committee claims
"These settlements failed to prevent a recurrence of scandals, which have driven up healthcare costs for everyone," said committee chairman Dr. M. Lee Pearce. "There is justified concern that yet another settlement, the eighth, will result in just more of the same.
"These settlements should be more than some kind of an endless pro-wrestling match between the government and Tenet's hired guns," he adds.
The committee recommends these seven provisions:
-- to hold Tenet executives and board members responsible for unjust enrichment at the expense of patients, shareholders and taxpayers,
-- to terminate and ban offending individuals from future participation in government healthcare programs,
-- to base hospital CEO pay incentives on the delivery of quality healthcare,
-- to disclose records turned over to the government during investigations,
-- to tighten enforcement of corporate integrity agreements,
-- to open access to CIA compliance reports, and-- to recover all funds misappropriated from government healthcare programs.
Good news for home health agencies: Medicare intends to increase your payments by $270 million in 2005, according to a proposed rule in the June 2 Federal Register.
According to the Centers for Medicare & Medicaid Services, the government expects to save $90 million in 2005 by changing the home health prospective payment system to a calendar-year update cycle instead of a fiscal-year cycle. Therefore, you should see the 2.5 percent pay hike on Jan. 1, 2005 instead of Oct. 1, 2004.
The pay increase is based on the proposed home health market basket, which is expected to increase 3.3 percent in 2005, minus 0.8 percentage point, yielding a national 60-day per-episode payment rate at $2,268.70 for 2005. The calendar year 2004 rate is set at $2,213.37.
Provisions in the Medicare reform bill also update payments for home health services furnished in rural areas. Episodes or visits ending on or after April 1, 2004 and before April 1, 2005 will be increased by 5 percent, according to CMS.
The privacy rule lets patients view their protected health information. What it doesn't do is give you a strategy to make that happen. These steps will have you properly responding to patient requests in no time.
Step 1: Get a Guru
Any policy or procedure is going to fall apart at the seams without a trained professional to "shepherd the process," says Gina Cavalier, an attorney with Sonnenschein, Nath & Rosenthal in Washington, DC.
Your patient record point-person must be able to "look at the records and do an overview of them before deciding whether to approve or deny the request," asserts Deborah Larios, a partner in the Nashville, TN office of Miller & Martin. Patients have to know what they're looking at, she explains.
Whoever you assign to this task must also have a good working relationship with your business associates, Cavalier reminds; he or she "has to know how to contact the appropriate people at those entities in order to fully comply with the patient's request" in a timely manner, she asserts.
Your records manager must also train the entire department on how to process and fulfill requests, reminds Cindy Nixon, medical records director and privacy officer for Cookeville Regional Medical Center in Cookeville, TN. "Any problems must be immediately sent to the medical records person" to ensure that patients receive the best possible outcome, she asserts.
Step 2: Make the Record Work For You
"You may always provide access, but you may choose to deny access in limited cases," Cavalier says. Example: You're not required to provide patients with their psychotherapy notes, she states. "You have to use your best judgment to make that decision," she adds.
Problem: "The record may contain information about other patients or the patient's family," Larios notes. You cannot give your patient that information.
Remember: You should also leave out incident reports or any other information not part of the designated record set, she says.
Solution: Rather than waiting for patients to request their information, filter records as you create them. "The past practice was to lump all information about a patient together," but special information required for insurance purposes or for your attorneys doesn't need to be stored in the chart, Larios affirms. "It's too easy to forget and then give that information to the patient," she explains.
Caution: You cannot separate any information that has been used "for patient care or to make decisions about a patient," Larios reminds. "Train your staff to recognize what information a patient has a right to see," she suggests.
And be up-front with your patients about what information they are seeing, experts concur. If you are denying access, you must give patients a reason for it. A blanket form is a quick, painless solution.
Step 3: Bug Your Business Associates
"If your billing company has patient records, you have to ask for all the PHI they hold," Cavalier counsels. "You must also go to your business associates and pull back any information they have," she adds.
Plan ahead: Set up your business associate agreement (BAA) to highlight this need, Cavalier recommends. The BAA must require "the BA to promptly provide any PHI that you request in connection with an individual's request for access," she advises.
The privacy rule mandates that you supply information within 30 days, but "some states have laws that are more stringent," Cavalier reminds. Best practice: "Set a time limit in your BAA for getting information from your associates" so that you meet both requirements, she recommends.
Step 4: Be Present and Polite
When patients are handling their original files, your staff must be observant. "There are many cases where a patient gets mad, tries to tear up their record or pulls out a pen to change it," Nixon warns. Staff presence can deter this behavior.
However, your staff should not attempt to explain to patients what is contained in their files. "Tell them to talk to their providers," Nixon suggests. "If they are concerned about quality of care, then we have them make an appointment with the risk manager," she relates.
Considering the limited space at most hospitals, you will want to develop a process for allowing walk-ins. Strategy: "Schedule a mutually convenient time for the patient to come in and look at the record," she recommends. You can also offer to send them a copy of the record for a small fee and guarantee a quick turn-around time, she suggests.