Home health, hospice, and children’s health continue to be issues for the HHS.
Even with the best of intentions, recommendations often fall on deaf ears. Annually, the OIG calls out the HHS for not taking its quality and cost-savings advice into account in the Compendium of Unimplemented Recommendations. And this year’s report suggests the HHS has a lot to work on.
Background: In the Compendium, the OIG covers a wide array of HHS programs, including Medicare, Medicaid, marketplaces, and health IT, says attorney Connor Duffy, Esq., with Robinson & Cole LLP in Hartford, Conn. OIG highlights and details 25 unimplemented recommendations from its past reports. In addition to CMS programs, other organizations on the OIG’s 2017 radar are the Food and Drug Administration (FDA), the Administration for Children and Families (ACF), and the Indian Health Service.
Top issues: “HHS has made progress in implementing many of the recommendations included in this Compendium,” the the OIG report says. “However, as of April 2017, OIG has reason to believe that more can and should be achieved. More broadly, OIG continues to focus on several priority areas that require HHS and State improvements.” The federal watchdog pinpoints these top problem areas where it will continue to focus its attention:
OIG Homes In On Medicare
Warning: The OIG had a variety of unimplemented recommendations for Medicare Parts A and B. Specifically, the report said that CMS should:
Watch out: Medicare Parts C and D didn’t escape the OIG’s center of interest either. For these programs, the OIG charged that CMS should:
SNFs Come Under Fire
One of the more significant bombshells in the OIG’s report for Medicare Parts A and B impacts skilled nursing facilities (SNFs). In the Compendium, the OIG once again charges that CMS should change the way Medicare pays SNFs for therapy services. Also, the OIG wants CMS to reduce payment rates for therapy.
The problem: “SNFs increasingly billed for the highest level of therapy even though beneficiaries’ characteristics remained largely unchanged,” the report said. “Increases in SNF billing, particularly for the highest level of therapy, resulted in a combined $1.1 billion in Medicare payments in fiscal years (FYs) 2012 and 2013, despite beneficiary characteristics remaining nearly identical.”
The solution: OIG maintains that a revamp of the SNF therapy payment guidelines would improve the issues, but warns that “CMS would need additional statutory authority to reduce Medicare’s base payment rate for therapy,” the report said.
EHR Concerns Persist
Another issue targeted in the Compendium involves fraud vulnerabilities in EHRs. “We found that nearly all hospitals with EHR technology had audit functions recommended by RTI International, but these hospitals may not be using them to their full extent,” the OIG said in the report.
Though the Office of the National Coordinator for Information Technology (ONC) and CMS have worked jointly to eradicate fraud, abuse, and data loss, the OIG report suggests that the organizations can do more to solve this persistent issue. “ONC and CMS should strengthen their collaborative efforts to develop a comprehensive plan to address fraud vulnerabilities in electronic health records,” the OIG recommended in the Compendium advice.
Resource: To read the OIG 2017 Compendium of Unimplemented Recommendations, visit https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2017.pdf.