1. I want to get the word out about the benefits of home care medicine. How can I help?

Join the Academy! If you are not already a member, visit the Membership page of our website for information about member benefits and opportunities. The American Academy of Home Care Physicians is a 501(c)(3) nonprofit organization, offering many opportunities for donations and sponsorship. Individual and corporate contributions are welcome and are tax deductible. Donations can be given as unrestricted funds or to support specific projects such as educational seminars, conferences and the AAHCP's Annual Scientific Meeting, creation and updating of Academy publications, AAHCP website updating, and administration of the home care certification examination. Memorial and tribute gifts can also be made in memory or honor of an individual. If you are practicing home care medicine, you can also help spread the word by speaking about house calls at local or national meetings of your professional associations and/or writing newsletter articles.

1. What can I do to prepare for IAH, should the bill be passed?

The things to do now are to:

a. Read the bill summary and the bill itself please note requirements for qualification, the things you would be responsible for providing or coordinating; the risk requirements and begin to think about whether you/your practice fit the requirements stipulated in the bill and if not, what you can do to get ready.

b. Read the PowerPoint presentations on getting ready for IAH which was the theme of last year's Annual Meeting. Go to http://www.aahcp.org/2008annualmeeting.shtml. Pay particular attention to presentations about the practice management/risk management issues if you do not now participate in risk-based contracts. Think about the speakers' advice about how to get ready.

c. Follow the Newsletter articles on IAH as they evolve. One of the issues is the methodology for matching patients with payment data so that savings can be calculated. CMS will have to devise a final methodology and instructions if and when the bill passes. In the meantime, some have collected and some published data on cost savings using a variety of methods, any of which are worth trying if you have the resources to do the data collection and computations. We have posted the latest edition of the cost-effectiveness summary on the web which contains references to articles/studies that may be of use.

1. Is there a standard credential for those practicing home care medicine?

Yes. The Home Care Credentialing Examination enables home care medical providers to demonstrate their proficiency. Patients also benefit from proficiency testing and the Academy's recognition of those who receive the credential since the exam assesses the knowledge and skills identified by respected exerts as necessary to provide safe and effective medical care in the home. For information about the exam, visit http://www.aahcp.org/hccei.shtml.

2. Is training available for Medical Directors of HHAs?

Yes. The AAHCP offers training and certification specifically for home health agency (HHA) directors. As models for reimbursement to HHAs stabilize, interest is growing among agency management to have involved medical directors. If you or your agency is interested in having a custom course/certification examination designed, please contact us.

1. Is there a set of standards or ethics common to all home care physicians?

Yes. The AAHCP has developed a Standards of Conduct that can be found in the Member Resources section of our website. The AMA Principles annotated for Home Care are also available from the AAHCP.

1. What do I need to know about Stark rules?

The "Stark law" prohibits physicians from making referrals to providers who render "designated health services" if referring physicians have an ownership or investment interest in or compensation arrangement with the providers. Two provisions are of particular interest to Academy members, the Personal Service Consulting Arrangements Exception and the Payment Methodology rule. For details, see the April 2004 issue of Frontiers or visit the Information for Home Care Professionals section of our website.

2. Where can I find the latest updates to the Stark rules?

On September 5, 2007, updates to the Stark rules were published in the Federal Register, revealing a useful change for physicians serving as medical directors of home health agencies (a role that falls under Stark). The previous requirement that compensation be at fair market, based upon surveys of emergency room physicians or published salary surveys of similar specialists has been removed. Fair market compensation is still required, but no specific definition is given. Other requirements about advance determination of compensation and no link to number of referrals remains. For an advance view of the rules, see http://www.cms.hhs.gov/PhysicianSelfReferral/Downloads/CMS-1810-F.pdf. Pages 20-23 address fair market value. Pages 457-458 address the special provision for home care physicians.

3. I have been working with a home health agency who is asking me to see their hospice patients and they will pay for it. Are there any Stark violations?

Hospices are excluded from Stark regulations, but anti-kickback rules apply. For Medicare patients, if you are not the primary physician (i.e. certifying the hospice admission), you must bill the hospice for the visit(s). [Carrier will deny claim unless you are the primary physician]. You should have a written contract with the hospice. You may agree on any amount/fee schedule, but the hospice will only be reimbursed by Medicare (in addition to their per diems) at the Medicare fee schedule rate. If you have a medical director type relationship, you also bill the hospice at your negotiated rate.