This transcript was auto-generated using Adobe Premiere Pro.
00:00:05:00 - 00:00:32:02
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond, where we connect you to what matters in the ever changing world of hospice and palliative care. The Results Are In: More Wins for Hospices in HIS Appeals. Jake, Bryan, I never thought we'd record this episode, but yet again, we got all these victories for these HIS appeals, which was super exciting.
00:00:32:03 - 00:00:59:21
Meg Pekarske
So, Jake, let's start with you because we did a podcast, you and me without Bryan, July 20th of this year, letting people know, hey, you know, you might have gotten one of these letters saying you're noncompliant with the quality reporting requirement and that folks should contact us to appeal these. And we actually did get a lot of phone calls from that.
00:00:59:21 - 00:01:02:01
Meg Pekarske
But tell us what happened after that.
00:01:02:08 - 00:01:31:19
Jacob Harris
Sure. It feels like it was just yesterday that we were recording the podcast that you mentioned advising clients of the issuance of the noncompliance notices. And now here we are just a couple of months later. Nearly every decision has been rendered for each of our hospice provider clients, and all of them have been favorable. All of them have resulted in reversals of the 2% reduction in APU for fiscal year 2023.
00:01:31:19 - 00:01:45:12
Jacob Harris
And we couldn't be more excited for our clients that this burden has been relieved for them. And that they'll head into the fiscal year, which starts in just a couple of days with a clean slate.
00:01:46:04 - 00:02:15:07
Meg Pekarske
It felt really good to and I appreciate the government recognizing that COVID wasn't just a 2020 problem. And because when you think of 2021 and when we got into the nuts and bolts with all of our clients and pulling together these appeals, you almost forgot all of the hardship that went on during 2021 related to COVID.
00:02:15:07 - 00:02:59:00
Meg Pekarske
And you know, I remember one of our clients when they were doing, you know, free vaccination clinics and they're going into people's homes giving vaccines and just really significant burdens and and whatnot. It was, it was really significant. But obviously as we talked about in our prior podcast and like 2020, there wasn't this waiver that was in place where we were arguing last year about well it was for the first half of the year when a lot of stuff with COVID was the second half of the year, you know, change how you're maybe applying that this was a little bit different and I guess how was it different, Jake?
00:02:59:06 - 00:03:23:05
Jacob Harris
That's right. So just to review for calendar year 2020 seems issued an across the board exemption from reporting requirements for quarter one and quarter two of 2020 probably engaging in the same wishful thinking that many of us did that you know COVID-19 was going to be a you know sort of a transitory event. We were going to get back to normal fairly quickly.
00:03:23:22 - 00:03:48:17
Jacob Harris
That's not obviously what happened and so when they looked at the quarter three and quarter four of 2020 reporting period, there were still a lot of providers that were facing challenges related to the public health emergency. CMS was very lenient with respect to our reconsideration requests for fiscal year 2022 which corresponded to reporting during calendar year 2020.
00:03:49:19 - 00:04:41:21
Jacob Harris
But it was an open question whether they would take a similar approach to calendar year 2021 reporting which affects the APU for fiscal year 2023. And so we really had to marshal together some some compelling arguments regarding the ways in which challenges related to the public health emergency continued to affect providers in 2021. And one of the things we encouraged CMS to do was to remember despite the fact that things have moved quickly throughout the pandemic, what the circumstances were like at the beginning of 2021 vaccines were not publicly available at the beginning of 2021, many personnel were still working remotely which which creates challenges, staffing issues, certainly absences due to COVID-19
00:04:41:21 - 00:05:20:20
Jacob Harris
infections surges and COVID 19 hospitalizations and deaths and the effect that that has on census and all these other things. And then we also had to come up with ways that 2021 was a little bit different right because we didn't just want to repeat the same arguments we made in 2020, but we wanted to come up with something new or additional that we could bring to CMS attention and that's where we, you know, in talking with some of our clients about the challenges that they actually faced, we realized that the great resignation was huge, you know, for free for all health care providers really.
00:05:20:20 - 00:05:58:13
Jacob Harris
But for hospices specifically, it's losing large numbers of staff members without, you know, adequate notice and trying to cover for their responsibilities. Vaccination, as you mentioned, Meg, that many of our clients were, you know, not just vaccinating their own staff or their own patients, but also community sources of a vaccine. So, you know, we really did try and, you know, reiterate some of the the points that worked in 2020 while also developing some some strong additional arguments for 2021.
00:05:58:19 - 00:06:01:10
Jacob Harris
And it's really gratifying to have been successful with those.
00:06:01:18 - 00:06:31:08
Bryan Nowicki
And I think that the overall theme we were trying to or I guess question that we were anticipating or trying to preempt would be CMS getting a lot of these reconsideration requests and thinking, well shouldn't you have figured this out by now or I thought COVID we hit the peak of that and it's been dwindling because again they're going to be looking at these reconsideration requests in July and August and September--
00:06:31:08 - 00:07:04:15
Bryan Nowicki
2022 which as Jake said, we had to remind them of what things were like during the actual reporting period. And that's where stuff like the great resignation, which I think has become a defined term with a certain time period, it applies to in 2021 is how we could put time markers out there for stuff specific to 2021 that would really was our factual basis for saying the CMS COVID is not over in the obstacles it presented certainly did not conclude with the end of calendar year--
00:07:04:15 - 00:07:28:00
Bryan Nowicki
2020. And then in addition to doing these appeals we do outreach to CMS informally. We've worked with those folks at CMS in this matter in prior years and I think it's good to have those connections so we can kind of give them a heads up about what we're arguing and thinking about and do additional advocacy in that way.
00:07:28:06 - 00:07:59:02
Meg Pekarske
And what we're seeing. Because, you know, I think CMS was definitely open to what the provider experience was. And I think this is a great recognition of, yeah, we're hearing you and the difficulties you're having because I think on top of the great resignation and, you know, all of the vaccine issues and whatnot, I mean, we also have this weird flow of patients to people census, right?
00:07:59:02 - 00:08:22:11
Meg Pekarske
So a lot of people are getting a lot of admissions and then, you know, their length of stay is just hanging. So you have a lot of work to do in terms of reporting. And I mean, there's just there is a lot of things sort of a perfect storm for folks related to this. So this is just really, really wonderful.
00:08:22:11 - 00:08:43:16
Meg Pekarske
And great work to you, Jake, who is doing a lot of the heavy lifting on these. And so, I mean, I think the lesson learned is, you know, when things happen to you, it's worth a phone call because I think it happened last year and happened this year that people are like I'm sure there's nothing you can do.
00:08:43:16 - 00:09:12:07
Meg Pekarske
Right. And and then it's like, well, no. And you start asking questions, right? That's what good lawyers do is they ask lots of questions. And so sometimes they think we're as an industry, sometimes too willing to be like, well, I guess I didn't meet it. So there's nothing that can be done. And, you know, that's why we have jobs, has to deal with problems and help find a way sort of through things.
00:09:12:22 - 00:09:37:18
Jacob Harris
Yeah, I think that's an excellent point. You know, number one, I think first and foremost, we put together strong advocacy pieces on behalf of each of our clients with respect to this issue, seeking reversals. And that's always what it's going to be about, primarily. But I think the other value that we were able to add to this is there is some strength in numbers.
00:09:38:03 - 00:10:15:07
Jacob Harris
In other words, when they see, you know, 12, 13, 14 of these coming in all with the same law firm's letterhead that you know that triggers their attention. Right? Their antennae up and they start to think, okay, maybe there actually is a problem here that warrants some additional relief. And so being part of that larger pool of providers who are similarly situated, you know, conveying similar circumstances and making similar requests I think can be really, really advantageous for a provider that receives one of these payment reduction letters.
00:10:15:21 - 00:10:46:16
Jacob Harris
And then as Bryan touched on earlier, you know, just having a line of communication open with the people at CMS who consider and review these requests is is similarly very, very valuable. You know, unfortunately, the letters that reverse the noncompliance determinations are very short and their form letters. And they don't tell us, you know, this is the specific argument you made or this is the specific reason why we're reversing, and--
00:10:46:16 - 00:11:05:02
Jacob Harris
I have to believe that most providers probably don't care. Right? I mean, they just want the payment reduction reversed and they want their full APU for fiscal year 2023. And we're happy to deliver that. But if we had to hazard a guess, I think it's a combination of of all these different things that that led to success in this area.
00:11:05:16 - 00:11:28:12
Meg Pekarske
Well, and this is exactly why we do podcast, right? I mean, back when we started this, I don't know if it's four years ago or when we started this, but, you know, it was to get our timely information to people. And so I think that every time we've done this, people are like, oh, wow, there is something that can be done about this.
00:11:28:12 - 00:11:50:15
Meg Pekarske
I heard your podcast and so that feels good in the sense that, you know, we're meeting our purpose and mission with our podcast and getting our timely information. And I feel like rarely do we have such wonderful news to share. So we need to get another kick at the can here of just sharing the good news.
00:11:50:15 - 00:12:17:06
Meg Pekarske
But I do think that people really need to be mindful of quality reporting. I mean, in if we look really big picture, right, quality reporting, we care about it because it can impact our trade. And next, next year it's going to, you know, if you don't do it or mean you don't comply with the 90% threshold, you know, your rate reduction is going to be 4%.
00:12:17:06 - 00:12:48:12
Meg Pekarske
So it's going to be even more painful. But right data reporting and all this stuff, it's in the bigger scheme of things is becoming more significant. And as we work with payers and other people, our star ratings are all these other things. And so quality reporting and having people committed to gathering data for your organization is just really, really important, not just for this rate--
00:12:48:12 - 00:13:12:23
Meg Pekarske
decrease, but just in the role of the future to be able to talk about how we add value, how we save money, how we do all this other stuff is getting to become more and more important. And so when we think about, you know, what hospices have to invest in for the future, to pivot, to be successful, a lot of it's about data and data analytics.
00:13:12:23 - 00:13:47:01
Meg Pekarske
And so right now we're really focused on what, you know, CMS is specifically asking us to report. But increasingly, as we talk to Medicare Advantage plans and other commercial payers, you know, we want to be able to track even more data than what the government's currently asking us to report on. So data analytics and resources you know, that is going to become more of a cost center because it's going to be bigger part of our business to be able to show how we add value.
00:13:47:01 - 00:14:15:14
Meg Pekarske
But so I do think and you know, all of us, I think are hopefully feeling a little less burdened by COVID than we were in years past. And so I don't know next year if there will be, you know, the same understanding or not and so talking about, you know, tracking your compliance and knowing whether or not you're going to run into a problem.
00:14:15:14 - 00:14:18:05
Meg Pekarske
And so, Bryan, you were going to say something?
00:14:18:05 - 00:14:40:12
Bryan Nowicki
Yeah, well, I think that's the right thing to think about as time goes on. We all hope and think. And it's I think it's true that people are getting better at dealing with COVID. And I think CMS may have an expectation that people are going to get better at dealing with COVID as it relates to reporting in particular. But that doesn't mean--
00:14:40:12 - 00:15:13:12
Bryan Nowicki
and to add to that, I think the success for the past couple of years that we've had with this, frankly, is due to COVID. I mean, that has been the focus of our appeals and describing just all the obstacles COVID has put out there. So it doesn't mean that we can't continue to appeal these going forward. It just means if COVID continues to be an issue that is causing problems with call quality reporting even this year, document it.
00:15:13:12 - 00:15:38:03
Bryan Nowicki
And, you know, there may be things that are happening this year that are different from 2020 and 2021 for particular locations. It doesn't necessarily have to be a nationwide thing to try to address it, but start thinking about how to start tracking your reporting to see if you're at the 90% threshold and if you're not going to be at that 90% threshold, really examine why that's the case.
00:15:39:00 - 00:16:13:22
Bryan Nowicki
And I don't know that a lot of providers are aware of it, but there are also things you can do in real time to try to avoid getting a noncompliant letter next July. There are what there are exemptions from reporting requirements and extensions of time to reporting requirements that are available to providers in certain circumstances. Now, when we've been dealing with this the last couple of years, I don't think providers knew about those that they could have potentially taken steps back in the year at issue to try to avoid this.
00:16:14:10 - 00:16:31:06
Bryan Nowicki
So if you think that you're having a problem with timely submission or being able to submit, give us a call and let's talk through exemptions and extensions of time to solve the problem now rather than having to solve it next July when you might get a letter.
00:16:31:23 - 00:17:19:17
Meg Pekarske
Yeah, no, I think that's a really good point, Bryan. And I do think that in general, there are other as people migrate to different EMRs, as people have staff leave, as people like all the things you can think about that can, you know, impact because how your quality reporting who does it, how it's reported, what it's tied to is making sure from an operations standpoint, you keep this top of mind in terms of making sure because sometimes it is sort of a gotcha like, oh, I didn't know there was some glitch or you know that because you only have two passwords for your organization and all these other limitations.
00:17:19:17 - 00:17:45:09
Meg Pekarske
So there is a lot less flexibility here. So you know, if you do have staff changes or you know, you're using a different vendor to help you or, you know, whatever that may be, making sure that you're on top of it and knowing if you're going to have a problem because some people you can see that you're going to have a problem because you really blew it for a certain chunk of time.
00:17:45:09 - 00:17:58:22
Meg Pekarske
And so I think it's worth a phone call talking through what's the best strategy. But, you know, once again, awesome work. Jake and Bryan, this is amazing, amazing results. And...
00:17:58:22 - 00:17:59:03
Jacob Harris
Thank you.
00:17:59:12 - 00:18:27:07
Meg Pekarske
It's, I'm like, this is one of the most gratifying things because it just, you know, oftentimes, you know, you've got to push, push, push, push and to not have to you know, push further up the chain and things like that because I think this is the right result. And I really appreciate CMS really listening to, you know, what was happening out in the field.
00:18:27:19 - 00:18:37:14
Bryan Nowicki
I'm working on nicknames for Jake. Mr. September. Perhaps the most favorable decisions come out or the summertime superstar because...
00:18:37:14 - 00:18:38:04
Meg Pekarske
Ooh, Summertime Superstar.
00:18:38:08 - 00:18:47:04
Bryan Nowicki
Maybe we should take that. But, you know, people can email in their votes for Jake's hero or hero name and maybe even an outfit or something.
00:18:47:12 - 00:18:52:13
Meg Pekarske
I was just going to say outfit. I like the costume part of that.
00:18:52:18 - 00:19:09:21
Jacob Harris
Summertime kind of covers it all, doesn't it? Because the letters are issued in July, and then the reconsideration requests are due in August. And then we get the decisions in September. So it really is this, this time of year, late, late summer, where this process begins and ends.
00:19:09:21 - 00:19:13:16
Bryan Nowicki
Jake's vote is for summertime superstar, I guess.
00:19:13:16 - 00:19:24:07
Meg Pekarske
Yeah, I guess so. So we need to buy you a cape a little like, well, you could be Robin, Bryan.
00:19:24:18 - 00:19:28:09
Bryan Nowicki
I'll be there. I'll be the faithful sidekick. Yes. Happy to do that.
00:19:29:21 - 00:19:56:18
Jacob Harris
Well, yeah, hopefully we're not dealing with too many of these in future years as providers are, you know, able to adjust to their their staffing levels and COVID related challenges. But as Becky and Bryan represented, we're here for you if you do run into an issue with potential noncompliance with the timeliness reporting requirement.
00:19:57:07 - 00:20:19:00
Meg Pekarske
At the minimum, it's always worth a phone call because this is not tooting my own horn. But rarely is there something that someone calls us with that we have not dealt with that. So you know, and there might be nothing that can be done about this or, you know, whatever thing you may call about. But most things we have some level of experience with--
00:20:19:00 - 00:20:39:10
Meg Pekarske
And so can help you quickly navigate things. And is this worth an investment or not? So and I think this is just one of those examples because we do have clients in, you know, nearly every state. And so, you know, we see these kinds of trends and can really bundle them for people.
00:20:39:10 - 00:21:06:18
Jacob Harris
Yeah, and that calculation with reference to is it worth it? I think it's going to skew significantly towards yes, it's worth it when that penalty goes from 2% to 4%. I mean, that's that's a big difference, right? It's double. And so for the 2022 reporting period fiscal year 2024 APU, that's the first year when it will be a 4% reduction as opposed to a 2% reduction.
00:21:07:14 - 00:21:15:04
Jacob Harris
And so that's something where, you know, you'll really want to have your put your best foot forward as far as reconsideration goes.
00:21:15:09 - 00:21:33:10
Meg Pekarske
Well yeah too many millions of dollars for people take in Bryan. Yes. It's a wonderful thing. So thank you again for your hard work and this is such a wonderful recording that we can actually do this and celebrate it. So thank you.
00:21:33:18 - 00:21:34:06
Bryan Nowicki
Thanks, Meg.
00:21:34:13 - 00:21:35:05
Jacob Harris
Thank you, Meg.
00:21:38:02 - 00:21:53:21
Meg Pekarske
Well, that's it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast visit our website at huschblackwell.com or sign up wherever you get your podcasts. Till next time. May the wind be at your back.