More about the PECOS Conundrum...

A follow-up to this post.

Here's an email I just sent Senators Kerry and Brown.  Here's the Junior Senator from Massachusetts version:

Dear Senator, 

As a result of the Patient Protection and Affordable Care Act,  physicians who have not enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as participating, non-participating or opted out physicians will not be permitted to order or refer patients for Medicare covered home health services.   Effective July 6, 2010, Medicare will not pay for home health services ordered by physicians that do not have an approved enrollment record in PECOS. Home health agencies have found that, on average, 30% of physicians currently ordering home health services are NOT enrolled in PECOS. Further, it takes a minimum of 60 days to approve an enrollment application. As a result, home health agencies will most likely not be able to accept their patients on to service. In addition, patients currently on service may be discharged or be financially liable for care. 

We believe that this new ruling has unfairly placed the burden of physician compliance squarely on the shoulders of the very patients it intends to help.  Many of the elderly, chronically or seriously ill patients cared for by the Visiting Nurse Association of Boston will be placed at risk for losing their Home Health Care services due to this ruling.  

You may be aware that the VNAB is the oldest home care organization in the United States; we take pride in offering state-of-the-art, affordable home care services to all residents of Greater Boston, regardless of ability to pay.  Our mission is to keep our patients independent and at home, and thus, out of more costly settings.

Senator, I am writing to ask that you:

1. Urge CMS to delay implementation of the rule requiring that physicians ordering home health care be enrolled in the PECOS data base (i.e. until January 1, 2011). Further, CMS should hold harmless home health providers until such time as physicians have had a reasonable opportunity to enroll.

2. Urge Congressional leaders to intervene with CMS to resolve this issue.

Thank you for your help in preserving access to medically necessary home health services. 

Reynold G. Spadoni

President & CEO

Visiting Nurse Association of Boston & Affiliates