How the Supreme Court’s Chevron Decision Could Help Stop Home Health Cuts

Home Health Care News | By Andrew Donlan

On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward.

The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year.

Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. Moving forward, it’s likely that these agencies will need more explicit direction from Congress to regulate on firm standing.

The reaction to the Supreme Court decision has mostly been centered around issues like the environment and reproductive rights.

But the decision could also be the breakthrough that home health providers needed to stop – and potentially undo – payment cuts. This week, CMS proposed a 1.7%, or $280 million, decrease to aggregate home health payments for 2025. The final rule is expected in late October or early November.

The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023.

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What Olympians Can Teach the Rest of Us About Pain

Lisa Marshall

Lying in an ambulance, her nose busted, gums sliced to the bone after hitting a barricade on her bike, Katie Zaferes had one question on her mind: How soon can I get back to training?

The World Triathlon Grand Final was 17 days away, and Zaferes was also competing for a seat at the Summer Olympics in Tokyo. So, a few days later, she was back at it, enduring the sting of the pool's chlorine on her mouth's 23 stitches and the dull throb in her face during runs and rides.

"It's not like I love pain, but I do kind of embrace it," said Zaferes, 35, who went on to win the world championship that month and take home a silver and bronze at the Tokyo Games in 2021. (She just missed qualifying for this year's Paris Olympics but is going as an alternate.) 

Remarkable as her story is, it is not, in the world of Olympians, uncommon. 

The history books are filled with examples of athletes triumphing in the face of seemingly insurmountable injuries. And injuries aside, the burn of pushing the body to its physical limits can, in itself, be a suffer-fest most people are unwilling to bear.

How do they do it?

"You could say elite athletes have a friendlier relationship with pain than the average person," said Jim Doorley, PhD, a sports psychologist with the US Olympic and Paralympic Committee. 

In fact, an overwhelming body of evidence shows that high-level athletes have a higher tolerance for pain: They take longer to "cry uncle." Some studies suggest they also have a higher pain threshold, meaning it takes more punishment for them to start to feel pain in the first place, and lower pain sensitivity, meaning they rank their pain as, say, a 4 when others subjected to the same hurt call it a 9.

Precisely what's going on in their brain and body is a matter of great interest to doctors, psychologists, and physical therapists. By taking a cue from people at the pinnacle of sport, experts say, we mere mortals can potentially get fitter, deal with adversity better, and even prevent or manage chronic pain…

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HIPAA Violation: Mom Needs More Fiber?

Elizabeth E. Hogue, Esq.

Imagine that a celebrity receives care where you work and curiosity gets the better of you, or someone you know is admitted and you would love to know the details. It’s oh so very tempting! So, you access records of care provided to patients that you have no legitimate need to view. The HIPAA police are on it! Because let’s not forget that the HIPAA Privacy Rule is a criminal statute.

An emergency room physician, for example, pled guilty to illegally obtaining the personal health information of multiple individuals. He was convicted of one count of wrongfully obtaining individually identifiable health information under false pretenses. The physician received a resident physician license and participated in an emergency medicine residency program at a university hospital. He worked in the emergency room of two hospitals in the university system.

The doctor used his access as a resident physician to the hospitals’ electronic health record to access the records of two patients without their knowledge or consent. He was never the patients’ physician. The patients were not receiving care in the emergency rooms where the doctor worked at the time he accessed the records.

The doctor also admitted that he sent a photograph to someone else of one of the patients wearing a hospital gown in which the patient’s rectum was hanging out of the patient’s body. And now for the “best” part: the doctor also admitted that he falsely wrote in a letter that he sent the picture of the patient with a prolapsed rectum to his mother to remind her of the importance of fiber intake!

Do you remember the comedian, Flip Wilson, who repeatedly claimed that the devil made him do it? When it comes to accessing patients’ medical records in violation of HIPAA, you must “put the devil behind you!” Protecting patients’ private health information is serious business - serious criminal business. Be vigilant!

By the same token, providers must also always remember that the HIPAA Privacy Rule isn’t just about protecting health information; it’s also about giving appropriate access to it. In the zeal to protect information, it anecdotally seems that practitioners have lost sight of the fact that access to information is at least as important as protection of information. In fact, the Office for Civil Rights, the federal enforcer of HIPAA violations, has focused on denial of access in enforcement actions for the past several years.

Remember that, however tempting the information you would like to have may be, temptation pales in comparison to jail time!

©2024 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.

USPSTF Recommends Exercise to Prevent Falls in Older Adults

Medscape | By Heidi Splete

Exercise interventions are recommended to help prevent falls and fall-related morbidity in community-dwelling adults aged 65 years and older who are at increased risk of falls, according to a new recommendation statement from the U.S. Preventive Services Task Force (USPSTF) (JAMA. 2024 Jun 4. doi: 10.1001/jama.2024.8481).

Falls remain the leading cause of injury-related morbidity and mortality among older adults in the United States, with approximately 27% of community-dwelling individuals aged 65 years and older reporting at least one fall in the past year, wrote lead author Wanda K. Nicholson, MD, of George Washington University, Washington, and colleagues.

The task force concluded with moderate certainty that exercise interventions yielded a moderate benefit in fall reduction among older adults at risk (grade B recommendation)

The decision to offer multifactorial fall prevention interventions to older adults at risk for falls should be individualized based on assessment of potential risks and benefits of these interventions, including circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences (grade C recommendation), the authors wrote.

The exercise intervention could include individual or group activity, although most of the studies in the systematic review involved group exercise, the authors noted.

The recommendation was based on data from a systematic evidence review published in JAMA (2024 Jun 4. doi: 10.1001/jama.2024.4166). The task force reviewed data from 83 randomized trials published between January 1, 2016, and May 8, 2023, deemed fair to good quality that examined six types of fall prevention interventions in a total of 48,839 individuals. Of these, 28 studies involved multifactorial interventions and 27 involved exercise interventions.

Overall, multifactorial interventions and exercise interventions were associated with a significant reduction in falls (incidence rate ratio, 0.84 and 0.85, respectively).

Exercise interventions were significantly associated with reduced individual risk of one or more falls and injurious falls but not with reduced individual risk of injurious falls. However, multifactorial interventions were not significantly associated with reductions in risk of one or more falls, injurious falls, fall-related fractures, individual risk of injurious falls, or individual risk of fall-related fractures.

Although teasing out the specific exercise components that are most effective for fall prevention is challenging, the most commonly studied components associated with reduced risk of falls included gait training, balance training, and functional training, followed by strength and resistance training, the task force noted…

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