OxyContin

u 6 tips to prevent trouble with OxyContin ............3

u CMS-picked committee advances 15 recommended changes to OASIS ...................4 Visions of a new, less-burdensome OASIS are one step closer to materializing after a recent meeting of CMS's regulatory reform committee.

u List of reform committee's 15 OASIS recommendations ...........................5 u The trade: OASIS changes for support of quality indicators .....................6 u Sample of ad comparing quality indicators for nursing homes; HHAs next .......................7

u House & Senate bills would loosen homebound definitions ............................6 When lawmakers finally get around to passing Medicare provider relief legislation, it could include an important change in the homebound definition to allow non-medical absences from home.

u Benchmark of the Week #46 Intense focus on weight key to keeping CHF patient rehospitalizations in check..............9 What's Adventist Home Health's secret for maintaining rehospitalization rates at less than one third the national average for congestive heart failure patients? u Chart: CHF patient rehospitalizations double the norm .............................................10 u CHF patients pay less, stay longer...............11

u PRRB rules agencies' legal & marketing costs not reimbursable .....................11 Legal fees incurred by a Denver home health agency in a court battle over who controlled the now-defunct HHA shouldn't have been charged to Medicare, the Provider Reimbursement Review Board has ruled.

u Home care market notes .....................................12 3M names the new boss of its home care systems unit. Amedisys hires a new accounting firm. VITAS and Option Care expand. And Star says "not so fast" to NASDAQ delisting efforts.

Charges against home care employees spotlight danger of powerful drug OxyContin An HME company's regional manager starts making unscheduled stops at patients' homes. A home health agency's director of nursing falls asleep in the car on a trip to an off-site conference. Either incident could have an innocent explanation. Regrettably, however, they both were the first warning signs that these companies' high-ranking employees allegedly were stealing the powerful opiate OxyContin from patients' homes. Brendan Murphy, a delivery technician and regional manager for Merriam Graves Medical Equipment, in Winooski, Vt., entered a "not guilty" plea last month on seven counts of obtaining a regulated drug by deceit and six counts of exploitation of a disabled adult. He faces up to 23 years in jail and $95,000 in fines if convicted on all counts. The Vermont attorney general's office contends that complaints were received about the 36-year-old man from no fewer than eight families. A five-year employee of Merriam Graves who supervised nine other workers, Murphy allegedly was caught on tape stealing drugs after police set up a video sting operation. But Murphy is not the only home care worker to fall prey recently to the addictive qualities of OxyContin. Just this week Mary Jo Williams, a former home health aide at Home Health United, Portage, Wis., pled "not guilty" to charges that she stole a patient's OxyContin supply and substituted the steroid Prednisone. The

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patient, who was paralyzed from the neck down due to a motorcycle accident, reportedly

patient, who was paralyzed from the neck down due to a motorcycle accident, reportedly experienced seizures and lost almost 40 pounds before the medication switch was detected. Williams, 38, was diagnosed with Lupus in 1996 and prescribed both Percoset and Vicodin, according to charging documents. She allegedly was suffering from withdrawal when she stole 80 to 100 OxyContin pills over a period of several days.

Following patient complaints, Home Health United interviewed Williams, the patient and his family, as well as all other staff who had been in the home, Tom Brown, the agency's president,

tells …hhl. Before Williams' arraignment, United employees informed all of her patients about the problem and notified them that she had been terminated. The company also is beefing up its medications safety training and regularly instructing its nurses to talk about preventing other visitors to the home from accessing medications, Brown says. If convicted on separate counts of theft and reckless endangerment, Williams could face up to 11 ½ years in prison. She's also charged with stealing prescriptions of Percocet and Roxocet, allegedly replacing another patient's pills with Tylenol.

...home health line Subscriber Services We want to help you in any way possible. Here's how to reach us: OUR FAX NUMBER: 301/816-8945. STAFF: Group Publisher: Tonya Nevin, 301/287-2454 ([email protected]) Publisher: Jason Huffman, 301/287-2476 ([email protected]) Senior Editor: Burt Schorr, 301/287-2258 ([email protected]) Associate Editor: Linda Busche, 301/287-2442 ([email protected]) Associate Editor: Elizabeth Orr, 301/287-2551 ([email protected]) Associate Editor: Marisa Torrieri, 301/287-2305 ([email protected]) Marketing Specialist: Stu Simon, 301/287-2289 ([email protected]) Advertising Coordinator: Christian Deck, 301/287-2662 ([email protected]) SUBSCRIPTIONS: Direct questions about newsletter delivery and account status to the Home Health Group at 1-888/293-9383 or e-mail to: [email protected] Price: $437/year. ADVERTISING: To inquire about advertising in ...hhl, call Ad Coordinator Christian Deck, 301/287-2662. REPRINTS: To receive photocopying permission, call 1-888/293-9383 and ask about our copyright waiver, multiple copy and site license programs. Or e-mail: [email protected]

...home health line ISSN 1078-2389 is published weekly (except for Memorial Day, Labor Day, Thanksgiving and Christmas) by UCG, 11300 Rockville Pike #1100, Rockville MD 20852-3030 (www.ucg.com). Periodicals postage paid at Rockville, MD, and at additional mailing offices. Postmaster send address changes to ...home health line, 11300 Rockville Pike #1100, Rockville MD 20852-3000. Copyright 2001. Register today at WWW.MYHOMEHEALTH.COM to get access to your …home health line newsletter days before the print publication arrives in your mailbox. Plus, you get tons of other features, like continuously updated news postings; a new action item each morning to help you run your home care operation more efficiently; a calendar of important home care events and much, much more. If you’re having trouble getting access to your Internet edition of …home health line, send an e-mail to [email protected] to get your password now. INTERNET FORUM: To join ...home health line’s free Internet discussion group for all home health agencies, go to WWW.MYHOMEHEALTH.COM, click on “Idea Exchange” and follow the simple instructions. You can start talking to other home care execs across the country today. CONFERENCES: ...home health line holds seminars to help you meet professional challenges. For program schedules, call 800/929-4824, ext. 2684; e-mail address: [email protected] COPYRIGHT WARNING: Copyright violations will be prosecuted. ...home health line shares 50% of the net proceeds of settlements or jury awards with individuals who provide essential evidence of illegal photocopying or electronic redistribution. To report violations contact: Roger Klein Esq., Howrey & Simon, 1299 Pennsylvania Ave. N.W., Washington, D.C., 20004-2402. Confidential line: 202/383-6846.


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Neither attorneys for Murphy and Williams could be reached for comment at press time. A heroin-like high; related crimes up 75% Given the largely independent nature of your field staff, as a home care company you're already more susceptible to the danger of employees stealing and using patients' prescription drugs. But your staff has never confronted anything as addictive and readily available as OxyContin. Even if you don't provide the drug, there's a good chance your home care employees will come across it in a patient's home. OxyContin is the more commonly known brand name for the narcotic oxycodone, manufactured by Purdu Pharma, Stamford, Conn.

Since it was first introduced in 1996, prescriptions have increased by 1,800%, the U.S. Drug Enforcement Administration reports. There were 5.8 million prescriptions dispensed in 2000. It's rapidly becoming a $1-billion-a-year drug, the DEA says. In the home health arena, the drug is most commonly provided in tablet form to terminal patients or those with severe chronic pain. OxyContin's advantage over other opiates is its time-release formula, which provides long-lasting relief from pain. Unlike some other opiates, the drug allows users to remain awake and alert. To sidestep the time-release factor and achieve what they describe as a heroin-like high, addicts often crush the tablets and snort the drug.

6 tips to prevent trouble with OxyContin Have your nurses update your patients' medication records every time they visit. Have them count the pills and ask the patient how many have been taken. Those are few of the precautions Sue Crabtree, branch manager at Jonesville, Va.-based Independent Home Health Care takes to make sure her patients are taking their prescription drugs as scheduled and their drugs are not being lifted. As a home care company, you're particularly susceptible to prescription-drug theft. And the growing pervasiveness of OxyContin doesn't help [See related article, p.1]. Other techniques to protect your agency:

n Track your OxyContin stock carefully. A perpetual inventory is one way to do this, says Donna Morscheiser, pharmacist director, Family Pharmacy & HME, Peru, Ill. Family Pharmacy keeps the drug locked up and records the number of pills dispensed and the number left every time it's prescribed.

n Encourage employees to report their suspicions. "Employees always know what's going on," says Washington, D.C. attorney Jim Pyles, attorney for the American Assn. for Homecare. To make sure an employee who suspects a problem doesn't keep mum, Pyles recommends you implement a compliance plan that includes a mechanism for anonymous reporting, such as a toll-free number. The policy should also stress that people who report problems won't be punished, Pyles says.

n Don't pass the problem along. It can be painful to bring in law enforcement officials, so providers might opt to simply dismiss the employee. But that's the worst thing you can do, says John Burke, vice president of the National Association of Drug Diversion Investigators (NADDI) and commander of the Warren County (Ohio) Drug Task Force. Not only does it fail to address the staffer's problem, but it often violates state regulations that require you to report missing narcotics, Burke says.

n Start with a thorough criminal background check on all new hires. Following the arrest of an HME regional manager for allegedly stealing OxyContin, Merriam Graves Medical Equipment recently expanded its background checks to cover surrounding states, Jim Barker, spokesman for the Winooski, Vt., company, says in a written statement.

n Make sure your drug testing firm can detect opiates. Not all do, believe it or not, says drug-testing specialist Tom Mieczkowski, a professor of criminology at the University of South Florida. If opiates are detected, another test, called the GC/MS, is necessary to determine exactly which opiates are present. This test typically costs $75-100 per person, Mieczkowski says. u


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As of summer 2001, the DEA reports: • 400 deaths nationwide associated with

OxyContin; • 700 pharmacies robbed for OxyContin;

Crimes associated with OxyContin increased by 75% since 1999 Misuse is most prevalent in the Appalachian and New England states, the DEA reports, although reports of OxyContin-related crimes are up throughout the country. Typically, addicts either alter prescriptions or "doctor shop," visiting doctor's offices and feigning injury until the drug is prescribed, experts say. It also can be purchased on the street, where a typical price is about $1/milligram, or $20 for a 20/milligram pill, the National Clearinghouse for Alcohol and Drug Information says. OxyContin comes in 10-, 40-, 60-, and 80-milligram strengths. Purdue Pharma has taken "virtually every step that anyone can think of" to try to thwart addiction, spokesperson Tim Bannon tells …hhl. While the manufacturer has no special tactics for home health or healthcare professionals, it has taken measures to make prescription pads tamper proof, educate physicians and law enforcement on prescription drug abuse, and provide special brochures for pharmacies detailing the signs of a drug abuser. Lots of unexpected time off was a clue One of the first publicized incidents of a home health employee stealing OxyContin occurred in 1999 -- three years after it was introduced. A Sauk County, Wis., judge ordered 180 days in jail and 36 months probation for Michele Stanton, the former director of nursing at a home health agency in Lancaster, Wis. The 48-year-old, who once supervised three nurses, pled guilty to a charge of narcotic drugs possession. Like HME manager Murphy, Stanton was caught after patients reported drugs missing from their home, says the owner of the Wisconsin HHA, who asked to remain anonymous. The owner, who inherited Stanton as an employee when she acquired the agency, says she suspected there was a problem when her director of nursing began to take a lot of unexpected time off. She discovered Stanton already was on probation for stealing drugs from a hospital that

previously employed her. The day Stanton fell asleep while riding in a car on the way to a conference, the owner says she searched her vehicle and found alcohol. The next day, employees at another branch office called to let the owner know that one of Stanton's patients had called to report missing painkillers. Stanton could not be located at press time for comment. Consequences go beyond embarrassment Don't want your home-care company spotlighted by the media because one of your employees stole pain-killing drugs from a chronically ill patient? Bad press may be the least of your concerns, warns attorney Tom Antone, Mintz Levin Cohn Ferris Glovsky Popeo, Washington, D.C. In one recent case where a nurse substituted a grape drink for a patient's morphine, the home health agency's insurer settled a civil suit with the family for $1 million […hhl, 3/29/02]. Plaintiffs like to go after employers "because that's where the deep pockets are," Antone says. A criminal case would require more proof, but it is a possibility if an agency "recklessly" employed someone known to have a problem with drugs, he adds. Another possible consequence to a home health agency might be having its Medicare participation revoked, Washington, D.C., attorney Jim Pyles, with the American Assn. for Homecare, warns. The conditions for participation require that narcotics are properly handled and stored, he notes. In the past, agencies have been excluded from Medicare for transgressions such as allowing nurses to store drugs in their cars overnight. u -- Special contribution by Elizabeth Orr, editor, HME Answer Book [[email protected]] Non-medicare requirement tabled for later HHS-picked committee advances 15 recommended changes to OASIS

Visions of a new, less-burdensome OASIS are one step closer to materializing following a recent meeting of the Department of Health and Human

OxyContin

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