Home infusion study could expand coverage
Home infusion study could expand coverage
The Government Accountability Office (GAO) has recommended that the Health and Human Services (HHS) Secretary conduct a study of home infusion therapy to evaluate potential program costs and savings, payment options, quality issues, and program integrity associated with a comprehensive benefit under Medicare. The differences between Medicare fee-for-service, Medicare Advantage, and commercial insurance coverage were examined in the GAO report.
The report found that the extent of Medicare fee-for-service coverage of home infusion therapy was dependent on whether Medicare beneficiaries met certain criteria. For example, certain homebound patients with Medicare Part D receive comprehensive coverage, including nursing services, supplies, and drugs. However, in 2008 only 7% of Medicare patients were eligible for this coverage. Patients who are not homebound face more limited coverage that may only pay for supplies and some drugs. GAO found that the range of coverage offered under traditional Medicare contrasted with the more comprehensive coverage for home infusion therapy that was available from several of the largest Medicare Advantage plans and commercial health plans. The study will be completed by 2012.
"The GAO report illustrates what private payers have known for years that home infusion therapy can be dramatically cost-effective when provided appropriately," said Russ Bodoff, president of the National Home Infusion Association. To see a copy of the GAO report and recommendations, go to http://www.gao.gov/products/GAO-10-426.
Caregivers' stress affects well-being
A study published by Healthways Center for Health Research (CHR) in its May 2010 publication of Outcomes & Insights provides new knowledge of the impact of age on well-being, and the effect of care giving on the well-being of the 52 million Americans providing care for an adult who is ill or disabled. The study is based on more than 355,000 individual responses collected as part of the Gallup-Healthways Well-Being Index.
The study, "Estimating the Impact of Caregiving and Employment on Well-Being," demonstrates those who provide care for other adults are in need of well-being support themselves. Employed non-caregivers experience significantly higher well-being than their employed caregiver counterparts.
"One in five American households is already providing support for a loved one (who is not a child) 18 hours or more each week," according to Joseph Coughlin, an author of both CHR papers and director of the Massachusetts Institute of Technology AgeLab. "The need for caregivers is not going away. We need to look now at how we can help these people who will be overworked and overstressed."
The study also shows caregivers worry more than non-caregivers and also experience less happiness. Employed non-caregivers reported feeling happiest (47.1%), with employed caregivers falling significantly behind (39.9%). The higher stress and lower happiness scores are even more apparent in non-employed caregivers, of whom less than one-third reported happiness the day before.
Although the financial and social support offered through employment appear to diminish some of the stress stemming from the caregiving role, employees who act as a caregiver are worse off than their counterparts, who do not have to juggle both responsibilities, according to the study.
Know penalties for privacy reg violations
The unauthorized release of employee health information can result in civil, and sometimes criminal, liability under both federal and state laws. For example, covered individuals under the Health Insurance Portability and Accountability Act (HIPAA) face civil fines ranging from $100 to $25,000, depending on one's level of intent. Criminal penalties include fines ranging from $50,000 to $250,000 and imprisonment of up to 10 years.
"Personal liability may also arise under the Family and Medical Leave Act, depending on your jurisdiction, and give rise to state law claims for invasion of privacy, defamation, negligence, and breach of confidentiality," warns Kathleen Liever, an employment law associate at Fowler White Boggs in Tampa, FL.
Unauthorized disclosure could also result in disciplinary proceedings before licensing boards. "Likewise, employers may face civil and criminal liability under federal and state laws," says Liever.
Your first step is to become very familiar with federal and state laws and regulations addressing privacy and confidentiality issues, especially any limitations and exceptions to confidentiality. Next, educate management and human resources.
"You are in the best position to tell your employer how to safeguard employee health information," says Liever. "Get involved in the development or revision of policies and procedures, before you find yourself in a difficult position."
Your best bet is to keep your response simple. "Absent employee consent or the application of a limited exception, an occupational health nurse or manager is obliged to release health information only to the extent of advising the employer whether the employee is fit, unfit, or fit within limitations, to perform a particular job without endangering anyone else," explains. Liever.
Provide what information you can. Then, explain that anything beyond that is "confidential and protected by law from disclosure." "If that is not enough, try reminding management and human resource personnel that there are strong penalties for inappropriate disclosure," says Liever.The Government Accountability Office (GAO) has recommended that the Health and Human Services (HHS) Secretary conduct a study of home infusion therapy to evaluate potential program costs and savings, payment options, quality issues, and program integrity associated with a comprehensive benefit under Medicare. The differences between Medicare fee-for-service, Medicare Advantage, and commercial insurance coverage were examined in the GAO report.
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