News From Home Care
News From Home Care
HH Medicare spending down 45%
A report published by the Congressional Budget Office and featured in the April 21 issue of the New York Times shows that the amount of Medicare spending on home care has dropped by 45% over the last two fiscal years.
In 1997, Medicare spending totaled $17.5 billion; in 1998, it was $14.9 billion; and in 1999, Medicare spending on home care had fallen to $9.7 billion, the study said. The study found that spending for home care dropped by 34.9% in 1999 alone (spending had dropped by a mere 14.9% in 1998).
Costly alternatives
The report showed that because of those dramatic spending cuts, more Americans are forced to spend more time in hospitals and nursing homes, both of which are considerably more expensive than home care. The study failed to give estimates on how much payments to hospitals and nursing homes have increased over this same period, nor did it provide statistics on the number of people who may be going without treatment or who have died as a result of these spending cuts. Recent figures show that some 3.6 million Americans received home care through Medicare in 1997. By the following year, that number had dropped to 3 million, and although final figures are not yet available, experts believe that number continued to decline in 1999.
Before those spending cuts were enacted through the Balanced Budget Act of 1997, government experts predicted that Medicare spending on home care would be close to $127 million between 1998 and 2002. Now, those experts are predicting that the number will instead total $58 million — a difference of $69 million — and more than four times what Congress expected to save when it passed the BBA.
HCFA proposes new coverage criteria rules
The Health Care Financing Administration (HCFA) has proposed developing national standards to help guide coverage decisions for the country’s more than 39 million Medicare beneficiaries.
Administrator Nancy-Ann DeParle said the process HCFA is launching will help establish "the most open, timely, and dependable system possible" for making national Medicare coverage decisions.
According to DeParle, a coverage criteria rule will mark the latest step in the agency’s ongoing efforts toward a more understandable and predictable process for making Medicare coverage decisions. Last year, the agency adopted a new administrative process for coverage decisions and created a Medicare Coverage Advisory Committee to inject private sector expertise into the process.
The debate over national standards has been going on since 1989 when the agency made a similar proposal that was never implemented. The problem stems from the fact that Medicare has never actually defined "reasonable and necessary," the standard required by law before expenses incurred for an item or service can be covered. By and large, there have never been any guidelines to help make that determination.
HCFA has the authority to make national coverage decisions, which are binding on all contractors and the administrative law judges who hear Medicare appeals in the administrative process. But most coverage decisions are made at the local level by carriers or fiscal intermediaries, and those decisions are binding only in the local area covered by each contractor.
Telemedicine bill could aid home health providers
Congress will consider legislation that would simplify federal regulations for and enhance the delivery of telemedicine services targeted at senior citizens living in rural areas. The legislation would amend Medicare rules to increase coverage of the costs of telemedicine. Last year, Medicare only covered 6% of all telemedicine doctor-patient visits with senior citizens and the disabled.
The legislation has garnered bipartisan support. It was introduced by Sen. Jim Jeffords (R-VT), chairman of the Senate Health, Education, Labor, and Pensions Committee, and Sen. John Rockefeller (D-WV). The bill also has eleven co-sponsors.
The National Association for Home Care (NAHC) quickly endorsed the bill, and said it would give home health providers the flexibility to provide quality, cost-effective home care visits within the prospective payment system (PPS).
"By better utilizing high technology, we should not only be able to increase the quality of health care, but also increase efficiency and see cost savings," Jeffords says. He notes that more than 25% of the nation’s senior citizens live in rural America and says his legislation streamlines federal regulations to help better utilize telemedicine programs.
Jeffords’ bill also eliminates several current provider requirements and clarifies current law to permit telehomecare visits under the home health PPS. He says telehomecare should not be prohibited. "Where home health providers are paid on a prospective basis, nothing prevents them from incorporating telehomecare where appropriate into their care plans," says Jeffords.
According to the NAHC, Jeffords’ bill also mandates that a telehomecare visit for a low utilization payment adjustment, outlier payment, or therapy service cannot be used as a substitute for in-person visits for purposes of establishing coverage and payment under PPS.
The bill would also allow limited Medicare reimbursement for referring clinics to recover the cost of their services, and allow all providers to receive reimbursement for services delivered via telemedicine.
Study: Boomers more likely to need nursing homes
A new study shows that because of the increasingly expensive costs of home- and community-based long-term care, the chance that baby boomers will end up in nursing homes is higher than many thought. Also suggested by the study is the fact that middle-income families have a higher chance of entering a nursing home later in life.
The study, Can Aging Baby Boomers Avoid the Nursing Home?, released by the Washington, DC-based American Council of Life Insurers (ACLI), urges people who are part of the baby boom generation to invest in long-term care insurance, saying that is the only way many people will be able to receive care at home.
"Middle-income baby boomers will find that to successfully age in place . . . they will have to use their retirement savings to pay for increasingly expensive long-term care services," said Barbara Stucki, primary author of the study. "Without private, long-term care insurance, many will face potentially catastrophic costs that could lead to impoverishment and the need to use Medicaid-funded nursing home care."
The study projects that the costs of long-term care services will more than quadruple by 2030. Home care assistance, which now costs $61 per visit, ACLI said, will cost about $260 per visit. In addition, adult day care, which ACLI says costs an average of $50 per day, will increase to $220 a day; and staying in an assisted living facility, which ACLI says now costs an average of $25,300 per year, will rise to $109,300 per year.
"When the youngest boomers reach age 65 in 2030, the nation’s elderly population will double to 70 million, and the number of severely impaired elders at risk of needing nursing home care could double to 6 million," Stucki predicted.
Complete OASIS data for better PPS reimbursement
Accurately completing the Outcome and Assessment and Information Set (OASIS) will have a major impact on the per-episode payment that home health agencies receive under the prospective payment system (PPS).
Cynthia Hohmann, vice president and COO for Health Care Management Consulting (HCMC) in Jacksonville, FL, says that is why agencies must master the OASIS question set before PPS is implemented next fall.
Hohmann, who advised agencies on how to improve their use of OASIS at the National Association for Home Care’s (NAHC) recent National Policy Conference in Washington, DC, notes that she attended all of the Health Care Financing Administration’s (HCFA) training sessions for surveyors and OASIS coordinators, and points out that they are also in a learning mode.
Hohmann told agencies at the conference that she has performed more than 40 OASIS accuracy audits since last September, and has found discrepancies and inaccurate answers made by nurses or therapists in each one. "The discrepancies in answers are not intentional," she said. "It is a lack of training." In fact, many agencies had not reviewed the OASIS training manual in months, she added.
Follow the rules
According to Hohmann, many inaccuracies also have to do with interpretation. "Many of the nurses and therapists were interpreting the questions and answers on their own," she told agencies. But she emphasized that the OASIS manual must be followed verbatim, item by item.
Hohmann added that many of the mistakes made on the OASIS assessment were attributable to the fact that nurses were not getting enough information from the intake process or referral form. She advised agencies to modify those forms for OASIS by including some of the OASIS questions that must be answered during intake.
Hohmann said this is especially important for questions relating to the dates and places patients have had in-patient treatment, as well as their diagnoses.
"This is important not only for PPS, but also the areas where [HCFA officials] are looking for fraud," she said. If HCFA believes agencies are putting one diagnosis on the OASIS assessment to generate a certain home health resource utilization group, but a different diagnosis on the 485, they will likely run into trouble, she warned.
(Editor's note: HCFA posts timely OASIS-related announcements, information, downloads, and updates on its Web site. The "What's new" page can be found at www.hcfa.gov/medicaid/oasis/hhnew.htm.)
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