Feds admit IPS changes access to home care
Feds admit IPS changes access to home care
The Office of Inspector General (OIG) recently concluded that the interim payment system (IPS) has affected Medicare beneficiaries’ access to home health services, although not as dramatically as some people may have feared.
The OIG conducted a random survey of 181 discharge planners at hospitals, asking them how easily they can find a home health agency to take a Medicare patient being discharged from the hospital.
IPS benefits
Based on those interviews and a review of Medicare home health data, the OIG concluded that IPS has had an impact. For instance, it has reduced the number of beneficiaries served and the number of visits per user to below the peak 1996 levels, according to an October 1999 report by OIG Inspector General June Gibbs Brown.
Also, from Oct. 1, 1997 — when IPS was implemented — until Jan. 1, 1999, 14% of home health agencies were closed and about 40% of those closures were in Louisiana, Oklahoma, and Texas.
Still, the OIG report concludes that those closures have not greatly impacted the average beneficiary’s access to care, because most of the agencies that have closed were high-utilization, low-volume agencies. So while most beneficiaries still can receive the home health care services they need, patients whose treatment costs are higher than average may have increased difficulty in obtaining home health care, the report says.
The findings
Here are the report’s basic findings:
• About 85% of hospital discharge planners say Medicare patients are able to obtain home health when they need it.
• About 83% of hospital discharge planners say it is either not difficult or only slightly difficult to place Medicare patients with home health agencies.
• Hospital discharges to home health has remained constant, according to HCFA Medicare data. The proportion of Medicare discharges to home health was 11% in the first six months of 1997 and 10.9% in the first six months of 1999.
• The 28 (15%) out of 181 discharge planners who said they can’t always place Medicare beneficiaries with home health agencies say the problems were that Medicare won’t cover home health if the patient does not require skilled care or is not homebound; and there are fewer home care agencies now, and those available are more selective in which patients they will accept.
• About 61% of discharge planners say home care agencies have changed their admission practices in the past two years.
• Sixty percent of discharge planners say IPS has made it more difficult to place Medicare patients with home care agencies.
• And more than 50% of the discharge planners say certain patients are particularly difficult to place, and they include patients with chronic health care needs, IV care, high-cost care, intensive care, renal failure, and Alzheimer’s/ dementia.
The Health Care Financing Administration (HCFA) asked the OIG to assess whether IPS was causing access problems to Medicare patients. IPS, which was implemented on Oct. 1, 1997, will be in place until the prospective payment system is implemented, which is expected on Oct. 1, 2000. Congress initiated IPS as part of the Balanced Budget Act of 1997, which required a payment change in Medicare from a cost-based method to a system of fixed, predetermined rates for home health services.
IPS controls aggregate costs of services by reducing per-visit limits and subjecting home health agencies to a new payment limit based on an aggregate per-beneficiary amount.
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