What They’re Saying
What They’re Saying
• In a regulatory update, Prudential Securities (New York) praised the new coverage policy adopted recently by the Health Care Financing Administration (HCFA; Baltimore). The policy will involve outside advisory committees, consisting of noted experts, who will help Medicare officials review evidence to make coverage decisions. The first advisory committee will convene in July or August to discuss urinary incontinence products. HCFA is looking for discussions on the circumstances and context for which patients should be covered to use a particular product or treatment.
• Home is the best place for ailing seniors and others with chronic conditions, but home health agencies in Massachusetts need help, stated an editorial in the Boston Globe. Medicaid has increased payment rates for home health providers by only 2.1% during the 1990s, and Medicare has reduced its reimbursements. The Visiting Nurse Association of Boston, for instance, pays about $74 to send out a physical therapist, but receives about $59 from Medicaid. A nurse visit costs the company about $89, but Medicare reimburses about $62. The VNA laid off 23 managers last week and plans to close its downtown office. It ran a $4.7 million deficit in 1998, the Globe reported. A bill to force the state Division of Medical Assistance to increase Medicaid funding by the inflation rate, giving a total of $6 million to $10 million more, is currently under consideration. But the division can act without the legislature, stated the editorial. "The inflation adjustment is long overdue and should be put into effect immediately."
• The American Health Care Association (AHCA; Washington) said it supports the introduction of a bill, called the Medicare Rehabilitation Benefit Improvement Act of 1999, introduced recently by Reps. Richard Burr (R-NC), Ben Cardin (D-MD), Jim McCrery (R-LA), and Frank Pallone (D-PA). The bill gives qualified Medicare beneficiaries relief from the $1,500 per year cap on therapy services. "Like any arbitrary system, these types of caps ignore the real needs of real people," said Linda Keegan, vice president of AHCA. "Enactment of this legislation would allow senior citizens who suffer from common conditions such as stroke, hip fracture, and Parkinson’s disease, to receive the rehabilitative services they need to resume a healthy, productive life." With the caps, providers are now forced to choose whether they will ration therapy as patients approach their limit or whether they will provide services beyond the limit. Many beneficiaries have already reached their cap, AHCA officials said, andthey are at the mercy of the agencies that must decide whether to continue their therapy for free.
• Nancy-Ann Min-DeParle, administrator for the Health Care Financing Administration (HCFA; Baltimore), responded with a letter to the editor to an editorial that ran in the New Orleans Times-Picayune. DeParle said the editorial "failed to give an accurate description of (HCFA’s) commitment to confidentiality and quality care for homebound Americans." Home health agencies have always had to perform assessments and had a responsibility to protect privacy, she wrote. "As the nation’s largest insurer, Medicare consistently safeguards confidential information through the use of encryption and other techniques. We demand," she wrote, "that states and providers take the same kinds of precautions."
• A forum on "Crisis in Home Health Care" opened the Kentucky Home Health Association’s spring conference last week, reported the Courier-Journal in Louisville. Industry leaders complained that about 20% of providers across the country have closed their doors. The industry has suffered payment cuts of up to 40% because of plans to reduce Medicare spending, said Augusta Evans, who runs Methodist Home Health. And sequential billing has caused cash flow problems for the agencies. Morris Lloyd of the Visiting Nurse Association (Louisville, KY) said the VNA has had to cut 80 positions. "It’s been the most devastating year ever in the 109 years" the VNA has been in existence, he said.
• The market is opening up for nurses, and some employers are having trouble filling positions. One hospital in Idaho, St. Luke’s Regional Medical Center, has 63 vacancies. Part of the reason for the shortage is that nurses are spread over a much wider range of jobs, from risk management and insurance companies to skilled nursing facilities and home health agencies. "Employment in home healthcare is expected to grow at a more rapid rate than any other individual area of nursing," stated an editorial in the Pittsburgh Post-Gazette. The editorial urged the community to spread the word to young adults searching for viable careers. "Nurses specializing in home healthcare will have a number of exciting prospects to consider," it stated.
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