Bethany Stadalman, of Douglas County Visiting Nurses, Rehabilitation and Hospice Care, keeps a watchful eye on Clyde Rice, 75, as the two work on Rice's balance during a therapy session Friday, April 15, 2011, in his Lawrence home. Under new requirements that took effect April 1, a Medicare beneficiary must have a face-to-face meeting with a doctor 90 days before or 30 days after starting in-home health care services in order for the home health agencies to be reimbursed. Rice, who has Medicare, saw his doctor about two weeks ago. by Nick Krug
Doctors, home health agencies and consumer advocates are in an uproar about a new “face-to-face” rule that aims to curb fraud and abuse in Medicare.
They say the rule is just making it harder for seniors to access home health care.
Under the requirement, which took effect April 1, Medicare beneficiaries need to have a face-to-face visit with their doctors 90 days before or 30 days after starting home health services in order for the home health agencies to be reimbursed.
And, patients who have been in hospice care for six months must have a face-to-face visit to continue to receive care.
Under the old law, doctors didn’t have to see their patients to prescribe home health care.
“It basically boils down to limiting care for the patient,” said Jane Kelly, executive director of Kansas Home Care Association.
Stadalman records Rice's oxygen saturation and pulse following a home therapy session. by Nick Krug
Local effects
Douglas County Visiting Nurses, Rehabilitation and Hospice Care staff members say the rule is complex and frustrating.
Carol Schmitt, hospice team manager, was dealing with the effects Friday.
She said a woman called seeking hospice services. The woman had been on hospice and then was taken off because her condition improved. She was feeling ill again Friday and seeking home health care, but because of the new rule she needed to see a doctor.
Before the rule, VNA would have sent a nurse out to get an assessment and then would have called the woman’s doctor. Now, she has to see a doctor. Schmitt said the woman’s other option is to go to the hospital — something she didn’t want to do.
“It’s crazy,” Schmitt said of the new regulation.
Angie Lower, VNA chief financial officer, provided another example of how access could become an issue: A man becomes sick, goes to the hospital and then is released into a skilled nursing facility. Then, he goes home and needs home health services. Now, he has to see his doctor within 30 days.
“Not only are the home health agencies and physicians having to jump through hoops, but the patients are having to jump through hoops and they are sick,” she said.
About 85 percent of the Douglas County VNA’s clients have Medicare. It found 57 percent of its Medicare patients had not had a face-to-face visit since starting home health services in January. That’s two-thirds of its admissions.
Janet Cairns, home health team manager, said the challenge for many home health patients is that they can’t physically get to the doctor. This is especially true in rural areas where doctors may be more than two hours away.
“We are their eyes and ears in the home,” she said. “We are their medical connection and we’ve built up that relationship and this trust with the physician. So, they in essence know what’s going on with that patient for a long period of time because we are always communicating with them.”
Rejection of rule
Douglas County VNA is working to make sure its clients and doctors understand and comply with the new rules.
But, there are home health agencies that aren’t accepting clients if they haven’t had the face-to-face visit.
Kelly, of Kansas Home Care, said many home health agencies are operating on a negative margin as it is, so they can’t provide services without getting reimbursed.
“It just boils down to less access to what is proven to be a cost-effective care,” Kelly said. “I know firsthand how expensive having a parent or relative in a facility costs. It’s much more cost-effective to care for them at home. Now, here’s another roadblock to cost-effective care. So, that’s where we are at.”
There are 140 licensed home health agencies in Kansas that care for about 30,000 patients. Of those, 56 percent are on Medicare.
Kelly said home health agencies and advocates are working to get the regulation, which was part of the Affordable Care Act, repealed. Anyone who has not been able to access home health services can contact Kelly at khca@kshomecare.org or 785-478-3640.
The National Association for Home Care and Hospice surveyed about 3,200 of its members in late February. The results were released in March. It found:
• 70 percent — would refuse to take on clients if they hadn’t had a face-to-face visit.
• 72 percent — said doctors complained about the rule and 66 percent said doctors were confused.
• 47 percent — said the doctors indicated they would refer them to other care settings, like a nursing home.
Nancy Rios, of the Centers for Medicare & Medicaid Services, said nobody was available to comment on the rule Friday.
Tagged: home health care, Medicare, Douglas County Visiting Nurses, Rehabilitation and Hospice Care
Comments
monkfellow (anonymous) says…
Whoa!! Wait a minute! I thought the "historic" health care act passed by the libs and signed into law by His Holiness was supposed to usher in a new day of health and happiness for us all! No more illness..no more pain..FREE FREE FREE health care without those bad old doctors and insurance companies standing in the way. Begone,evil ones!
Let's pick on the old people..don't you get it?? The Demos are aiming their pitch to the young, uneducated, and unsophisticated "new voter" who hasn't figured out someone will lose with "free" health care. This is one element coming to light.
Lynn731 (anonymous) says…
This is just one example of the crap that is in the new health care law. Pelosi said we have to pass it, to know what is in it. She was right. Now the goblins are starting to come out. Watch for the next ones. That law needs to be repealed and start over. It is an onerous law that will hurt seniors, rather than helping them.
Jimo (anonymous) replies…
It's so difficult to keep track of Republican health care concerns. One moment it's exterminating Medicare; the next, it's whinging about a modest curb to an out of control expense.
So, in sum: GOP pushes death panels, Dems ask for a recent meeting with a physician in order to take advantage of a subsidized, no-deductible(!) benefit. ROFL
rhd99 (anonymous) replies…
You're right, but let's take it even one BIGGER step further. How 'bout we repeal OBAMA!!
sourpuss (anonymous) says…
Um, why not just send a doctor around? Doctors used to make housecalls...
lawrenceguy40 (anonymous) says…
Why do people expect their neighbors to pay for their idle lives? You need healthcare when you are older, so plan for that when you are younger. If you are just to idle to work, then you shouldn't expect everyone else to work to pay for their healthcare costs and pay for YOURS.
People have lost all of their self respect, relying on liberal government programs.
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toe (anonymous) says…
It is all about self respect and having the government do what you should do for yourself is making children of all who participate.
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lando (anonymous) says…
"Under the old law, doctors didn’t have to see their patients to prescribe home health care." Really? So it's preferable for a frail and ailing patient to go without medical evaluation by a trained physician and instead be evaluated by a home health nurse who has everything to gain by documenting the need for extensive, frequent, and ongoing services for which her agency will be reimbursed. Home health agencies don't like this requirement for a reason and it's just possible that it has less to do with paperwork and more to do with the pocketbook.
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kbritt (Karrey Britt) says…
I would be interested in hearing from those who have Medicare and have used home health services. Did you see a doctor within a certain time frame? Could this be a problem or has it been? Also, how is this affecting local doctors? Other home health agencies? The hospital?
khunt (anonymous) says…
Ugh...too many middle aged white men in suits trying to impose their will on the aged and disabled. Have they ever cared for a family member 24/7 at home? Believe me, its much harder than being a talking head. When will we wake up and make these phony leaders get a real job!
Pleiku (anonymous) says…
I am trying to understand the comments being submitted. It seems that no matter the subject the only comments deal with republicans and democrats. How about actually reading the article.
Physicians should be able to order home health services for their patients. Bringing patients to the office for a formal E&M visit (Evaluation and Management) seems to be excessive if the physician has seen the patient within a reasonable time frame, say 2 to 3 months or has information available to know the need for the services. Somewhere, someone must think that physicians are ordering these services without thought or reason.
jestevens (Jane Stevens) says…
Just a reminder: Any comments in which people call each other names or are otherwise abusive are removed. We welcome having people in the community participate, so please keep the discussion civil. And please fill out your profile to add your name. You can comment anonymously three times before we require that you use your name. Thanks!
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