HHS OIG claims access to home health still intact
HHS OIG claims access to home health still intact
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The Health and Human Services’ (Washington) Office of Inspector General (OIG) released a report Nov. 1 that purports to undercut claims by the home care industry that the interim payment system (IPS) has led to major disruptions in access for Medicare beneficiaries requiring home health services. But home health representatives counter that the reports actually substantiate their arguments that major disruptions have occurred, especially for high-cost, medically complex patients. The report was completed at the request of the Health Care Financing Administration (HCFA; Baltimore).
The report Medicare Beneficiary Access to Home Health Agencies found that 85% of hospital discharge planners surveyed reported that Medicare patients were able to obtain home healthcare services, while another 15% reported that home healthcare is not always available. The OIG found no difference between urban and rural hospitals or hospitals with a financial interest in a home health agency compared to those without.
"Hospital discharges to home healthcare appear to remain constant," the report concluded. "The proportion of Medicare discharges to home healthcare was 11% in the first six months of 1997 and 10.9% in the first six months of 1999."
An OIG spokesperson said the report was designed to determine how IPS has affected access to care. "The industry has painted a picture that IPS has decimated home health, and beneficiaries can’t get care," said the spokesperson. "Our survey of the hospital discharge planners shows that the overwhelming majority of Medicare beneficiaries who need home health services after being discharged from the hospital are being placed."
The spokesperson also noted that among the 15% that cited difficulties, not all are related to IPS. In fact, 13 of the 24 discharge planners that noted difficulties cited a lack of coverage for IV medication or venipuncture or a problem related to Medicare’s definition of homebound.
"Essentially what we are saying is that there are still inflated costs in the program and that that should be taken into account when and if Congress decides to change the IPS and also the payment for the (prospective payment system)," the spokesperson said.
Industry takes opposing view
Several home care representatives take a much different view of the report, however. "I thought their headlines were really misleading and did not reflect what are the most significant findings in the report," asserted Jim Pyles, counsel for Home Health Services and Staffing Association (Jacksonville, FL). He pointed out that more than half of the discharge planners found that the sickest patients were being denied access to care.
Pyles also noted that 25% of discharge planners reported that home health patients were not getting the care they required as evidenced by re-hospitalizations and increased admissions to emergency rooms. "That is very significant," argued Pyles.
"The packaging belies the content," concurred American Federation of Home Care Providers Executive Director Ann Howard. "The subtitles would make one believe there is not much of a problem, but when you read the fine print, there are some pretty significant factors."
Howard noted that 28 out of 181 discharge planners reported problems securing home care for beneficiaries. "That is a fairly large chunk," said Howard. "They also admit that higher cost medically complex patients are having trouble."
In addition, Howard noted that the study interviewed only hospital discharge planners and that only 14% or 15% of home care patients come to home health from hospitals.
"In effect, this is a very, very sketchy report," Howard said.
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