Industry condemns venipuncture provision
Industry condemns venipuncture provision
The new law will eliminate home care for thousands
The home care industry for months has been fighting a provision in the Balanced Budget Act of 1997 that eliminates venipuncture as a qualifying skilled home health service under Medicare. The provision was included as a weapon against fraud and abuse, according to the Health Care Financing Administration.
But industry experts see the measure as causing far more harm than good.
"The venipuncture change will have an immediate negative effect on a number of patients," says Martha Pulley, executive director for the Virginia Association for Home Care (VAHC) of Richmond, VA. "Some patients will lose their home health aides, and for many of them, it is the presence of home health aides that keeps them out of hospitals and nursing homes."
The American Federation of Home Health Agencies (AFHHA), which has been working to get the legislation amended, predicts that hundreds of thousands of Medicare beneficiaries will lose all of their home health care if the provision goes into effect Feb. 5 as scheduled.
Ann Howard, executive director of AFHHA, says, "I have not seen the numbers, but I have heard it would be as many as 800,000 beneficiaries. It’s one of the dumber pieces of legislation I’ve seen. If they take them off home health, they will pop up somewhere else in the system. And that will cost more than home health wherever they pop up."
We did what?’
According to Howard, many members of Congress who voted for the BBA are now expressing chagrin over the venipuncture provision. Apparently, many did not read the legislation thoroughly before casting their votes. Howard declined to identify the lawmakers but says the ones she has spoken with "express great surprise we did what?"
Rep. Nick Rahall (D-WV) has introduced a bill, H.R. 2912, which would repeal the provision. The Rahall bill also would require the Department of Health and Human Services (HHS) to conduct a study within a year to find out how many Medicare beneficiaries qualify on the basis of a need for venipuncture, and how much actual fraud and abuse is involved in the provision of venipuncture. Also, the bill would require HHS to determine how much it would cost states and beneficiaries to pay for replacement services for patients who no longer are able to get their blood work done at home.
When he introduced the legislation last November, Rahall told members of the House of Representatives he had received more than 234 letters from "concerned Medicare patients or their family members and caregivers in my district expressing their grave concern over the devastating impact this provision will have on seriously ill and disabled seniors."
Rahall went on to note that "while [HCFA] claims the venipuncture prohibition was put into law to fight fraud and abuse in the Medicare home health benefit, there are no studies or reports that exist, either from HCFA, the HHS Inspector General or the General Accounting Office, linking blood monitoring in home care to fraud, waste, or abuse. Removing blood monitoring as a qualifying service for the Medicare home health benefit was a vast overreaction indeed, it was a solution in search of a problem, in my view."
The National Association for Home Care (NAHC) in Washington, DC, also has been working hard to convince Congress to pass H.R. 2912, and restore venipuncture as a Medicare Part A service. NAHC has developed a grassroots strategy to have home care employees and patients contact their Congressman or Congresswoman to discuss how disastrous the change will be, says Eric Sokol, JD, NAHC assistant director for government affairs.
However, Congress will only have about 11 days after reconvening Jan. 26 to pass the bill before it is set to go into effect on Feb. 5, Sokol says.
"What we’re hoping is there will be a groundswell of people contacting them during their recess so that when they get back to Congress they will want to do something at a minimum delay," he adds.
Grassroots efforts to convince Congress to support the legislation have been difficult because few people outside of the industry have been aware of the venipuncture change, says VACH’s Pulley.
Study assesses effects of the change
Her organization conducted an unscientific survey about venipuncture to assess how many patients might be affected by the change. Forty-seven agencies responded to the survey, and these agencies had a total of 2,096 patients who received skilled nursing visits solely for the purpose of venipunctures.
Of these patients, 83% or 1,736 would not be able to receive venipunctures at a physician office or outpatient facility.
The study listed several home care providers’ comments about why their patients will suffer if venipuncture is excluded:
• Only 5% or less of our patients live above the poverty line, so they cannot afford an ambulance trip once a month.
• Living in a rural area, there are no phlebotomists that can go and perform a venipuncture. What is a patient to do?
• Clients in rural areas will be particularly penalized. Physician shortage and inability for clients to access busy MD offices will put these clients at higher risk.
• Our clients are in a rural area, and most live a significant distance from laboratory facilities or MD offices. Homes are usually old with narrow doorways that preclude use of wheelchairs and/or steps that must be negotiated.
VAHC concluded that if the survey reflected a representative sample of home care agencies, then the total number of Virginia home care patients who would have to be transferred to a hospital or nursing home could be more than 15,000.
Cost shifts from the feds to the states
This transfer of patients from home care to nursing homes would also shift the cost of caring for these patients from the federal government to the states.
This is because the federal government funds Medicare, which is an entitlement for people over age 65, and the states mostly fund Medicaid, which is a health care benefit for the poor and disabled. Medicaid pays for nursing home care, but Medicare does not.
Sokol said NAHC also is concerned that this change will impact the states. "There is no long-term care benefit under Medicare."
Tammy J. Kelly, RN, staff development coordinator for Flowers Home Health Division, affiliated with Flowers Hospital in Dothan, AL, agrees that the change will leave many patients without the home care services that keep them out of the hospital or nursing homes.
Flowers Home Health, which has 20 agencies in southern Alabama and northwestern Florida, surveyed its patient population and found that 65% of the the patients who now receive venipuncture will lose their home health aide visits in February when the law goes into effect.
"These people will have to be placed in an ambulance for a routine doctor’s visit," Kelly says. "Their care will revert to family members or to a nursing home, which is going to be a more costly type of care in the long run for the government."
Flowers Home Health has been spreading the word about what will happen to its staff, physicians, and pharmacies, Kelly says. But the agency also is preparing to educate staff and patients’ families on how the families can take over the care when the venipuncture exclusion goes into effect.
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