Despite being wheelchair-bound from multiple sclerosis, Richard Pascucci has a full-time job as a senior engineer for Raytheon. He lives alone, but a visiting-nurse service helps him get through his everyday routine.
“They’re there early in the morning so I can get to work, and they’re there at night so I can get to bed,” Pascucci said. “I know I would not be able to exist in my home without their help. And I can continue to work full time, which makes me a taxpayer, rather than me being a burden on the system.”
Your Business Has Gone Global. Has Your Insurance?
A decade ago, “doing business internationally” was mostly a large-company concern. Today, a manufacturer in…
Learn More
By allowing patients like Pascucci to remain in their homes, the home-health industry provides an essential service that keeps those people from ending up in hospitals and nursing homes, where costs can be several times higher.
But during a panel discussion at Butler Hospital last week – sponsored by Care New England Home Health and Congressman Patrick J. Kennedy (D-RI) – officials said the home-health industry is buckling under the weight of Medicare reimbursement cuts, a severe staffing shortfall and tedious federal regulations.
“The people that paid the biggest price for the (Balanced Budget Act of 1997) cuts were our home-health workers, our visiting nurses,” Kennedy said.
Home-health agencies in Rhode Island and nationally – like most health-care providers – have seen revenues plunge during the past four years as a result of steep cuts in Medicare payments.
The Balanced Budget Act of 1997 reduced Medicare reimbursements for home health care by $69 billion nationally – more than four times greater than Congress initially intended, according to the National Association for Home Care.
Another round of cuts to home-health reimbursement is planned next year. Kennedy is co-sponsoring legislation that would eliminate the additional 15 percent cut in Medicare payments to home-health facilities, scheduled to be implemented by October 2002. He called the planned reduction “totally unnecessary.”
About 2,000 Rhode Islanders receive home-health care, which provides “recovering, disabled, chronically or terminally ill patients assistance with the essential activities of daily living,” according to the NAHC.
Home-health agencies in Rhode Island have lost $56 million in Medicare reimbursements since the BBA took effect. As a result, the number of patients receiving home-health care in the state has dropped 22 percent, Kennedy said.
But that doesn’t mean those cases have gone away. Instead, other providers such as nursing homes or hospitals have had to pick up the slack – at a far greater cost than home health agencies offer, officials say.
“(Home-health agencies) are being much more selective about the patients they take,” said Helen Reed, director of utilization for Kent County Memorial Hospital.
“It’s very difficult to watch patients who give you multiple choices of home-care agencies and we can’t satisfy any of them,” Reed said. “And the patients get very frustrated. They want to go home to loving families, but instead they have to go to a nursing home.”
Administrators also get frustrated, because hospitals sometimes have difficulty getting reimbursed for those extra days when patients can’t be discharged. And the problem sometimes causes backups in the emergency room, Reed said, because there are fewer beds for ER patients to be moved to.
Meanwhile, home-health agencies are having trouble finding enough registered nurses – a problem plaguing the entire health-care industry. And the staffing problem is compounded by what many industry officials say are cumbersome federal regulations, which generate paperwork.
For example, one federal form introduced in 1999 requires agency workers to ask patients as many as 105 questions. What’s more, agencies have been forced to spend tens of thousands of dollars on computer systems to track all the documentation.
“The bottom line is that paperwork has been causing stress and fatigue because of the hours it adds to a nurse’s day,” said Kathy Thompson, vice president of government relations at the Visiting Nurse Associations of America. “It directly affects the ability to recruit and retain nurses.”
She added that nationally the turnover rate is 21 percent for RNs in home health and 28 percent for home-health aides.
Thompson said as much as 70 percent of a nurse’s two-and-a-half-hour visit to a new patient is spent generating paperwork. She said reducing regulatory burdens is the VNA’s “primary priority.”
Relief – at least for the paperwork problem – could be on the way.
Dallas R. Sweezy, director of public affairs for the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), said regulators are rethinking the documentation process for home-health providers.
“Our ultimate end is to let nurses be nurses, not for them to spend an inordinate amount of time with regulations,” he said. “I think you can expect some significant relief from that in the near future.”
The panelists also expressed frustration over the apparent lack of public understanding of home-health care – of both its role and its availability.
“What astounds me is how home-health care can be so undervalued when its contributions are so huge,” said Thomas G. Parris Jr., senior executive vice president for system development at Care New England and president of Women & Infants’ Hospital.
“Society doesn’t have a clue as to the extent to which there is a need for home health,” Parris said, adding that as much as 80 percent of the U.S. population would need some form of home health-care during their lifetime – if it’s available.
