Is the 1997 BBA private duty's best friend?
Here's how to benefit from Medicare cuts
There may still be opportunities for private duty providers to benefit from the Balanced Budget Act of 1997-mandated venipuncture elimination. As of Feb. 5, venipuncture is no longer a qualifying Medicare service. This change significantly affected beneficiaries and Medicare-certified agencies, particularly in rural and Southern areas.
Many patients who have chronic, progressive conditions such as Alzheimer's Disease, cardiac illnesses, and diabetes have complicated medication regimens that require routine drug level monitoring.
Yet state home care associations report thousands of patients discharged and agency downsizings largely affecting home health aide staff after the provision's elimination. Agencies report they discharged these medically complex patients only after exhausting attempts to find other payer sources or skilled services.
Now three months after the change, circumstances may be right for private duty providers who did not dive into the first post-venipuncture wave to take the plunge. "Some people may look at the changes in the venipuncture law as an opportunity for private duty agencies. And agencies could certainly benefit in providing the venipuncture service," says Donna Franks, RN, MS, CCM, home care consultant at HomeCare Resources Associates in Des Plaines, IL.
"Many patients [who did not have other skilled needs or payer sources] chose not to pay privately. They may have wanted [venipuncture] if their insurance pays for it but not otherwise," says JoAnne Ruden, MPA, RN, president and chief executive officer for Visiting Nurse Association of the Delaware Valley in Trenton, NJ. After initially rejecting a private pay option, three months into monthly or even weekly trips to their physician's office or lab for blood draws, former venipuncture patients may be willing to reconsider.
"There may also be an opportunity for new patients coming along," notes Rosalie Rose, RN, BSN, executive director of the Visiting Nurse Association of Johnson County in Iowa City, IA.
Attract patients by combining services
Others may have wanted the service but simply could not afford the discharging agency's proposed pricing, says Rose. Competitive venipuncture pricing, perhaps bundled with other services, may help former patients opt for private duty provider-offered services, says Franks.
For example, a combined venipuncture and home health aide or personal care service may attract patients. The private duty provider may then recover their venipuncture-related costs from the other services.
"I see private duty agencies becoming more creative in looking at the costs of special programs like these. However, the potential volume of patients will dictate whether or not the agency can provide the program at a reasonable rate," says Franks.
Before offering services to former venipuncture patients, check your own licensure status, warns Nancy Woods, RN, specialty services director for Chattanooga, TN-based Contin-U-Care Home Health. Regulations thwarted her plans to have patients privately pay for phlebotomist-performed blood draws.
Identify potential patients
"I found out that since my private duty portion operates under the same license as our Medicare side, I would have a problem. It would have appeared to Medicare that we are charging a patient out of his or her pocket for a Medicare-reimbursable service and that seems to be a no-no," she says. Exclusively private duty providers may not face the same issue, she adds.
To identify potential patients, "let key people and organizations know [of your interest] as soon as possible. If you don't, another agency will have time to think about forming alliances to create referral preferences and partnerships," says Woods.
Sources advise providers take the following actions:
· Meet with Medicare-only agencies to discuss a potential referral arrangement.
Show them that private pay is an option for a portion of their population and that your company offers reasonably priced services.
· Target emergency rooms, nursing homes, walk-in clinics, and senior centers.
Distribute specific information about your service and how it can help seniors in need.
· Contact hospital discharge planners, social workers, and physicians.
Specify how your proposed service addresses the former venipuncture patients' needs. Physi-cians especially may be more willing to hear about alternatives.
· Get the word out in the community.
Distribute flyers in the community and send a representative to local senior association meetings such as the American Association of Retired Persons.
Other considerations
When setting-up a program, providers should consult with local physicians and labs, sources advise. Follow these tips:
· Arrange for consultation with the patient's physician.
He or she may prefer that a specific lab perform testing. Agencies should be aware of this and confer with the physician to ensure that lab tests and results arrive as scheduled.
· Create an alliance with local labs for mutual referrals and backup.
The lab may serve as your subcontractor, but they may also need private duty providers as a backup.
· Determine area lab capabilities.
Some labs do not provide services in rural areas because of travel time. In this case, the agency may want to hire a phlebotomist or train a staff member to draw blood.
In addition to a new patient stream, the venipuncture elimination may benefit private duty providers in other ways. With the Medicare-certified agencies' home health aide layoffs, "[providers] should anticipate a need to beef up their recruitment program. This change could signify an increase of quality personnel in the marketplace," Woods notes.
"There is quite a lot of speculation about the long-term effects of this new law," says Woods. "As time goes by, we will be better able to tell how patients will fair with losing their Medicare services and switching to private pay, as well as any increase in hospital use."
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