Home care venipuncture becomes political football
Here’s what to expect unless new law is changed
The home care industry for months has been fighting a provision in the Balanced Budget Act of 1997 that will prevent Medicare patients from receiving venipuncture as a qualifying service.
This drastic change will go into effect Feb. 5, 1998, unless Congress passes an amendment to the Balanced Budget Act that would reinstate payment under Medicare for venipuncture solely for the purpose of obtaining a blood sample. (See guide to venipuncture provision, p. 5.)
The change will leave many patients without the home care services that keep them out of the hospital or nursing homes, says Tammy J. Kelly, RN, staff development coordinator for Flowers Home Health Division, affiliated with Flowers Hospital in Dothan, AL.
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. (See education tips for coping with venipuncture change, p. 6.)
The National Association for Home Care (NAHC) in Washington, DC, has been working hard to convince Congress to pass the amendment that would restore venipuncture as a Medicare Part A service. The bill is titled H.R. 2912. NAHC has developed a grassroots strategy to have home care employees and patients contact their congressman or congresswoman over the holiday break 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 Feb. 5, Sokol says.
"What we’re hoping is there will be a ground swell 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 amendment have been difficult because few people outside of the industry have been aware of the venipuncture change, says Martha Pulley, executive director for the Virginia Association for Home Care (VAHC) of Richmond, VA.
"The venipuncture change will have an immediate negative effect on a number of patients," Pulley says. "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 VAHC 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.
Problems without venipuncture
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.
The 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.
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 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 the NAHC also is concerned that this change will impact the states. "There is no long-term care benefit under Medicare."
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