The sun also rises on the private duty side
Medicare moratorium, federal budget equal private duty growth
President Clinton has struck another blow to Medicare-certified home health providers by establishing a six-month moratorium on the admission of new providers to the Medicare program, and requiring that they first offer private duty home health services before they are allowed into the Medicare program. (See fax bulletin, inserted in this issue.)
That’s not going to stop the growth of home care, says one home health administrator, who expects all the current budget and regulatory happenings to fuel growth on the private duty side.
"Private duty home care is going to be one of the major growth areas, especially with what’s happening now with the budget reforms," says Cathy Frasca, RN, BSN, FACHCA, vice president of Home Health Services for South Hills Health System in Pittsburgh.
Home care will lead shift away from institutional focus
"The consumer is going to pay more out of pocket since hospital stays are going to be even shorter. Home care visits will be fewer as managed care clamps down, so the only other alternative will be for the consumer to subsidize their care in some way to continue to have someone to come in their home," Frasca says.
"We are moving from an institutional focus to de-institutionalized care, with home care leading the way. And regardless of what the president does, home care is going to continue to lead the way, whether it’s completely covered by Medicare and managed care, or whether the consumer is going to subsidize the care themselves," she says.
In a speech to the Service Employees International Union (SEIU) in Washington, DC, President Clinton said, "Today, I’m declaring an immediate moratorium on the admission of new home health agencies to Medicare, and during this moratorium we’ll develop tough new regulations to ensure that no fly-by-night providers enter or remain in the Medicare program."
In addition, the Health Care Financing Administration (HCFA) in Baltimore will require agencies to serve a minimum of private-pay patients prior to seeking Medicare certification, says Health and Human Services Secretary Donna E. Shalala, though she didn’t say how many. Agencies also must have sufficient funds on hand to operate for the first three to six months and be able to post $50,000 surety bonds before they are certified.
The president also told the SEIU that HCFA will require all home health agencies to re-enroll every three years, and will double the number of audits of home health agencies from 900 to 1,800 per year. The number of claims reviewed by HCFA also will increase, from 200,000 to 250,000 per year,
As part of the re-enrollment process, agencies will have to submit an independent audit of their records and practices. If agencies fail to meet the new requirements, they will not be recertified.
HCFA also will require that agencies supply information about related businesses they own. This is to cut down on "unscrupulous home health agencies [that] funnel fraudulent activities through subsidiaries or front companies that don’t really exist."
There should have been more forethought regarding the moratorium, says Bonnie Whorton, BS, MS, executive director of HomeCare of Mid-Missouri in Moberly. Agencies that are ready to be certified now have to wait until the moratorium is lifted. "Maybe no new applications would have been the better statement. And there was no consideration whether there was a shortage of providers in a particular area."
The action comes after the General Accounting Office reported in July that Medicare policing methods are inadequate. According to the report, Medicare’s recertification process has four primary problems:
• Home Health agencies (HHAs) do not have to periodically demonstrate compliance with all of Medicare’s conditions of participation.
• Surveyors do not fully review an HHA’s branch office operations.
• Rapidly growing HHAs do not receive more frequent surveys, even though rapid growth has been linked to difficulties in compliance.
• HHAs repeatedly cited for serious deficiencies identified during a standard survey are rarely terminated or otherwise penalized.
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