Visiting nurses and other home health professionals are the hidden angels of American health care--they are highly mission driven and in the course of helping people in need they routinely overcome many challenges like bad weather, high crime neighborhoods, traffic conditions, complex health problems and stressed out families--but, they're now confronting a new obstacle, a paperwork mess created by a little known Affordable Care Act (ACA) "face to face" rule. The timing is terrible because home health access and quality is being hurt at the very moment when extra focus on improving home health is needed to prepare for rapidly growing numbers of older Americans.
Buried in Title 6 on the 769th page of the ACA are about 30 straightforward words to ensure doctors have seen patients "face to face" before authorizing home health services paid by Medicare. There have been unfortunate cases of Medicare fraud, ensuring doctors are involved before Medicare pays is well intended and makes sense. However, Medicare officials have turned those 30 or so words into over 35,000 words of confusing and contradictory guidance and regulations--this has resulted in a paperwork and electronic documentation debacle that is souring the situation for nurses and doctors trying to care for vulnerable shut-in patients.
There's a bit of good news; Senators Bob Menendez of New Jersey and Pat Roberts of Kansas have authored a bi-partisan fix to the situation. They should be recognized as true advocates and praised as guardians of home health care for older adults and people with disabilities. However, for their solution to be adopted, more members of Congress need to sign on. This requires citizen input on an issue that is fairly technical; please take a few more minutes to understand the problem.
A good analogy can be made to the well-known scenario of how doctors' prescriptions for medicines are handled by pharmacies (even though in this case we're really talking about doctors' prescriptions for needed home health nursing or physical therapy). Imagine if each prescription had an additional sworn attestation by the doctor that they had seen their patient and the medicine was absolutely appropriate and needed.
Now imagine that in spite of that prescription /attestation, Medicare officials also required pharmacies to assume the doctor didn't know what they were doing when writing the prescription and they must demand photocopies of additional records from the doctor before filling prescriptions. Then, after all the paperwork exchange, imagine if nobody was really sure what Medicare was expecting in the paperwork and feared that an audit could invalidate the essential services because a government reviewer's preferred wording or phrase was missing or was in a different part of the patient's chart.
Imagine the frustration, delays, and harm that would be created for health professionals and people needing medications if this were the norm. Unfortunately, this illustrates the current situation for doctors' prescriptions for needed home nursing and physical therapy services--services that are often urgent and essential for Medicare beneficiaries to get home from hospital and nursing home stays, or to avoid them in the first place.
Ironically, while the paperwork ordeal is burdensome to well-intended doctors and home health caregivers, it is still too easy for fraudsters to pass off falsified documents.
Many organizations have dedicated new staff specifically to deal with all the paperwork and to deal with frustrated doctors being told their medical records aren't good enough, even though doctors are already doing tons of paperwork and electronic recordkeeping. The new paperwork burdens have consumed thousands of work hours in the visiting nurse organization I lead. At a time when more older and disabled patients need extra help, resources are being put into paperwork that could be focused on care. Some doctors have become so frustrated they've threatened to stop ordering needed home health care for patients just to avoid the paperwork.
Home care leaders have repeatedly asked Medicare to fix this. We have offered more effective and less disruptive approaches to addressing fraud. In spite of the extensive outreach, the situation on the ground remains unsatisfactory. The Menendez/Roberts fix offers a ray of hope. But, more members of Congress must sign on to make this happen. If you are concerned about home health quality and access for yourself or your loved ones please urge your Senators and Representatives to take action.
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