Medicare Class-Action Settlement?


As an agency passionate about and committed to home care, in all its facets, Support For Home Health Care is an affiliate member of the American Academy of Home Care Physicians.  AAHCP is a leading organization in the effort to provide necessary health care in patients’ homes.

In the latest issue of Frontiers, the President of AAHCP, Dr. Bruce Leff, discusses a proposed settlement of a class action law suit that has great potential impact not just for the providers of home health services, but to the patients they serve.  At issue is the expectation from Medicare that home health services may not be paid if the patient is not “improving” from the skilled services provided by a home health agency.

The premise of the rule is often referred to as “no outcome, no income.” If a patient is not getting better, as a result of the clinical services provided by a home health agency, current Medicare rules indicate that payment to the home health agency can be withheld. 

Superficially, that approach sounds good.  The goal of medical care should be to make folks better, right?  However, if you just barely scrape the surface, you begin to see the flaws.  First, hospice benefits are paid out under Medicare, and there is no expectation of the patient improving.  There are parallel conditions that do not qualify for hospice but from which improvement on the part of the patient is unrealistic.

Examples of such conditions are easy to catalog.  Alzheimer’s and many other forms of dementia are conditions where the goal of skilled home health services is to slow the progress of the disease, not cure it.  Other conditions would include MS, Parkinson’s, COPD, and congestive heart failure, for example.

Doctor Examining an Elderly Patient

Thus, Medicare rules really need to reflect the diagnosis for the patient and what realistic goals for that patient would be.  If I had a hip or knee replacement, even a minor stroke, or perhaps I am completing chemotherapy, setting goals for the patient that reflect improvement may be appropriate.  For many other situations, the goal should be maintaining the patient at a certain plateau or even simply slowing the progression of a disease.

Hopefully, the proposed settlement of the class action law suit will produce the needed modifications in the Medicare payment rules to reflect appropriate goals.

What are you thoughts?

Best wishes.  Bert

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