When reading the dismal headline "Health Affairs Study Finds No Link Between Cost, Quality of Care" as reported in the Kaiser Daily Health Policy Report (2009, May 27), I thought about all the effort going across healthcare types and kinds and levels and geographic areas, and felt depressed. There has got to be another way!! And at the same time reading about the Center for Medicare & Medicaid Services' (CMS) use of recovery and audit contractors (RACs), I felt worse. On the CMS' Web site, it states "Section 306 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) required [the] CMS to complete a demonstration project to demonstrate the use of recovery audit contractors in identifying underpayments and overpayments and recouping payments under the Medicare program for services for which payment is made under Part A or B of title XVIII of the Social Security Act. The demonstration operated from March 2005 through March 27, 2008. Section[horizontal ellipsis].required the Department of Health and Human Services (DHHS) to make the RAC program permanent and nationwide no later than January 1, 2010. CMS is planning a gradual expansion to all 50 states" (2009, May 19). The expansion schedule can be viewed at http://www.cms.hhs.gov/RAC.
And we have heard that President Obama is expected to propose significant cuts to the Medicare home health benefit in his FY 2010 budget. There may be no doubt that those caring for people at home-patients and families who cannot be "seen," are not in a building (e.g., a hospital, nursing home, etc.), and are homebound may literally be "voiceless" in this process. We must be their collective voice and represent them to those who choose NOT to see our (sometimes hard-to-see) patient population!! And unfortunately, home health is not alone; hospice is also threatened.
Today is the day to e-mail the White House, call your Congressional representatives (both House and Senate) and offer to take them with you to see your sick (and clearly) "voiceless" patients. Contact the representatives' aides in your local communities and jam the phone lines with your concerns. Fax and call your representatives to preserve access to home healthcare. Mobilize patients and their families (if they are able)-who better to explain what you do every day and its value? We cannot just accept this proposed budget; to do so would devastate the very organizations that care for the sickest and frailest in their homes.
All of which brings me back to the need for a Discharge Department. When the feds or their designees (such as RACs or ZPICs) come looking for money, a Discharge Department could be important. Think about how much effort is put into processes related to admissions, such as an Admissions Department. It is important to assess who we admit and why. Think about discharge: that is where/how transitions to other care levels and care occur, how patients are discharged when identified goals are met, how records are summarized and closed, and how documentation paints/supports the picture of covered, medically necessary skilled care, homebound, etc. Or, in the case of hospice home care, the patient and family are cared for and supported by the team, bereavement care is initiated to loved ones, etc. The hospice documentation supports the need for the services, and the certification processes are timely and documented. There are many "back-end" processes that occur; perhaps when there is one entity coordinating varying aspects that occur in every discharge, these related processes could improve? These include communications with the physician, closing out the record with the last/discharging clinicians and notes, writing the summary, verifying the final bill and numerous other operational "to-dos." In addition, I would like to think that this proactive approach to the end of the care would assist organizations as they seek to protect themselves from the government's further encroachment and this latest expedition into the heart of heathcare-care at home.
P.S. Some good news: at press time, the AARP Public Policy Institute released a new Fact Sheet entitled "Providing More Long-Term Support and Services at Home: Why it's Critical for Health Reform," accessible at http://www.aarp.org/research/housing-mobility/homecare/fshobshcr.html. I encourage you to read this, share the data, and support common sense initiatives. The voices of our patients, their family members, our team, and others must be heard!!
TINA MARRELLI
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