by Karen E. Culp
Home health agencies are finding it harder and harder to stay in business, and Sen. Christopher Bond has introduced legislation that he hopes will alleviate some of their financial concerns.
Bond's bill, the Medicare Home Health Beneficiary Protection Act of 1998, is "designed to put pressure on the Health Care Financing Administration to move quickly towards the establishment of a more equitable payment system for reimbursing home health providers," according to a release from Bond's office.
The system now being used to reimburse home health agencies is an interim payment system that is in place until a prospective payment system goes into effect Oct. 1, 1999. Both of these systems came about as part of the Balanced Budget Act of 1997.
Since the interim system went into effect, 35 home health agencies have closed their doors in Missouri, the release said.
Freddie Porter, administrator for Friends & Family, a Springfield home health agency, said she does not want to close down, but that the current system for reimbursement is making it a very real possibility for agencies like hers small, independent, locally owned agencies.
"The new system has added a per-benefit limit that has made it nearly impossible for us to cover our staff costs," Porter said.
The HCFA has established a formula for determining the reimbursement payments made to an agency. The result is that each patient has a limited amount of funding available for their care. The reimbursement the smaller agencies receive is not sufficient to meet their expenses, Porter said.
"The per-patient limit for this agency is about $2,700. If a patient will need therapists, home health aids and skilled nurses, he can use up all of his benefit in January. Then what happens to that patient if he needs more care later in the year? Agencies will have to turn him away if he's used up his limit," Porter said.
Though her agency has "really pinched pennies," it is still struggling to cover the costs incurred by dispatching skilled nurses, occupational and physical therapists and home health aides to patients.
Porter said Medicare has said it intends to decrease the number of home health agencies in the business, and that the increase in such agencies has been attributed to an increase in fraud and abuse in the system.
"Medicare has said there are all these agencies cropping up because there are people out there wanting to get rich by defrauding, but the growth has actually occurred because of the need and the aging of the population," Porter said.
Porter said she worries that the small agencies will no longer be available for patients.
"We've been a good choice for these people because we take good care of them. People come to us because they want that personal service," Porter said.
Porter said she is hoping that the payment plan will become one that is more generous to agencies like hers. Craig Orfield, a spokesman for Bond, said that is what Bond's bill intends to do. Orfield said the bill, which was introduced prior to Congress' recess, has a significant amount of interest from both parties.
"We will see further action on this bill at the end of this month," Orfield said.
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