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Budget balancing act affects home health

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by Ann Bucy

SBJ Contributing Writer

With Congress making cuts in home health care reimbursements under Medicare, local providers are continuing service with some new adjustments.

According to the March issue of the AARP Bulletin, Congress last summer curbed the money it was spending on home health through Medicare.

"To curb surging home health care costs which had quadrupled from about $3 million in 1990 to $17 billion in 1996 Congress included a number of far-reaching measures in last year's Balanced Budget Act. One creates an interim payment system that puts a cap, or ceiling, on the amount Medicare will reimburse each home-health agency. Another seeks to correct a practice whereby some home-health agencies would routinely provide clients costly personal care beyond what the law intended."

Susan Goff and her husband, Jim, own Health Force, a stand-alone home- health agency located at 2032 E. Kearney. According to Susan Goff, that means they are not affiliated with a hospital, however Health Force is a national health care chain.

Goff said providing home care is contingent on patients "having to be homebound; something that needs ongoing care, but there has to be an end in sight. It can't go on forever.

"The government is trying to set limits: that there can only be so many visits per patient. It's hard to be an entrepreneur in this area,"Êshe added.

Jim Goff said that home health agencies really don't know what their rate of reimbursement will be under Medicare until the Health Care Financing Administration issues its figures in June. HCFA is the federal agency responsible for administering Medicare, as well as overseeing the states' administration of Medicaid.

In addition to home health, Health Force provides a 24-hour live-in companion service and a staffing agency that provides registered nurses, licensed practical nurses and certified nurses aides. "Companion care is an out-of-pocket expense," Goff said. "It's not covered by Medicare or any kind of insurance."

The AARP Bulletin also said, "In general, Medicare covers home-health services if they are furnished by a home-health agency participating in Medicare and acting on a doctor's certification that the patient is confined to home; needs skilled nursing services on a part-time or intermittent basis or is in need of physical, speech or occupational therapy; is under a doctor's care; and a plan of care has been established by a doctor."

Chuck Goforth runs Oxford Home Health, part of Cox Health Systems.

"The government expects 50 percent of the home-health agencies to close," he said. "We're big enough to handle it and should do just fine. The smaller agencies may be gone, though, and I don't like that. It could be adverse to the patients, because they won't have as many places to choose from. Also, it's reduced our services some because Medicare is paying us less. The government was trying to save money for the balanced budget and got carried away."

He said that when he started Oxford 23 years ago, home health wasn't even an industry. "Patients were typically left in the hospital for everything. But now people are sicker than they used to be and they're getting out of the hospital faster."

He said that 75 percent of the people Oxford serves are geriatric patients: people 75 to 85 years of age. "They need supportive care, not medical care, which is what home health is. They want trained nurses aides or someone to clean their house or run errands for them."

The second largest group of people served are those with heart disease: those who've just had a stroke or a heart attack. "They need someone to check on them."

And a growing area is pediatric care: babies coming out of delivery, children born with breathing problems, etc.

He also said that home health is becoming more specialized. "I think people think this is a good thing: they're glad we're here. They know what they've experienced with home health, but that's all. They don't know all the services that are available. People call in and are amazed at what can be done."

In addition to home health, Oxford has a medical equipment company and provides intravenous therapy through Home Parenteral Services. "In a year or so, we're going to have all the services located under one roof," he said.

"Everything will be on the Medical Mile near Cox South." Oxford is located at 3660 S. National.

Oxford serves 25 counties including patients in Missouri, Oklahoma and Arkansas.

"We haven't been affected by the cuts yet," said Suzanne Dollar, an administrator for the Visiting Nurses Association, located at 531 S. Union. The VNA became a part of St. John's Health System in July of 1995.

"Our new fiscal year will start in July. But the cuts have definitely caused us to be very mindful of efficiencies in our programs. Patient care will continue as it is for the most part. I don't see the delivery of care being affected."

The VNA offers home infusion, hospice care, medical equipment and private duty nurses. "Private duty includes services provided by the hour and isn't usually reimbursed by a third party like Medicare or insurance."

Dollar said that a lot of VNA's recommendations come from local doctors. "The hospitals provide a list of local home health agencies. It would be illegal for the St. John's doctors to only recommend St. John's VNA," she added.

"Home care is meant to meet a need," Dollar said. "When it's met, you can't be billing Medicare beyond that. We need to find programs to meet their personal needs. That's where a private duty nurse, or some other service, fits in. This can be in lieu of a nursing home."

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