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Is Home Care Getting Harder to Find?

Wed, 09/27/2000 - 12:00am — Karen Stevenson
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The Office of Inspector General of the Health Care Financing Administration (OIG-HCFA) investigated claims that home health agency (HHA) placements have become more problematic since reimbursement was reduced with the implementation of the Interim Payment System (IPS). They say that their data shows a 25% decrease in HHAs from 1997 to 1999, which some of them attribute to IPS. The report says that 85% of discharge planners reported no problems in placing patients, 9% report problems with 5% or more of their placements and the rest report they have problems with placements less than 5% of the time.

In spite of these findings, which they categorize as insignificant problems, the OIG made some disturbing observations. They report that there appears to be a drop in home health care staffing in some areas. About one quarter of discharge planners report home health staffing shortages in their area have contributed to delays in placement, which they most commonly attribute to IPS. They explain that because of low reimbursement, they believe that HHAs have cut back on staffing or have closed. These discharge planners say that the remaining staff have been unable to provide care for everyone who needs home care in their area. Other discharge planners cite labor market forces when asked about the cause of staff shortages. These discharge planners say that, in some areas, nurses and home health aides are simply in short supply.

They also report that during the placement process, home health agencies are now looking more carefully at whether patients meet Medicare homebound and skilled need eligibility requirements, which may be a result of recent enforcement activities by the OIG-HCFA. Some discharge planners suggest agencies are using information on medical condition and service needs to screen certain patients. On the occasions when there are placement delays, discharge planners most commonly cite problems with patients needing IV antibiotics or expensive drugs. They also cite delays in placing patients who have decubitus ulcers or who need other wound care, as well as those who need rehabilitation. On average, about a third of those who cite delays due to medical conditions attribute these delays directly to the interim payment system.

The Office of Inspector General of the Health Care Financing Administration (OIG-HCFA) investigated claims that home health agency (HHA) placements have become more problematic since reimbursement was reduced with the implementation of the Interim Payment System (IPS). They say that their data shows a 25% decrease in HHAs from 1997 to 1999, which some of them attribute to IPS. The report says that 85% of discharge planners reported no problems in placing patients, 9% report problems with 5% or more of their placements and the rest report they have problems with placements less than 5% of the time.

In spite of these findings, which they categorize as insignificant problems, the OIG made some disturbing observations. They report that there appears to be a drop in home health care staffing in some areas. About one quarter of discharge planners report home health staffing shortages in their area have contributed to delays in placement, which they most commonly attribute to IPS. They explain that because of low reimbursement, they believe that HHAs have cut back on staffing or have closed. These discharge planners say that the remaining staff have been unable to provide care for everyone who needs home care in their area. Other discharge planners cite labor market forces when asked about the cause of staff shortages. These discharge planners say that, in some areas, nurses and home health aides are simply in short supply.

They also report that during the placement process, home health agencies are now looking more carefully at whether patients meet Medicare homebound and skilled need eligibility requirements, which may be a result of recent enforcement activities by the OIG-HCFA. Some discharge planners suggest agencies are using information on medical condition and service needs to screen certain patients. On the occasions when there are placement delays, discharge planners most commonly cite problems with patients needing IV antibiotics or expensive drugs. They also cite delays in placing patients who have decubitus ulcers or who need other wound care, as well as those who need rehabilitation. On average, about a third of those who cite delays due to medical conditions attribute these delays directly to the interim payment system.