Medicare Home Visit Benefit May Soon Require Senior Co-pay

Medicare pays for skilled home care visits currently, as long as a senior's medical doctor approves of the skilled home care which only includes visits by one of the following skilled professionals:  Registered Nurse (if there is an open wound or medical treatment that requires a R.N. to administer or monitor), Speech Therapists (S.T.), Occupational Therapist (O.T.), Physical Therapist (P.T.), and Certified Nursing Aide (C.N.A.).

These visits are approved for a short-time period to assist a senior in recovering from a medical condition such as a stroke or hip replacement.  The senior must be showing improvement for the visits to continue to be approved.

Yesterday, the Medicare Payment Advisory Commission recommended that Congress implement a co-pay to discourage overuse of the free Medicare home health care "skilled" visits and  the fraud that it invites.

The current Medicare service for home health care visits have been plagued by fraudsters.  However, Congress must take responsibility for setting up a system where it was easy for fraud to take place.  For example, one of the reimbursements for home care provides a bonus $2,000 to Medicare home health agencies on the 10th visit.  The home health agency could then discontinue services - - - and oops, turns out most seniors have ended up needing exactly 10 visits.  However, we cannot entirely blame Medicare agencies for taking advantage of such a bonus, even if it does seem completely silly.  Typically, private companies set-up bonuses to be connected to performance.  Imagine if Microsoft or Wal-mart were tossing out an extra $2,000 bonus for the 10th day of service for one of their products.  Their shareholders would not allow this as bonuses are connected to going the extra mile to increase sales or deliver better quality.  Why the government would not do the same is confusing or maybe this is just the success of a profitable industry's lobbyists. 

This Wall Street Journal article profiles how one of the largest Medicare home care providers always tries to make sure seniors need a 10th home health visit in order to get the extra bonus.

The Medicare Payment Advisory Commission did not give an amount for the co-pay for the Medicare home health visits but has suggested the charge be $150 for a series of related visits.  The Congressional appointed commission voted 13-1 to recommend that lawmakers impose the new charge.

Medicare fraud has eaten up more than $60 billion (yes, billion with a "b").  Let your congressman know that you support changes in Medicare reimbursements so that your tax dollars can be spent on actual care for seniors (wouldn't an extra $2000 for a senior to pay for home care or for prescriptions be better than giving it to a Medicare agency who is gaming the system for 1 more visit?).

The Senate is investigating Amedisys , a home health care company which the Wall Street Journal provided an investigative report on profiling how they appear to be gaming the reimbursement system for home health visits.  The Senate also admits that the system does possibly have some flaws.

Reimbursement rates should be fair but not set-up to allow for $60 billion in fraud to take place and not set-up for a company to squeeze in one more visit for a bonus that is not connected to quality of care or achieving a performance milestone in delivering care.

The home health care industry does have a very strong lobby in Washington, D.C, funded partly by their association which has deep pockets from the healthy reimbursements the industry has been enjoying.

Seniors and caregivers should ask questions of home health agencies (the agencies providing the "skilled visits" - these are NOT the private duty home care agencies providing companion caregivers and nursing aides for home care).  Skilled care provided by the Medicare-reimbursed home health agencies is for brief visits for care provided by a  R.N., S.T., O.T., or P.T., along with a small portion of care by a Certified Nursing Aide (C.N.A.).  If you are a loved one or senior client are receiving home health care by a Medicare-reiumbursed skilled care agency, ask about their reimbursements and ask about their relationship with your medical doctor who approved the visits.  Find out if your doctor is on the home health care agency's Advisory Board - this is another practice where, under the table, the doctor is receiving a benefit for the referrals - it can all be legal on paper when done in the right way but is still not really ethical.  If a doctor receives recognition in any form (vacation trips, meals at restaurants), these are kick backs for referrals, even if it is identified as "advisory board" recognition.  As a senior's tax dollars are paying for Medicare, it is fair information to request in an effort to keep the system honest.  This also eliminates any need for an agency to be competitive in delivering quality care when they know all of their referrals are guaranteed from a certain doctor.

It is also fair to point out that some of these same lobbyists are against "Obama care" we have reported previously, the majority of senior caregivers do not have health insurance.  Many seniors in the U.S.A. have never had health insurance their entire life until they go onto Medicare/Medicaid when they retire.  Imagine how much money the government would save if these senior's had been having health care earlier and preventive health care.  It seems everyone in America should have access to affordable health insurance.











Log in