U.S. Rep. Greg Walden (R-Ore.) was among 21 co-sponsors introducing bipartisan legislation today to ensure that seniors and disabled citizens have timely access to home health services under Medicare.
The Home Health Care Planning Improvement Act of 2013 would allow physician assistants (PA), nurse practitioners (NP), clinical nurse specialists, and certified nurse midwives to order home health services for Medicare beneficiaries.
“We have a responsibility to provide America’s seniors with high quality, cost effective health care. A key part of that is ensuring they have timely access to health care services in the privacy, comfort and security of their own homes,” said Rep. Allyson Y. Schwartz (D-Penn.). “These highly-skilled health care professionals play a central role in the delivery of primary care, particularly in medically underserved areas, and are crucial to coordinating team-based care.”
Currently, Medicare recognizes PAs, NPs, clinical nurse specialists, and certified nurse midwives as authorized providers who are able to perform many services for Medicare beneficiaries, including ordering nursing home care and prescribing medicine. However, they are not able to order less costly and less intrusive home health care services. Even in states such as Oregon that have expanded their laws to allow other medical providers to order home care, Medicare will still not certify payment for these services until a physician signs the order.
Those seniors and disabled citizens who see these medical professionals as their primary care providers often need an extra office visit with an unknown physician in order to get the care they need. Walden said amounts to extra administrative and paperwork burden, and creates an unnecessary step that fails to recognize current training and scope-of-practice guidelines. As a result, said Walden, patients in need of home health care services are either placed in more expensive health care settings, or experience a delay in receiving the care they need.
“This legislation will relieve that burden for our most vulnerable citizens,” said Walden.
If enacted, this legislation could produce significant savings for Medicare, with one study estimating that the plan would save over $100 million over ten years.
In the rural eastern Oregon town of Enterprise, Theresa Russell serves as the only permanent primary care provider in her clinic, Olive Branch Family Health. As an NP, current law allows her to treat patients in home health settings, but she must wait for a physician’s signature to do so. In rural towns like Enterprise, that wait time can stretch for a week, or sometimes even a month. The legislation would allow NPs to make the decision and speed rural health delivery to seniors.
“Under current law, NPs not being able to order home health for Medicare patients results in delay for the patient and interruptions in continuity of care,” Russell said. “This also leads to increased cost of care when a patient of mine needs to be seen by an additional provider.
“Studies have shown that the expanded use of these professionals can result in dramatic decreases in expensive hospitalizations and nursing home stays,” said Val Halamandaris, President of National Association for Homecare and Hospice. “
This bill is supported by national health care groups such as the National Association for Home Care and Hospice, the American Nurses Association, the American Academy of Physician Assistants, the American College of Nurse Midwives, and the American College of Nurse Practitioners.
