Home health care is an increasingly important benefit to Medicare enrollees, enabling homebound patients to receive skilled nursing and rehabilitative care once available only in hospitals or physician offices. According to an analysis of the Medicare Payment Advisory Commission's data presented in the March 2011 Report to Congress, home healthcare is less expensive than care provided in institutional settings. Skilled home healthcare is recognized as highly cost effective, offering patients clinically advanced care in the setting they prefer.
Nurse practitioners have been authorized since 1998 as Medicare providers, authorized to render, order and refer for services and be directly reimbursed. NPs order physical therapy, occupational therapy and speech therapy, provide telemedicine services, and perform and interpret diagnostic tests within their scope of practice. NPs also play a vital role in providing care coordination for people with multiple diseases and chronic conditions.
Barriers Prevent NPs From Ordering Home Health Services
Nurse practitioners' advanced education and clinical preparation provides them with the knowledge and experience to refer patients for home health and hospice services. Despite this, Medicare rules and regulations do not allow NPs to sign certification documents to allow consumers to receive these needed services. NPs are authorized to perform a face-to-face assessment of the patient's needs, but a physician is required to document the encounter has taken place, even if the physician is not involved in the assessment.
The landmark Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health specifically recommends that NPs and other advanced practice nurses be authorized to certify eligible patients for home health and hospice services. In a July 2012 "Insight on the Issues" report entitled Removing Barriers to Advanced Practice Registered Nurse Care: Home Health and Hospice Services, the AARP Public Policy Institute concluded, "Allowing APRNs to certify home health and hospice services can potentially decrease costs, expedite treatment by eliminating the need for physician sign-off, and allow patient-centered health care teams to practice more efficiently."
The "Home Health Care Planning Improvement Act"
Bipartisan legislation currently before Congress will enable nurse practitioners to certify patients to receive home health care and services and approve plans of care. This legislation will reduce Medicare costs while and improve the quality and timeliness of care for beneficiaries who need home health services. An independent analysis by Dobson DaVanzo & Associates concluded that this legislation would save Medicare $309.5 million over ten years.
Senators Susan Collins (R-ME) and Kent Conrad (D-ND) introduced the Home Health Care Planning Improvement Act in the Senate as S. 227 on January 31, 2011. Representatives Greg Walden (R-OR) and Allyson Schwartz (D-PA) introduced a companion bill, H.R. 2267, in the House of Representatives on June 21, 2011.
- A bipartisan group of 115 Representatives and 17 Senators have joined in supporting this legislation as cosponsors.
- AARP, the American Nurses Association, the National Association for Home Care and Hospice, and 44 organizations in the Nursing Community are among the groups that have endorsed the bill.
Urge Your Members of Congress to Pass the Home Health Care Planning Improvement Act
Despite strong bipartisan support, Congress is unlikely to vote on the Home Health Care Planning Improvement Act on its own as a free-standing bill - its provisions will have to be included in other "must-pass" legislation the House and Senate will consider, such as a measure to prevent a 27 percent cut in Medicare payments on January 1, 2013.
The opportunities are limited: Congress will only be in session for about 20 days in September and early October before the November election and a post-election "lame duck" session could be just as short.
The only way we can ensure that Congress passes this legislation this year is to have as many members of Congress as possible insist that their House and Senate leaders (including the chairmen of the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee) include the Home Health Care Planning Improvement Act as part of any "must-pass" legislation they vote on this fall.
Take Action Now!!
Step 1: Identify your members of Congress. Do you know your Representative and Senators? If not, go to www.senate.gov to find your Senators and www.house.gov to identify your Representative.
Step 2: Are your members of Congress already cosponsors? It's easy to find out:
- Go to http://thomas.loc.gov and type "Home Health Care Improvement Act" in the search box provided.
- To see if your Representative is a cosponsor of H.R. 2267, click on the "Cosponsors" link under that bill.
- To find out if your Senators are cosponsors of S. 227, click on the "Cosponsors" link under that bill.
If your Representative or Senators are not cosponsors of the Home Health Care Improvement Act, ask them to sign on. If you've asked before and they still are not cosponsors, ask why not.
If your Representative or Senators are already cosponsors, they should be willing to talk with their leadership and the chairs of relevant committees to take action on a bill they already support.
Step 3: Plan your message. As a constituent, you can explain to your members of Congress and their staffers what a "nurse practitioner" is, describe your practice, and explain how this legislation will help you and other NPs ensure that patients with Medicare coverage get the home health services they need in a timely manner. Your experiences and perspective are critical to making your legislators understand how passage of this legislation will help their constituents and improve health care in the communities they represent in Congress.
Some general talking points for phone conversations, emails, or letters:
- As a nurse practitioner providing health care services to your constituents, I am writing/calling to ask you to ensure that Congress takes action this year on legislation that will allow me to make sure my Medicare patients get the home health care services they need.
- Medicare's current policy compromises my ability to provide appropriate care for my patients because the Medicare law and regulations do not authorize me to order home health services - even though I can provide all other aspects of care for that patient leading up to and after the home health services order has been placed. This restriction makes it necessary to involve another provider who is often unaware of the patient or their current condition. In many cases, this means that my patient has to come in for a second office visit at considerable cost to both the patient and to the Medicare program.
- Provide a personal story (i.e. I live in a rural area and don't have access to a physician to sign off on my order. / I have my own practice and don't have a relationship with a physician. / I have a patient who was not able to get the services she needed because of this law.)
- There are a number of "must-pass" bills that Congress still has to consider this fall, including legislation to prevent a 27 percent cut in Medicare payments in 2013. The saving from this improvement in home health care will not only help to offset the cost of preserving Medicare payments, it will improve the care that Medicare beneficiaries receive.
- Please help me serve my patients by improving their access to cost-effective Medicare services by cosponsoring the Home Health Care Planning Improvement Act (H.R. 2267/S. 227).
- Most importantly, I urge you to speak directly with your leadership and the chairmen and members of the committees with jurisdiction over Medicare and ask them to include this important legislation in any "must-pass" legislation you will vote on this fall. We need to know that you're with us in improving health care for Medicare patients.
Step 4: Contact your members of Congress, either by phone or email, and urge them to demand action this year on the Home Health Care Planning Improvement Act (H.R. 2267/S. 227).
- The easiest and most effective way to reach your Senators or Representative is to call their Washington, DC office. Call the U.S. Capitol Switchboard at (202) 224-3121 and ask to be connected to the office of your Senators or Representative.
Ask to speak with the Representative or Senator, but if he or she is unavailable ask to speak with the Legislative Assistant responsible for Medicare issues.
- You can send an email to your Representative and Senators through their websites. To find the websites of your members of Congress, use your favorite search engine or direct your browser to the House (www.house.gov ) or Senate (www.senate.gov) websites and use the member directories to find your legislators. Once on their website, just look for the "contact" or "email" link.