Diana Mason

About eight years ago, I was quite ill with what I thought was the flu. When I became even sicker, I realized that it was something else. I called my primary care providers’ office on a Sunday and was told by the physician-on-call to go to the emergency room.  But I decided to go to the primary care office the next morning because I knew too much.

I knew that “hospital-acquired infections” claimed 99,000 lives in 2002 and cost around $30 billion a year. The Centers for Medicare and Medicaid will no longer pay for such infections, leaving it to the hospitals to cover the costs. (Of course, they’ll try to shift these costs to others, whether to private insurance companies or consumers.) Why do we continue to allow needless health care spending when there are other, better options?

Most of us want to heal or die in our own homes – not in a seemingly sterile environment where unseen organisms and errors can kill you.  So home care is a good thing – right? If it is, then why can’t nurse practitioners and physician assistants order home care services for their patients?

The Medicare law includes a provision requiring home care services to be ordered by a physician. This provision is inefficient and costly. My husband is on Medicare and, despite the fact that our nurse practitioner knows when he needs home care, she must get a written referral from a physician. This can delay the referral and put the patient’s health and well-being at risk.

The Home Health Care Planning and Improvement Act (S. 227/H.R.2267) would change this. It would permit nurse practitioners, certified nurse midwives, clinical nurse specialists, and physician assistants to order home care services under Medicare. It has been estimated that this law could save about $235 million over 10 years.

It didn’t get passed this year – but not much legislation is moving in Washington. The provision is part of a larger package that deals with home care policy. I know it’s an election year and everything is being fought over and politicized to score points with “the base”, but we can’t make our health care system safer and more efficient and affordable if federal and state policymakers can’t talk with each other. Maybe legislators should have been delayed from going home or on vacation until they agreed on five ways to improve health care. They could start with changing the Medicare law to allow advanced practice nurses and physician assistants to refer Medicare patients for home care.

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3 Responses to “Taking health care home”

  1. yes Says:

    The whole primary care system is inefficient and ineffective – a waste of time and money. Been there, done that.

    First when you call a doctor you should not be referred to an emergency room. That is just plain stupid. Someone should be on call 24/7 to see patients.

    the system is driven by fear and money. The only answer is better education from kindergarten up and separate health care from medical care.

  2. Andrea Brassard Says:

    Here’s a new AARP Public Policy Institute resource you can give to your legislators plus three talking points:
    http://championnursing.org/APRN-barriers-7-2012
    http://www.aarp.org/health/medicare-insurance/info-07-2012/removing-barriers-to-advanced-practice-registered-nurse-care-home-health-hospice-AARP-ppi-health.html
    Removing barriers to advanced practice registered nurse (APRN) care in home health and hospice services will benefit consumers, nurses, physicians, and the health care system. Removing these barriers, which will require legislation, would increase access to care for vulnerable patients and their family caregivers. Allowing APRNs to certify home health and hospice services can decrease costs, expedite treatment by eliminating the need for physician sign-off, and allow patient-centered health care teams to practice more efficiently.
    Andrea Brassard, Center to Champion Nursing in America at AARP

  3. Kenya Beard Says:

    Where is the evidence that supports why nurse practitioners should not be allowed to order home care services? This is yet another barrier to accessing care and needs to be remedied sooner rather than later. Perhaps legislators should be forced to stay until they can agree on 5 ways to improve health care. Heck, it’s a start!!

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