New survey suggests healthcare providers are failing to provide required services at home

Medicare-certified home health professionals are inadequate in terms of the amount of care services they provide, according to a new survey by the Center For Medicare Advocacy (CMA) released Thursday.

“Our surveys have confirmed what we unfortunately hear all the time [CMA], either directly from beneficiaries, family members or friends who have tried to have services ordered from an authorized physician and cannot, “Judith Stein, founder and chief executive of CMA, told Home Health Care News. “Some services are wholly – or partially – canceled during an episode. Access is a huge problem. “

CMA is a Washington, DC-based not-for-profit legal organization focused on health equity and improving access to full Medicare coverage.

As part of the survey, CMA collected responses from 217 Medicare-certified home health authorities in 20 states to determine what beneficiaries are likely to experience when attempting home care.

To gather this information, the CMA inquired about the available services of each agency for a hypothetical patient with a mandate from an authorized physician certifying one hour of physical therapy per week, one hour of qualified nurses per week, and 20 hours of home health care per week.

All agencies said they could offer one hour of physical therapy per week, and 99% said they could provide one hour of skilled nursing per week. However, responses began to falter when authorities were asked about access to home health services.

In particular, 15% of the agencies did not give a clear answer on availability. The majority of the agencies that responded were unable to provide the amount of support services that were in line with what the Medicare Act defined, according to the CMA.

Although Medicare law allows 28 or more hours per week for beneficiaries who meet the criteria, only 4% of agencies said they could provide 20 hours of home care assistance per week. Approximately 95% of the agencies were able to deliver six hours or less per week.

The CMA also found that the agencies misunderstood the Medicare Coverage Act. In fact, 20% of agencies from 17 states provided incorrect information about Medicare coverage in response when they were unable to provide the required number of hours or types of home health care.

More than 20% of agencies wrongly stated that “bathing and grooming” are the only services provided by home health workers.

“There is a list of over 15 services that general practitioners can provide under Medicare coverage, and Baden is only the first of those many services,” Stein said. “This is personal care you can touch and it is particularly defined in the federal ordinance. [Agencies] should look at that. Far too often people are told that there is only one bathroom or everything else that is simply not right. ”

In addition, the agencies tended to falsely state that Medicare health insurance at home needs improvement. Approximately 33% of agencies answered “no” to the question, “Does your agency provide Medicare-covered services to maintain a person’s condition or prevent their decline?”

Although the COVID-19 emergency has undoubtedly contributed to staff shortages in the agencies, Stein points out the problems that were highlighted in the survey that began a few years ago.

“However, given that there are staffing issues right now, for years before COVID-19 we heard inaccurate knowledge about what Medicare coverage is for home care,” she said.

To improve access to medical care, Stein urges agencies to familiarize themselves with Medicare law and what it offers.

“I hope they will take another look at what Medicare should really offer beneficiaries in terms of the quality services, care and therapies, but most importantly, they will become familiar with two important things,” she said. “One of these is the personal care insurance that is available or that must be provided by home nurses. … The second important thing is for providers to learn and incorporate into their practices that Medicare does not need to improve to cover home health services. “

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