HH and the new HC bill

[mightymitern]

Hello Home Health Nurses,

I am from Massachusetts and will give a little info on my experience before I ask my question if that is ok.

I worked as a Hospice RN in an inpatient house (which I LOVED), but then got steered in the direction of a nice hospital "union" job. You know the kind where you always get your dinner break and know when you will get a yearly raise. I now work on a Tele Med/Surg floor and have learned a great deal. However I do not remember being so stressed and achy after leaving work before this particular job.

Ok here is my question, I was inquiring into a home health service (preferably hospice part) which is still part of our union (belongs to the same enterprise). My husband and I are having a debate about whether home health care itself will change dramatically with the HC changes coming about. I say more people will need this service because insurance companies only allow a certain amt of days in the Hospital, then send pt's home. My husband thinks HHC will slow because insurances won't pay for the private care, and I am better off staying at the Hospital, and finding my niche. (chuckle, it's not there) I am only looking for thoughts on whether you think HHC will grow or may be in jeapardy. I feel HHC companies are needed and expanding. If this is not an appropriate topic, I apologize. Any feedback is appreciated.

[caliotter3]

For the past year and a half I have only had sporadic home health work. The multiple agencies that I am signed with all tell me that they just don't have the work. This has been going on for quite some time before the passage of this bill. Have no idea how the bill will affect home health but I bet there will be even less work for me in the future. I am considering leaving home health and getting a "real" job, if only I could find one of those.

[chenoaspirit, ASN, RN]

Well, I consider homehealth a "real job". So not sure what the poster meant by that.

But Ive been wondering the same thing about the HC bill, if it will pay for homehealth services at all. Right now Medicare and Medicaid pay 100% and with this new system, if it costs alot, alot of patients will refuse it due to their finances.

I could never go back to working the floor in a hospital. I like the freedom with my job and the support I have with my coworkers. I never had any support at the hospital, everyone was back-biters and it was STRESSFUL.

[caliotter3]

What I meant by real job is one where you work and get paid for it. Of my six home health agency employers, two have NEVER provided me with work, one has provided no work in a year and a half, etc. I don't know what causes these employers to not have available work, but whatever it is, I can't pay my rent with their excuses.

[KateRN1]

Caliotter does shift work in homes which is typically covered by Medicaid and thus state-specific. Intermittent visit home care is covered under the federal Medicare benefit and I can only see it growing. The direction I see is that we will be reimbursed less per episode and will have to justify everything we do, leading to cherry-picking among agencies (moreso than they already do). The push will be to bring on more patients with education needs (diabetic ed, CHFers, A-fibbers, etc.) and fewer holes (wounds, trachs, pressure ulcers, etc.). There may ultimately be a co-pay for both hospital and home care, but I'm willing to bet that insurers will go with intermittent home care as a more cost-effective option than hospital care. Think of the patients who need 6 weeks of vanco therapy, where the drug is covered only if the pt is in the hospital. Eventually insureres will realize that it's cheaper to cover the drug and home care nursing than the drug and inpatient hospitalization.

I truly think that home care is going to explode as the Baby Boomer Generation ages and that cohort wants to age in place as much as possible. How it's reimbursed may be another issue altogether, and I see changes as earth-shattering as when PPS first came to being in the early 90s. It's simply a matter of adjusting to meet patient needs while maximizing reimbursement--same as it's been for the last 15 years.

[nursel56]

Most of our patient's home health funding comes from the state and county in my area. But most are under 65 yrs old. My own completely unscientific guess is that homecare is cheaper for both the intermittent patient education visits, and the "shift work" with trachs, vents, etc. is cheaper than an LTC. I really wonder if anyone has attempted to estimate or research into c-diff, MRSA etc, infection rates with homecare vs LTC. I'm going to guess there will be a decent sized difference.