Referring to Home Health

How to refer to home health and the benefits for both patient and referring physician.

Medicare Advantage Plans Overcharge for Home Visits

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Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, an investigation found.

Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, an investigation found.

Home Health Care News reports:

Health plans are cashing in on home visits, taking advantage of Medicare profits when the house calls unearth patients’ medical problems, according to a report by The Center for Public Integrity, a nonprofit investigative news organization in Washington, D.C., reports Home Health Care News.

Some senior citizens are finding that their Medicare Advantage health plans were eager to send a doctor to visit them at home, a service that is part of a burgeoning medical information and data analysis industry that’s thriving behind the scenes. Health plans profit because Medicare pays them higher rates for sicker patients, using a billing formula known as a “risk score,” The Center for Public Integrity reports.

Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, “mostly overbillings based on inflated risk scores,” the investigation shows.

Doctors and nurses who visit patients’ homes don’t offer any treatment during their visits, but report their findings to primary care physicians. And when a home visit uncovers a medical condition, health plans may raise a person’s risk score and cash in on thousands of dollars in added Medicare revenue, even if they don’t incur additional expenses when treating the patient. More than 70 health conditions may push up the risk scores, and thus the payments made by Medicare.  Read more


Paramedics Deliver Home Health Care Under Pilot Program

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The paramedic's role will evolve to someone who responds to emergency situations, as well as helps prevent them.

The paramedic’s role will evolve to someone who responds to emergency situations, as well as helps prevent them.

In a fundamental shift in how emergency medical services are delivered, several Massachusetts ambulance companies are branching into home health care, reports The Boston Globe.

Rather than just responding to emergencies and sending patients to emergency rooms, paramedics  – as part of a pilot program – are treating patients where they live.

The idea is to expand the paramedic’s role to a provider who not only responds to emergencies but also helps prevent them, treating patients with infections, minor wounds, injuries from falls, and problems associated with chronic diseases like diabetes and congestive heart failure. It could reduce unnecessary emergency room visits and hospital stays, which can cost thousands of dollars, according to The Boston Globe. Read more


Report Ranks Healthiest States for Seniors by Home Health Availability

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Availability of home health care factored in healthiest states for seniors.

Availability of home health care factored in healthiest states for seniors.

Ready availability of home health workers vaulted Minnesota to the top state for seniors for the second year in a row, according to a new report that ranks the healthiest states for older adults, as reported by Home Health Care News.

Hawaii ranks second, followed by New Hampshire, Vermont and Massachusetts in the second edition of America’s Health Rankings’ senior report, released by the United Health Foundation.

On the other end of the spectrum is Mississippi, ranked the least healthy state for seniors in the 2014 Senior Report and preceded by Louisiana, Kentucky, Oklahoma and Arkansas, respectively.

Within the report’s clinical care category—which includes home health care, among other attributes—Delaware ranks first, while Mississippi ranks 50th.

State rankings were determined by data including a rate of annual dental visits, percentage of volunteerism, percentage of quality nursing home beds, percentage of marginal food insecurity and percentage of prescription drug coverage.

“We commissioned this report to understand and identify ways to improve seniors’ health because Americans are living longer,” Reed Tuckson, M.D., senior medical adviser to United Health Foundation, says in a news release.

In the next 25 years, America’s senior population is expected to double, increasing the demand for home health workers. Read more