Issues of Financial Pressure On Home Care Agencies: Dealing With the Potential of Fiscal Abuse

Abstract

Abuse (abiu.s), sb. [a. Fr. abus:-L. abusus, 1. wearing out, 2. Misuse; n. of completed action from abut-i. See Abuse v.] 1. The process of or wearing out. 2. Wrong or improper use, misuses, misapplication, per version. 3. A bad or improper usage (i.e., a use which has become chronic), a corrupt practice. 4. Imposture, deceit; delusion. Obs. 5. Injury, wrong, ill-usage. Obs. 6. Violation, defilement (now only in self-abuse). 7. Injurious speech, reviling, execration; abusive language. Although some may find practice of beginning an article with a definition an affectation, it serves useful purpose of reminding reader of its etymology and many interpretations that have been derived over years. In this case, tribute must be given to The Pro fessor and Madman: A Tale of Murder, Insanity, and Making of Oxford English Dictionary by Simon Winchester for this convention. By looking at definition of abuse, one finds several interesting definitions and connotations that are borne out in a review of financial pressures that have been imposed on home care agencies over last few years. First, it is important to note that as both a verb and a noun, term means to misuse, misapply or use up. In fact, it requires two parties for to occur- abuser and abused. Today we often speak of the cycle of abuse that can occur in society with a single act of begetting further mistreatment. In case of fiscal and home care agencies, only way subject can be fully understood is to review history of home health, its utilization and variation, and federal government's actions in response to use patterns. With such a review, we find that has become reinforcing and therefore cyclical, with government and providers reacting and responding to actions and activities of each other. More important, responses may have led to a using up of Medicare home health benefit federal government miscalculating effects of Balanced Budget Act (BBA) o this service. WHY THE BBA In order to understand nature of fiscal pressures of today's home health provider, an overview of Balanced Budget Act of 1997 is necessary. From 1990 to 1995, home health expenditures had increased from $3.3 billion to $15.1 billion, a nearly fivefold increase, and from 1992 to 1993, expenditures for home health had increased 78% (Office of Inspector General, 1997). By 1996, year before BBA was passed, home health expenditures had reached $17 billion annually, and average annual increase between 1988 and 1996 was 31%, making home health fastest growing expenditure in overall Medicare budget (Medicare Payment Advisory Commission, 1997). The increase in home health caused federal government to take a closer look at cause for this growth, specifically whether it was uniform throughout country and with respect to auspice. When it looked at variations in July of 1995, Office of Inspector General of Department of Health and Human Services found that there was a fivefold difference in amount of Medicare reimbursement per beneficiary in what was defined as of home health agencies from group (Office of Inspector General, 1995). To draw comparison in dollars, highest group of agencies received on average $7,978 per beneficiary for home health services and lowest received $1,534. In addition, two-thirds of agencies defined as being in lower and middle groups provided home health services at or below national average reimbursement per Medicare beneficiary of $2,957. In addition to looking at reimbursement, same study found that number of visits varied widely. At time of study, national average number of home health visits per beneficiary was 50. …