Congressman Jim Gerlach Reiterates his Support for Home Care at Town Hall Meeting Hosted by NAHC Chairman Andrea L. Devoti
Supports Authorizing Nurse Practitioners to Write Medicare Orders for Home Health, Opposes Any More Home Health Cuts, Calls forReform of the ACA Employer Mandate, and Blasts CMS’s New “Rebasing” Rules
August 20, 2013 08:46 AM
Standing (l to r): Eric Kiehl, Heidi Owen, Andrea Devoti,Jim Gerlach. Seated (l to r): Gina Petersen and Vivian Fielder
Congressman Jim Gerlach (R-PA) thinks “it’s time for real solutions” as we strive to improve health care for all. He supports legislation that will help more employers provide their workers with health insurance and give morepeople access to affordable care. He also supports a plan that keeps the promises we’ve made to America’s seniors and those nearing their retirement years. “It’s a plan,” he says, “to preserve and strengthen Medicare so that all seniors have access to quality affordable health care.”It would give seniors more options, and it does not include more cuts to home health care, as he recently told NAHC Chairmen Andrea L. Devoti when she convened a town hall meeting at Neighborhood Health, her agency in West Chester, Pennsylvania.
Devoti brought the congressman together with numerous Pennsylvania home care providers for a wide-ranging discussion of issues affecting home health and hospice. Among those participating were Eric Kiehl, public affairs director at Pennsylvania Homecare Association and several staff members of Neighborhood Health: Heidi Owen, director of hospice/oncology services; Gina Petersen, chief information officer; Pat Bush, director of home care services; and Vivian Fielder, director of customer service/intake.
They all came away impressed with the congressman’s devotion to their industry and to the patients they serve. “Congressman Gerlach was not only attentive and supportive,” Devoti says, “but also knowledgeable about the challenges we face.”
The issue that concerned him most was a possible rebasing of the Medicare prospective payment systemcalled for under the Affordable Care Act of 2010. Since the law was passed the Centers for Medicare & Medicaid Services has proposed a rule cutting home health reimbursement by a total of 14 percent over the next four years.
This equals another $25 billion in cuts on top of the $77 billion that Medicare home health has been cut since 2009. If approved the rule would lead most agencies to have negative margins, and it has been a bad idea from the start, Gerlach contended. “I don’t understand,” he said, “why someone going two years back would consider rebasing as an answer to the problems Medicare faces.”
Gerlach has seen in his own state the challenge involved in caring for our aging population. Pennsylvania confronts severe budget shortfalls in coming years and providing quality services to the state’s growing number of seniors is a major source of the state’s fiscal dilemma. Pennsylvania faces a record-breaking increasein the population of those 65 and older, a demographic shift that requires the stateto rework the way it cares forthe aged so spending is controlled, efficiency is enhanced, and servicesreflect seniors’ wish to remain at home.
The congressman has witnessed first hand how home care can help them reach this goal. Two years ago, Rep. Gerlach went on a home care visit with Ms. Devoti - as CARING Magazine reported in the cover story of its July 2011 edition. The visit strengthened his avid, long-time support of home care and hospice. So he is now working in Congress to pass bills that will let home care and hospice do even more for their patients and staff.
He wants to help agencies comply with the employer mandate by making it easier for them to give theirworkers health insurance coverage. He’s also wants to revise the face-to- face requirement, whichrequires a doctor to see a patient before certifying them for home health. Someone who has been in a hospital shouldn’t need to have a face-to-face encounter, he told Devoti and her colleagues.
He also talked about the value of letting nurse practitioners order home health care for their patients. At present Medicare law doesn’t allow nurse practitioners to sign home health plans of care or certify Medicare patients for the home health benefit. These prohibitions delay health care delivery - especially in places with few physicians - so having nurse practitioners sign orders will facilitate care for patients, as the congressman understands. He strongly supports the Home Health Planning Improvement Act (H.R. 2504) giving nurse practitioners the ability to certify patients for the home care services they need. Yet he doesn’t believe the bill could get signed on its own. Perhaps it might be better, he suggested, to tack it onto a bill for a permanent “doc fix,” a matter that Congress will focus on after its August break.
But Gerlach doubted that Congress would actually come up with a permanent fix since they would choose instead to keep the federal budget at its current rate. The costs of erasing cuts to physicians once and for all is in the neighborhood of $208 billion - a hefty sum that would have to come out of other programs like hospitals and home care. Rather than making these changes, Congress would probably go back to a one-year fix of $18 to $20 billion, Gerlach predicted.
He was also optimistic that Congress would get something done about the issues that concern home health care. Many members of Congress support home care, he told Devoti and her colleagues. He counted himself in their ranks, and he was proud of having signed Congressional letters that opposed rebasing and the face-to-face requirement, along with one allowing nurse practitioners to order home health. He said he supported NAHC’s efforts because he had seen the value of letting patients receive quality care without leaving home. “Giving patients and their doctors a broader range of treatment options, such as home health services, is critical to improving our nation’s health care delivery system.”