NAHC Survey on the Role of Non-Physician Practitioners in Home Care: Preliminary Results
Survey results strongly support advocacy efforts for legislation allowing NPPs to certify home health plans of care
October 16, 2015 04:49 PM
The National Association for Home Care & Hospice (NAHC) recently conducted a nationwide survey of the use of and impact of Non-Physician Practitioners (NPPs) in Medicare home health services. The purpose was to develop additional information that could be used in our advocacy to gain the right of NPPs to authorize Medicare-covered home health services.
NAHC would like to thank all of those who completed the recent survey on the role of NPPs in home care. NAHC received 667 responses to the survey, which is one of the best ever responses to a NAHC survey. Multiple responses came from every state.
The questions focused on the impact and outcomes of the Medicare limitation on certification authority. The intent was to elicit the positives and negatives of the current limitation as well as the likely outcomes if NPPs are given Medicare authority comparable to physicians. As NAHC predicted, the preliminary survey results will bolster our advocacy efforts in support of the Home Health Care Planning Improvement Act of 2015 (S. 578/H.R. 1342) to allow NPPs to certify Medicare home health plans of care.
First, the results demonstrate that reliance on NPPs as primary practitioners is indeed growing among Medicare beneficiaries across the country. 55.65% of responders stated that 41-100% of their patients rely on an NPP as their primary or significant “medical” practitioner rather than a physician. Unfortunately, Medicare remains stuck in the 1960s by allowing only physicians to establish the patient’s plan of treatment and to certify Medicare eligibility for the home health services benefit. The high percentage of patients relying on NPPs as their primary practitioners indicates the need to enact S. 578/H.R. 1342 to change Medicare’s antiquated policy.
The results also support NAHC’s argument that NPPs gaining the authority to certify Medicare home health plans of care would not increase costs, because it would result in NPPs substituting for physicians rather than increasing utilization. Nearly 40% of responders stated that 91-100% of NPPs currently have a relationship with a physician who is available and willing to certify Medicare home health services. This high percentage of NPPs with a close working relationship with a physician indicates that NPPs would easily substitute for physicians as the primary practitioner without increasing Medicare spending on home health services. It is very important that the Congressional Budget Office (CBO) understands that the bill would provide authorization for NPPs to substitute for physicians, since increased utilization would result in CBO scoring the bill as having an increased cost to Medicare (see previous NAHC Report article regarding NAHC’s recent meeting with CBO here).
In addition, responders by high percentages predicted the following positive outcomes as a result of the legislation to allow NPPs to certify Medicare home health services:
88.94% predicted reduced delays in care and access;
85.93% predicted improved patient care;
83.58% predicted improved patient satisfaction;
77.55% predicted reduced administrative burdens;
65.33% predicted lower care costs;
51.42% predicted less paperwork.
These preliminary results from the survey are for use by the home care community in its advocacy efforts supporting the legislation on Capitol Hill. However, given that the analysis is still preliminary, NAHC recommends that you wait to use the White Paper report that is in development and will be released shortly. When that is available, please contact your members of Congress using NAHC’s Legislation Action Center (click here) with the request that they cosponsor the legislation.