NAHC Releases Final Report on Non-Physician Practitioners Survey
Findings Support NAHC’s Advocacy Efforts in Support of Legislation Permitting NPPs to Authorize Home Health Services
October 21, 2015 12:42 PM
The National Association for Home Care & Hospice (NAHC) recently conducted a nationwide survey regarding the use 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. The total responses numbered 669, and the survey results included multiple responses from all 50 states and the District of Columbia, making it one of the best ever NAHC surveys.
NAHC has completed the final report based on the survey, which concluded that permitting NPPs to authorize home health services will result in “significant improvements” to the quality and timeliness of patient care, as well as cost efficiencies in the Medicare program. As a result, the final report will bolster NAHC’s 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.
The questions in the survey focused on the impact and outcomes of the Medicare limitation on certification authority, including:
What percentage of your patients would you estimate have an NPP or had an NPP prior to admission as their primary or significant "medical" practitioner rather than a physician?
What percentage of the NPPs that serve your community have a relationship or connection with a physician who is available and willing to certify Medicare home health services plans of treatment for the NPP's patients?
What of the following current outcomes has your agency experienced with patients who have an NPP involved in their care because of the requirement for a physician certification?
If NPPs are given authority to establish and certify Medicare home health services, will it increase utilization?
What outcomes would you expect if NPPs are authorized to establish and certify Medicare home health services?
Based on the responses to these questions, the final report released by NAHC reached the following findings:
A significant proportion of Medicare home health patients rely upon NPPs as their primary community practitioner.Over 55% of respondent home health agencies indicate that a minimum of 40% of their patients had an NPP as the primary practitioner prior to admission to home health services. Over 10% of the agencies indicate that 81-100% of their patients are under the care of an NPP. The responses support the contention that permitting NPPs to directly certify an individual’s eligibility would mean that the NPP substitutes for the physician as the certifying party. The responses indicate also that the inclusion of the NPP as a certifying practitioner would strengthen the integrity of the certification as the primary care practitioner is best positioned to understand the patient’s home health service needs in conjunction with Medicare coverage standards.
The vast majority of NPPs maintain relationships with their physician colleagues and health care professionals in the treatment of the NPPs patients.Nearly 65% of respondents indicate that over 71% of the NPPs in their community have relationships or connections with physicians available and willing to step in and certify the NPP’s patient’s plan of treatment. This means that NPPs would primarily continue their role as the practitioner of choice for the patient and would certify Medicare compliance as a substitute for the physician who assumes that responsibility upon transfer from the NPP due to the current restriction on authorizations.
The NPP’s lack of authority to certify Medicare coverage eligibility for home health patients brings significant and numerous negative consequences for patients, physicians, and home health providers.Respondents note a deep and varied set of negative outcomes primarily affecting patients such as timely care access, obtaining prompt orders for care, and care conflicts between the physician and NPP.
The establishment of Medicare coverage certification authorization for NPPs would improve care quality, efficiency, access, and patient satisfaction.All around improvement in home health care delivery, administration, and cost are the resounding forecasts of survey respondents when asked what they expected as outcomes from a change that would authorize NPPs to certify Medicare home health services coverage.
Medicare utilization of home health services will improve in terms of practitioner knowledge of the service appropriateness and capabilities, particularly in underserved rural areas.Overwhelmingly, survey respondents view the NPP authorization reform measure as removing barriers to the initiation and delivery of care rather than a means to increase Medicare home health utilization.
“Removing this barrier should not create program integrity or service utilization concerns as NPPs are sufficiently connected to physicians such that patients in need of home health services eventually get that care, but only after obstacles are overcome,” NAHC concluded in the report. “In return for eliminating the Medicare authorization barrier, Medicare beneficiaries can be expected to gain improved care quality and timeliness while Medicare benefits from new cost efficiencies.”
To view the report, click here. This report is for use by the home care community in its advocacy efforts supporting the legislation on Capitol Hill. For example, NAHC is working to persuade the Congressional Budget Office (CBO) 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).
Please contact your members of Congress using NAHC’s Legislation Action Center (click here) with the request that they cosponsor the legislation.