By tovarichpeter follow 2012 Oct 28, 4:22am 524 views 1 comment
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Blind since the age of 19, the 76-year-old Bristol, Vermont, resident is confined to a wheelchair due to disabling conditions that include a below-the-knee amputation stemming from her diabetes. "But it's been an interesting, full life," she says. "I have four children." Now, she's lent her name to a class action lawsuit.
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This settlement won't save many lives (altho each one is important and I don't mean to negate that). People have been receiving the care but not at home, or it's being performed by unskilled workers just as well as if it were done by home health agencies. What this will do is allow people to be served by home health agencies if 1) they are homebound (if they can get out of the house for treatment they don't qualify for home care), and 2) if they require skilled services that under licensure laws must be provided by an RN. It will translate into more visits for wound care, etc. But its greatest impact will be upon the agencies that are competing for the $$$.
Currently, if a patient requires "skilled care" and isn't homebound or has used up all the Medicare benefits available, the patient is referred to hospice. Hospices will stretch the criteria and fit the patient in if at all possible - so they're going to be pushing the fact that this means a few rn visits, certainly not the in-home care that it implies.
Patients who have been deemed disabled but aren't eligible for Medicare yet (2 years after disability determination); well - they're not going to receive the care. That means that people who are newly disabled, generally with more acute conditions, won't be eligible to receive the care they're dangling as "life changing."
Seriously, this translantes into a few more visits to help people maintain their independence. But the implementation will be interesting - the visits have been limited in the past and require assessment and data entry into a nightmare computer system. The system spits out the allowable number of visits. That's Part A. So the Medicare system is going to approve a few more visits but someone - a happy govt contractor - is counting his pennies because he's going to get a huge fucking contract to expand the program.
And there will be test implementation studies, which means that agencies will be paid a premium to implement the care. Big $$$ that will trickle down, eventually, to a little extra care.
Part B, which is a different type of care, will be impacted even less. It actually applies in situations like nursing homes, which are required to provide the care without reimbursement. Nursing homes will surely find a way to screw the system and make more $$$, even though they are doing it now. And making a shitload of money in the process.