nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Friday, July 2, 2010

Home Nursing Under Investigation

The Securities and Exchange Commission has opened an investigation into two home-nursing firms, Amedisys and Almost Family.

I agree that this investigation (Bloomberg Businessweek, July 1) will widen. 
The U.S. Senate Finance Committee in May said it was reviewing whether the home-nursing industry manipulated the number of visits made to patients to boost government reimbursements. The Almost Family and Amedisys statements suggest the probe is widening and raise the risk that other agencies may expand it further, said Sheryl Skolnick, a CRT Capital Group LLC analyst in Stamford, Connecticut.
The core allegation here is that these firms, and possibly others, have been churning the benefit.  They may have provided more home visits than is necessary, in a effort to reach a reimbursement threshold.  Beyond that number of visits the companies get more money.

It's a little complicated but, let's say you had surgery, and need help at home.  The type of operation you had typically needs 3 home visits unless there are other reasons of prolonged recovery or complications, that would necessitate, say, 6 visits.  A company would do much better if more of the patients could be put into the latter category, doubling the number visits they can charge for.

Alternatively, they charge for what they do per visit.  You can offer more services per visit (medication review, activity assessment, patient safety recommendations, etc) to obtain a higher reimbursement.

I don't know what will come of these investigations, but as a doctor, I have some concerns about the whole home-nursing infrastructure that has grown up over the last twenty years.

There are patients who are clearly in need of home help.  They are elderly, or frail, or live alone, or the medical condition interferes with being able to do everyday things.

But the industry has expanded to offering services when they aren't really necessary, and what they offer doesn't go much beyond what a reasonable person could figure out for themselves.

When I had back surgery last year, I was offered a series of home visits because "it was authorized by your insurance plan."  My surgery didn't limit my activities any; yeah, my back was sore for a while, but that was expected.  My initial reply to them was, "What for?"  They said, "It's a benefit provided to you."  I said, "To do what?"  They said, "We could show you how to retain range-of-motion for your joints and strengthening exercises for your muscles." 

OK, I was getting sarcastic at this point, but I said, "So, you're going to demonstrate that I need to move around and use my muscles?"

They gave up at this a huff.  I think the hospital may have received some contractual incentive to offer home-nursing, but I'm not sure.

This type of service has exploded across the country, using the typical argument that people are in need, and it would be immeasurably cruel to deny them relief from suffering, blah, blah, blah....

But it shouldn't be just a pro forma benefit that you should accept just because it's there, and a lot of what we are paying for as taxpayers (since a lot of it comes through Medicare for the elderly) is what I call "no-value-added" care.  Some of these home nursing companies charge $300-500 a visit.

We need objective criteria for authorizing this care.  Right now it's out of control. 

And, if people just need TLC, that's what families are for.

Doc D

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