Medicare Expansion Will Help Patients Stay Home Longer

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Medicare Expansion Could Fuel Home Health Agency GrowthMost people have never heard of Glenda Jimmo, but she’s about to make healthcare history. The recent settlement of her court case is a significant boon to home care, helping more chronic disease patients with Medicare stay at home longer.

Jimmo is a 76-year-old Vermont resident who has been blind since childhood. A right-leg amputation stemming from diabetes means she is now in a wheelchair. According to court documents referenced in a recent New York Times article, Jimmo received home care for her wound and other issues, but Medicare denied coverage based on a long-time requirement that beneficiaries must show a likelihood of medical or functional improvement.

As you can imagine, the recent settlement of a class-action lawsuit, in which Jimmo is the lead plaintiff, is causing those in the home health industry to rejoice. In October, the Obama administration and the Center for Medicare Advocacy agreed to change the rules, and U.S. District Judge Christina Reiss of Vermont is expected to approve the settlement. Once approved, Medicare will pay for home care services if they are needed to maintain the patient’s current condition or prevent or slow further deterioration (regardless of whether or not the patient’s condition is expected to improve).

Although the deal will likely mean higher spending on home health services, it seems unlikely to result in any added cost to Medicare because of the much higher costs of caring for disabled, chronic disease patients in other settings. It could also ease the overburdened Medicaid program, which pays for large amounts of nursing home care.

More patients could be coming your way. Do you have the people, the processes and the clinical and agency management home health software in place to handle the increased load?

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