The Importance of Home Health Care
I appreciated your story on controlling healthcare costs, “Cost conscious” (April 27, p. 18). I would like to point out that many times what we consider “costs” are really expenditures or prices, and these are outputs of the healthcare system.
These prices are the result of inputs, such as expensive labor, equipment (surgical, imaging), information technology, pharmaceuticals, facilities, etc. My hope is that the discussion on reducing or controlling expenditures, “the output,” will involve somehow helping healthcare providers deal with the high cost of inputs. Expectations on hospitals are high, and they should be. Trouble is, while hospitals deal with both higher expectations and mushrooming input cost, they are reimbursed less for the services they deliver. The process to even get reimbursed by public and private payers gets more complex every day. Providers are getting pinched in the middle.
My peers and the clinicians I work with are undoubtedly in favor of safer, more appropriate and efficient treatment. After all, we chose healthcare as a career to help people. I feel as though the providers (doctors and hospitals) are caught in the middle of expensive suppliers and labor shortages on the one hand, and complex and wealthy insurers on the other.
What politicians are missing is that insuring everyone just makes the federal government bigger and insurance companies richer. A real solution would address the cost of inputs in the healthcare system and guarantee that at least 75% of healthcare premiums are spent paying providers fairly for good care.
Christopher R. Stipe
CEO Clarinda (Iowa) Regional Health Center
We wish to correct a comment you made in your May 4 article (“Under the influence,” p. 8).
You make the statement, “But when the agreement expired none of the devicemakers had plans to continue voluntary disclosure of their consulting and research agreements.”
This statement is inaccurate.
Biomet’s disclosure Web site is still available for public scrutiny. We plan to continue disclosing information, subject to pending legislation in the U.S. Senate and in five other states that will affect when, how and what we must disclose.
Bill Kolter
Corporate vice president, government affairs, public affairs and corporate communication Biomet Warsaw, Ind.
I am a telephone triage nurse. My company answers telephones afterhours for a large number of providers.
In my job I talk with a lot of patients who just need more support, instructions or reinforcement after being in the hospital. They have been given a lot of information and are often overwhelmed. After all, they are not at their best when being discharged. They have been ill or had surgery.
I think the care coaches need to be, at the least, registered nurses (“Bill introduced to reduce hospital admissions,” Daily Dose, May 11). Nurses have used nursing processes with a focus on evaluating the whole person, not just the main diagnosis. Patient teaching and referral would be invaluable to the individual patients and families dealing with illness after hospitalization.
Alice Shartran
Registered nurse RNs on Call Colorado Springs, Colo.
Just wanted to say that clinical nurse specialists could be ideal candidates for these positions to help patients in this area.
Jo Ellen Rust
Clinical nurse specialist for children with complex care needs Riley Hospital for Children Indianapolis
When we looked at rehospitalization of Medicare patients in the past, we found that many were tied to the individual being released too early by the hospital because the CMS would only reimburse for X number of days for Y condition. We also found that many patients were rehospitalized for pneumonia acquired during a “nursing home” visit.
Virginia A. Cardin
Senior consultant Frost & Sullivan San Antonio
Isn’t this the purpose of home health agencies? A primary function of nurses within the home-care industry is to educate their patients on proper self-care and disease management for the purpose of readmission prevention.
As a past-practicing home-health registered nurse, I have worked with physicians who have been quick to send their patients back to the emergency room when complications brew, while others have not. Physicians with whom I have had frequent contact and who have come to trust my assessment/judgment skills, tend to feel more comfortable about working through at-home solutions for patients’ early complications.
It is clear the home-health industry has grown exponentially in these past few years, and primary-care physicians may be having difficulty building trusting relationships with the home-health nurses assigned to the care of their patients. Inherent in this lack of ability to build relationships is the nature of the home-care industry itself.
Home-care nurses may work for more than one agency at a time as a means of increasing their personal income. Different agencies pay differing amounts per nurse visit. Simply put, home-care nurses are going to stay with the agencies that offer the highest visit rate or at the very least, an agency that can keep them working consistently.
Additionally, home-care agencies’ patient census may ebb and flow, creating “waves” of work for nurses. These inconsistencies in pay and work volume help create a circular movement within the nursing workforce.
This “revolving door” effect of nurses seeking work from competing home-health agencies may be impeding the valuable formation of the nurse-physician relationship, ultimately affecting patients’ ability to remain home when complications arise.
As a related side note, home health and hospice nurses are paid the least in the industry. A new graduate nurse working for a hospital can expect to make a similar wage to a “seasoned” home-care nurse. It is no wonder (only) approximately 4% of nurses choose the home-health sector.
Solutions to reduce hospital readmissions may lie within this proposed legislation, but home-health industry initiatives aimed at nurse attraction and retention would move us in the right direction now. Likewise, physician use of standardized protocols for chronic-disease home management may bridge gaps in times when the comfort of an established nurse-physician relationship is nowhere to be found.
Kymberly Townley
Consultant/owner Healthcare Quality Solutions Grosse Ile, Mich.
Before debating healthcare reform, the citizens and lawmakers of the United States of America need to consider, debate, and (for the first time ever) actually decide the answers to the following questions:
Should government-mandated (or tax-funded) payment to the providers of healthcare services ever be considered an inalienable right in a fashion similar to the right to a fair trial, the right to a national defense or the right to vote?
Should government-mandated payment to the providers of healthcare services be considered an inalienable right of:
- All U.S. citizens?
- All legal alien residents of the U.S.?
- All illegal alien residents of the U.S.?
- All visitors to the U.S.? For which healthcare services should such government-mandated payment be considered an inalienable right of:
- All U.S. citizens?
- All legal alien residents of the U.S.?
- All illegal alien residents of the U.S.?
- All visitors to the U.S.? For which healthcare services should government-mandated payment be considered not an inalienable right of:
- All U.S. citizens?
- All legal alien residents of the U.S.?
- All illegal alien residents of the U.S.?
- All visitors to the U.S.?Before these questions (and others like them) are publicly, honestly and actually answered for each of these categories of people in the U.S., we cannot begin to determine the government’s proper role in the fashioning of a new healthcare system.Although, and probably because, there are wide differences of opinion as to the proper answers to such questions in a democratic republic, they have never been fully, or even truly, debated or decided in a public forum.William B. McMillan
Vice president of medical affairs Norman (Okla.) Regional Health System
I am responding from the provider side of the aisle. I am glad to see the extra funding to stop the blatant abuses of the CMS in many areas (“White House budget aims to bolster fraud control,” Daily Dose, May 11). We, as a hospital, spend a lot of time and money just trying to keep up with the ever-changing rules and regulations in our day-to-day billings.
We do this so we are not wrongly accused of fraudulent activities, yet the government is spending a lot of money to roll out the Recovery Audit Contractor Program and recover funds that, for the most part, were wrongly paid because of the ever-changing regulations on Capitol Hill. In other words, honest errors.
This happens because we are all caught in a huge bureaucratic game of the Balanced Budget Refinement Act and trying to keep up with the day-to-day operations. Now add in more uninsured patients, greater unemployment, reduced reimbursements for both hospitals and physicians who are honest and practice good medicine, and you get a formula for a system disaster.
I do hope that the single-payer system of healthcare gets some real consideration in Congress and they really try fixing the fundamental problems. These expensive Band-Aids of going after everyone seem counterproductive to our ability to deliver good healthcare to our communities.
Linda Vallery
Business coordinator Cardiovascular lab Providence Health & Services Portland, Ore.
Regarding Rebecca Vesely’s report, “In exchange for coverage” (March 23, p. 6), please be aware that there is another fine state-level exemplar available, from the yon side of the continent and the private sector. The CaliforniaChoice exchange pioneered and has provided for 13 years similar “connector” services, affording 10,000 (primarily small) employers and their 200,000 employees a choice of several health plans and carriers, structured so the individual employee can choose from among them and an array of healthcare coverage options.
Federal policymakers are considering a public national exchange as an element of the healthcare reforms. They would be wise to allow also for multiple exchanges, both public and private, to provide alternatives and “competing” choices.
Many might prefer to use a local or private exchange to select their coverage rather than use the federal “One Big National Exchange.” Diversity, informed choice and competition remain sound consumer principles for market delivery systems.
Richard Spohn
Attorney Nossaman San Francisco
Billions of healthcare dollars are taken by insurance companies for profit and executive pay. I thank the protesters for acting on behalf of citizens whose healthcare needs should come before profits (“Protesters push for single-payer health system,” Modern Healthcare.com, May 12). Our leaders need to understand that health is not a commodity:
Our health is not for sale.
We need healthcare dollars to go to healthcare providers. We need prevention, cost-containment, better quality and evidence-based delivery systems. How can we get this when one-third of every healthcare dollar goes into the pockets of insurance companies?
A place at the table is little to ask.
Cheryl Lilienstein
Progressive Democrats of America Palo Alto Calif.