August 1999

Outlook unsettling for Home Care patients

Until she reached 92, Mildred Bengston maintained her independence. She lived alone in the same Kansas City, Kan., neighborhood she had called home for 40 years. And with her daughter and grandchildren nearby, help was always at hand. But in spring 1996, she became bedridden with assorted ailments.

The nation's home health-care system, which through Medicare has helped many elderly patients stay in their homes, stepped in to help. A nurse treated Bengston at home three times a week.

But the system now is in a tailspin, rocked by financial and regulatory restrictions from the Balanced Budget Act of 1997 (BBA '97). For millions of in-home patients throughout the country, the outlook is unsettling.

The home health-care industry and its advocates say more patients are losing services and more are forced to seek expensive treatment elsewhere, while some -- the number is not known -- are disappearing through the cracks.

"If all aspects of the Balanced Budget Act of 1997 are allowed to continue without changes, we may be feeling the impact and may be faced with some very difficult decisions about who we can provide services to and what level of services we can provide." Dan Peterson Perham Memorial Home Care director

Supporters estimate that about 2,000 home health-care agencies have shut down since Congress passed the BBA '97, which contained new controls and cutbacks in Medicare spending. Mildred Bengston's original provider was one of the agencies that closed. She is now being cared for by another agency, but sees a nurse only once a week. Her 68-year-old daughter retired from teaching elementary school to stay home and care for her. It was either that or send her to a nursing home.

The full impact of the reforms, however, appears to have been unanticipated. The goal was to make the program more efficient, and the Congressional Budget Office originally concluded that the changes would cut Medicare home health expenses by $16 billion over five years. That estimate has swollen to nearly $50 billion, half of the total health care cuts.

Senators Kit Bond of Missouri and Susan Collins of Maine, both Republicans, introduced a bill that would ease some of the restrictions Congress placed on the industry two years ago. Their bill, which has bipartisan support, would eliminate a 15 percent across-the-board cut in federal home health care payments scheduled for Oct. 1, 2000.

The 1997 reforms created an Interim Payment System that changed federal home health reimbursement practices. Instead of paying agencies according to the cost of their services, they get a predetermined limit per patient. But that limit is based on what they received in 1994.

The fallout from the interim system severely hit patients who need long-term care, because they are more expensive. Many agencies are operating under government-imposed caps of around $3,000 annually per patient. That's less than it can cost to see a long-term patient just once a week for a year.

According to Dan Peterson, Perham Memorial Home Care director, the local agency has not experienced the same difficulties. No patients have been refused needed services, nor has the level of needed services been reduced due to these changes.

"If all aspects of the Balanced Budget Act of 1997 are allowed to continue without changes, we may be feeling the impact and may be faced with some very difficult decisions about who we can provide services to and what level of services we can provide," Peterson stated.

What can be done about this?
Contact your congressmen now. Tell them your experiences with home care - if any - and the added value home care has made for you. Express your concerns about the future of home care. Ask them to sponsor/support the Collins-Bond bill (S 1310).

• Congressman Collin Peterson
2159 Rayburn House Office Building
Washington, D.C. 20515
(202) 225-2165

• Senator Paul Wellstone
136 Hart Senate Office Building
Washington, D.C. 20510
(651) 645-0323

• Senator Rod Grams
261 Dirksen Senate Office Building
Washington, D.C. 20510

Smart card demonstration begins this summer
Medical records soon could be as near as your wallet

The nation's health care future may be stored in something that looks like a credit card. The so-called "smart cards" contain computer chips to store information like medical records and eligibility for insurance programs that can be read when the cardholder authorizes its use.

But first, the public and health providers must accept the concept.

"It is not an easy process to persuade people to use technology," said Wyoming Gov. Jim Geringer at HI99: Improving Health in a Digital World, a conference sponsored April 26-28 by the Friends of the National Library of Medicine.

Health Passport
A three-city demonstration on using smart cards in health care, known as Health Passport, will kick off this summer and run for 18 months. It links public and private health providers serving pregnant women, new mothers, and children.

The Western Governor's Association (WGA) is sponsoring the project, which will take place in Cheyenne, WY; Bismarck, ND; and Reno, NV. Some have said the project could set the standard for future health care smart card applications.

As part of Health Passport, Geringer explained that individuals eligible for public health programs will get smart cards that contain key information for several government-run programs like Medicaid; Women, Infants and Children; and Head Start.

Information on the card includes an address, telephone number, routinely shared health data like immunization status, height and weight, and location and date for follow-up medical appointments.


Children might receive their Health Passport when they enroll in Medicaid, and be referred to Head Start or a family physician, according to the WGA.

At each visit, information will be stored on the smart card. Providers will be able to access basic information such as birth date.

The card will also contain safeguards to ensure that any additional information will be limited to the needs of a particular agency or private provider.

Privacy safeguards
Patients will control access to the information through a personal identification number (PIN), Geringer said. The PIN will cut down on attempts by some to steal a Health Passport and illegally obtain benefits.

Individuals will be able to access their records at kiosks - booths located in demonstration communities that allows users to view and print out any information on their card, Geringer said.

More information about Health Passport is available at http://www.westgov.org/hpp/.