GOVERNMENTPhysicians struggling with home health oversight rulesReport says many doctors are not familiar with responsibilities and liabilities in authorizing Medicare home care.By Markian Hawryluk, amednews staff. Jan. 21, 2002. Washington -- A new report by the Health and Human Services' Office of Inspector General has cast into the spotlight the oversight role doctors are expected to provide for Medicare home health care. Controls designed to limit the growth in spending for Medicare home health services have put doctors in the unenviable role of overseeing the adequacy of those services for Medicare beneficiaries. That's a role physicians are ill-equipped to provide, said Robert Gilmore, MD, AMA deputy executive vice president, in written comments on the report. "The current expectations that individual physicians can police the home health agency's provision of services are completely unrealistic," Dr. Gilmore said. "No other health care delivery system functions without a strong internal administrative structure for physician oversight of appropriateness and quality of care." The AMA and other physician groups have called for Medicare to require home health agencies to hire medical directors that could better oversee the provision of services. The AMA said physicians who are neither at the site where service is provided nor at the home health agency cannot be expected to track the adequacy of home health services provided to their patients. In the past, Medicare paid for the cost of all home health services, so physicians were able to serve as a "gatekeeper" ensuring that beneficiaries received only those services that were medically necessary. But since October 2000, home health agencies have been paid under a prospective payment system that sets a fixed rate per episode of care.
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Copyright 2002 American Medical Association. All rights reserved.
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