Home Health & Hospice Week

Patient-directed care the wave of the future, experts say.

If you've trapped yourself in the traditional Medicare box, now may be the time to break out.

Consumer-directed care programs, in which participants have the ability to hire and manage their own workers and decide what to spend their allocated funds on, are growing in popularity, noted attorney Claudia Schlossberg in a presentation at the National Association for Home Care & Hospice's National Policy Conference April 1.

Policy-makers have tracked nearly 140 consumer-directed care programs across the nation, said Pamela Doty, senior policy analyst with the Department of Health and Human Services, in the session, "Consumer-Directed Health Care - Is There a Role for Home Health Agencies?"

Some of the biggest consumer-directed programs, including the "Cash and Counseling" programs in Florida, New Jersey and Arkansas, are under Medicaid. But many private insurers offer consumer-directed plans, as well as state and local programs, Lauren Smith, staffer for U.S. Rep. Cliff Stearns (R-FL), noted in the session.

And soon Medicare will offer a consumer-directed care option as well. Rep. Stearns spearheaded the effort to include the demonstration project for consumer-directed chronic outpatient services in the Medicare Modernization Act passed last December, Smith recounted. The project covers personal care services and related goods. The law requires the Centers for Medicare & Medicaid Services to initiate the demonstrations by December 2005, CMS notes on its Web site.

What to expect: A demonstration project is likely just the beginning, Smith predicted. Studies of other consumer-directed care projects show the programs save money, maintain or improve patient outcomes, and make participants happy. When people who have consumer-directed care options in their current private insurance hit Medicare age, they will start to demand a regular consumer-directed care option there too, Smith believes.

And, despite popular opinion, home health agencies can play a vital role in the new wave, encouraged Schlossberg, who recently left HHS and is now with Blank Rome in Washington, DC. "Hopefully you will see that consumer-directed services can be not only integrated into the current services that you provide and become a part of what you provide to your customers, but it will enhance what you do and how you do it and make you more competitive in the home health field," she told attendees.

HHAs can offer the caregivers used for consumer-directed care and/or offer to administer the payroll, tax and other administrative functions for participants, Schlossberg offered.

"Consumer-directed services ... will enhance what you do and how you do it and make you more competitive in the home health field," said Claudia Schlossberg, attorney with Blank Rome in Washington, DC.

In the Cash and Counseling Medicaid waivers, participants spend 80 percent of their allocated funds on personnel and 20 percent on goods ranging from wheelchair ramps to washers and dryers, Doty said.

There is a waiting list for the Cash and Counseling programs, which proves the popularity of the consumer-directed care model, Smith noted.

Agencies attending the session were concerned about issues ranging from Medicare conditions of participation compliance to liability to fraud and abuse.

Doty noted that under the Cash and Counseling program, certain requirements have been waived. HHS expects the same to occur for COP staffing requirements under the Medicare demonstration, she said.

One agency that participates in Nevada's consumer-directed care program said it had to set up an entirely separate entity to join up.

The incidence of fraud and abuse has been very low in the programs so far, the experts claimed. Most programs are set up so that an intermediary pays the caregiver or vendor, instead of handing cash directly to the patient, minimizing the chance for fraud.