Home Health & Hospice Week

SNF and rehab facility use would go up too.

Medicare says reducing rehospitalizations is one of its highest priorities, but you can’t tell from a recent regulatory proposal to require prior authorization for home health.

More than 325 parties filed comments in response to a Feb. 5 Federal Register notice in which the Centers for Medicare & Medicaid Services proposed a demonstration where its contractors would perform home health prior authorization in five states (see story, p. 114).

One of the most commented-on effects of prior auth is skyrocketing hospital readmissions, according to the comment letters. “From our experience with HMOs — the patient ends up in the hospital because it takes 1 week to get the authorization,” explained a Florida commenter.

“This proposal will completely destroy the very reason home care exists; to improve patient outcomes and reduce re-hospitalization,” said a commenter from Michigan. “Patient must be seen in the first few hours in order to achieve the best clinical outcomes and requiring a bunch of hurdles that can take days and at a massive administrative cost will only harm our most frail and in-need patients.”

With one Florida agency’s current managed care patients, “an average of 5-7 days is a good start” for prior auth, it related. “Many of these patients or potential patients go back to the ER/hospital prior to our ability to obtain authorization.”

“I thought CMS’s focus was on timely starts of care and reduced hospitalizations,” said another Florida commenter. “Well it won’t happen with pre authorizations. We have seen this negative impact far too often in managed care,” the commenter exclaimed.

Increased facility use: If prior auth is required, “I see more patients not going home from a hospital stay but going to a long-term care or a rehab center,” predicted an Illinois commenter. “Either of the two would be much more expensive care.”