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Challenging times ahead for home care clinicians
By Cheryl Pacella MSN, RN, CS
Across the country home care agencies have been
scrambling to prepare information systems and educate staff about
the implementation of Prospective Payment System (PPS). It is the
biggest change in home care since Medicare was enacted 35 years
ago. PPS came about as a result of the Balanced Budget Act (BBA)
of 1997. It became effective Oct. 1, 2000. The purpose of PPS is
to gain better control of the escalating costs of home care for
Medicare beneficiaries. It is a reimbursement system based on episodes
of care. The actual reimbursement is a standardized payment that
is adjusted by case mix and wage index.
Clinicians will recall the impact of Diagnosis Related
Groups (DRGs) in the 1980s. At that time Medicare imposed regulations
that dictated the length of hospital stay based on diagnosis. PPS
works in a similar manner. It is a type of “managed care” for home
care. The home care agency will assume some of the cost and risk
for managing the care of Medicare beneficiaries. A number of agencies
have already been forced out of business since the implementation
of the Balanced Budget Act and the Interim Payment System (IPS,
a precursor to PPS).
PPS will have a tremendous impact on home care as
we know it today. Clinicians must be knowledgeable about the new
reimbursement system. They need to work together with employers
to help provide quality yet cost-effective care to home care clients.
Community Health Role Group formed
The issue of the impact of PPS has been a subject
of ongoing discussion by the Safe Care Task Force on Community Health
Nursing. As that task force has concluded its work, the members
of the Task Force believe there is a continuing need within the
MNA to have a forum for community health nurses to gather and network
around issues related to their unique concerns. As a result, members
of the Task Force have established a new role group under the MNA
2000 structure for Community Health/Home Care Nursing. The first
issue to be addressed by the group will be the impact of PPS. The
new Role Group invites all interested community health nurses to
become members of this group. The first meeting will be held at
the MNA headquarters in Canton on Jan. 24, 2001 at 6 p.m. Those
interested in joining the group, or in being informed of upcoming
meetings should contact David Schildmeier at 781.830.5717; dschidmeier@mnarn.org
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