Home health care has become an increasingly important part of our health care system. It can allow individuals to avoid extended hospital stays and nursing homes and receive health care where they want to be — in the privacy, comfort, and security of their homes, near family, friends and loved ones. In rural communities, home health allows people to avoid long, and sometimes difficult, trips to medical facilities or to doctor’s offices, which can be far from home.
Nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists are all playing increasingly important roles in the delivery of health care services, particularly in rural and medically underserved areas of our country.
But despite their important role, these advanced practice nurses and physician assistants are currently unable to order home health services for their Medicare patients. Under current law, only physicians are allowed to certify or initiate home health care for Medicare patients, even though they may not be as familiar with the patient’s case as the non-physician provider. In fact, in some cases, the certifying physician may not even have a relationship with the patient and must rely upon the input of the nurse practitioner, physician assistant, clinical nurse specialist or certified nurse midwife to order the medically necessary home health care. At best, this requirement adds more paperwork and a number of unnecessary steps to the process before home health care can be provided. At worst, it can lead to needless delays in getting Medicare patients the home health care they need simply because a physician is not readily available to sign the form.
The inability of advanced practice nurses and physician assistants to order home health care is particularly burdensome for Medicare beneficiaries in medically underserved areas, where these providers may be the only health care professionals available. A nurse practitioner told me about a case in which her collaborating physician had just lost her father and was not available. As a consequence, the patient experienced a two-day delay in getting needed care while they waited to get the paperwork signed by another physician. Another nurse practitioner pointed out that it is ridiculous that she can order physical and occupational therapy in a subacute facility but cannot order home health care. One of her patients had to wait eleven days after being discharged before his physical and occupational therapy could continue simply because the home health agency had difficulty finding a physician to certify the continuation of the same therapy that the nurse practitioner had been able to authorize when the patient was in the facility.
I have introduced legislation, the Home Health Care Planning Improvement Act, to help ensure that our Medicare beneficiaries get the home health care that they need by allowing physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to order home health services. My legislation is supported by the National Association for Home Care and Hospice, the American Nurses Association, the American Academy of Physician Assistants, the American College of Nurse Practitioners, the American College of Nurse Midwives, the American Academy of Nurse Practitioners, and the Visiting Nurse Associations of America.
Home health care has consistently proven to be a compassionate and cost-effective alternative to institutional care, and I will continue to work to help ensure that our seniors and disabled Americans have access to the quality home health services they deserve.
