[Congressional Record Volume 145, Number 25 (Thursday, February 11, 1999)]
[Extensions of Remarks]
[Page E227]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page E227]]


       INTRODUCTION OF THE MEDICARE HOME HEALTH CASE MANAGER ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, February 11, 1999

  Mr. STARK. Mr. Speaker, I rise today to introduce the Medicare Home 
Health Case Manager Act of 1999. The Medicare home health benefit has 
received much attention in recent years. The reason for that attention 
has been the dramatic growth of home health services over the past 
decade.
  The Balanced Budget Act of 1997 (BBA) made a number of changes to the 
home health benefit to help stem that growth. However, much more needs 
to be done.
  The Medicare Home Health Case Manager Act is a double winner. It 
would simultaneously reduce Medicare spending on home health while 
improving the quality of the benefit. It does this by introducing a new 
component to the benefit: an independent case manager.
  Today, home health care is prescribed by a patient's physician, but 
then the actual plan of care is executed by the home health agency 
treating the patient. This creates incentives that have nothing to do 
with quality or appropriateness of care. Under the cost-based 
reimbursement system that existed before passage of BBA, the incentive 
to home health agencies was to over-utilize services for patients 
because that is how the agency made more money. In the BBA's 
prospective payment system (PPS) of the future, the incentive will be 
the opposite and there are real concerns about potential under-
utilization of services.
  The Medicare Home Health Case Manager Act would ensure that home 
health care decisions for long-stay patients were being made by an 
independent case manager who in no way financially benefited by the 
length or type of home care provided to a patient. They would be paid 
by a Medicare fee-schedule that would in no way be influenced by the 
amount or type of care they recommend. The legislation would also 
provide the Health Care Financing Administration (HCFA) with the 
flexibility to investigate the effectiveness of reimbursing home health 
case managers on a competitively bid basis in certain regions where 
that would prove appropriate.
  The creation of a home health case manager for long-stay patients is 
endorsed by the Medicare Payment Advisory Commission (MEDPAC), a 
Commission appointed by Congress to provide expert advice on Medicare 
and Medicaid policy. In their March 1998 report to Congress they 
recommended that such a case manager be adopted for the home health 
benefit.
  Their report states: ``Such an assessment would help to minimize the 
provision of services of marginal clinical value, while ensuring that 
patients receive appropriate care. Requiring case management of long-
term home health users could improve outcomes for individuals with 
long-term home health needs and at the same time slow the growth of 
Medicare home health expenditures.'' (Emphasis added).
  There is also a new Massachusetts Medical Society study in which two-
thirds of the physicians who participated in the study stated that ``on 
occasion, they thought their patients didn't have enough home health 
coverage,'' even as 90% of them said that they routinely prescribe home 
health. They also expressed concern about ``the difficulty of getting 
information about the condition of patients receiving home care,'' 
noting that some information does not reach the doctors until ``it's 
well out of date.'' A home health case manager would remedy those 
concerns.
  In addition, there are real-life examples of case management systems 
saving money and improving care. For example, Maryland's Medicaid 
program has a high cost user initiative which in FY 96 saved the state 
$3.30 for each $1 spent--a savings of 230%. The Health Insurance 
Association of America also commissioned a study of its member plans 
and found that rehabilitation/case management programs return an 
investment of $30 for every $1 spent.
  History has shown us that simply throwing more money into home health 
is not the answer for assuring that patients receive appropriate care. 
Let's use this opportunity to make a real, tangible improvement in the 
quality of care obtained by Medicare patients and simultaneously save 
Medicare spending by reducing inappropriate visits. I look forward to 
working with my colleagues for passage of this important legislation.

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