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Don't put government between a patient and her doctor

Published by The Hill Congress Blog
Former Rep. Billy Tauzin
April 25, 2016

During a recent doctor’s visit, I saw a coffee mug emblazoned with a funny saying that has stuck with me. “Please don’t confuse your Google search with my medical degree,” it read. I chuckled, since certainly there are a fair share of patients these days who use online information to challenge the knowledge, years of experience and judgement of their physicians.

Advances in healthcare and technology have undeniably led to changes in the way we all approach healthcare. Consumers are more informed.

Policymakers and insurers are demanding increasingly efficient environments where costs are contained yet outcomes are maximized. And providers, who want to do the best for their patients, are finding themselves facing difficult situations that are not in the best interests of those for whom they care.

It seems that amidst efforts to reduce healthcare costs, the government has found small, yet impactful ways to insert itself between the provider and the patient. One of the most recent and alarming examples is a Centers for Medicare & Medicaid Services (CMS) initiative to require prior authorization for Medicare home health services.

Shortened hospital stays for Medicare patients has been a key goal over the past several years, since shorter stays drive improved outcomes, less risk of infection and greater patient satisfaction. But for a great many patients, a short stay and quick discharge simply aren’t safe without the ready availability of skilled home health providers. Skilled home health – which many physicians require as a condition for a patient’s discharge – allows patients to continue recovering under the watchful expertise of nurses and therapists who can monitor the effects of medications, ensure proper wound healing, and quickly recognize any clinical changes or deteriorations.

As proposed by CMS, prior authorization for home healthcare will mean waiting – potentially up to 10 days – until Medicare beneficiaries can receive care. For recently discharged patients, those days are the most critical, when complications that lead to costly re-admissions are likely to occur. For patients with life-threatening or complex conditions, those days without a skilled caregiver could lead to rapid, yet completely preventable, declines.

Although CMS has instituted similar prior authorization policies for other healthcare sectors, doing so for services like home health is a dangerous new frontier. The decisions of physicians and other healthcare providers – those individuals most familiar with a patient’s condition – would be subject to review by a government representative who has no relationship with the patient or firsthand knowledge of his or her clinical needs. In addition to longer wait times for care, the policy would increase the administrative burden on physicians and home health agencies, who are already required to provide extensive documentation on patient eligibility for home healthcare services.

Although prior authorization has been offered as a tool to combat fraud and abuse within the Medicare program, endangering patients through lengthy waits for care is not the solution. Protecting patients and Medicare from fraudulent claims is a critical aspect of program integrity, but prior authorization for home bound seniors waiting for critical (post-acute) care is an inappropriate barrier to place on the recovering frail and elderly that need care that keeps them where they want to be, at home.

CMS’ move toward home health prior authorization, which the agency further does not have statutory authority to impose, is a bad move. It puts bureaucrats squarely between licensed healthcare providers and the needs of his or her patients. CMS, please take a step back and remember that decisions regarding the care of patients are best left to those trained to make them.

Tauzin served in the House of Representatives from 1980 to 2005. He currently serves as senior counsel to the Partnership for Quality Home Healthcare.

Click here to see the original article on The Hill Congress Blog.

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