Prior authorization would be mistake
Published by Chicago Sun-Times
May 26, 2016
Medicare’s home health benefit is widely regarded as a clinically appropriate and cost-effective health care setting preferred by American seniors.
As seniors manage chronic conditions and myriad health challenges that arise while aging, Medicare’s home health benefit offers seniors access to care that keeps patients at home — and out of the hospital. Despite the clinical and fiscal benefits of home health, Medicare would like to require prior authorization of home health services. This means that after a patient’s physician prescribes home health, a government bureaucrat will be charged with reviewing the order and deciding if the care is warranted and approved. All the while, a sick and weak senior is at home, with no medical supervision, waiting for Medicare to approve his or her care.
Considering that many patients are prescribed home health care when leaving the hospital, a prior authorization requirement is even more troubling. Physicians prescribe home health with the goal of ensuring patients heal properly and safely under the supervision of home health clinicians so patients don’t experience repeat hospitalizations. Medicare’s idea to create lengthy delays for home health directly contradicts its commitment to reducing hospital costs through patient-centered care.
While Medicare hopes this policy would reduce fraud and abuse in the home health sector, there is no evidence prior authorization would deter bad actors from taking advantage of the system. Instead, policy makers should look for targeted solutions that promote program integrity while protecting patient access to timely, safe and clinically effective home health.
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