Academic journal article Care Management Journals

Issues of Financial Pressure on Home Care Agencies: Dealing with the Potential of Fiscal Abuse

Academic journal article Care Management Journals

Issues of Financial Pressure on Home Care Agencies: Dealing with the Potential of Fiscal Abuse

Article excerpt

Abuse (abiu.s), sb. [a. Fr. abus:-L. abusus, 1. wearing out, 2. Misuse; n. of completed action from abut-i. See Abuse v.]

1. The process of using up or wearing out.

2. Wrong or improper use, misuses, misapplication, per version.

3. A bad or improper usage (i.e., a use which has become chronic), a corrupt practice.

4. Imposture, deceit; delusion. Obs.

5. Injury, wrong, ill-usage. Obs.

6. Violation, defilement (now only in self-abuse).

7. Injurious speech, reviling, execration; abusive language.

Although some may find the practice of beginning an article with a definition an affectation, it serves the useful purpose of reminding the reader of its etymology and the many interpretations that have been derived over the years. In this case, tribute must be given to The Pro fessor and the Madman: A Tale of Murder, Insanity, and the Making of the Oxford English Dictionary by Simon Winchester for this convention. By looking at the definition of "abuse," one finds several interesting definitions and connotations that are borne out in a review of the financial pressures that have been imposed on home care agencies over the last few years.

First, it is important to note that as both a verb and a noun, the term "abuse" means to misuse, misapply or use up. In fact, it requires two parties for abuse to occur- the abuser and the abused. Today we often speak of "the cycle of abuse" that can occur in society with a single act of abuse begetting further mistreatment. In the case of fiscal abuse and home care agencies, the only way the subject can be fully understood is to review the history of home health, its utilization and variation, and the federal government's actions in response to use patterns. With such a review, we find that the "abuse" has become reinforcing and therefore cyclical, with the government and the providers reacting and responding to the actions and activities of each other. More important, the responses may have led to a "using up" of the Medicare home health benefit the federal government miscalculating the effects of the Balanced Budget Act (BBA) o this service.


In order to understand the nature of the fiscal pressures of today's home health provider, an overview of the Balanced Budget Act of 1997 is necessary. From 1990 to 1995, home health expenditures had increased from $3.3 billion to $15.1 billion, a nearly fivefold increase, and from 1992 to 1993, expenditures for home health had increased 78% (Office of Inspector General, 1997). By 1996, the year before the BBA was passed, home health expenditures had reached $17 billion annually, and the average annual increase between 1988 and 1996 was 31%, making home health the fastest growing expenditure in the overall Medicare budget (Medicare Payment Advisory Commission, 1997).

The increase in home health caused the federal government to take a closer look at the cause for this growth, specifically whether it was uniform throughout the country and with respect to auspice. When it looked at variations in July of 1995, the Office of the Inspector General of the Department of Health and Human Services found that there was a fivefold difference in the amount of Medicare reimbursement per beneficiary in what was defined as the "highest group" of home health agencies from the "lowest group (Office of Inspector General, 1995).

To draw the comparison in dollars, the highest group of agencies received on average $7,978 per beneficiary for home health services and the lowest received $1,534. In addition, two-thirds of the agencies defined as being in the lower and middle groups provided home health services at or below the national average reimbursement per Medicare beneficiary of $2,957.

In addition to looking at reimbursement, the same study found that the number of visits varied widely. At the time of the study, the national average number of home health visits per beneficiary was 50. …

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