Years ago, there was a company, Home Intensive Care, which provided staff-assisted home hemodialysis.
It was reimbursed by Medicare, back when there were two different payment methods (Method I and Method II) for home hemodialysis (and maybe PD as well).
In the late 1980s the company was forced to stop these services, due to what some claimed was overcharging Medicare.
U.S. to Reduce Its Payments For Home Kidney Dialysishttp://www.nytimes.com/1988/11/30/us/us-to-reduce-its-payments-for-home-kidney-dialysis.htmlBy MARTIN TOLCHIN, Special to the New York Times
Published: November 30, 1988
WASHINGTON, Nov. 29— The Department of Health and Human Services, beginning Jan. 1, will reduce payments for Medicare patients who receive professionally assisted kidney dialysis at home.
Private insurance companies under contract to the department recently completed their evaluation and reduction of these payments at the agency's behest.
The department contends that Congress never intended to provide this home dialysis service, which it says is nearly twice as expensive as that in hospitals and clinics. Critics respond that Congress supported home dialysis as a desirable alternative to hospital and clinic care in terms of costs to the patient and society and that the H.H.S. action will effectively end the program, which is used by as many as 5,000 people. Court Arguments Scheduled
A Federal court is scheduled to hear arguments next week in a lawsuit brought by Home Intensive Care Inc., a Florida-based company that serves more than 1,000 people who will be affected by the H.H.S. action. The company, which Blue Cross and Blue Shield of Florida notified of the planned reduction in payments, claims that H.H.S. has abused its authority.
The arguments will be heard in Federal District Court here by Judge Stanley Sporkin, who last August struck down the H.H.S. decision not to pay for more than four home visits to Medicare patients by nurses or health aides. Such a policy, Judge Sporkin found, would have ''a devastating impact'' on elderly or ailing people.
In both of its decisions, H.H.S. is seeking to save money and reduce the Federal deficit.
Congress in 1972 extended Medicare to include kidney dialysis for people of all ages. The coverage is triggered after a year of dialysis treatment, and about 90 percent of all dialysis patients are covered. Private insurance companies such as the Blue Cross & Blue Shield Association administer the Medicare dialysis program under contract from H.H.S. and are required to follow its directions. $2 Billion a Year This year Medicare will pay $2 billion for the dialysis of about 100,000 Americans, of whom 20,000 are treated at home.
Nearly 5,000 of the latter are on hemodialysis, in which the patient's blood is circulated through an artificial kidney machine that filters out toxic wastes before returning the blood to the patient. It requires someone to help the patient, but H.H.S. does not know how many people are assisted by medical professionals.
The remaining 15,000 patients treated at home receive peritoneal dialysis, in which the blood does not leave the body but is filtered through the peritoneal membrane in the abdominal cavity. There is no need for outside assistance.
H.H.S. says that patients receiving hemodialysis at home cost Medicare about $3,000 a month, as against $1,800 for the same treatment in hospitals and clinics. Those who are treated at home and deal directly with suppliers are reimbursed under an H.H.S. method based on ''reasonable charges.'' The others are reimbursed based on a hospital or clinic's composite costs. Question of a Loophole
In February, H.H.S. directed private insurers to examine their reimbursement policies with a view toward lowering them to the hospital-based price. It believed that some suppliers, including Home Intensive Care, had found a loophole in the law, which it said was not intended to cover professionally assisted home dialysis.
''We shouldn't be paying nearly twice as much under one method compared with another method,'' said Kathleen Buto, acting director of the Bureau of Eligibility, Reimbursement and Coverage of H.H.S.'s Health Care Financing Administration. ''The charges have been creeping way up, and we have to find a way to bring them down.''
''Congress never intended to have Medicare pay for staff-assisted hemodialysis,'' she added. End of Program Is Feared
But critics say that a goal of the 1972 legislation was to encourage home hemodialysis. H.H.S. says that Congress envisioned family members helping dialysis patients, but critics of the department respond that that proved unrealistic and that the program hinged on professional assistance, which increased its cost.
The critics say that the health department's directive will result in the end of this federally funded program because patients' relatives usually have psychological problems administering hemodialysis. Patients could still hire professional help and pay the balance in cost, they say, but because of the expense many patients would have to abandon home treatment and return to dialysis centers.
''The clear result will be to deprive individuals of the right to receive renal dialysis in the home setting,'' said William A. Dombi, director of the Center for Health Care Law, a division of the National Association for Home Care. ''Access will be diminished, if not totally eliminated. The structure that they're trying to impose will make it impossible for the service to be delivered.''
Many areas of the country lack hospitals and clinics that provide dialysis, and some patients now receiving hemodialysis would have to travel hundreds of miles to receive the treatment that they now get at home. In addition, some of the nation's 1,400 dialysis centers already are overcrowded.
I Hate Dialysis Message Board
Author
