Your cover story on home healthcare ("Home health heats up," Aug. 18, p. 28) contains a great deal of valuable data. However, I am most concerned that its emphasis on Columbia/HCA Healthcare Corp.'s current legal difficulties has obscured the legitimate motivation for making hospital-based home care the linchpin of high-quality integrated delivery systems.
In health systems where physicians are assured that their patients receive high-quality care in the most appropriate setting in the continuum, and are neither overserved or underserved, referrals to home care are not subject to abuse. A large part of our company's success is an initiative that prepares our clients' hospital-based specialty nurses to follow their patients' progress at home during the early post-hospital period.
There is one glaring overstatement in the article regarding the shift to prospective payment for home care. The article failed to point out that it is only traditional fee-for-service Medicare that currently reimburses home-care agencies for "the full amount of their costs, within certain limits." The discounts and visit limitations in managed-care contracts make it very difficult for home-care agencies to realize a profit from this segment. Meanwhile, the federal government is pushing more Medicare patients to join HMOs. These efforts will make it even more important that healthcare systems be able to coordinate their efforts through practice guidelines and outcomes measures that drive clinical improvement while holding down costs.
The government must take some accountability for generating confusion regarding the "beauties of an integrated delivery system" as well as its ambiguous directives and quixotic pattern of fraud-and-abuse inspections and litigation. It is the extreme greed of a small percentage of home-care providers that has drawn negative attention to the industry. The vast majority of providers work to offer the most appropriate level of care in the setting most patients prefer, the home.
Connie R. Curran
North Riverside, Ill.