Home Healthcare Agency Malpractice Insurance
Home healthcare is an increasingly popular patient option to residential, long-term or institutional-based nursing care. In a 2008 study by the National Association for Home Care, it was reported that approximately 12 million individuals receive in-home care for reasons of acute illness or long-term health conditions, such as permanent disability or terminal illness. The Centers for Medicare & Medicaid Services (CMS) estimates that it reimburses home healthcare providers more than $72 billion annually for services rendered. With the baby-boom generation entering its golden years, those numbers are expected to grow exponentially in the near future.
Home healthcare is a catch-all phrase, covering any type of healthcare dispensed to a person in their home. Professionals most often involved in the delivery of home healthcare include nurses, physical therapists, respiratory and occupational therapists, social workers and mental health workers. They may be providing medical and/or psychological treatment, wound care, disease and medication education as well as physical, speech and occupational therapy. The care offered may even extend to “instrumental activities of daily living,” which include tasks such as light housework, preparing meals, shopping for groceries and assisting in money management.
Most experts believe home healthcare is the future of medicine, ultimately replacing many healthcare treatments previously only offered in a doctor’s office or hospital setting. Because home healthcare is usually less expensive, more convenient and just as effective as traditional delivery models, both patients and CMS realize benefits in this healthcare service model.
In order to qualify for home healthcare, a patient must be under the care of a doctor who establishes and regularly reviews the prescribed plan of home healthcare. The doctor must certify the patient requires one or more of the following health services:
- intermittent skilled nursing care;
- physical therapy;
- speech-language pathology services;
- continued occupational therapy.
In addition, the doctor must also certify that the patient is homebound, which is defined as having a condition that keeps one from leaving home without help or that leaving home takes considerable and taxing effort.
Medicare is the largest single payer of home healthcare services, accounting for 41 percent of home healthcare expenditures. Other public funding sources include Medicaid, the Older Americans Act, Title XX Social Services Block Grants, the Veterans’ Administration and CHAMPUS (Civilian Health & Medical Program of the Uniformed Services). Commercial healthcare insurance plans typically cover a portion of home care services for acute needs, but benefits for long-term services can vary greatly from company to company.
In order to receive reimbursement from CMS, a home healthcare agency must be certified as meeting Medicare/Medicaid’s conditions of participation and associated standards. The certification process is based upon a survey of the agency to determine if it is in compliance with CMS standards in such areas as patient rights, acceptance of new patients, established plans of care as well as medical supervision and skilled nursing services offered.
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Medical Liability and Adverse Medical Events