Physicians currently function as the gatekeepers to certifying patients for Medicare-covered home health care and hospice benefits, but advanced practice registered nurses (APRNs) should be allowed to certify patients for these services as well, recommends a 2011 Institute of Medicine report, The Future of Nursing, Leading Change, Advancing Health.
Under the present system, Medicare laws and regulations prohibit APRNs from conducting the certification for these services, but changing those rules could be a win-win for all involved, from patients to physicians to the health care system in general.
APRNs provide high-quality primary care on a daily basis in communities across the nation, explains an AARP Public Policy Institute Insight. Their roles include providing care coordination for people with multiple diseases and chronic conditions, and they’re qualified through education and training to refer patients for home health and hospice services.
However, Medicare rules don’t allow APRNs to sign certification documents allowing consumers to receive those services, if deemed necessary, as physicians are the “gatekeepers of the Medicare home health benefit” despite nursing being the “fundamental” home health service, AARP says.
For Medicare beneficiaries to receive home health care services, a physician must first certify that the patient is homebound and requires those services, whether it’s nursing care or therapy. The same is true for hospice: physicians must certify that a prospective hospice patient’s life expectancy is six months or less.
Medicare’s laws and regulations regarding the role of APRNs is inconsistent, according to AARP.
“[A]lthough Medicare does not allow [nurse practitioners] or other APRNs to certify patients for hospice or home health services, since 1995, APRNs have been authorized to certify patients for post-hospitalization extended care services in skilled nursing facilities,” says the AARP Insight. “Medicare accepts APRN signatures on certification or recertification forms to enable beneficiaries to receive post-acute care and rehabilitation for complex medical conditions such as joint replacement, stroke, and heart failure.”
Certifying Medicare beneficiaries for home health services is within the scope of practice of a nurse practitioner, clinical nurse specialist, certified nurse midwife, and other types of APRNs, says the Institute of Medicine, as they have the education and training to be able to determine whether or not a patient is in need of skilled nursing or therapy services in the home.
“Removing these barriers, which will require legislative action, would increase access to care for vulnerable patients and their family caregivers. Continuity of care would improve if the NPs who provide house calls or other primary care services could be the providers of record for their patients’ Medicare home health and hospice services,” concludes the AARP Public Policy Institute Insight. “Allowing APRNs to certify home health and hospice services can potentially decrease costs, expedite treatment by eliminating the need for physician sign-off, and allow patient-centered health care teams to practice more efficiently.”
View the report.
Written by Alyssa Gerace