Kara's Blog - Medicare Regulations and Absurdities: Tidbit #1

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Posted by: Kara Clapp	2/4/2008
Recently I have taken on Medicare insurance so I can provide home visit services to those who are homebound and cannot get to a medical provider's office. While learning the terrain of "Medicare Regulations", I stumbled upon what has to the be the most ridiculous regulation known to mankind. As a Nurse Practitioner, I am licensed to diagnose, prescribe, and supervise my own medical treatment plans for patients who visit my private office. When I was a registered nurse, I was responsible for delegating nursing activities and supervising the outcomes of the activities of licensed practical nurses, student nurses, and nursing assistants. Medicare even pays me for the services I render to home bound patients. HOWEVER, as a Nurse Practitioner, I am not allowed to sign the home health agency document (called the "485") that summarizes the treatment plan for the home-bound patient, not even to direct a nursing assistant to give a patient a daily bath! Apparently only an MD has sufficient brain power and authority to tell the home health agency that it is okay to give a patient a bath when he or she needs one. Other examples of what the "485" does may include: directing an RN to do wound care dressings, check blood pressures or blood sugars, etc---all the things I did as an RN and can still do as an NP---but Medicare regulations will not allow me to tell a fellow nursing colleague to perform an activity that is nursing care because I am not an MD. I think several factors are at play here: a very powerful American Medical Association Lobbyist group that continues to put legal barriers in the way of the profession of nursing, and the failure of legislators to pass regulations that are consistent within general Medicare guidelines. On what planet it is acceptable to tell an NP she can be paid for services she personally renders, but that signing documents that allow even simple things like directing a CNA to bathe a patient or for an RN to change a wound dressing are prohibited and can be only handled by an MD? I wonder if this absurdity makes any one else laugh as I did the first time I heard it? I only laughed the first time because when I found out this absurdity is really true, I got angry and wrote this blog. My next step is to contact my congressional leaders and complain like hell until its changed. And I believe you should too if you don't have something else to do at this very moment.
Copyright ©2008 Kara Diersing Clapp, PhD, NP-c
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Re: Medicare Regulations and Absurdities: Tidbit #1	By doctorkara on 9/9/2008
Update: A bill has been introduced at the federal level to request a language change in the Social Security Act that will bring everything up to snuff and embrace how Home care services are currently used today. There is hope that I can eventually have legal authority to ask an RN to carry out treatment plan orders, as it should be. keep your fingers crossed! Kara : )

Re: Medicare Regulations and Absurdities: Tidbit #1

By Linda Meeker on 9/25/2008

You seem like a Maverick!...good for you and good for consumers when Mavericks arise to question, even threaten the status quo.

I do Health Insurance strategies...even though I'm a broker for all the major health insurers here in Utah, I promote the HDHP/HSA arrangements for clients as often as it is suitable because HDHPs effectively remove the Insurance company from the Healthcare provider's office and instead re-affirms the central 'patient-provider' relationship. I'm happy to learn about your clinic, because my clients consistently seek preferred providers who 'work with' HSA arrangements.

I have an HDHP myself and love having an HSA to pay tax-free for care also including dental and vision.

I saw your ad in the Midvale Journal and I'm sure I will use your clinic for my next medical need..in the meantime, do YOU have a smart HDHP plan?...would you like to talk about it?..I left a message at your office this morning with the receptionist...plus, here's my phone number 566-7755 in Midvale...I work nearly excluvisely with business owners and professionals and can offer references if you like....Linda Meeker Liberty Benefit Group.

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