A long, healthy process

Ohana Home Health founder Suzie Woolway spent the past year absorbed with getting the Kalaheo company its provider number and completing application processes for billing Medicare Part A through the big five health providers in the state, as well as the insurance companies.

Finally, it is done.

“I didn’t leave work, for the last two months especially,” said Woolway, who manages 13 full-time and six part-time medical and administrative staff. “It’s been a very long journey but we now have a full staff to serve the island and it has taken until this week to say that.”

Part A provides inpatient hospital coverage and intermittent skilled services such as in-home care and hospice, but not private home attendants. Part B is for outpatient and preventive care, physical therapy, and is for someone who can get to their doctor without too much difficulty.

Understanding the difference between home care and home health is important to avoid paying copays and deductibles for services some think is covered under Medicare, Woolway said.

A patient needs to qualify for homebound services, and the provider must also be certified to bill to Part A.

“A doctor defines whether a person is homebound and not the paraprofessionals,” Woolway said.

There were two home health agencies on island. Kauai Health Care Professionals closed under investigation a few years ago, and St. Francis closed their Kauai office this past June.

Woolway was working as an outpatient speech pathologist and sports medicine specialist in late 2011 when the idea for a home health business came after discussions with patients about cuts to their coverage and services. There was a lack of Part A services and she had no idea how much work it would take to establish a company that could cover everything from wound care to physical to occupational rehabilitation.

In the long run, she expects the needs of the community to create more competition. At that time, they will focus on specialty areas.

“I would like to build a really strong rehab team, not just for chronic disease, but for post-stroke and neurological disorders,” she said.

A large part of her work is to educate people who fear that applying for homebound status means they can’t leave the house, even to go to church, she said. They can go to church, but they need to know what will not be permitted.

Someone in a hospital setting who is anticipating a need for skilled home services should talk to their transition coordinators before discharge, she said.

“If you are coming out the hospital and are homebound, then you should definitely look at getting skilled services on Medicare,” she said. “If you feel that you are truly homebound, then talk to your physician or doctor.”

In most cases, an individual is automatically enrolled for Medicare at age 65 or when they apply through the Social Security Administration. The best way to plan ahead is to create a checklist of needs and sit down with the Kauai Agency on Elderly Affairs, or the Hawaii State Health Insurance Counseling and Assistance Program, Woolway said.

“The benefits may also be different with managed care Medicare to traditional Medicare,” she said. “You have to be a smart consumer and do your homework to find out what suits you best.”

People under age 65 who qualify as homebound for Medicare A may have had an unusual health event such as an accident or fall, pneumonia, or they may have just gotten out of the hospital with a lengthy rehabilitation period. Medicare usually works through their work insurance primary carrier.

The open enrollment period for Medicare will conclude Dec. 7. It is important for people to review traditional and managed care plans because what is available on Oahu is not always available here, Woolway said, and the right supplemental plan depends on the primary plan, along with special needs and therapies.