Who Should Administer Medications?

Today’s Managing Health Care Costs Indicator is $15,100
NPR and Kaiser Health News reported today on a dilemma facing the state of Connecticut. The state is facing huge budget deficits, and the governor has promised to send thousands of patients out of nursing homes (where the state funds half of the cost of Medicaid) to get care in their homes.  

The problem is that state law mandates that nurses administer any drugs to the homebound.  Drugs cannot be set up by nurses and administered by home health workers.  Some patients are visited by nurses as many as three times  a day.  The total cost is over $128 million for 8500 patients (or over $15,000 per patient per year).

These nursing visits are not bad.  The nurses say they assess the patient, build rapport, and can potentially prevent hospitalizations.   However, the mandate to have nurses administer medications drives up costs substantially.  Ironically, it might make it so that some patients have to stay in nursing homes rather than be cared for at home.

The requirement to use nurses for medication administration prevents “downshifting” to less-skilled workers.   This requirement also discourages innovation.  Innovative companies should be designing technology to promote high levels of medication adherence requiring no skilled professionals.   No need to do this when regulations will inhibit the market for such a machine.  Regulations that protect “professional turf” are always positioned as promoting patient safety.  This is a good example of how they can lead to lower-value health care delivery.