February 16, 2019
Congress must step up to protect Medicare home health care
The year ahead will see continued change to health care with congressional and administration focus on the movement to value-based care, refinements to provider payment systems, and improvements in health care system efficiencies. In the Medicare program, reforms have been proposed to drastically change the way in which patients receive care and how home health providers are reimbursed for delivering these services.
For lawmakers new to Congress, it is important to understand the value the Medicare home health benefit brings to an estimated 3.5 million beneficiaries annually. For beneficiaries needing home health care, it is an essential benefit allowing them to keep their independence while receiving necessary clinical care. Every day, home health professionals deliver quality medical care – such as cardiac care, wound care, pain management and therapies – that was once only offered in a hospital or clinical setting.
Those receiving care at home are some of our nation’s most at-risk populations. Data show they are older, sicker, more likely to live in poverty, to be a minority, and in need of more assistance with basic daily activities than the average Medicare population. To amplify these challenges, these patients are also more likely to live in rural areas with fewer health care options, underscoring the importance of home health access.
Fiscally, home health care just makes sense, reducing overall health care costs through disease management and the prevention of rehospitalizations and emergency room visits. Data show patients in a high-quality home health care program experience 26 percent fewer acute care hospitalizations and 59 percent fewer hospital days. When utilized after a patient receives a major joint replacement, for example, data show home health can save Medicare more than $5,000 per beneficiary.
Despite the growing need for home health to support shifting demographics and value-based care models, the Centers for Medicare & Medicaid Services (CMS) recently finalized a new payment model called Patient-Driven Groupings Model (PDGM) which could, if not refined, destabilize the delivery of care for some of our nation’s home health patients and their care providers.