October 24, 2017
Untested proposals will cut Medicare and hurt seniors
As a family and geriatric medicine doctor, I am incredibly passionate about home health care, visiting nurse services and their incredible impact on America’s seniors and family caregivers. For more than a decade I have been professionally immersed in home health care as a doctor making thousands of house calls to homebound seniors.
I am a medical director and advisor to home health programs, a home care researcher, an author and speaker about home health care, a consultant in home health care, and for five years I have served as the chief executive officer for one of the largest, oldest and most respected non-profit home health-care services organization in the United States.
It is fairly common to meet physicians who have specialized in hearts, knees, eyes, emergency room care and intensive care. I’m a bit unique in that I’ve specialized in home health. For lack of a better term, I’m one of the very few “homecare-ologists.”
It is from this perspective that I wholeheartedly and unequivocally condemn the Trump administration’s current proposal to cut Medicare home health services. I feel especially let down as someone who was quite optimistic about the new presidential leadership for Medicare; I was pleased with the president’s campaign promises to not cut Medicare, his commitments to roll back paperwork and regulatory burden, and to slow top-down Washington-first health system engineering. I was also encouraged by Ivanka Trump’s advocacy for family caregivers who rely quite heavily on the support of home health care.
The Trump proposal to cut home health, called the Home Health Groupings Model (HHGM), breaks all of these promises. HHGM is a totally untested and unpredictable, ivory tower top-down Washington science project being foist on America’s most vulnerable seniors and the home care nurses and caregivers they so deeply need and appreciate.
The HHGM proposal seeks to aggressively cut home health payments at just the wrong time, as our country needs to be strengthening our home health resources for an aging population. When we help seniors with serious illness succeed at home, we promote dignity and independence, keep families intact, and save on more costly hospital and nursing facility care. With over 80 million baby boomers hoping to age in place at home, now is the time for a more dynamic and strengthened home health sector, not one that is diminished.
HHGM is especially problematic because there is no way to know how severely it will change home health care for older Americans. The proposal was developed by data analysts and Medicare insiders and has never been tested in the real world in any fashion. So many untested changes are being proposed at once, it is virtually impossible to predict its impact.
But, it is clear, that the proposal monkeys with some of the most important and valued aspects of home health care including physical therapy services and the length of time people are under the care of a home health agency (cutting the standard payment period from 60 to 30 days).
Medicare’s home health program isn’t perfect and there are many opportunities for improving this critical health system resource as we face the “silver tsunami.” Some of these opportunities include better aligning payment with outcomes through fine tuning value-based purchasing and readmission reduction models, optimizing the clinically appropriate use of home health in place of more costly facility care, an enhanced role for tele-health and other technologies, and spawning training and workforce development initiatives so we have enough qualified people to care for a growing population of seniors at home.
New ideas are needed, and even HHGM is worthy of being tested in some sort of pilot or demonstration program. However, it is absolutely a bad idea to make such a sweeping, complex, and untested change to our senior’s home health services at a time when they will be needing it more than ever before.
Dr. Steven Landers, MD, MPH serves as President and CEO for VNA Health Group.