Home Health Leaders Seek Program Integrity Reform and Quality Initiatives to Protect Most Vulnerable Seniors

Following a recent New York Times article, “With Sickest Patients, Cost Sharing Comes at a Price,” home health leaders with the Partnership for Quality Home Healthcare underscored the need to protect vulnerable American seniors from the negative effects of cost sharing, which data show results in increased hospitalizations, especially among the chronically ill.

As reported by the New York Times, “When applied indiscriminately, cost sharing can hurt the sicker patients by prompting them to delay or avoid the preventive care they need. A 2012 study showed that higher cost sharing reduces spending on physician visits and drugs, but can increase hospital spending. When Medicare beneficiaries face higher cost sharing, hospitalizations go up, not down, especially for those with chronic illnesses.”

Among homebound home health beneficiaries, copayments have historically generated unfavorable results. In 1972, the U.S. Congress repealed a copayment imposed on Medicare home health beneficiaries because it proved ineffective and resulted in increased institutionalized care, which increased costs to Medicare, taxpayers and patients.

Instead of the re-imposition of a home health copayment, the home health care community advocates for achieving cost-savings via program integrity and value based purchasing reforms:

• The Skilled Home Health Integrity and Program Savings Act (SHHIPS) would target Medicare fraud and abuse by preventing the payment of aberrant claims, strengthening the claims review process, improving participation standards, and establishing temporary entry limitations to prevent excess growth, which are critically needed to reduce spending and shore up the Medicare Trust Fund.

• The Securing Access Via Excellence (SAVE) Medicare Home Health Act would replace across-the-board cuts to the Medicare home health benefit with sustainable hospital readmission reforms that incentivize quality care for Medicare beneficiaries and achieve savings by reducing avoidable healthcare spending.

• The Bundling and Coordinating Post-Acute Care (BACPAC) Act would created episodic payments for post-acute care delivery and has the potential to save Medicare money and improve clinical outcomes for frail, elderly patients by incentivizing coordinated, efficient care delivered in the most clinically appropriate setting.

“The New York Times article drives home the point that to make Medicare more efficient and effective, we need to tear down barriers to care like high out-of-pocket costs for beneficiaries,” stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. “The proposals put forth by the home health community offer patient-centric solutions that keep healthcare costs low, protect vulnerable patients, and prevent unnecessary hospital admissions and readmissions.”

Approximately 3.5 million homebound seniors, who are documented as Medicare’s oldest, poorest and sickest patient population, use home health to manage chronic conditions or recover from a hospital stay. Home health is widely recognized as clinically-advanced, cost-effective and patient preferred.

“If higher cost sharing harms sicker patients and doesn’t even save money, insurers and public programs then might want to reconsider how they impose it,” the Times article concluded.