Medicare cut may force elders to nursing homes

Rural elderly patients may be forced from their homes and into hospitals or nursing facilities after Congress allowed a Medicare provision that boosted reimbursement rates for patients who live outside cities to expire.

“Service to some rural markets will absolutely cease without (an extension),” said Keith Myers of LHC Group, the second-largest home health provider in the country and one of the largest public companies headquartered in Louisiana.

Myers, chief executive and co-founder of the Lafayette-based LHC Group, is also volunteer chairman of the Partnership for Quality Home Health Care in Washington.

“This will result in patients being prematurely placed into nursing homes and increase hospitalization, both of which are more expensive than home health care,” Myers said.

Medicare reimbursement rates for rural patients had been 3 percent higher than for urban patients before the provision expired on Dec. 31. Advocates insist the subsidy helped to offset increased costs to serve rural patients.

“A nurse in a rural area may have to drive 20 to 30 miles to get to a patient and may only be able to see four patients a day, where a nurse in a city might be able to see eight patients in the same apartment complex,” Myers said.

More than 3.5 million Medicare patients use home health, including about 69,000 in Louisiana.

A provision making reimbursement rates higher for rural patients has been in place since 2000 and has been extended at some level four times since then.

Congress could still come to the rescue with a package of what are called “Medicare extenders” that has broad, bipartisan agreement in the House.

U.S. Rep. Ralph Abraham, R-Alto, who is also a doctor, said passage of the extenders “is critical for rural patients and providers.”

“This service is a lifeline for those patients,” Abraham said. “I can’t overstate the difference in a patient’s quality of life with home health as compared to hospitalization or institutionalization.

“That’s the primary benefit, but home health also saves tons of money, so it doesn’t make fiscal sense to remove a provision that would force patients into more expensive options.”

U.S. Sen. Bill Cassidy, R-La., who is also a doctor, supports the Medicare extenders package as well.

“Seniors in rural Louisiana may live far from their doctor and face other challenges getting care,” Cassidy said. “Temporary Medicare extenders address this. We also need a long-term solution to give Medicare patients and providers certainty.”

Abraham said he believes the package of extenders will eventually be passed, either as a stand-alone bill or inclusion in the continuing resolution or another budget instrument.

But Myers, who said Abraham has been a champion for rural health care delivery, remains pensive.

“I’ve never felt like it’s been at risk before, but this time there have been a couple of proposals that suggest (the rural subsidy) is unnecessary and should be phased out,” he said. “I want to be confident, but that makes me uncomfortable.”

LHC served about 200,000 patients annually in 24 states. Myers said his company’s patient mix is about 60 percent urban and 40 percent rural.

Home health was also under the gun last year before Abraham and Rep. Terri Sewell, D-Ala., led a bipartisan effort to scuttle a new rule that that would have diverted money from home health to hospitals in 2019.

The new rule would have cut Medicare home health reimbursement rates in 2019 by almost $1 billion and cut the time a patient could access the services from 60 days to 30 before it was withdrawn.

“Too many of these rules are being presented as legislation with no input from providers about how it would impact patients and the industry,” Myers said. “Instead, we’re having to see the legislation after it’s presented and react to it.”

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