As the “Super Committee” in Washington debates ways to reduce the deficit, health care providers are increasingly concerned about the impact that proposed changes may have on their ability to care for patients. Unfortunately, as some in Congress search for savings within our besieged Medicare program, home health care could become a target for funding cuts.
Georgia’s home health care providers have joined a chorus of national stakeholders urging Congress to make smart decisions that will both reduce the deficit and improve the care provided to our nation’s seniors. We believe this is best done in two ways:
First, Congress needs to recognize the value of skilled home health care in reducing Medicare expenditures and giving patients what they want – quality care in the comfort of their own homes. Second, before a single dollar is cut from programs that benefit patients, Congress must act to stop fraudulent and improper Medicare payments, which cost taxpayers more than $70 billion each year.
Nationwide, more than 3.2 million Medicare beneficiaries – 90,000 of them here in Georgia – receive skilled home health care services to treat acute illnesses, chronic health conditions, permanent disabilities and terminal illnesses, all at a significant savings to taxpayers. According to a June 2011 study by Avalere Health, use of home health care was associated with a $2.81 billion reduction in post-hospitalization Medicare spending from October 2006 to September 2009 in patients with certain chronic illnesses.
Avalere compared Medicare beneficiaries suffering from diabetes, chronic obstructive pulmonary disease or congestive heart failure who received post-hospital care at home to beneficiaries who received post-hospital care in institutional settings. It found that Medicare Part A spending on the home health users was $2.81 billion less than it would have been if they had received other post-acute services.
The Avalere study also found that home health use after an initial hospital visit was associated with an estimated 20,426 fewer hospital readmissions. Avoiding these readmissions saved Medicare an estimated $670 million during that period. Further, the study revealed an additional $485 million in Medicare savings that could have been generated from fewer readmissions if beneficiaries who received other post-hospital services had used home health care.
Amid the current budget deliberations, some have proposed co-payments for skilled home health care. Our community feels that such a step would be nothing but a “sick tax” on seniors. A home health co-payment, unfortunately, would fall hardest on the low-income and clinically disadvantaged seniors who need the Medicare program’s help the most.
The vast majority (83 percent) of Medicare home health beneficiaries do not have secondary Medigap coverage and could therefore be responsible for the full co-payment, which could be as high as $300 for a 60 days of treatment. That may not seem like much, but consider that for this specific population, budgeting for such basic needs as housing, utilities and food is already a challenge. In fact, nearly 60 percent of the affected beneficiaries have an annual income below the poverty line, according to Avalere.
Although a home health co-pay would be intended to generate Medicare savings, it could actually drive costs up, both for seniors and for the government. Research shows that requiring co-pays could shift costs of care from Medicare to Medicaid, and it could drive up Medicare costs by forcing patients to seek costlier inpatient services. Some beneficiaries, when faced with a high co-pay, might simply try to do without the home health care they need. That, in turn, could cause them to suffer worse medical problems, and they would wind up requiring treatment in a more expensive institutional setting.
Cuts to Medicare payments are known to jeopardize patient access to affordable, quality services. The home health care community believes that instead of endorsing cuts or increased fees, the Super Committee should advance reforms that strengthen Medicare and Medicaid and protect the beneficiaries who depend on them.
According to some government estimates, the Centers for Medicare and Medicaid Services makes at least $70 billion in improper payments each year, and probably much more is lost to fraud and abuse. Funds for these programs are intended to provide services for our nation’s oldest, poorest and most vulnerable populations, but flaws in the system are allowing vast amounts of taxpayer dollars to fall into the hands of criminals.
The Georgia Association for Home Health Agencies recently partnered with the National Association for Home Care & Hospice and The Partnership for Quality Home Healthcare to host an event with U.S. Rep. Tom Price (R-Ga.), who is also a physician, to discuss these important issues. Collectively, national providers are working to advance policy solutions that will fight fraud first and avoid burdens on American seniors. With the help of our dedicated lawmakers, we can ensure Georgia’s seniors ongoing access to the care they depend on.
Clay Campbell is president and CEO of Archbold Health Services in Thomasville, and serves as chairman of the Georgia Association for Home Health Agencies’ Government Affairs Committee.