Lawmakers Must Protect Home Health To Alleviate Hospital Bottlenecks

KFF Health News
 
The stark reality that countless seniors lie stranded in emergency rooms across the country waiting for care underscores the need for models of care that better support older Americans (“Stranded in the ER, Seniors Await Hospital Care and Suffer Avoidable Harm,” May 6). As KFF Health News reports, even if patients need to be admitted, at times, there are simply no rooms available.
 
As noted in the article, the backlog of patients waiting to be discharged to home health care has partly contributed to this problem in ERs. Medicare’s home health care program enables complex, disabled, and older patients to receive care and rehabilitation in their own homes after their hospitalization. Not only is this the preferred site of care by patients and their families, but it also helps open needed hospital beds and lessens the burden on emergency rooms and hospital staff.
 
Unfortunately, years of Medicare cuts are making it harder for home health providers to meet growing demand and provide vital care. The Centers for Medicare & Medicaid Services has repeatedly cut the Medicare home health program, and more cuts are expected in future years, already totaling $19 billion in cuts through 2029. 
 
Despite Medicare’s own data showing that home health saves taxpayers money, the cuts continue forcing home health providers to scale back the services they can provide, making it more difficult to recruit and retain staff, which ultimately harms patient access.
 
To protect home health and free up capacity in hospitals, Congress must pass the Preserving Access to Home Health Act (S 2137/HR 5159), which would prevent Medicare from implementing steep payment cuts to the Medicare Home Health Program in 2025 and beyond.
 
No patient should have to wait hours in an ER hallway while sick or injured. By stopping these cuts to the Medicare home health program, Congress can give patients access to high-quality care while also alleviating the burden on hospitals in crisis.
 
— Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, Washington, D.C.

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Contradictory Policymaking Has Led To Costlier Care: The Future of Health Care Is In The Home

Home Health Care News | By Guest Contributor
 
The following is an op-ed submitted by: Ken Albert, CEO, Andwell Health Partners; David Causby, CEO, Gentiva; Marcylle Combs, CEO, MAC Legacy; Brent Korte, CEO, Frontpoint Health; John Olajide, CEO, Axxess; Billy Simione, Managing Principal, SimiTree; Jennifer Sheets, the former CEO of Interim HealthCare; Susan Ponder-Stansel, CEO, Alivia Care; David Totaro, Chief Government Affairs Officer, BAYADA; Sara Wilson, President & CEO, Home Assist Health; and Bryan Wolfe, the former CEO of Traditions Health

As the nation faces a debt ceiling of $34 trillion and climbing, it’s no surprise that the federal government is under pressure to find ways to cut program costs and crack down on overspending. 
 
What is surprising is that the program they continually target in budget cutbacks has an impressive record of saving the government billions: Medicare-certified home health care. 

Though home health care helps nearly 36 million 65+ and permanently disabled Americans recover at home and avoid costlier placements in institutions, the Centers for Medicare & Medicaid Services (CMS) has initiated deep cuts to the Medicare home health industry, totaling $25 billion in cuts over the next decade. 

Government-funded health care programs like Medicare, Medicaid and Medicare Advantage (MA) home health are closely connected in how they are financed. 
 
This is because Medicaid and Medicare Advantage have such insufficient funding to begin with, forcing providers to rely on Medicare to cover the shortfall to offset the costs incurred in treating patients under Medicaid and Medicare Advantage – a decade-old system that is severely flawed and requires all three programs to ride on the backs of one another for financial stability. 
 
The solution is two-fold: First, CMS must stop cutting Medicare home health care funding. Cutting funding year after year has only created turmoil in the very industry that is essential in providing stable, in-home care for vulnerable Americans. 
 
Second, CMS and the Medicare Payment Advisory Council (MedPAC) must seek to develop new policy approaches that account for Medicare’s cost-savings and support a sustainable funding model for Medicare, Medicaid and MA. This two-fold solution will ensure that purported federal efforts to save money and cut programs are not done so to the detriment of millions of seniors and adults with permanent disabilities. 
 
As funding cuts continue, the costs of business and operations increase, leaving home health providers forced to either cut wages, services and coverage areas or shut their doors altogether. This ultimately costs Medicare more money by pushing patients into costlier institutional settings while simultaneously risking health outcomes. 
 
Medicare home health patients have better health outcomes and are at less riskfor rehospitalization. Since COVID, we have seen a substantial shift in America’s future of health care as more evidence has shown home to be the safer and more comfortable setting. Without fixing the flawed system, vulnerable Americans won’t be able to access this option of care and our government will be forced to spend even more money. 
 
To put it into perspective:
 
It costs $2,010 per month to care for a patient at home for 30 days under home health care.
A skilled nursing facility costs an astronomical $16,500 for that same care.
 
That’s a cost savings of approximately 88% for every patient diverted from a skilled nursing facility and cared for at home. Put another way, we can care for eight people at home for the cost of caring for one person in an institution…

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‘Time To Claim The Future’: The Hospital-At-Home Model’s Chance To Decentralize US Health Care

Home Health Care News | By Andrew Donlan

Hospital-at-home care has a chance to become a mainstay in the larger home-based care ecosystem. As its stakeholders aim to get it there, there are a few factors that need to be considered. 
 
Firstly, without payment, there is no hospital-at-home model. Early pioneers of the model in the U.S. know that all too well. 
 
But Medicare providing adequate payment for hospital-at-home care during the public health emergency (PHE) was a major first step to get other payers to follow. The Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver has already been extended through 2024 – it was initially supposed to expire at the end of the PHE – and now is up for another extension. 
 
Earlier this month, Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.) introduced a bill that would push back the expiration date of the waiver program by five years. An extension bill was also introduced in the House. 
 
That would make for an obvious tailwind for hospital-at-home stakeholders. It not only would keep the payment valve open for current hospital-at-home programs, but also give health systems interested in the model the assurance that investment will be worth their time. 
 
Additionally, earlier this year, Sens. Marco Rubio (R-Fla.) and Tom Carper (D-Del.) introduced the At Home Observation and Medical Evaluation (HOME) Services Act, which would allow providers to admit patients into hospital at home prior to being admitted in the brick-and-mortar hospital. 
 
The Acute Hospital Care at Home waiver taking on a wider scope, more payers following Medicare’s lead and more home-based care providers becoming involved isn’t just good news for the hospital-at-home model, though. 
 
It pushes forward the idea that the home can eventually be the epicenter of health care in the U.S., which is an idea that many home-based care stakeholders are behind, but also a major departure from the current system. 
 
“One may ask why a five year extension, as opposed to something made permanent,” Medically Home CEO Rami Karjian recently told me. “We think Medicare wants to go the bundled route for making this permanent. We think they have this vision, like with BPCI-A, acute and post-acute care integrated and paid for together. That’s where we think this is 
ultimately going to go.” …

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