The COVID-19 pandemic supercharged in-home care in the U.S. Suddenly it became possible to get a house call from a primary care provider; home-based physical therapy, dialysis, or an infusion of medicine; even a full complement of hospital-level services at home became possible. And Americans overwhelmingly liked it.
The Centers for Medicare & Medicaid Services recently proposed a 4.2% cut ($810 million) in home health services, the underpinning of home-based services in Medicare. These include in-home services such as physical therapy, occupational therapy, medical supplies, skilled nursing, and more. Medicare and other payers need to be building on that foundation, not chipping away at it, to achieve a broader set of home-based care options for patients, which provide them and their families with better outcomes, better quality of life, sustained independence, and lower costs.
As the daughter of elderly parents who want to stay in their home, my sincere hope is that policy change advances a new and better set of home-based options, rather than restricting them. Providing all Americans with in-home care inspired me to start Moving Health Home, a coalition working to change federal and state policies to make home care a standard part of health care.
Medicare’s proposal not only works against the future, but it doesn’t even measure up against CMS’s own strategic goals to drive accountable care, advance health equity, support innovation, address affordability, and partner to achieve system transformation.
Driving accountable care. Home health agencies play a vital role in working with health systems and payers to deliver high quality, person-centered care through innovative value-based contracts, in which payment for care delivery is tied to the quality of care. It’s a way to reward providers for improved outcomes rather than for just providing services. Medicare’s proposed cuts will make these innovative, cost saving models less feasible, and therefore less likely to expand to new services.
Advancing health equity. Medicare’s cuts could affect health equity in two ways. First, the industry is already struggling to bolster the home health workforce, which is largely made up of immigrants and people of color. Instead of bolstering the industry’s ability to recruit and retain workers through adequate wages and health care benefits, these cuts create pressure to reduce costs, potentially at the expense of wages and benefits. Second, to improve care for people living in rural areas, which is more expensive due to travel time and distance, funding cannot be reduced.
Supporting innovation. Innovation in the home health space has skyrocketed in recent years due to the pandemic and Medicare’s stable payment environment. Providers have been able to experiment in system transformation and better learn how to drive higher quality and reduced costs. Take the Choose Home Care Act (S. 2562/H.R. 5514), which would allow people who are eligible for nursing home care to receive skilled nursing care in their homes instead of in a facility. Analysis by the National Association for Home Care and Hospice showed that this proposal would save Medicare $144 million to $247 million per year. Innovative proposals like Choose Home are at risk if the Medicare cuts are finalized.
Addressing affordability. Medicare’s cuts appear to address affordability for the federal government, but what the nation’s citizens will get is less transformation, fewer services, less innovation, and less access for hard-to-reach populations.
Given Americans’ preference for receiving health care at home — and its proven feasibility and effectiveness — Medicare needs to move forward, not backward, and double down on its investment in-home care.
Krista Drobac is the founder of Moving Health Home.