Home Health is facing increased challenges to sustainable care delivery in the home. The latest from the increased co-pays being faced by many seniors as their premiums go up and their pension is diminished by rising costs to just live.
Premiums continue to rise, co-pays are now hovering around $50 per visit while the cost-of living and struggle to pay for medication and food have skyrocketed to an almost unaffordable level. More seniors are now homeless or being forced to live with family, many in their vehicles, with others draining their pensions at a rapidly increasing rate.
Home care is at the forefront of some of these challenges. Deductibles, pre-authorization, and now co-pays are forcing patients to make healthcare decisions that will ultimately cost all of us much more as patients are becoming sicker and seeking care later. This is the free world, land of opportunity – but we are fast equaling the third world in reduced care outcomes and homelessness.
Home care agencies are being forced to review prior authorization which is adding further delay for patients to obtain care resulting in many unnecessary rehospitalizations. With the increase in chronically sick patients, home health agencies are facing decisions on how much care can be provided when CMS may not pay for the services delivered and then they decline those patients with more need.
A study in the JAMA Health Forum showed MA recipients received fewer home health visits and functional outcomes were worse than traditional Medicare beneficiaries. The MA patient’s average home health stay was 1.62 days fewer than that of the traditional Medicare recipient with fewer nursing, physical therapy, occupational therapy, speech therapy, and home aide visits!
In comparison, MA patients are also more likely to be community-discharged despite living alone with fewer resources for continued support. This increases the likelihood of rehospitalization or caregiver burnout.
Cost-reducing tools used by the MA’s are limiting the provider’s ability to deliver necessary care and at the same time reducing the number of providers willing to participate in these programs as they negatively target star ratings – which have become an important tool for insurance companies when choosing to contract with a provider.
Home health is being impacted the hardest when it’s needed the most. Our seniors deserve better.