We call it “home” for a reason. It’s where many of us find comfort, where we know one another, where our communities are, where our identities lie. Indeed, the casual question “where is home?” is often an invitation to get to know someone a little better. It shouldn’t be a surprise that with advances in home healthcare, recent studies show nearly 9 in 10 adults would prefer to receive care in their own homes after a trip to the hospital; home is where people want to be. Staying at home is just as important, and home healthcare also reduces the risk of being readmitted to the hospital, especially after a surgical procedure.
And home health is often a less-costly setting for care compared to nursing homes and other institutional settings. A 2017 study from the Cleveland Clinic found that “patients who receive home healthcare after a hospital discharge save the system about $6,500 over the course of a year.”
Yet despite these patient preferences and lower costs, the Medicare program will be applying a permanent -2.89% payment cut to Medicare’s home health benefit beginning next year. These 2024 cuts represent a sliver of the overall total cuts that Medicare will have made to home health since 2020 – nearly 11.2%.
And it’s why I am writing this: The erosion of traditional Medicare support for home health means it is becoming more difficult for patients across the country to access these services.
Home healthcare providers make care in the home possible by employing high-quality clinicians and providing ways to access patients at their residences. This enables patients to recover in the comfort of their own communities and gives their loved ones peace of mind knowing that professional caregivers are there to help along the way.
Rehabilitation and recovery at home are often delicate periods of life, especially for elderly individuals. And our country’s demand for home health is only growing as the aging population continues to increase.
But despite these trends, access to home healthcare services is becoming more difficult to come by for many Americans. Home health agencies nationally are faced with a perfect storm of sorts: rising costs, limited numbers of available clinicians, and over the past four years, major payment cuts from the Medicare program too.
The problem is becoming evident in national surveys of health systems, showing that patient referrals for home health services are being rejected at historically high rates. In other words, the portion of patients who are referred to home health but are unable to receive care is at an all-time high of 76%, up from 54% in 2019.
This is an access problem. Patients who need home healthcare are less likely to be able to access it. And this access problem is linked to the instability of home health reimbursement from the Medicare program. It needs to change before things get worse.
Over the past few years, Medicare has cut reimbursement rates for home healthcare services multiple times, resulting in payment updates that do not align with the growth in costs that has occurred along inflationary trend lines. This makes it harder for home health providers — many of whom operate as small local businesses — to make ends meet and continue their coverage of certain areas.
A home health operator in southern Nebraska testified in Congress this fall that its decision to pull back from serving 13 counties in the state to now only serving one resulted from the perfect storm of rising costs and dwindling Medicare reimbursement support.
Home health providers – and those that rely on them – need to lend their voices to the importance of access to care at home. The aging population is not slowing down, and demands for care are continually outpacing the supply available.
The advocacy efforts that the home health community is presently undertaking – with Congress, the administration and in the courts – will not stop until a more stable, rational approach to home health reimbursement is achieved.
While the payment cuts from Medicare are concerning at any level, the bigger issue is how our nation’s growing population of aging adults will get reliable access to home health care both now and into the future.
If home health services are important to you or a loved one, you can make your voice heard. Call Congress; write a letter; or communicate to Capitol Hill through the Partnership for Quality Home Healthcare’s advocacy website.
Preserving our options to be treated where we live is important to many people. After all, there’s no place like home.
Andrew Baird is vice president of government affairs at Enhabit Home Health & Hospice.
