Medicare Reimbursements Hinder Patients’ Access to Home Health, Report Says

Most home health agencies (HHAs) and physicians report that access to home health care for Medicare fee-for-service beneficiaries is is good, however, insufficient reimbursement remains an issue in serving this vulnerable patient population, according to a new report.

That is the sentiment of 1,075 Medicare-ceritfied HHAs and 510 physicians surveyed in a recent report to Congress titled “Medicare Home Health Study: An Investigation on Access to Care and Payment for Vulnerable Patient Populations.”

The Patient Protection and Affordable Care Act directs the Secretary of Health and Human Services to conduct a study on home health agency costs involved with providing ongoing access to care to low-income beneficiaries or beneficiaries in medically underserved areas, and in treating beneficiaries with severe illnesses. 

In order to examine access to Medicare home health services and payment for vulnerable populations, the research team collected survey data from physicians and HHAs to examine factors associated with potential access to care issues. 

Over 80% of HHAs and over 90% of physicians reported that access to home health care for Medicare fee-for-service beneficiaries in their local area was “excellent” or “good.”

When respondents reported access issues, specifically their inability to place or admit these Medicare fee-for-service patients into home health, the most common reason reported was that patients did not quality for the Medicare home health benefit. Agencies and physicians also cited family or caregiver issues as an important contributing factor in the inability to admit or place patients. 

One of the biggest factors contributing to both physicians’ and agencies’ inability to admit or place patients in home health care services related to insufficient reimbursements, with about 17.2% of HHAs and 16.7% of physicians reporting this viewpoint.

In terms of HHA ownership, proprietary HHAs were more likely to report insufficient reimbursement, the expectation of the patient needing greater than two episodes of care, and language barriers/communication problems as important factors complicating admissions. 

On the other hand, freestanding agencies were more likely than provider-based HHAs to report that unavailable, but required, equipment/supplies and language barrier problems were important factors in not admitting a patient—but less likely to indicate that lack of availability of therapy staff was an important issue (16.25% vs. 27.5%).

“The survey results suggest that much of the variation in access to Medicare home health services is associated with social and personal conditions and therefore CMS’ ability to improve access for certain vulnerable patient populations through payment policy may be limited,” the report states.

For its next steps, CMS plans to further explore margin differences across patient characteristics and possible payment methodology improvements suggested by the study’s results. 

“By decreasing margin variation within the payment system, CMS can more accurately pay for services and may decrease any potential incentives to selectively admit patients,” the study concludes.

Written by Jason Oliva

Jason Oliva

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