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-- Programs and Services -- Contact Information University study finds HHA bias against sicker Medicare patients
Home health agencies (HHAs) are responding to Medicare’s interim payment system (IPS) by not taking sicker patients, a George Washington University (GWU) Center for Health Services Research and Policy study indicated last month. Relatively healthy beneficiaries appear to have unchanged access to care. IPS will continue until at least October, when the new prospective payment system is expected to be in place.
The study was funded by the home Health Services and Staffing Association and the National Association of Home Care (NAHC).
Data contradicts HCFA, GAO
GWU data contradict assertions by the federal Health Care Financing Administration and General Accounting Office, that cuts in Medicare reimbursement are not affecting patient care. NAHC President Val Halamandaris said the study adds to "the body of evidence pointing to the devastating impact of the IPS on home health." More than 2,500 HHAs have closed since 1997.
Almost 70 percent of hospital discharge planners (HDPs) surveyed reported increased difficulty making initial HHA placements and 61 percent said it is harder to get the same services for a second placement. About 56 per cent had to make other arrangements, such as skilled nursing facility (SNF) care, because home health care was not available.
"The increased difficulty also reported by some HDPs in referring Medicare beneficiaries to SNFs underscores concerns that Medicare payment methodology may be creating a class of patients unwanted by any health care sector because of the high costs of their care.," the researchers said.
Some patients more difficult to place
Patients most likely to face displacement difficulties are those with short-term, high-intensity needs; beneficiaries needing complex wound care; and beneficiaries suffering from chronic diseases, such as pulmonary or cardiac disease, including congestive heart failure, and diabetes.
Lead author Barbara Markham Smith said, "the disproportionate impact of the 1997 reductions on Medicare’s sickest and most vulnerable beneficiaries provides a vivid illustration of how changes in provider payment structure can affect beneficiaries. It should come as no surprise that providers respond to financial incentives to reduce care."
"Given the evidence that sicker beneficiaries have been disproportionately affected by IPS, the need to structure payments to providers that create incentives for appropriate care to higher cost beneficiaries is emphasized," the researchers said.
For information on the study, "An Examination of Medicare Home Health Services: A Descriptive Study of the Effects of the Balanced Budget Act Interim Payment System on Hospital Discharge Planning, " contact: Barbara Smith, GWU, (202) 530-2310; or Val Halamandaris, (202) 547-7424.
The above is reprinted from the Older Americans Report, 1/21/00.
January 26, 2000