A recent study, published in the June 2014 edition of Health Affairs, examines a growing body of evidence suggesting that Medicare reimbursement policies may compromise access to care for certain groups of beneficiaries due to insufficient payment to providers for their complex needs. The study was conducted by the Center for Home Care Policy and Research, with support from CHAP, the Visiting Nurse Associations of America and the Visiting Nurse Service of New York.
As we previously covered, under the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) will reduce home health payments 3.5 percent per year in the period 2014-2017. The study, “Medicare Home Health Payment Reform May Jeopardize Access for Clinically Complex and Socially Vulnerable Patients,” examined OASIS, claims records and patient files for more than 96,000 Medicare episodes provided in 2011 by 26 non-profit home health care agencies across the United States. The authors found that “patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients.” According to the study, “this financial disincentive could reduce such patients’ access to care as Medicare payments decline.”
Given the clinical complexities and other characteristics of vulnerable populations, the authors caution that careful examination of home health care use and costs is needed when planning rebasing and future adjustments to the prospective payment system.
The complete study can be accessed with a subscription on the Health Affairs