News From Terre Haute, Indiana

October 6, 2013

Flashpoint: Access to home health care hangs in the balance

Cheryl Funk
Special to the Tribune-Star

TERRE HAUTE — Growing older is a fact of life that the baby boom generation is facing head on. As our population ages at a rapid rate and people are living longer lives, more attention is focused on long-term care. Home health care is an important part to that conversation. Quality, skilled home health care is widely recognized as clinically advanced, cost-effective and patient preferred.

Home health care helps patients to manage multiple chronic conditions and post-acute care needs — both on the rise due to seniors living longer lives.

Older or disabled patients should live in their homes and remain independent as long as possible. Therapies once only available in an institutional setting are now safely and effectively administered in the comfort of a patient’s own home. Physicians, nurses, therapists, aides and social workers all work with home health care patients to make sure they receive coordinated, comprehensive care.

However, seniors and disabled individuals’ access to home health care is threatened by looming cuts proposed by the Centers for Medicare and Medicaid Services last June. In its draft regulation, CMS proposes to “rebase” home health care at the highest possible rate, which amounts to a 14 percent cut over the next four years. These are drastic cuts to a community that has already absorbed $72.5 billion in cuts since 2009. Even worse, CMS failed to take into account the negative effect these cuts will have on providers and patient access.

Furthermore, a detailed analysis by Avalere Health and Dobson DaVanzo & Associates shows that the 3.5 percent payment adjustment proposed by CMS in June and the billions in cuts since 2009 will cause 47 states, including Indiana, and the District of Columbia to experience net Medicare home health losses by 2017. In Indiana, Medicare margins are projected to reach 13.6 percent by 2017.

These potential cuts come at the expense of a very vulnerable and frail population — especially for seniors and disabled individuals in southern Indiana. Nearly 70 percent of the patients I work with live in a rural area served by limited medical facilities. Even then, the medical facilities that do serve a patient’s area are located miles away from their home. For someone who is homebound, this can make receiving care in a doctor’s office or other facility extremely difficult.

If CMS’ draft regulation is implemented as is, many providers will be rendered inoperable, as Medicare will not reimburse therapies and services at the actual cost of care. Since Medicare is the largest payer for home health services, compensation from private insurers and Medicaid will not cover the losses from Medicare.

I urge CMS to reconsider its proposed rule. It is clear not all factors — especially that of patient access — were taken into account when the draft regulation was proposed in June. We must protect home health care for those who need it today and the millions more who will need it in the future.

— Cheryl Funk

Area director of sales


Southern Indiana

Gentiva Hospice