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Medicare co-payment for home healthcare bad idea, group says

December 2, 2014
by Lois A. Bowers, Senior Editor
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Re-establishing a co-payment for the Medicare home health benefit, as some in the federal government have expressed interest in doing, would exacerbate the challenges facing U.S. seniors related to access, coordination and person-centered care, according to the Partnership for Quality Home Healthcare (PQHH).

“It’s clear from multiple sources that re-imposing a co-payment on the home healthcare population could make it impossible for many to continue receiving care in the setting they prefer—their home,” Eric Berger, PQHH CEO, said in a statement. As an alternative to a co-payment, PQHH suggests “program integrity reforms that would achieve significant savings while safeguarding patient access to vital home healthcare services.”

PQHH cited a recent study by the Commonwealth Fund that included adults aged more than 65 years across 11 countries. It found that, despite having Medicare coverage, seniors were the most likely to report that cost posed a barrier to care. “One-fifth (19 percent) said cost was the reason they did not visit a doctor, skipped a medical test or treatment recommended by a doctor, did not fill a prescription or skipped doses,” PQHH noted.

In fact, home health recipients are older, poorer, sicker and more likely to be from a minority population than Medicare beneficiaries as a whole, the organization said. Data from Avalere Health indicates that 24.4 percent of home health recipients are more than 85 years, whereas 12.1 percent of all Medicare beneficiaries fall into that age range, and 66.2 percent of home health seniors live at or below 200 percent of the federal poverty level, compared with just 47.9 percent of all other Medicare beneficiaries, PQHH added. Additionally, 74.7 percent of seniors who receive the Medicare home health benefit have four or more chronic conditions, compared with 48.5 percent of the general Medicare population, the organization reported.

“These study findings, coupled with Avalere Health’s research into the vulnerability of Medicare home health patients, underscore the risk of re-imposing a co-payment on Medicare home health patients,” Berger said. “Congress repealed the home health co-payment in 1972 for a very good reason: It failed to reduce healthcare costs and instead drove seniors to higher-cost institutional settings. Re-imposition of such failed policy has the potential to compel poor seniors to forego cost-effective home healthcare simply because they cannot pay.”

Other findings of the Commonwealth Fund study cited by PQHH: “U.S. older adults were much more likely to face financial barriers to care,” and “despite Medicare coverage, older Americans have less protection from healthcare costs, primarily because of high deductibles and copayments.” Data from Avalere also notes that nearly 40 percent of non-dual eligible Medicare home health beneficiaries do not have additional coverage and would be responsible for the full copayment.