GW University study shows how home care is suffering

Diabetics hardest hit among patients

In "An Examination of Medicare Home Health Services: A Descriptive Study of the Effects of the Balanced Budget Act Interim Payment System in Access to and Quality of Care," a study conducted by the George Washington University Center for Health Services Research and Policy, one-fifth of the home health agencies surveyed admitted to overtly screening high-cost patients because of reduced Medicare reimbursement.

The study, which was partially funded by the National Association for Home Care (NAHC) in Washington, DC, also found that Medicare patients make up a lower percentage of agencies’ patient bases in 1998 than in 1996.

Phase II will look at affect of IPS

In the final analysis, the study’s authors recommended that the 15% reduction in home care payments scheduled to being next October be eliminated. The study’s second phase will examine how the interim payment system has affected other segments of the medical community, including nursing homes, hospitals, and Medicaid.

The study surveyed home health agencies in California, Florida, Indiana, Iowa, Louisiana, Massachusetts, Mississippi, Pennsylvania, and Texas — states selected for their mix of urban/rural populations as well as their geographic diversity. In all, information was collected from 28 agencies: nine freestanding, for-profit agencies; 11 freestanding, nonprofit agencies; and eight hospital-based or affiliated agencies.

Among the study’s other findings:

• Of the nonprofit agencies, 50% reported subsidizing care for Medicare patients with endowment or grant contribution funds.

• On average, agencies have spent $423,576 in donations and from other sources to subsidize caring for Medicare home health patients.

• Southern agencies are more likely to rely on reducing levels of services and are less able to change their case mix characterized by more chronic illness.

• Agencies in other regions are more likely to rely on patient screening or the altering of marketing patterns to control their case mix and reduce the number of visits.

• Nearly all agencies surveyed reported significant cuts in clinical and administrative staff as part of their cost-containment strategies. Since 1994, skilled nursing staff declined 23%, health aides staff declined 43%, and total clinical staff declined 37%.

• Diabetics, especially those with complex cases, were most affected by changes in admission practices made in order to meet with the Balanced Budget Act of 1997 budgetary constraints.

• The total number of unduplicated Medicare patients dropped 30% since 1996.

• Medicare revenues for the study agencies in 1998 were 25% lower than 1994 levels and 35% lower than 1996 levels.

• Medicare patients accounted for 21% less of the total patient census for study agencies since 1994.