Industry Voices—Medicare's assault on home health keeps patients from going home

A home health agency in Missouri recently announced it is shutting down due to the impact of Medicare reimbursement cuts. Another agency in upstate New York is also closing. These are only two of the growing number of closures across the country. 

Home healthcare providers are experiencing severe payment cuts along with challenges to retain nurses and therapists, putting healthcare services at home in jeopardy. What this means for Medicare patients is that it is becoming more difficult to leave the hospital after a serious health event to return home to rehabilitate and recuperate.

Among America’s home healthcare providers, this story is increasingly common. A report released in July shows hospitals placing patients in post-acute care after hospital discharge remains challenging, with the rejection of patient referrals for home healthcare at an all-time high. Home health agencies simply don’t have the capacity to accept all the patients needing home health.

Despite these disturbing trends, the Centers for Medicare & Medicaid Services (CMS) has proposed yet another round of devastating cuts to the Medicare Home Health Program. Unless Congress steps in, CMS will move forward with a permanent -9.36% payment cut to Medicare Home Health and at least another $4 billion in “clawback” cuts for Medicare services already provided during the pandemic. These unprecedented cuts would translate to nearly a $25 billion reduction over the next ten years in a Medicare benefit that is only a $17 billion annual program. 

Highly reliable data and other objective evidence show that great harm will come from the payment cuts. Yet, CMS justifies its proposal by relying upon a deeply flawed payment methodology that has triggered a lawsuit now pending in federal court.

This could spell disaster for the nearly 3 million older Americans who rely on home healthcare—and who vastly prefer to recover at home than in other settings. Home health is the patient-preferred option by a very wide margin: 86% of adults (including 94% of Medicare beneficiaries) prefer short-term care after a hospital stay in the comfort and safety of their homes rather than a nursing home.

Additionally, home healthcare helps stretch Medicare dollars while freeing up hospital resources sooner. According to CMS’s own data, home healthcare saves the Medicare Trust Fund more than a billion dollars over six years by avoiding hospitalizations and nursing home stays.

However, due to Medicare home health cuts exacerbating the existing staffing shortages, an increasing number of home health referral rejections has resulted in longer hospital stays, preventing the smooth transition of patients from the hospital back into their homes—a lose-lose for everyone. Everyone knows the frustration when a loved one can’t return home after a hospitalization. It doesn’t have to be this way.

We are asking Congress to intervene. Together, our organizations support the Preserving Access to Home Health Act of 2023 (S. 2137/H.R. 5159) to prevent these cuts and protect access to Medicare home healthcare nationwide.

Introduced by Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME), and Representatives Terri Sewell (D-AL) and Adrian Smith (R-NE), the Preserving Access to Home Health Act would safeguard access to essential home-based, clinically advanced healthcare services by blocking the cuts proposed by CMS and repealing the agency’s ability to impose such cuts.

The overwhelming majority of Medicare beneficiaries prefer home health options after leaving the hospital. However, CMS’s misguided cuts are based on faulty data and would negatively impact access to critical home healthcare services nationwide. Lawmakers on both sides of the aisle should rally around this patient-protection legislation for the older Americans and the families they represent who want to receive care at home.

Without help, the viability of home health for older Americans is in grave jeopardy.

William Dombi is president of the National Association for Home Care & Hospice and Joanne Cunningham is CEO of Partnership for Quality Home Healthcare.