2024 Medicare Payment Advisory Commission Report to Congress
Home health agencies provided services to 15% fewer traditional Medicare beneficiaries from 2019 to 2022.[1] In-person home health care visits declined during that time by more than 30%, while payment per in-person visit increased almost 29%.[2] Home health agencies reported a 23% marginal profit from traditional Medicare beneficiaries in 2022.[3]
Access to home health services: The existence of a Medicare-certified home health agency operating within a zip code led MedPAC to conclude that services are accessible for 98% of Medicare beneficiaries, [4] although MedPAC conceded that a home health agency might not serve the geographic area of an entire zip code.[5] However, MedPAC failed to perform an access analysis, acknowledging that agencies are free to (and do), pick and choose patients who produce the highest profit margin, while declining to serve qualified patients with higher resource needs. Currently, Medicare-certified home health agencies are not required to record or report qualified patients they decline to serve, with lack of access growing unchecked.
Admissions to home health: MedPAC’s 2024 report did not analyze the importance of admissions from the community (home). Instead, the report focused on patients who entered home health care after a hospital, rehab, or skilled nursing facility stay.[6] MedPAC had previously reported that home health admissions from the community were 75% in 2019 and 74% in 2020.[7] But, MedPAC’s focus on post-institutional admissions ignores the need for critical services to qualifying beneficiaries who avoid institutionalization to remain in their homes.
Discharge to the community: Without acknowledging Medicare law covers qualifying beneficiaries for an unlimited duration, MedPAC’s 2024 report highlighted quality of home health care criteria as both discharge to the community and potentially preventable readmissions. For beneficiaries living with life-long conditions, their inability to be discharged from home health care limits access to obtain services.
Virtual elimination of home health aides and medical social services: The delivery of covered home health aide and medical social services visits has declined so precipitously that, as of 2024, MedPAC reports visits for both those disciplines as one combined number, an average of half a visit every 30 days, which is a 32% decline just from 2019 to 2022, but more than a 94% decline since 1998, with no change in aide or social services Medicare coverage law.[8]
MedPAC’s limited analysis of home health care payment incentives, and its focus only on post-acute, short-term, and skilled home health services, leads MedPAC to recommend a reduction in the home health care base payment rate by 7%.[9] This recommendation ignores a significant unmet need for Medicare beneficiaries with longer-term and chronic conditions who currently find themselves with extremely limited access to Medicare-covered home health care services.
April 25, 2024 – K. Holt
[1] MedPAC March 2024 Report to the Congress, page 217, Table 7-8. Mar24_MedPAC_Report_To_Congress_SEC.pdf
[2] Id. at page 208, Table 7-2.
[3] Id. at pages 202, 212.
[4] Id. at pages 206-207.
[5] Id, at page 207.
[6] Id. at pages 208-209.
[7] MedPAC March 2022 Report to the Congress, page 282, Table 8-3. MedPAC March 2022 Report to the Congress
[8] MedPAC March 2021 Report to Congress, page 236 http://medpac.gov/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf; Federal Register 2023-14044.pdf (govinfo.gov), pages 43663, 43671.
[9] MedPAC March 2024 Report to the Congress, page 203.