Medicare Residence Care Protection Is Not a Brief-Time period Profit: Witness to Senate


The Actuality

“Sadly, Stein stated, “the middle hears recurrently from individuals who meet Medicare protection standards however are unable to entry Medicare-covered dwelling care or the suitable quantity of care.”

Gaining access to dwelling well being aides to supply assist with actions reminiscent of bathing may be particularly difficult, regardless that federal regulation authorizes Medicare protection of 28 to 35 hours per week of dwelling well being aide providers.

Stein stated Medicare creates disincentives for long-term dwelling care advantages use by:

  • Paying extra for the primary 30 days of providers than for providers after 30 days.
  • Paying extra for dwelling well being providers for sufferers who come from a hospital or establishment.
  • Utilizing a top quality measurement system that rewards solely enchancment in situations, not success at efforts to take care of individuals’s well being or sluggish deterioration.

“We want auditing that appears at underutilization, not simply so-called ‘over-utilization,’” Stein added.

The Residence Care Provide

David Grabowski, a Harvard Medical Faculty professor, testified that he believes that Medicare supplies beneficiant funds for dwelling well being care in a lot of the nation, and that this system ought to intention any additional funds meant to extend the availability of dwelling care providers at rural areas, the place providers could also be tougher to seek out.

Different witnesses seen that Medicare might give an inaccurate image of sufferers’ entry to dwelling care providers by exhibiting that the sufferers have sufficient entry in the event that they stay within the service space of at the very least two dwelling care businesses, even when the businesses are overloaded and usually are not accepting new sufferers.

William Dombi, president of the Nationwide Affiliation of Residence Care & Hospice, stated in testimony on the listening to and in written testimony that tendencies within the quantity of dwelling care lined by Medicare present that the house well being providers profit is in hassle.

In 2021, Medicare paid for a mean of 25.4 visits for simply 3 million enrollees, down from a mean of 74 visits for 3.6 million enrollees in 1997, Dombi stated.

Medicare spending on dwelling well being providers elevated to simply $16.9 billion in 2021, from $16.7 billion in 1997, as Medicare spending on expert nursing services elevated to $27.2 billion, from $11.2 billion.

“The proof is mounting that sufferers in want of dwelling well being providers are coping with main boundaries to entry to care at this time, a few of which can attain a degree the place they’re insurmountable,” Dombi stated.

Judith Stein. Credit score: Senate Finance


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