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Tag: Home health care

  • Private equity profiting wildly on home care at the expense of older adults

    Private equity profiting wildly on home care at the expense of older adults

    A new report from the Center for Economic and Policy Research, “Profiting at the Expense of Seniors: The Financialization of Home Health Care,” finds that new policies at the Centers for Medicare and Medicaid Services (CMS), which administers Medicare, let private equity and other corporate players profit wildly from owning home health care agencies. At the same time, these corporate players shortchange people with Medicare, keeping them from getting medically necessary home care that Medicare covers.

    Unlike in days of yore when home care agencies were often mom and pop shops and nonprofit agencies, today private equity firms and health insurance companies often own home health care agencies. And, their incentive is to stint on care. The less care they cover, the more they profit. So, they override your treating physician regarding the care you need. They tend to think you don’t need care or need less care.

    CMS says it wants to crack down on fraud. But, in many ways, it is encourage it, allowing health insurance companies and private equity firms to direct care and not overseeing these profit-maximizing entities or holding them accountable for their bad acts.

    The fraud and bad acts go beyond home health care; it is pervasive in Medicare Advantage. The CMS Medicare Advantage payment system is defective, allowing corporate insurers who run Medicare Advantage plans to charge the government way more for their services than is appropriate. By CEPR’s calculations, based on various Medicare Payment Advisory Commission (MedPac) studies, Medicare Advantage plans receive about 19 percent more for each enrollee than CMS spends on people in traditional Medicare.

    Corporate insurance company overcharges drive up Medicare Part B premiums for everyone with Medicare. As a result, people in Original Medicare are helping to subsidize the corporate health insurers running Medicare Advantage. Everyone, including taxpayers, are paying more for Medicare than they should be paying.

    “Medicare services are almost entirely funded by the payroll taxes of working people. They deserve a health care system in their older years that is patient-centered, not profit-driven,” said Eileen Appelbaum, one of the authors of the report. “The goal of CMS is to change Medicare as we know it by 2030, and Congress  must rise to the occasion to protect patients and taxpayers.”

    Among other things, the report’s authors recommend that Congress strengthen Traditional Medicare. CMS also must oversee the insurance companies and private equity firms operating home health agencies and hold them accountable for their bad acts.

    Here’s more from Just Care:

  • Shortage of home health aides undermines people’s ability to age in place

    Shortage of home health aides undermines people’s ability to age in place

    Since the Covid-19 pandemic, it has become increasingly hard for people to get the care they need at home. The Wall Street Journal reports on a woman with ALS who needed to rely on seven different caregivers over six months because of the shortage of home aides.  This home health aide shortage undermines people’s ability to age in place, and it’s not likely to end any time soon.

    Mary Barket has ALS. She struggles to manage with activities of daily living such as cooking, cleaning and bathing. On some days, she could not get her home health agency to send an aide to help her. She has no family or other volunteer caregiver.

    Without a home aide, the situation can be dire for Barket. She can barely use her hands. And, she can’t go out on her own for food.

    When people must rely on multiple aides, it jeopardizes continuity of care. In order to get the home health care they need, patients and their families have to teach each new aide about their daily habits anew. When do they wake up, nap, go to sleep? What do they eat at each meal? What do they wear? How do they like to spend their days, and more?

    Unfortunately, we are facing home health aide shortages and significantly high turnover rates. The supply chain is inadequate to meet needs for the large number of people who rely on home health care to age in place. Covid-19 has increased demand for aides, making it harder for people to hire them.

    Home health agencies have been increasing wages for home care workers, expanding their benefits, offering training and giving signing bonuses. Agencies are looking to ensure job satisfaction and reduce turnover rates.

    But, annual income for home health aides still averages under $30,000. Average pay remains under $15 an hour, though the agencies generally charge double that or more for their time. The work can be quite difficult both physically and emotionally and the hours unpredictable.

    The US has seen a doubling of home health aides in the 10 years between 2008 and 2018. There were 2.26 million in 2018, up from 900,000. And, the numbers should grow another 550,000 or so by 2033.

    The home health care industry is growing much faster than other industries. But, it is not growing fast enough. Demand for home health care far exceeds supply.

    Do you need to hire home health aides? Medicare covers home health aides to a limited degree for some people needing physical therapy or skilled nursing, who are homebound, for whom leaving home requires a considerable effort. Otherwise, unless you also have Medicaid, you will likely have to pay out of pocket.

    If you’re hiring home health aides, you should look into hiring two, one as backup. You might also want a geriatric care manager to coordinate care and help find back-up aides when a caregiver is not available.

    Be prepared: Keep a checklist with your loved ones daily routines to share with the home health aides.

    Here’s more from Just Care:

  • Data show Medicare Advantage covers less nursing, rehab, home health care

    Data show Medicare Advantage covers less nursing, rehab, home health care

    The Kaiser Family Foundation just released a new study looking at more than 60 past studies of Medicare Advantage. The takeaway is familiar: People with few health care needs fare well in Medicare Advantage. People with costly and complex health care needs receive less post-acute care: they get less nursing, rehab and home health care, often from lower quality providers, in Medicare Advantage. When deciding whether to enroll in Medicare Advantage, keep in mind that health insurance should meet your unforeseeable health care needs down the road.

    The 62 studies, conducted since 2016, focused on people’s experiences affording health care, using health care and getting quality care in traditional Medicare and Medicare Advantage. The authors found that people in Medicare Advantage were less likely than traditional Medicare enrollees not only to use post-acute services but to get treatment in hospitals, skilled nursing facilities, and home health agencies which have the highest quality ratings. The study could not determine whether less use of post-acute care jeopardized health outcomes of study participants.

    We already know from the HHS Office of the Inspector General that Medicare Advantage plans use prior authorization requirements for post-acute services that inappropriately delay and deny care their enrollees need. These “widespread” inappropriate delays and denials likely contribute to why MA enrollees use fewer of these services than people in traditional Medicare, which has no prior authorization requirements for these services. It’s also likely why people with costly conditions tend to disenroll from Medicare Advantage plans at higher rates than other people.

    The data also show that people in Medicare Advantage often forgo care in order to avoid going into medical debt and/or having no money to pay for food and rent. Copays and deductibles can be high in Medicare Advantage plans, particularly for post-acute care. People in traditional Medicare, particularly those with supplemental coverage, experience fewer cost-related problems.

    Medicare Advantage plans do not appear to do a better job of keeping enrollees healthy than traditional Medicare, based on the available data. Satisfaction rates with both care and wait times is similar in traditional Medicare and Medicare Advantage.

    Here’s more from Just Care:

  • Government proposes cuts to Medicare home health care

    Government proposes cuts to Medicare home health care

    In an opinion piece for Stat News, Krista Drobac writes about a proposed government cut to Medicare home health care that, if finalized, will take a toll on older adults and people with disabilities. Since the Covid-19 pandemic, more people with Medicare have been receiving a wide range of care at home. They benefit from home health care and value their ability to get care at home.

    Home care is particularly valuable because it allows people, who might otherwise need to move into a nursing home, to age in place. But, the Centers for Medicare and Medicaid Services has proposed a $810 million reduction in Medicare home health care spending beginning in 2023. If the cut goes through, it will reduce the number of people with Medicare able to get physical therapy, skilled nursing care and home health aide services in their home. 

    As it is, the Medicare home health benefit is quite limited. Only people who are effectively homebound–for whom leaving home requires a considerable and taxing effort–are eligible for the benefit. To qualify for Medicare covered home health care, they must also require either skilled nursing care or physical therapy on an intermittent basis–either daily for a short term or longer term for only a few days a week. The Medicare home health benefit should be expanded, not cut.

    Cutting home care benefits would make aging in place even harder for older adults and people with disabilities. It would also undermine the government’s purported goal of promoting health equity, innovation and health care affordability. Home-health services help drive accountable care.

    Home-health services are particularly valuable for people who live in rural areas. Cuts to Medicare home health care could make it harder to help ensure people in rural communities receive needed care.

    If Medicare finalizes its proposed cuts to its home health benefit, home care services will become less affordable and accessible to people with Medicare.

    Editor’s note: The federal government is overpaying Medicare Advantage plans tens of billions of dollars a year, and they are profiting wildly. Yet, CMS is planning to increase payments to these plans by 8.5 percent in 2023. Rather than continue to put money into the pockets of Wall Street investors, CMS should be helping to assure good affordable home care for people with Medicare.

    Here’s more from Just Care:

  • Washington State delays plans to give residents a long-term care benefit

    Washington State delays plans to give residents a long-term care benefit

    If the US does not already have a long-term care crisis, and there’s a good argument we do, it’s hard to imagine we won’t face a crisis shortly. As the cohort of older Americans grows, so does the need for long-term care, and the cost is likely to be prohibitive for most. While Congress is currently sitting on its hands, Washington State passed a state-based long-term care benefit, but its launch is now delayed until 2023, with coverage not beginning until 2026.

    Washington is the first state to pass a law offering residents long-term care coverage, albeit quite limited in scope. The benefit covers up to $36,500 in long-term care costs in an individual’s lifetime. It is designed to pay for aide services as well as home modifications and other needs, or 2o hours a week of home care for one year. It could be a huge help for many, and still not enough help for some.

    The Washington long-term care benefit, WA Cares Fund, has been delayed to July 2026. To cover the costs of WA Cares Fund, 3.1 million workers in Washington are expected to pay a small payroll contribution beginning in July 2023, much like they do with Medicare and Social Security. Annual costs will be about $302 for someone earning $52,000 or 0.58 percent of earned income. Costs will be far higher for wealthier individuals. You must pay in for at least three years to qualify for the benefit.

    Most people don’t realize that Medicare does not cover long-term care. It covers no more than 100 days in a skilled nursing facility for people who have been hospitalized for at least three days and who need daily skilled nursing or therapy services. It also covers some home health care services–between 20 and 30 or so hours a week–for people who are homebound and need skilled therapy or nursing services on an intermittent basis.

    Medicaid does cover long-term care. It is an invaluable benefit. But, in order to get Medicaid, your income and assets need to be extremely low. Thankfully, in many states, if your income and assets are above the eligibility level, your health care expenses need to bring your income and assets down to the eligibility level before Medicaid will kick in.

    Can the Washington state long-term care benefit work? It’s hard to know. With more than six in ten people needing long-term care at some time in their lives, it will take a lot of money to cover the cost of the benefit. And, many Washington state residents appear to be worried about paying in and not being able to get back what they invested.

    Nearly 500,000 Washington state residents have turned to buying private long-term care insurance as an alternative that exempts them from the requirement of paying into the state fund. Private long-term care insurance has always been a gamble, with premiums able to double out of nowhere and the benefit often more limited than people realize.

    Congress needs to step in to avert a long-term care tsunami. The population of people over 85 and the population of people with dementia are expected to double by 2042. The cost of long-term care is only rising. Countless people will die needlessly, in isolation, if nothing is done.

    Here’s more from Just Care:

  • Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care

    Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care

    Jake Johnson writes for Common Dreams about a new report from the Private Equity Stakeholder Project that focuses on private equity’s “disastrous” hold on home health care and hospice care. Vulnerable older adults and people with disabilities are paying a high price, as is the Medicare program. Congress is sitting back and watching.

    Non-profit agencies once provided most home health and hospice services. Today, for-profit companies have taken over the majority of these two industries. Two in three hospices are for-profit and two in five home health care agencies are for-profit. Private equity has invested heavily in the corporations that own these agencies.

    Medicare home health care and hospice care can be good money for corporations, so long as care is limited and low-cost. So, they are likely working to get more people to take advantage of these benefits. More Medicare investment in this care would be wonderful–many people who would benefit from this coverage are unaware they are eligible for it–if the money is being spent wisely and being directed towards more people with Medicare who want and need these benefits.

    But, if private equity investment in nursing homes and PACE programs is any indication, people are getting far lower quality hospice and home health care from companies with private equity backing, and Medicare is spending more than it should for their care. Private equity ownership of nursing homes is associated with poorer care and more deaths. The home health and hospice industries are even less regulated than nursing homes.

    With private equity, profits come first. The cost to vulnerable older adults and people with disabilities receiving care from private-equity backed companies is likely high but hard to measure. In a 2021 Congressional hearing on private-equity owned nursing homes, Congressman Bill Pascrell of New Jersey asked, “How many grandmothers and grandfathers died because profits were prized above lives, with our taxpayer dollars funding this?”

    So, are any private-equity owned hospice agencies delivering quality care and not driving up Medicare spending needlessly? As with Medicare Advantage plans, we do not have good agency-specific information. The Private Equity Stakeholder Project report concludes, more generally: “Unfortunately, for-profit home healthcare and hospice companies have been linked to lower standards of care compared to their non-profit counterparts, including, but not limited to, a lower number of visits to patients by healthcare professionals (registered nurses, physicians, or nurse practitioners) in their final days in hospice, higher rates of hospitalization in home healthcare, and poorly paid—yet highly stressed—employees in both sectors.” “This is additionally troubling, because such for-profit entities serve higher percentages of people of color and those with low incomes.”

    Congress needs to start paying attention. Already a number of home health and hospice agencies have been charged with overbilling Medicare, underpaying their workers and neglecting patient care needs. For example, there are allegations that Kohlberg Kravis-owned BrightSpring, a home health care agency, put patients at risk, and other private-equity backed agencies have been charged with fraudulent billing of Medicare and Medicaid.

    In October of last year, Senator Elizabeth Warren reintroduced the Stop Wall Street Looting Act to stop private equity’s  “predatory” and “abusive” practices, but that bill is going nowhere at the moment.

    Here’s more from Just Care:

  • PACE helps older adults stay in their community

    PACE helps older adults stay in their community

    The Program of All-inclusive Care for the Elderly (PACE) is a home and community-based program designed to keep older adults who are at risk for nursing home placement living in their community.  PACE is a partnership between a local sponsoring organization, and Medicare and Medicaid health insurance programs. To become a PACE “participant,” a person must be nursing home eligible. While a person can pay privately for services, most participants have Medicare, Medicaid, or both insurance programs.

    The PACE philosophy: PACE members are called “participants” because they are encouraged to participate in their care–decision making and active care–whenever possible.  The overarching goal of the PACE Model of Care is to keep people living in the community and out of institutional care.  While an individual does not need to visit the PACE Center, which offers adult day programs with wrap around health services, it promotes socialization and addresses common problems of isolation, loneliness, and boredom.

    Who can get PACE? Programs of All-Inclusive Care for the Elderly (PACE®) serve individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment and live in a PACE service area.

    How does PACE work? PACE works by providing care and services in the home, the community, and at the PACE center. It is team-based care that provides everything covered by Medicare and Medicaid if authorized by your health care team.  If your health care team decided you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.  The team provides comprehensive coordinated care and includes the PACE participant, physician, nurse, social worker, recreational specialist, rehabilitation specialists, and transportation specialists.

    Services: Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to older adults with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:

    • adult day health care that offers nursing; physical, occupational and speech/language therapies; recreational therapies; meals; nutritional counseling; social work and personal care;
    • medical care provided by a PACE physician familiar with the history, needs and preferences of each participant;
    • home health care and personal care;
    • all necessary prescription and over-the-counter medications;
    • medical specialties, such as audiology, dentistry, optometry, and podiatry and speech therapy;
    • respite care; and
    • hospital and nursing home care when necessary.

    See more at: http://www.npaonline.org/policy-advocacy/value-pace#services

    Find a PACE program near you: Currently, there are 144 PACE organizations in 30 states serving 58,000 people. To find out if you or a loved one is eligible, and if there is a PACE program near you, visit www.pace4you.org or www.Medicaid.gov, or call your Medicaid office.

    Beware of for-profit PACE programs: Government audits find for-profit PACE program neglects patients, delays needed care and cancels critical care.

    Learn what to do to ensure safety at home for people aging in their communities. And, see how one new program is helping older adults remain at home with assistance from a handyman, occupational therapist and nurse. For those who like technology solutions, check out how sensors can offer peace of mind to caregivers.

    _________________________

    This post was originally published on March 2, 2016

    Here’s more from Just Care:

  • Roundup: Caregiving

    Roundup: Caregiving

    Over the last several years, we have posted a series of pieces to help caregivers care for an aging loved one. You can find most of the key posts in this roundup:

    Planning ahead

    Caring for an older friend or relative

    If you do not live in the same city:

    If you live nearby:

    No matter where you live:

    Caring for a loved one with dementia or other serious condition

    Resources for caregivers

    Resources to benefit your loved ones:

    Resources to help yourself:

    Housing that comes with caregiving

    When the caregiving ends

    Here’s more from Just Care:

  • How to lower health care costs 1 percent at a time

    How to lower health care costs 1 percent at a time

    The goal of the 1% Steps for Health Care Reform Project is to come up with discrete areas where the data show the US could lower health care costs in small meaningful ways. Reform is hard, in part because our health care system is so large, larger than Germany and the United Kingdom. It’s also hard because of the myriad political hurdles associated with reform and the resource and practical constraints that make certain reforms unworkable.

    1% Steps project participants believe that there are many “1 percent” problems that could be solved. They believe that we could take small steps with drug pricing, Medicare payments and health insurance premiums, among other things. As I see it, the small solutions they propose are no more likely to become law than the major reforms we need. They are complicated, might not even achieve one percent savings, and require heavy lifts. There would be plenty of opposition to them from stakeholders. Here are a few of the proposals:

    Michael Chernew and colleagues at Harvard University suggest a very conservative approach to containing ever-escalating doctor and hospital prices in the commercial health insurance market. Rather than a government-imposed cap on provider prices, which would treat everyone equally, they want to prohibit any providers from charging more than five times the 20th percentile of prices at the local level. Of course, this solution would benefit those providers in areas where the 20th percentile is inappropriately high. In effect, it locks in excessive pricing and rewards the providers who have been charging high prices.

    These researchers also suggest that there should be a limit on health care price increases, although they do not say how much that limit should be. Presumably, it would be pegged to the consumer price index. This makes some sense. But, again, it locks in prices that are already way too high, rewarding the providers who are charging these prices and penalizing those who are charging less.

    These researchers understandably recognize that, for these policies to work, states and the federal government must have the ability to oversee and enforce them, although they say nothing about the resources needed to do so or penalties for non-compliance. Often, providers flout obligations when they believe it is more valuable to do so than pay the penalty.

    Zach Cooper at Yale and his colleague Martin Gaynor at Carnegie Mellon propose doing more to prevent hospital consolidation. Right now, 80 percent of the hospital market is highly concentrated, driving up prices. They think the Department of Justice (DOJ) and Federal Trade Commission (FTC) should do more to enforce antitrust laws. And, they propose giving them more resources and more authority.

    The Cooper-Gaynor proposal makes sense in theory. But, in practice, if it were even possible, it would take a few lifetimes to break up all the big hospitals. And, it is not at all clear that we would end up with lower prices or a better health care system. They also propose that Medicare pay the same rates for the same procedures wherever they are undertaken, something Medicare has begun to do.

    Also concerned about antitrust issues, Daniel Kessler at Stanford wants the FTC and the DOJ to look harder at mergers between doctors and hospitals. It’s hard to believe that Congress would pass a law that could be used effectively to stop these mergers, presumably leaving the ones that have already occurred in place. Kessler also proposes that physicians who work for hospitals not be able to be paid higher rates. But, why stop there? That seems as heavy a lift as across the board rate regulation. Lastly, Kessler proposes that Medicare not pay hospitals and doctors more for the same service performed in a high cost setting than in a lower-cost non-hospital setting. CMS is already moving in that direction.

    Stephen Lee at Benesch and Jonathan Skinner at Dartmouth have a plan to reduce Medicare home health care fraud. They believe that changing a form that physicians use to qualify people for home health coverage to ensure home health care is medically necessary would be helpful. Along with this provision, physicians would learn about Medicare funds spent on home care through reports. They don’t explain why physicians would read the reports or care what’s in them.

    They do not want physicians to be able to waive home health copayments, a proposal that is troubling if only because it would keep some low-income people from getting home care or put them into debt unnecessarily. Finally, they suggest that Medicare do a better job of auditing home health care agencies, although they do not factor in the cost of these audits or suggest the need to give CMS additional resources for this undertaking.

    At the end of the day, the 1 percent steps proposed here are as likely to fail as to succeed and deliver very little for the time and energy it would take to get them enacted into law. We should do the heavy lifting for reforms that matter and enact Medicare for All.

    Here’s more from Just Care:

  • Medicare covers physical, speech and occupational therapy

    Medicare covers physical, speech and occupational therapy

    Whether it’s because of an illness or an injury, or simply to improve balance, at some point in our lives, many of us will need therapy to regain or maintain our ability to function. Medicare covers physical, speech and occupational therapy in a variety of settings. Talk to the doctor about whether therapy would benefit you or someone you love.

    Medicare offers several outpatient therapy options. You can receive outpatient therapy services at a Comprehensive Outpatient Rehabilitation Facility, hospital, public health agency or from a private therapist, so long as the provider is Medicare-certified and you qualify for coverage. You can also receive outpatient therapy services from a Medicare-certified home health agency, so long as you qualify for the Medicare home health benefit.

    For Medicare to cover outpatient therapy, you must meet the eligibility criteria:

    • Therapy must be a safe and effective treatment for you.
    • A therapist must deliver the services or direct the delivery of the services.
    • Your doctor must certify you need the therapy to regain or maintain your ability to function and set up a plan of care for you in advance of your receiving services. And, if you need ongoing therapy, your doctor must review it and recertify your need.

    Medicare now covers as much outpatient physical, speech and occupational therapy as people need.

    Traditional Medicare pays 80 percent of the cost of these covered services. Supplemental coverage, such as Medicare supplemental insurance or “Medigap,” retiree coverage or Medicaid,  should pay the rest.

    Medicare also offers several inpatient therapy options. It covers physical, speech and occupational therapy in a nursing home as well as in a rehabilitation hospital. Coverage is limited. If you want inpatient care in a nursing home, you will need to have been hospitalized as an inpatient for at least three days in the 30 days prior to admission. You must receive care in a Medicare-certified skilled nursing facility. (Note: You can spend three nights at a hospital and the hospital may still deem it an outpatient stay.)

    If you simply need rehabilitation services–be it nursing, therapy, social worker help or psychological services–Medicare will cover care in a rehabilitation hospital under its hospital benefit.

    Medicare also covers cardiac rehabilitation care.  Click here to read more about this coverage.

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