Why many Medicare beneficiaries do not receive home health care

One in five Medicare beneficiaries needs home health care after being hospitalized. However, a recent analysis based on Medicare records found that recommended care after discharge has decreased significantly over six years.

Implementation rates for household health transfers have fallen from 66% to 59% between 2016 and 2022, according to an analysis by The Commonwealth Fund. Incomplete home health recommendations are associated with increased hospital readmissions and higher death rates among Medicare and Medicare Advantage recipients. The authors noted that this trend could have a significant impact on hospitalized Medicare beneficiaries.

Journalists can use the information provided in this review and other Medicare information to follow implementation standards in their communities and hold hospitals and home care organizations more accountable.

Why this is important

The researchers noted the largest decline in home health services among white beneficiaries (7.2 percent), but declines were also seen among Black and Hispanic patients. Dual eligibles, those eligible for Medicare and Medicaid, were no more likely to complete home care transfers than Medicare-only beneficiaries, regardless of race.

When the demographic index — a composite of demographic factors such as poverty, education, housing and employment — was calculated, home health referral rates were lower in counties with social deficit. Among all beneficiaries, rates have fallen in rural, large and medium-sized urban areas.

The decline in home health care is an aging and health equity issue. Lack of appropriate services can lead to frequent readmissions within 30 days of discharge and increased morbidity and mortality. Patients in disadvantaged communities are at greater risk of not receiving the services they need, according to research, yet they often suffer more physically and psychologically after being hospitalized.

How home health care works under Medicare

Traditional Medicare has strict rules about getting home health care. However, they pay for this service if it is provided by temporary or part-time skilled services and the person is considered a person who does not work at home. Skilled care includes wound care, neurological or nutritional therapy, chronic health care, and physical or speech therapy. Many studies find home health care is often less expensive, convenient, and effective than inpatient care in a hospital or skilled nursing facility.

A doctor or other practitioner, such as a nurse, must meet face-to-face with a patient before referral to home health care services. If appropriate, the provider will order home health care from a Medicare-certified health facility. Patients can choose from a list of centers in their area. Restraints, such as limited time away from home without medical appointments, also work to maintain this benefit.

What is causing this change?

Researchers have cited several factors that may contribute to the decline in home health care referrals:

• Inadequate staff and resources – the number of active home health organizations has steadily decreased since 2013, resulting in reduced access to care.
• Inadequate care is available to many racial and ethnic groups, leading to greater disparities in care. Independent research finds selection bias among some home health care organizations to avoid certain low-income areas and high-cost patients.
• Patient reluctance to use home health care was also a potential factor. Some people may believe that these services are not necessary or do not provide enough value; others do not want outside caregivers in their home or often do not trust health care providers.

This reduction in home health services was evident even before the start of the COVID-19 pandemic. Although the crisis played a role in the decline, the authors suggest that other factors, including labor shortages and low wages, contributed to this.

“The decline in home health referral rates points to a systemic problem that requires the attention of providers and policymakers,” the report said. They suggest better hospital follow-up on referrals, increased use of the telephone, and a review of the payment structure for home health care to help reduce this epidemic. there may be.

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