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To find Medicare savings, there’s a lot we can learn from home health

When I was chairman of the Senate Aging Committee, I had a saying I used whenever it was time to talk about Medicare, “There is good news and there is bad news. Good news: People are living a lot longer. Bad news: People are living a lot longer.”

Every 13 seconds, another American turns 65 years old and becomes eligible for Medicare. If the current predictions are right, then this trend is expected to continue for another 20 years. That’s a lot of seniors entering the country’s largest public healthcare system.

While it’s wonderful that so many seniors are living longer, healthier lives, it’s also important to have a conversation about how we’re going to make sure the program is still around to deliver quality care for future beneficiaries.

Years after I left the chamber, the situation is much the same. Beneficiaries are getting older, costs are rising and there are fewer workers around today to provide the revenue needed to support the program.

Did you know that in 1966, when Medicare was first signed into law, there were four and a half workers to support every retiree? Today that ratio is down to three-to-one. Even more worrisome: If current spending and demographic trends continue, the entire program will be insolvent by 2029, according to the latest Medicare Trustee’s Report.

Reforming Medicare to protect it for future generations won’t be easy, and I don’t pretend to have all the answers. But I do know that if we don’t fix these problems soon — by embracing innovative solutions that promote efficiency and control costs — then we shouldn’t count on the program being around by the time this current generation retires.

Fortunately, we’re already seeing some amazing feats of innovation play out all across the healthcare sector, particularly in the fields of home health and post-acute care. While it may have been the standard years ago to keep a patient in the hospital for days, or even weeks, after a routine surgery or acute procedure, patients now have the opportunity to recover in their own homes. For seniors who predominantly rely on Medicare, home health affords them the dignity of aging at home instead of in an institutional setting.

Home health also has the added benefit of being patient-preferred, and studies show that seniors actually recover better when in a familiar, comforting setting. It also saves patients — and taxpayers — a whole lot of money. Costs per home care visit are typically four and a half times lower than a day of nursing home care, and 46 times lower than a day’s stay at the hospital.

But there’s no need to take my word for it. Just ask my wife, Lois, who recently had knee replacement surgery at Johns Hopkins’ Sibley Memorial Hospital in Washington, D.C. The day after her procedure, she was discharged from the hospital and sent home to recover with the help of twice-weekly visits from a physical therapist in our home. In no time, she’ll be back on her feet and feeling as good as new without spending an extra day in the hospital. And all while receiving care to ensure she doesn’t end up back in the hospital because of a fall or other preventable post-acute complication. It’ll also end up costing us — and our insurance company — a lot less than what we would have had to spend on a multi-day hospital stay.

But home healthcare innovation goes beyond simply shifting patients out of institutions and into the home setting. In recent years, we’ve seen an enormous amount of innovation as both payers and providers have begun to recognize the value of home health. Home health agencies are increasingly investing in new technologies to improve quality. New electronic medical records software helps doctors monitor a patient’s health status in real time while advanced call systems allow patients to be in constant contact with clinical staff — an especially helpful feature for individuals with multiple chronic conditions.

We’ve also seen a new appetite for joint ventures between home health providers and hospital or health system partners, which are proving effective by establishing a dedicated patient pipeline for individuals leaving the hospital and in need of post-acute care. The home health agency takes on patients right after they leave the hospital, giving staff the ability to better anticipate patient needs.

Collaborative relationships like this make it easier to streamline care while allowing each partner to focus on what they do best. From there, participating in one of Medicare’s bundled payment programs, or forming an Accountable Care Organization, becomes much easier and allows both partners to save even more money. It’s a win-win for everyone, especially the patients.

Of course, I don’t want to make it sound like finding cost savings in Medicare is a breeze. There will always be challenges along the way. Proposals such as the Home Health Groupings Model (HHGM) — which threatens to radically disrupt the way home health reimbursements are delivered — as well as efforts to roll back bundled payments programs, could seriously jeopardize some of the progress we’ve seen in saving taxpayer money while improving the patient experience.

The Centers for Medicare & Medicaid Services (CMS) and lawmakers should reconsider these proposals and instead work with the broader home health community to find policy solutions that save money without disrupting, or even restricting, patient care.

I am confident that the home health sector remains a model for policymakers interested in making Medicare more patient-centered and cost-effective. Through a mix of dedication, innovation and good old-fashioned hard work, we can ensure that patients continue to receive quality care while protecting the integrity of the Medicare home health benefit.





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