Throughout my over 25-year career in health care, my goal has been to keep patients from falling through the cracks. Never has this been more tested than during the past three years.
Having started at the bedside as an intensive care unit nurse, I know all too well the challenges both patients and caregivers face. My passion and commitment to health care is rooted in a deep understanding of all types of care, which has allowed me to experience firsthand how disconnected the health care delivery system can be. My focus is to break down silos across the continuum and improve the coordination of care to help patients and their family members gain more control over their medical journey, and in the process further enable better health outcomes.
Since the onset of COVID-19, home health care resources have been in extremely high demand as hospitals pushed to discharge patients, and more patients and their families opted to receive care in the comfort and safety of their homes. At the same time, home health care has been experiencing the same labor challenges as the broader industry, with difficulty recruiting and retaining staff amid increased burnout and competition. Meeting the growing consumer demand for home care services is directly dependent on our ability to hire qualified professionals to fill these positions so that we can continue providing services to the increasing number of individuals who need it.
The reality is for more than 50 years, the home care industry has stood at the ready, but only in the past three years has it become abundantly clear that home-based health care clinicians are integral to how this country can meet the increase in health care demand. The pandemic helped push our industry forward by 15 years in terms of the population’s knowledge of home care, and over 90% of Americans would now prefer to receive post-hospital care in the home.
Despite the overwhelming desire for home-based care, we continue to fight as an industry to receive the recognition, and funding, our patients deserve.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released its final payment rule for Medicare home health services in 2023, which included a negligible .7 percent aggregate payment increase. To arrive at this number, CMS made a number of provisions. First, an expected decline in rates was made worse, going from 7.69 percent to 7.85 percent before being arbitrarily halved to a 3.925 percent decline as part of a phased-in approach for 2023. The agency also updated the inflation factor to 4 percent instead of a previously proposed 2.9 percent. On top of that, CMS plans to compensate for having issued advance payments during the pandemic by clawing back those payments via lower rates starting in 2024.
While certainly better than the 4.2 percent cut CMS previously proposed, all is not what it seems. Our industry still comes out behind in 2023 under this rule, and the picture only gets worse in 2024. The cost of operating within the home care industry is increasing far more than 0.7 percent, with labor costs alone increasing an average of 8 percent year-over-year. CMS is signaling that they will institute the 7.85 percent rate decrease in 2024 and beyond, with the claw back coming on top of that. They’ve also indicated that we’ll see new rules, new fees, and more paperwork, making it even more costly to do business.
The cumulative impact of these cuts is billions of dollars carved out of the Medicare home health program as providers are already facing significant challenges as a result of the pandemic, threatening patient care and access. Small, rural, and medically underserved communities will be uniquely harmed because of the increased costs associated with serving these populations — which will be detrimental in our ongoing fight for better health equity.
This is counter to congressional intent to ensure the stability and preservation of the vital services provided to seniors and people with disabilities who rely on the Medicare home health benefit. The bare minimum of funding which the home health care industry receives undervalues its superior health outcomes and perpetuates low wages for our workers.
CMS should treat home health consistently — and apply the same budget methodology principles as it does in analyzing budget neutrality in the skilled nursing facility payment system. As our health system as a whole leans into and relies more heavily on home health care, home health providers are being asked to do more for less, which is not sustainable.
The reality is that home health is where people want to be and where the outcomes are better. It’s also how we can alleviate the growing strains on hospital systems as in many situations, it can keep people from reaching the point where they need to be admitted. Between overburdened facilities and looming staffing shortages, hospitals and health systems have been pushed to the brink and many are sounding the alarm on these unsustainable operating trends. We need real solutions to address the growing crisis in U.S. health care, and I firmly believe that home care is instrumental to this plan. However, without Congress’ support of the Preserving Access to Home Health Act of 2022, which will prevent further industry cuts until 2026, our ability to continue championing positive health outcomes will plummet.
Those of us in the health care industry live by a directive to improve people’s lives — but developments like this severely hinder our ability to achieve this mission. The pandemic was the proving ground to the broader health care industry for the high-quality, cost-effective care that home health can provide. Home health care is becoming more personalized, innovative and ultimately delivering better outcomes. The more that we can educate decisionmakers on the benefits of these services, the better care that seniors and other individuals will receive, leading to a healthier and happier population.
Jennifer Sheets is president and CEO of Interim HealthCare Inc. and Caring Brands International, which encompasses entities worldwide. She has over 25 years of experience in health care management in both acute and post-acute settings. She lends her expertise as a board and executive committee member of numerous health care groups.