Creator: Patrick Connole
Medicare Home Health - What’s its Purpose?
New research proposes changes to the way in which Medicare home health is administered. Right now, the report says, the program has no clear purpose.
A new Brookings report proposes that Medicare home health needs a refresh as it currently serves no clear objective and suffers for it.
Called “Rethinking Medicare Home Health,” researchers Liran Einav (Stanford University), Amy Finkelstein (MIT), Yunan Ji (Georgetown University), and Neale Mahoney (Stanford University) argue that Medicare home health appears to try to serve multiple purposes: (1) mitigating costs by substituting for institutional post-acute care, (2) covering the costs of treatment and recovery from acute health events for home-bound patients, and (3) providing in-kind, long-term services and supports for frail older adults.
“This last objective overlaps with the domain of Medicaid long-term services and supports. In particular, ‘community-based’ home health episodes, those initiated without a preceding hospital stay, are more consistent with a population receiving ongoing supportive care than a population recovering from an acute medical event,” the report’s summary states.
The authors assess how well current program design aligns with each of the three objectives and discuss reforms that might help the program better meet them.
For example, if Medicare home health is viewed as coverage for standard medical services—just delivered at home—the authors conclude that beneficiaries should probably face copays or other cost sharing, as they do for other Medicare services.
If the primary goal of home health is to reduce use of costly institutional care, then it might make sense for home health eligibility rules to align more closely with eligibility requirements for Medicare coverage in institutional settings.
And if Medicare home health is meant to serve as long-term care insurance, the authors recommend considering “cash-for-care” approaches, used in a number of European countries, that would give beneficiaries discretion over how to allocate a fixed budget for long-term care services.
Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.
