Medicare’s home health care benefit is widely considered a necessary component in the challenge of keeping the aging population of Americans healthy without having to be hospitalized or check into a facility. This of course creates a greater reliance on home health care, which has ripple effects across many industries, including caregivers, nurses, agencies, home health software providers and equipment manufacturers. More specifically, for seniors living in rural areas of America where a large swath of healthcare options are somewhat limited, the focus is more intensified. Home Health care access allows seniors in rural areas to control costs, stay in their homes, and enjoy a degree of comfort and peace unavailable to them via alternative options. Studies have consistently shown that Medicare reduces health care spending by circumventing what are considered “avoidable hospitalization” which can drive costs through the roof and place older patients at larger risk.
In spite of the wealth of statistics and evidence suggesting their inherent value to these rural areas and their inhabitants, Medicare payments previously authorized to cover the high costs of getting to rural beneficiaries recently expired at the end of 2017. As a result of this occurrence, there are growing calls for Congress to act swiftly to restore these often vital Medicare payments to patients.
Within the last 20 years, Medicare has acknowledged that providing homecare in non-metropolitan areas creates higher costs due largely to the bills incurred through travel and expanded staff expense. In an effort to handle this problem, since early 2000, Congress pegged funding for what is known as the “rural safeguard” – which comprises a 3 percent additional payment to providers to compensate for the heightened expenses to provide care. The so called “rural safeguard” has been renewed multiple times since its inception in 2000, but thus far in 2018, Congress has yet to pass these “Medicare extenders” – which is leaving rural patients, particularly elderly ones, and the agencies who serve them uncertain about what is to come.
Medicare’s home health benefit in the past has reduced the burden to these vulnerable citizens when illness or injury occurs. This value is also enjoyed by Medicare, as the agency saves money if and when patients receive prompt, quality care which can avert even more costly hospitalizations.
The facts of the data soundly support that rural seniors face higher health care costs and obstacles to good health and recovery than patients in metropolitan areas, their counterparts for argument’s sake. According to a recent certified study, the average rural Medicare beneficiary has to travel twice as far to reach a physician, or to get to the nearest hospital. These types of patients are generally older, in poorer health, have lower overall incomes or access to savings, and have more chronic conditions than the greater general Medicare population in America.
The “rural safeguard” is also almost a necessity home health agencies and providers whose staff deliver care within these often remote communities. In short, small agencies in small town America often means small scale operations, coupled with larger overall costs. Travel in of itself carries 36 percent higher costs to these providers in rural areas than in larger cities (to the tune of roughly $229 vs $168 per occurrence). Adding fuel to the fire, generally the most ill, and more chronically sick rural patients are a greater expense of time and resources to provide care for. These patients depend heavily on agencies and home health providers as their only caregivers. Undoubtedly, this has become a fragile system that seemingly works as it is if all stays consistent, which ultimately means this fragile system cannot withstand the destabilization in funding and ideological battles that politics often brings into play.
The challenges and obstacles these elderly patients face are not going away, and with the population aging they are becoming more intense. Reducing the most vulnerable citizen’s, in the most under-developed areas, access to home health care will result in more trips to the emergency room, more hospitalizations, and higher costs to all parties involved. Congress now has the option to restore and/or extend the rural safeguard payments to support the continued delivery of solid, timely home health care to these patients in rural America. In the coming months this decision may sustain, or drastically alter the landscape of homecare for a segment of the most vulnerable population of Americans.
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