A Comparison of Home Health Utilization, Outcomes, and Cost Between Medicare Advantage and Traditional Medicare

Medical Care ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Adrianne W. Casebeer ◽  
David Ronning ◽  
Richard Schwartz ◽  
Charron Long ◽  
Rituparna Bhattacharya ◽  
...  
Keyword(s):  
Home Health ◽  
Medicare Advantage ◽  
Health Utilization

scholarly journals HOME CARE EXECUTIVES SAY MEDICARE HOME HEALTH PAYMENT SYSTEM ENCOURAGES LESS-IS-BETTER PRACTICE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S301-S301
Author(s):  
William D Cabin
Keyword(s):  
Chief Executive Officers ◽  
Medical Model ◽  
Chief Executive ◽  
Prospective Payment System ◽  
Home Health ◽  
Payment System ◽  
Chief Financial Officers ◽  
Medicare Advantage ◽  
Home Health Aide ◽  
Executive Officers

Abstract There has been an increasing trend for Congress and the Centers for Medicare and Medicaid Services (CMS) to add non-skilled services to coverage under Medicare Advantage and Medicaid inpatient hospital. At the same time there has been a 75% decline in home health aide visits, the only Medicare home health non-skilled service, as a percentage of all Medicare home health visits from 2000-2016. A literature review indicates no studies addressing the potential factors accounting from these seemingly contradictory trends. The present study is based on interviews of five Chief Executive Officers (CEOs), five Chief Financial Officers (CFOs), and eight Chief Nursing Officers (CNOs) from Medicare-certified home health agencies between October 2017-July 2018. Results indicated agreement among interviewees on three themes: the Medicare home health relies on a medical model which focuses on intermittent skilled care; the Medicare home health prospective payment system (PPS) exacerbated the focus on skilled care by rewarding higher reimbursement for skilled care based episodes; and a synergy has evolved of “less is better” regarding utilization of home health aide services and reimbursement. Policymakers are urged to consider adding coverage of non-skilled services under Medicare home health, similar to Medicare Advantage, by funding demonstration projects with appropriate changes in reimbursement.

scholarly journals Medicare Home Health Utilization in Context

2003 ◽  
Vol 38 (1p1) ◽  
pp. 107-112 ◽  
Author(s):  
Eliot Z. Fishman ◽  
Joan D. Penrod ◽  
Bruce C. Vladeck
Keyword(s):  
Home Health ◽  
Health Utilization

Home Health And Postacute Care Use In Medicare Advantage And Traditional Medicare

2020 ◽  
Vol 39 (5) ◽  
pp. 837-842 ◽  
Author(s):  
Laura Skopec ◽  
Peter J. Huckfeldt ◽  
Douglas Wissoker ◽  
Joshua Aarons ◽  
Judith Dey ◽  
...  
Keyword(s):  
Home Health ◽  
Medicare Advantage ◽  
Postacute Care

scholarly journals Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage

2018 ◽  
Vol 37 (8) ◽  
pp. 1274-1281 ◽  
Author(s):  
Qijuan Li ◽  
Momotazur Rahman ◽  
Pedro Gozalo ◽  
Laura M. Keohane ◽  
Marsha R. Gold ◽  
...  
Keyword(s):  
Home Health ◽  
Medicare Advantage ◽  
Skilled Nursing ◽  
Regional Variations

The Relationship between Purchaser Type and Home Health Utilization and Outcomes

2000 ◽  
Vol 12 (4) ◽  
pp. 49-56 ◽  
Author(s):  
Carolyn E. Adams ◽  
Jayne Furness Moore ◽  
Yvonne Michel
Keyword(s):  
Home Health ◽  
Health Utilization ◽  
The Relationship

Home Health Use In Medicare Advantage Compared To Use In Traditional Medicare

2020 ◽  
Vol 39 (6) ◽  
pp. 1072-1079
Author(s):  
Laura Skopec ◽  
Stephen Zuckerman ◽  
Joshua Aarons ◽  
Douglas Wissoker ◽  
Peter J. Huckfeldt ◽  
...  
Keyword(s):  
Home Health ◽  
Medicare Advantage

“Less is Better” Philosophy Decreases Home Health Aide Utilization to Increase Reimbursement in Medicare Home Health

2019 ◽  
Vol 32 (2) ◽  
pp. 105-109
Author(s):  
William Cabin
Keyword(s):  
Medical Model ◽  
Prospective Payment System ◽  
Home Health ◽  
Social Needs ◽  
Medicare Advantage ◽  
For Profit ◽  
Home Health Aides ◽  
Health Agencies ◽  
Home Health Aide ◽  
Home Health Agencies

There has been a 75% decline in home health aide visits between 2000 and 2016, the only Medicare home health nonskilled service. A literature review indicates no studies addressing reasons for the decrease. This study summarizes interviews of nine executives from three for-profit chain-owned Medicare-certified home health agencies. Results indicate agreement on three themes: Medicare home health uses a medical model, focusing on intermittent skilled care; the Medicare home health prospective payment system exacerbated the focus on skilled care by rewarding higher reimbursement for skilled care–based episodes; and a “less is better” synergy has evolved regarding utilization of home health aide services and reimbursement. Policymakers are urged to use the forthcoming Medicare home health Patient-Driven Groupings Model Reform and recent Medicare Advantage changes covering nonmedical services to encourage greater utilization of home health aides and other nonmedical services addressing patient and caregiver social needs affecting care.

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