Unbiased Analysis of Today's Healthcare Issues

History of Medicare Home Health Payments

Medicare pays home health agencies (HHAs) to care for patients who cannot care for themselves in their own homes.  HHAs, however, have experienced significant changes in the way Medicare pays them over the past 30 years.  A recent paper by Huckfeldt et al. (2014) summarizes these changes: 1983: Medicare switches to an inpatient prospective payment […]

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Does Competition Improve Quality?

For the most part, the answer is “Yes” according to a recent study by Jung and Polsky.  The authors use a Herfindahl index to measure competition and examine how outcomes for home health patients vary based on the level of competition.  The (unadjusted) figures–based on data from OASIS– show that quality increases as competitions increases […]

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Expanision of Medicare Home Health Entitlement

Healthcare spending in the U.S. has been rising by 6.6%per year between 1990 and 2010.  Over this same time period, however, home health spending increased by 9.0% per year.  Do rising home health cost represent an increase in access to needed care or a costly expansion of heallth care benefits?  Or, is this just a […]

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Physicians: Coming to a Home Near You

In the 18th and early 19th centuries, physician home visits in the U.S. were very common.  In fact, the home was the primary place where medicine was practiced.  Because physician wages at this time were comparable to those of the average laborer, a market which forced physicians to internalize the time and transportation costs to […]

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The President’s Proposal to “Live Within Our Means”

President Obama released a proposal last week to jump start the economy and reduce the deficit.  The proposal includes many cuts to Medicare and increased cost sharing.  Senators Coburn and Lieberman are supporting these cuts. Increased cost sharing is a common theme in Medicare, Medicaid, but also for other programs as well.  For instance, the […]

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MedPAC’s Home Health Recommendations

In their latest 2011, MedPAC made four recommendations to alter payment policy in the home health setting.  These include the following: The Secretary, with the Office of Inspector General, should conduct medical review activities in counties that have aberrant home health utilization.  The Secretary should implement the new authorities to suspend payment and the enrollment […]

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Can Home Health Care Reduce Cost?

At one point, the answer may have been yes.  But today… “Although the initial impetus for establishing home health care was charitable, the Metropolitan Life Insurance Company (MetLife) discovered that by providing home health care, it could prolong life while collecting premiums and abstaining from death benefit payments. Yet the model experienced a requisite shift […]

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MedPAC’s 2011 Home Health Reform Recommendations

In 2009, 3.3 million Medicare beneficiaries used home health.  In the past few years, the home health expenditure growth rate has outpaced Medicare spending in all other areas.  This finding is likely correlated with the 9.7% increase in the number of home health agencies between 2008 and 2009.  How should Medicare reform home health to […]

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The History of Home Health Quality Measurement

Today I will discuss the evolution of home health care measures over the past 15 years. The majority of the content comes from an article by Robert Rosati (2009). Timeline Here is a link to a TIMELINE that briefly summarizes the key developments in home health care quality measurements. Risk Adjustment From the early development […]

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Home Health Case Mix

In 2006, 2.9 million Medicare beneficiaries received home health services.  The home health benefits provides Medicare enrollees to access to services such as: skilled nursing care;  physical, occupational, and speech therapy;  medical social work, and home health aide services. Medicare pays home health agencies (HHA) based on 60-day episodes of care.  Each HHA receives a flat payment for all […]

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