One in five Medicare recipients need home health care after hospitalization. Recent Analysis Based on Medicare claims data, we found a significant decline in recommended postdischarge care over a 6-year period.
According to a Commonwealth Fund analysis, home health referral fulfillment rates fell from 66% to 59% between 2016 and 2022. Unfulfilled home medical referrals It is associated with increased rates of hospital recurrence and mortality in both Medicare and Medicare. Medicare Advantage The authors noted that this trend could have serious implications for hospitalized Medicare beneficiaries.
Journalists can use the data provided in this analysis, as well as other Medicare claims data, to track compliance rates in their communities and further hold hospitals and home care agencies accountable.
Why is this important?
The researchers found that home health services declined most among white beneficiaries (7.2 percentage points), but declines were also seen among black and Hispanic patients. Regardless of race, dual beneficiaries (those eligible for both Medicare and Medicaid) were less likely to accept home health referrals than Medicare-only beneficiaries.
Time Social Poverty Index Taking into account the “social deprivation index,” a geographic composite measure of poverty, education level, housing, employment, and other demographic characteristics, home health referral rates were lower in counties with higher social deprivation. For all recipients, rates declined in rural areas, large metropolitan areas, and mid-sized metropolitan areas.
The decline of home medical care is an issue of aging and health equity. A lack of appropriate services Increased frequency of re-hospitalization Hospitalization within 30 days of discharge is associated with increased morbidity and mortality. Patients from disadvantaged communities are at higher risk of not receiving the services they need. the studyBut they often Worsening physical and mental decline After hospitalization.
How Medicare Home Health Care Works
Traditional Medicare has strict rules for receiving home medical care. However, They pay This service is only available if part-time or intermittent skilled services are provided and the recipient is considered homebound. Skilled care includes wound care, intravenous or nutritional therapy, monitoring of fragile health conditions, and physical occupational or speech therapy. Numerous studies Home medical care is usually Inexpensivemore convenient, Effective As inpatient care in a hospital or nursing home.
Clinicians, such as doctors and nurses, will need to meet with patients face-to-face before making a referral. Home medical servicesWhen appropriate, your provider will refer you to a Medicare-certified home health agency for in-home care. You can choose from: List of local distributorsTo maintain these benefits, restrictions also apply, such as limits on the amount of time you can leave your home except for medical appointments.
What is causing this change?
The researchers cited several factors that may be contributing to the decline in home health referral fulfillment.
- Staffing and resources are scarce — Number of active home health agencies Steady decline Since 2013, access to health care has declined.
- Receive inadequate care Disparities in care are widespread across many racial and ethnic groups, and independent studies have found that some home health agencies have selection bias that avoids socioeconomically disadvantaged areas and patients with high costs.
- Patient resistance Whether or not to use home health care is also a potential factor: some people may not need these services or see them as being of sufficient value, may not want outside caregivers in their home, or may not trust health care providers in general.
The decline in home health services was evident even before the COVID-19 pandemic began, and while the crisis contributed to the decline, the authors suggest other factors, such as staffing shortages and low wages for workers, also contributed to the issue.
“Declining home health referral fulfillment rates indicate a systemic problem that requires the attention of health care providers and policymakers,” the report states. To mitigate this potential crisis, the report suggests improving hospital follow-up on referrals, increasing the use of telehealth, and revising home health payment structures.
