More “Home Health Care” help is on the way.

Surging Functional Impairment Costs Could Mean Big Business for Home Care

By Robert Holly | November 12, 2018

Functional impairment is, perhaps, far more costly to the U.S. health care system than previously thought.

Functional impairment is broadly defined as a condition or status that interferes with one or more basic life activities, such as bathing, eating or dressing. To help carry out these activities, individuals living with functional impairments often turn to home care providers and personal care aides.

Roughly 39.5 million adults have some degree of difficulty when it comes to physical functioning, according to the U.S. Centers for Disease Control and Prevention. Of adults aged 75 and over, nearly 11% need assistance with personal care specifically.

Medicare beneficiaries with both multiple chronic conditions and functional impairments are twice as expensive to the Medicare program than individuals who have multiple chronic conditions alone, new data from Anne Tumlinson Innovations (ATI) has found. The findings suggest that the Centers for Medicare & Medicaid Services — and even Medicare Advantage (MA) plans — will fail to reduce health care spending if they don’t prioritize functional ability

“This data analysis shows that the population most likely to be receiving long-term services and supports — that is, people who have difficulty with basic life activities — are the ones who are also using the most health care,” Anne Tumlinson, ATI CEO and founder, told Home Health Care News.” Health plans need help identifying this population, assessing them and determining which interventions will have the greatest impact on costs and outcomes.”

In general, home care agencies are in the best position to care for individuals with functional impairments and multiple chronic conditions, Tumlinson said. It’s a value proposition that many home care agency leaders have touted in the past — and one that traditional home health providers have been widely pursing as well.

ATI is a Washington, D.C.-based research and advisory services firm that specializes in businesses, communities and public programs focus on older, frail adults.

“The very reason someone needs to hire a home care provider is the very same reason that person is using a lot of health care,” Tumlinson said.

Medicare spends, on average, half as much annually on beneficiaries with multiple chronic conditions as the program does on individuals who dually have multiple chronic conditions and functional impairment, according to the ATI data. Comparatively, that ends up being about $11,600 annually compared to nearly $27,000.

Additionally, health care utilization and spending also increases as the level of functional impairment increases, ATI data suggest. Indeed, individuals with the highest level of need — people who require help with two or more activities of daily living — use inpatient hospital services much more frequently, with Medicare spending nearly three times as much on them as the overall Medicare population.

“In-home care, together with care coordination, support for family caregivers and the involvement of primary care providers can make a big difference in reducing functional decline, avoiding unnecessary hospitalizations and addressing the underlying chronic conditions,” Tumlinson said.

To tackle these spending trends, functional ability should be included in the eligibility criteria for non-medical supplemental benefits available under the CHRONIC Care Act of 2018, ATI maintains. Among its provisions, the CHRONIC Care Ac gives MA plans more flexibility to target non-medical benefits to eligible Medicare beneficiaries.

CMS announced in April that non-skilled in-home care services will — for the first time — be allowed as supplemental benefits in MA plans starting next year.

Previous research has highlighted the cost of functional impairment as well.

A 2017 study published in the Journal of the American Geriatrics Society, for example, determined that functional impairment is associated with greater Medicare costs for post-acute care and may be an unmeasured but important marker of long-term costs that cuts across conditions. In the study, researchers found that the most severely impaired participants cost 77% more than those with no impairment.

Considering costs attributable to co-morbidities, only three conditions were more expensive than severe functional impairment, according to the 2017 study: lymphoma, metastatic cancer and paralysis.

Written by Robert Holly

The really poor job we’re “NOT” doing for our seniors

Frail Older Adults Not Getting the In-Home Health Care They Need

By Robert Holly | November 15, 2018

A huge gap exists between the need for home-based medical care and what is actually being provided to frail older adults, especially in rural areas, a new study has found. There also appear to be significant disparities in access to home-based care between male and female patients as well.

The study was published in the Journal of the American Geriatrics Society.

“Most homebound seniors have not received medical care at home,” Nengliang “Aaron” Yao, one of the study’s authors and an assistant professor at the University of Virginia School of Medicine, said in a statement. “More medical house call programs are needed.”

To further evaluate the use of home-based medical care in frail patient populations, Yao and researchers from Johns Hopkins University, the University of California, San Francisco, and the Home Centered Care Institute analyzed scores of Medicare claims from 2011 to 2014. To single out frail Medicare beneficiaries, the team of researchers “scored” patients based on the number and severity of their health impairments

About 7% of the Medicare patients included in the researchers’ analysis were considered “frail.”

Throughout the health care community, frailty is generally seen as something linked to exhaustion, weigh loss, low activity, slow gait speed and weak grip strength.

Among the frail older adults identified in the study, less than 10% received medical care at home in 2011. While there was a slight uptick in home-based care use from 2011 to 2014, the vast majority of frail Medicare beneficiaries still did not receive medical care at home.

“Most of us agree that the bedrock of clinical care is human connection,” Yao said. “Visiting the sick at home re-humanizes care for frail patients.”

Health care in rural areas

Access to home health care in America’s rural communities, in particular, has long been an issue. Policymakers have tried to address the challenge through rural add-on payments, which give home health agencies operating in sparsely populated and remote counties a slight financial boost.

During their study, researchers found that only 2% to 4% of rural Medicare recipients received home-based medical care, with rural residents 78% less likely to receive home-based care than Americans living in the most metropolitan of counties.

U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma touted the agency’s commitment to rural health care in a statement released on Thursday — National Rural Health Day.

“Approximately 60 million people live in rural areas — including millions of Medicare and Medicaid beneficiaries,” Verma said. “We at CMS recognize the many obstacles that rural Americans face, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or underinsured people.”

Michigan, Florida and Arizona had the highest percentages of Medicare beneficiaries who received home-based medical care between 2011 and 2014, according to the study. Vermont, Idaho, Wyoming, Iowa, Louisiana, Arkansas, South Dakota, Mississippi and North Dakota had the lowest percentages.

In 2014, many deaths among rural Americans were preventable, including those from heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke, according to the U.S. Centers for Disease Control and Prevention.