Sunday, January 16, 2011
Medicare coverage for home care visits has a checkered history. The original rationale for including home care in Medicare was straightforward and compelling: it’s much cheaper, healthier and pleasant for a patient to be at home receiving skilled care than to stay in a hospital for lack of enough support in the home environment. That logic remains solid. Unfortunately it doesn’t mean Medicare spending has dropped with home care coverage in place. That’s because operators of home care agencies don’t see it as their job to reduce Medicare spending and neither do hospitals. Both want to make as much money as possible under the fee-for-service system. Home care ended up being an additional cost to the system, not a cheaper substitute for the hospital.
There have been various attempts to control home care spending. The latest is a 13-1 recommendation by the Medicare Payment Advisory Commission to impose co-payments to discourage unneeded use of home care services.