Penny wise, pound foolish

The home health industry is just now beginning to grapple with the devastating cuts to Medicare reimbursement and now talk of a $150 co-pay for home care services has resurfaced.  In some ways, the concept of co-pays makes complete sense.  Adding co-pays defrays the growing cost of health care to our Federal budget and helps empower individuals by making them more aware of the cost of their care.  The other side of the coin, however, must be considered.  Past experience suggests that cash strapped individuals will forego care altogether in order to avoid having to shell out the co-pay.  Sick patients often become sicker and then require far costlier visits to hospital ERs or even require inpatient stays instead.  Additionally, many of the patients that mission-driven organizations such as the VNA of Boston see simply do not have the resources to cover a co-pay.  Because we're mission-driven, we are faced with the dilemma: provide the care and lose the $150 revenue or walk away.  We don't walk away...

Our national association, the Visiting Nurse Associations of America, had this to say today:

(Washington, DC) – January 18, 2011 – The Visiting Nurse Associations of America (VNAA), which represents nonprofit home health and hospice patients, strongly opposes re-instatement of co-payments for the home health benefit as recommended at MedPAC’s January 13-14, meeting.

While the formal MedPAC recommendation does not mention a specific co-payment, the figure $150 per episode was discussed. Under the MedPAC plan, the co-payment would not be applicable for patients that are discharged from a hospital or other post-acute settings but would apply to all community-based admissions.

For those who are eligible for both Medicare and Medicaid, MedPAC presumes that Medicaid would pay for the co-payment for community-based admissions – but there was also a recognition that States are in financial crisis and Medicaid agencies might be unable or unwilling to make the co-payment for duals. In addition, many individuals who live just above the poverty level would be unable to make a co-payment.

"A co-payment would create a significant access barrier for Medicare beneficiaries who need medically necessary home healthcare per their doctor’s orders,” said Andy Carter, President and CEO of VNAA. "These patients are much more likely to end up back in the hospital or another institutional setting at much greater costs," said Carter.

Congress eliminated co-payments in 1972 to encourage use of less costly, non-institutional services. VNAA will fight against co-payments because they do not work and they increase overall Medicare costs.

VNAA will work with other national organizations including those that represent beneficiaries to oppose co-payment. In an economy where many seniors and families are struggling to make ends meet, a co-payment does not make sense.
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VNAA Contact:

Emily Swanson
202-384-1422
eswanson@vnaa.org

About VNAA: VNAA is a national association that supports, promotes and advocates for community-based nonprofit home health and hospice providers that care for all individuals regardless of complexity of condition or ability to pay. They provide comprehensive services for Medicare, Medicaid, uninsured, and privately insured patients. VNAAhttp://www.vnaa.org/ today.