Making health care affordable for all

A Georgia home health care professional writes today about how Affordable Care Act-induced changes to Medicare are affecting the industry, and how new legislation sponsored by U.S. Rep. Tom Price, a Roswell Republican, can help. In our second column, former Health and Human Services Director Dr. Louis Sullivan, a member of President George H.W. Bush’s cabinet and founding dean of the Morehouse University School of Medicine, agrees that adjustments may need to be made, but stresses the importance of expanding Medicaid and what growing our health insurance numbers will do for citizens.

 

Home health care shouldn’t be cut

By Charlotte Weaver

Make a visit to almost any U.S. hospital today, and you’ll likely find a similar scenario: nursing units with an abundance of aging patients not necessarily sick enough to remain hospitalized, but not quite well enough to go home.

For these millions of Americans and their families, the choices can seem frustratingly limited. Once the acute phase of an illness or injury has passed, remaining an inpatient in a hospital is both expensive and unnecessary. However, with symptoms that still require intense monitoring and follow up, medical staff and case managers cannot safely discharge patients home. Independent seniors, who are comfortable in their own homes and communities, often bristle at the suggestion of skilled nursing facilities or assisted living.

Fortunately, a valuable alternative allows 3.5 million Americans — including more than 85,000 here in Georgia — to remain healthy and comfortable in their own homes. Skilled home health care has evolved in recent years from services that were primarily geared toward helping patients with basic daily tasks, to the delivery of increasingly sophisticated care for patients living with more chronic and complex health conditions.

As a nurse and chief clinical officer of a home health organization serving more than 12,000 seniors in the Atlanta area, I’ve witnessed the remarkable benefits home health care plays in the lives of patients and their families. Working hand-in-hand with family practice physicians, hospital doctors and case managers, my staff and I have helped patients effectively manage what can be debilitating health conditions, allowing them to continue their lives and daily activities in their own homes.

I’m also all too aware the delivery of this valuable care faces significant challenges if Medicare policies in Washington are not changed. Although the Medicare home health benefit enables millions of vulnerable seniors and disabled individuals to access this high-quality, clinically advanced care at home — at a cost far below the alternative option of expensive hospitalizations and facility-based care — recent changes to the Medicare benefit do not fully recognize the value.

On Jan. 1, the Centers for Medicare & Medicaid Services (CMS) cut funding for skilled Medicare home health by 3.5 percent annually for the next four years, equal to an unprecedented cut of 14 percent. According to CMS, this cut will leave “approximately 40 percent” of the nation’s home health agencies operating at a loss by 2017, putting 1.3 million vulnerable Medicare patients and upwards of 465,000 home health professionals in jeopardy.

Here in Georgia, where we have the nation’s 11th fastest-growing population of people 60 years old and older, data analyses show the Medicare cut will leave home health agencies across our state facing bankruptcy and closure — especially our state’s smaller agencies, which often treat patients in rural and underserved areas.

Fortunately, lawmakers in Washington, led by Georgia Rep. Tom Price, are taking steps to safeguard home health care for our seniors. These legislators need our support.

Congressman Price has sponsored the Securing Access Via Excellence (SAVE) Medicare Home Health Act which, if passed, would provide our patients and community with much-needed relief. By repealing the deep 3.5 percent-per-year cut currently slated for the next three years, this legislation would protect patients, jobs and home health businesses across our state. In their place, the SAVE Medicare Home Health Act utilizes hospital readmission reform to achieve savings by improving care for Medicare beneficiaries and reducing avoidable spending.

The legislation establishes a program to reduce hospital readmissions by establishing incentives that reward positive outcomes. These policy reforms would enable millions of seniors to remain in the comfort of their homes, rather than return to institutional settings, and would achieve significant savings for the Medicare program.

Even with today’s modern medicine, it’s impossible to delay the aging process. It is possible, however, to change and continually improve the process by which older Americans are cared for in their golden years. I hope all Americans, and Georgians, will continue to have the option of choosing skilled home health care should they ever need it. I applaud Congressman Price for introducing this critical Medicare reform legislation and urge his colleagues in Congress to follow his lead.

Charlotte Weaver is chief clinical officer at Gentiva Health Services Inc., an Atlanta-based provider of home health and hospice services.

 

Georgia should expand access to health insurance

By Louis Sullivan

Skilled home health care serves some 3.5 million Americans, including 85,000 Georgians. Because the fastest-growing segment of the U.S. population is those who are 80 years and older, we are seeing more chronic diseases today than ever before. These require more services and more health professionals. The promise of the human genome project includes the possibility of interventions which might mitigate the onset or progression of some aspects of the aging process.

Like so many health services, skilled home health care is important, and changing circumstances over time may require adjustments in delivery and reimbursement rates.

However, a larger issue that directly affected more than 47 million Americans, before March 2010, was lack of health insurance. Passage of the Affordable Care Act (ACA) was intended to address this reality through a series of mechanisms, including the expansion of the Medicaid program and the establishment of health insurance exchanges in each state.

A ruling by the U.S. Supreme Court gave states the option to determine whether or not to expand Medicaid. The ACA also provides that the federal government will support 100 percent of the costs of Medicaid expansion for three years, then 90 percent of the costs annually thereafter. Thus far, 25 states and the District of Columbia have elected to expand their programs, and the other half of the country has not yet done so. A preponderance of the states in the South, including Georgia, is in the latter group.

Among the reasons given for states to refrain from participating in Medicaid expansions: Georgia could not afford it; the federal government would not meet its financial commitments to the program; and the insurance exchanges would not work.
We now have the benefit of some nine months of experience since Medicaid expansion was implemented, along with the state or federally operated health insurance exchanges and their income-related health insurance subsidies.

A Health Reform Monitoring Survey done in June 2014 by the Urban Institute found the number of uninsured American adults had fallen by 8 million since September 2013.  In states that did not expand Medicaid, there has been little or no decrease in the number of uninsured citizens.

Among health service providers, HCA Holdings Inc., the nation’s largest publicly traded hospital company, just reported a 14.2 percent increase in second-quarter net income, along with a 48 percent decline in its number of uninsured patients. Tenet Healthcare Corp. reported a 22 percent drop in uninsured patients. The ACA is working for these companies.

A poll released by Gallup and Healthways on Aug. 5 found states that expanded Medicaid and developed health insurance exchanges had the largest decreases in numbers of uninsured, led by Arkansas with a 10.1 percent reduction, and Kentucky with an 8.5 percent reduction.

These reports show that, at this early stage, ACA is having a positive effect in states that expanded Medicaid and implemented health insurance exchanges. More remains to be done, but there is clear progress.

These accounts should encourage Georgia’s governor and state legislators to re-evaluate their current positions to not expand Medicaid and to not establish a state-run health insurance exchange. With the health status of Georgians ranking 38th among the 50 states, Georgia should be doing more to support our citizens in their efforts to obtain health insurance and access to health care.

According to the Bureau of Economic Analysis, Georgia’s gross domestic product of $454 million in 2013 was almost four times that of Arkansas and 2 1/2 times that of Kentucky. In 2012, the $25,309 per capita income of Georgians easily surpassed the per capita income of the citizens of Arkansas or Kentucky.

How is it that Arkansas and Kentucky can afford to expand Medicaid and establish health insurance exchanges and Georgia can’t? Georgia is not poorer than these two fellow Southern states, which are smaller than Georgia and traditionally rank lower on various economic measures. Are we poorer in our humanitarian spirit — in commitment to our fellow citizens?

As a Georgian, born and raised in this state, I urge all of us to aim higher and find ways to invest more in our most precious resource: our citizens, especially our children. We should demand more and expect more from ourselves and from our elected officials.

Dr. Louis Sullivan was secretary of U.S. Health and Human Services under President George H.W. Bush.


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