Medicare cuts take toll on home health care

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It's become a little tougher to find a home health care provider in southwest Missouri that's willing to accept payment from Medicare since the Balanced Budget Act of 1997 was passed. The act, which significantly reduced Medicare funding, has affected both home health care providers and recipients. |ret||ret||tab|

Nationwide, the total number of Medicare home health visits declined by 40 percent and the average number of visits per patient declined by 30 percent between 1997 and 1999, according to the National Association for Home Care in Washington, D.C. During this same period, the average payment per patient decreased by 38.5 percent. |ret||ret||tab|

According to Mary Schantz, executive director for the Missouri Alliance for Home Care in Jefferson City, approximately 120 home health care agencies have closed in Missouri since the Balanced Budget Act was passed in 1997. Several of these agencies were located in Springfield.|ret||ret||tab|

"I can think of at least five home health care companies in Springfield that have closed their doors since 1997," said Melanie Markham, who co-owns Access Home Health Agency with her husband Lloyd. |ret||ret||tab|

The Markhams, who have been in business since 1994, have restructured their operations as a result of Medicare cuts. Prior to 1997, approximately 90 percent the agency's business came from Medicare-funded home health care. Today, 35 percent comes from Medicare, while the remainder comes from other in-home services, and community programs that have been added or developed within the past three years.|ret||ret||tab|

According to Larry Pennel, senior vice president and chief financial officer for Cox Health Systems, many seniors in the region rely on Medicare to pay for their home health care services. |ret||ret||tab|

Cox Health Systems, which is one of largest health care providers in the region, has been affected by cutbacks in Medicare. Despite the cutbacks, Pennel said Oxford Health Care, an affiliate of Cox Health Systems, remains committed to providing home health care to Medicare recipients. |ret||ret||tab|

Like many other area businesses, Oxford Health Care is examining the way it delivers home health care and is striving to increase efficiency. |ret||ret||tab|

"During the intake process, we evaluate the client's needs and examine all sources of payment available," said Cynthia Glenn, assistant to the president at Oxford Health Care. "If Medicare won't pay, there may be other sources of funding available."|ret||ret||tab|

Smaller home health care agencies in Springfield also are feeling the effects of Medicare cutbacks. |ret||ret||tab|

Companies such as AmeriCare Home Care Inc. no longer accept payment from Medicare, and newer companies such as Integrity Home Care rely on other forms of payment. |ret||ret||tab|

The company, which has been in business nine months, accepts out-of-pocket payments from patients, private insurance, and Medicaid. |ret||ret||tab|

"I'm not saying we'll never accept Medicare for home health services," said Randy Rogers, administrator. "It just didn't make sense to accept Medicare as a form of payment when we started the company because we knew everything would change within three months, and it did."|ret||ret||tab|

In fact, things are still changing. Medicare on Oct. 1 implemented a prospective payment system covering home health care. |ret||ret||tab|

The concept behind the new system is to encourage efficiency by paying an amount based on the average national cost of treating a home health client for 60 days. |ret||ret||tab|

Final payments to home health care agencies are based on the average base payment and are adjusted to take into account patient characteristics and labor market differences. |ret||ret||tab|

Because the PPS is new, however, it is difficult to assess what impact it will have on both the quantity and quality of home care services provided. |ret||ret||tab|

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