In 2009, 3.3 million Medicare beneficiaries used home health. In the past few years, the home health expenditure growth rate has outpaced Medicare spending in all other areas. This finding is likely correlated with the 9.7% increase in the number of home health agencies between 2008 and 2009. How should Medicare reform home health to improve outcomes and reduce spending. A post by William Dombi of the National Association for Home Care & Hospice (NAHC) summarizes MedPAC’s recommendations.
- Eliminate any inflatinon update in 2012. In 2009, freestanding home health agency margins were 17.7% (although hospital-based home health agency margins were negative). Margins have average 17.1% since 2011. With such large margins, MedPAC believes an inflation payment update is unnecessary.
- Eliminate the therapy utilization threshold. MedPAC staff belive that “the current case-mix system overpays for higher case-mix weighted services such as episodes with therapy care and underpays for many non-therapy related episodes.” Instead, the case-mix adjustment should rely on patient characteristics to set payment for both therapy and non-therapy services. The NAHC has long criticized using therapy thresholds for the purpose of case mix adjustment.
- Establish risk corridors. This recommendation would modify the payment system to included more of a mix of prospective and cost-based reimbursement. “The ‘corridors’ are effectively limits on profit and losses that come from an imprecise system or abusive clinical practices that define care needs based on a provider’s desired margin.” The GAO proposed this alternative a number of years ago.
- Beneficiary cost sharing. To reduce the rise in the number of home health episodes per beneficiary–many of which may be unnecessary–MedPAC recommends some form of cost sharing. In particular, since the growth in home health spending is primarily driven from community-admitted patients, the copayment would apply only to community-admitted patients rather than hospital-admitted patients. One suggestion for the copayment amount was $300 per episode. “..Medigap insurances would be prohibited from covering the cost of any home health copayment.”
The MedPAC commissioners will meet in January 2011 to vote on the recommendations and will issue a report to Congress in March 2011.
- Number of home health beneficiaries: 3.3m
- Number of home health agencies: 11,300.
- Growth rates (2008-2009)
- Users: 3.8%
- Number of episodes: 7.5%
- Episodes/user: 4.5%
- Admission Source (2009)
- Community-admitted: 64%
- Hospital-admitted: 36%
Your article makes recommendations on ways to reduce Medicare expenditures in the home health care field but it’s unclear whether all of the 11,300 home health care agencies your article mentions accept Medicare.
My understanding is that very own health care agencies accept Medicare because of the tremendous amount of paperwork, regulations and red tape that are required in order to receive payments from Medicare.
New book urges use of antidepressants to treat and prevent cancer
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More than 120 clinical, laboratory and epidemiological studies illuminate the anticancer properties of antidepressants. Antidepressants kill cancer cells, inhibit their proliferation, protect nonmalignant cells from damage by ionizing radiation and chemotherapy toxicity, convert multidrug resistant cells to sensitive, and target the mitochondria of cancer cells while sparing those of healthy ones. Depression significantly increases the risk of cancer, and increases and accelerates its mortality. Antidepressants are capable of arresting cancer even in advanced stages, and occasionally eradicating it. Published reports to date reveal that antidepressants are potentially effective for such treatment resistant malignancies as cancer of the lungs, kidneys, and liver, malignant gliomas of the brain, and inflammatory breast cancer. Lieb points out that the use of relatively inexpensive antidepressants could make cancer treatment available to low-income and disadvantaged segments of the population. By slashing the cost of cancer care, antidepressants could energize health reform and economic recovery.
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About the Author
Dr. Julian Lieb is a retired Yale School of Medicine professor and author or co-author of 48 published articles and 11 books, Lieb is a recognized expert on the immunostimulating and antimicrobial properties of lithium and antidepressants, and the anticancer properties of antidepressants. He has worked closely with pioneers in prostaglandin research, and has been invited to address international cancer conferences in Greece, Germany and India.
For educational purposes only. Treatment decisions to be made with a physician.