Guest Column: Obamacare is forcing many home health agencies to slash services

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On. Nov. 22, the Centers for Medicare and Medicaid Services (CMS) announced that, effective Jan. 1, 2014, it will cut reimbursement for the home health benefit by 14 percent over the next three years.

This cut was forced down the throats of Americans by the White House to make sure all extra costs associated with the Affordable Care Act – Obamacare – could be funded. This was done in the face of strong objection by a bipartisan coalition of 51 U.S. senators and 142 members of the U.S. House of Representatives who all signed letters objecting to the cuts. Others in Congress joined in the fight after the official letters were sent.

These cuts do several things. First and foremost, they affect access to care for more than 4 million seniors who are homebound and who CMS admits are older, sicker, poorer and more likely to be minorities than the general Medicare population. CMS argues that access to care won’t be affected because home health providers will adjust to the rate reductions and continue as usual. But even CMS admits that 40 percent of home health providers will be losing money by 2017.

MANY SMALL HOME health agencies will, in fact, just hang in there as long as they can. They will be forced in many instances to provide less-effective, if not poor, service. They will not be able to provide employees with full benefits, workers’ compensation coverage or continuing education. They will need to recertify patients for home health continually, even when the need is marginal.

As a result, the quality of care and outcomes will go down, and patients will be driven back into high cost settings – i.e., hospitals and skilled nursing facilities. This is not a slam on smaller providers. They are just trying to survive. Many of them are operated by good people who have spent their lives building these small businesses. Many other small providers simply will not be able to stay in business because of economic constraints associated with the draconian rate cuts resulting in loss of jobs and loss of access to care, especially in rural areas.

The larger home health providers invest heavily in advanced care technology and continuing clinical education, for which CMS reimburses them nothing. The larger home health providers provide employees with competitive wages and full benefits. They provide workers’ compensation protection. They constantly are monitoring quality and looking at rehospitalization rates to ensure their hospitals and other provider partners are not being financially dinged by the CMS system. Now, on top of the rate cuts imposed through the White House, these employers of hundreds of thousands of employees must comply with the ACA, which costs them millions to their bottom lines.

AS A RESULT, the larger home health providers that in the past absorbed a great deal of unprofitable home health business will now simply shut that down. These larger providers will have to cut. They will have to eliminate marginally profitable or unprofitable locations. They will have to say: We cannot take care of that patient with a severe wound, or one who lives miles away in a rural area. They will have to provide less service to patients. They will have to reduce their work forces, thereby causing people to lose jobs.

The CEOs of two very large home health companies recently have indicated future actions to me. One company intends to close 57 more locations in January. One indicated he likely will close 50 more offices. These organizations have closed almost 100 locations between them. And these are just two examples of large organizations shrinking. Our organization – which is not as large as these, but nevertheless considered a large provider – also will be forced to reduce the number of locations we serve and the types of patients we serve.

While large players likely will hang around, but will adjust their operations, contrary to what CMS and the White House administration would have you believe, access to quality and timely home health care will be greatly affected negatively. Costs to Medicare are going to increase, and seniors are going to be denied needed health-care services – all in the name of ensuring that Obamacare survives intact at any costs.

(The writer is president and chief executive officer of CareSouth Health System in Augusta.)

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deestafford 12/29/13 - 09:35 am
Everyday more and more

Everyday more and more dastardly things surface about obamacare. Just yesterday I read where the 2300+ page bill calls for all vending machines to have the nutritional information next to each item in the machine. It is estimated that the initial requirement will cost $2400 per machine and $2000 a year to maintain.

One lady says she has five employees and hundreds of food vending machines and this requirement will put her out of business. Just think if she had 200 machines the set up cost would be $480,000 and $400,000 per year maintaining fees. How in he world could a small business absorb costs that are more than the profits.

What did the government say when asked? It said if even .02% of the people would reduce their caloric intake by 100 as a result it would be worth it. Folks, this shows the idiots we have in our government.

carcraft 12/29/13 - 01:16 pm
Deestafford, this will go

Deestafford, this will go down as one of the worse laws ever passed and I predict it will be repealed!

blues550 12/29/13 - 02:17 pm

The insight in this column schould scare the everyloving crap out of all who read it...and ALL should read it.

corgimom 12/30/13 - 09:06 am
Medicare expenditures have

Medicare expenditures have exceeded revenue since 2008, long before Obamacare.

I know that it's popular to blame everything on Obamacare, but these cuts have nothing to do with it.

Without the cuts, Medicare will go broke.

Something needs to be done about the health care system in this country, it is very broken.

teaparty 12/30/13 - 04:38 pm
"I know that it's popular to

"I know that it's popular to blame everything on Obamacare, but these cuts have nothing to do with it.
Without the cuts, Medicare will go broke."
corgimom, you are correct but if Obamacare had not stole about $700 billion from Medicare the cuts would not have been as bad. It is amazing how far progressives will go to defend this socialist program.

teaparty 12/31/13 - 06:34 pm
There are 11 States that now

There are 11 States that now have More People on Welfare than
they do Employed! Last month, the Senate Budget
Committee reports that in fiscal year 2012, between
food stamps, housing support, child care, Medicaid and
other benefits, the average U.S. Household below the
poverty line received $168.00 a day in government support.
What's the problem with that much support? Well, the
median household income in America is just over $50,000,
which averages out to $137.13 a day. To put it another way,
being on welfare now pays the equivalent of $30.00 an hour for a 40-hour week, while the average job pays $20.00 an hour.
> *************************************
> Furthermore:
> There are actually two messages here. The first is very
> interesting, but the second is absolutely astounding - and
> explains a lot.
> A recent "Investor's Business Daily" article provided very
> interesting statistics from a survey by the United Nations
> International Health Organization.
> Percentage of men and women who survived
> a cancer five years after diagnosis:
> U.S. 65%
> England 46%
> Canada 42%
> Percentage of patients diagnosed with
> diabetes who received treatment within six
> months:
> U.S. 93%
> England 15%
> Canada 43%
> Percentage of seniors needing hip
> replacement who received it within six
> months:
> U.S. 90%
> England 15%
> Canada 43%
> Percentage referred to a medical specialist
> who see one within one month:
> U.S. 77%
> England 40%
> Canada 43%
> Number of MRI scanners (a prime diagnostic
> tool) per million people:
> U.S. 71
> England 14
> Canada 18
> Percentage of seniors (65+), with low
> income, who say they are in "excellent
> health":
> U.S. 12%
> England 2%
> Canada 6%
> *************************************
> And now..for the last statistic:
> National Health Insurance?
> U.S. NO
> England YES
> Canada YES
> *************************************
> Check the last set of statistics!!
> The percentage of each past president's cabinet... who had
> worked in the private business sector...prior to their
> appointment to the cabinet. You know what the private
> business sector is; a real-life business...not a government
> job. Here are the percentages.
> T. Roosevelt................38%
> Taft.............................40%
> Wilson .......................52%
> Harding.......................49%
> Coolidge......................48%
> Hoover.........................42%
> F. Roosevelt.................50%
> Truman........................50%
> Eisenhower..................57%
> Kennedy.......................30%
> Johnson.......................47%
> Nixon............................53%
> Ford.............................42%
> Carter...........................32%
> Reagan........................56%
> GH Bush......................51%
> Clinton ........................39%
> GW Bush.....................55%
> Obama............... 8%
> This helps explain the incompetence of this administration:
> ONLY 8% of them...have ever worked in private business!
> That's right! Only eight percent---the
> least, by far, of the last 19 presidents! And
> these people are trying to tell our big
> to run their business?
> How can the president of a major nation and society...the
> one with the most successful economic system in world
> history, stand and talk about business...when he's never
> worked for one? Or about jobs...when he has never really
> had one? And, when it's the same for 92% of his senior
> staff and closest advisers? They've spent most of their time
> in academia, government, and/or non-profit jobs.
> "community organizers."
> They should have been in an employment line.

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