Home care: Medicare panacea or mirage?

The ideas and innovators shaping health care

Apr 24, 2023 View in browser   By Ben Leonard, Erin Schumaker and Ruth Reader WASHINGTON WATCH More home care could help save Medicare, lawmakers believe. | AP A growing lineup of health care companies thinks Congress can get a win-win on Medicare policy — both improving the quality of care and saving money — by moving more care to the home. Krista Drobac, who leads the Moving Health Home coalition of tech-enabled home care companies, including Best Buy’s Current Health, health system Intermountain and dialysis provider DaVita, as well as Amazon, cites surveys that show moving more care from hospitals and other health care facilities to patients’ homes is both popular and cost-effective. Lawmakers like what they’re hearing: Last week a bipartisan House duo, Adrian Smith (R-Neb.) and Debbie Dingell (D-Mich.), introduced a bill to facilitate the shift. “Seniors and their caregivers want the option to stay home. It’s better for overall health and recovery,” Drobac said. “The pandemic showed us it is possible, and we need to build on that.” And the evidence around costs is promising, too. The Congressional Budget Office scored an extension of existing hospital at-home care through 2024 as costing $5 million — a drop in the bucket of overall health care spending. What’s in the bill? The legislation would: — Create a new Medicare benefit allowing certain beneficiaries ineligible for Medicaid to have a home health worker for up to 12 hours a week — Facilitate house calls by allowing doctors to be paid monthly in place of the existing fee-for-service structure — Broaden reimbursement for home-based services, including dialysis, lab tests and infusions. “When you look at the numbers and demands on Medicare in the years on the horizon, we need to innovate,” Smith said. Even so: Some health economists are skeptical of the advocates’ rosy vision. “There is potential for cost savings,” said Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics. But she added that the package is difficult to assess. “The cost implications probably vary across the different provisions, and it’s hard to know what the total costs might be,” she said.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     WELCOME TO FUTURE PULSE The Potomac at sunset | Ben Leonard This is where we explore the ideas and innovators shaping health care. Time for a new sports bra? Wearing a high-support sports bra improved study participants' running performance by 7 percent, according to a new study published in the journal Frontiers in Sports and Active Living. More breast support is associated with increased knee joint stiffness, researchers found, which is linked to better running performance. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Katherine Ellen Foley talks with Ben about an effort to move more care from the hospital to the home — a shift that supporters, including a bipartisan group of lawmakers, say is a win-win that would give patients what they want and shore up Medicare’s teetering finances. Listen to today’s Pulse Check podcast TECH MAZE Many smaller hospitals are still using a lot of paper. | Carl Court/Getty Images Health providers can help patients and avoid medical errors by quickly sharing their records. A new report from the Government Accountability Office, the watchdog arm of Congress, finds doctors are doing a better job of it but significant disparities remain. GAO pointed to surveys showing that government initiatives have led to a significant rise in health data-sharing in recent years. Interviews with providers showed they have increasingly adopted technology that makes data-sharing easier. But small and rural hospitals are still much less likely to send or receive health data electronically than medium or large-sized ones. Nearly half of small hospitals are still heavily reliant on faxes and mail, for example. That’s compared with less than a third of medium- and large-sized hospitals. Only about a quarter of small hospitals said they often send data through a national health information exchange network, which facilitate sharing and safeguard data. That’s compared with close to half of their larger counterparts. GAO said that HHS’ Trusted Exchange Framework and Common Agreement, the health data-sharing project known as TEFCA, could help remove barriers to data exchange by reducing costs that now impede participation. Even so: Participation in TEFCA is voluntary, and using it won’t directly improve information technology staffing shortages and gaps in broadband access that pose challenges to small and rural providers, the GAO said.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     CHECKUP Patients have returned. | AP After a decline in the pandemic’s first year, health spending roared back. Health care spending per person in the private market spiked in 2021 after a dip in 2020, according to a new report from the Health Care Cost Institute, a research group that partners with insurers to gauge the health care market. The data, based on insurance claims from CVS Health/Aetna, Humana and Blue Health Intelligence, found that per-person spending grew 15 percent in 2021. The increase came after a 3.5 percent decline in 2020 when many patients delayed or avoided getting care because of the Covid-19 pandemic — the first decline in 12 years. That dip was concentrated in the pandemic’s first few months, the report said. The spending increase that followed was widespread, including on inpatient and outpatient services and prescription drugs. Part of the growth also stemmed from Covid care: vaccines, lab tests and hospitalizations. Inflation was also a big factor. Between 2017 and 2021, rising prices accounted for more than half of the change in spending, the report found.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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