Loud and Clear

You keep reading the headlines:

• According to government projections, U.S. health care spending is estimated to have reached $2.4 trillion in 2008.
• The nation’s health spending is projected to experience its largest single-year increase as a share of the economy in 2009 as the effects of the recession ripple through the health care sector.
• The economic downturn is expected to affect both public and private health care spending as more Americans lose their health insurance and as federal and state governments face projected increases in Medicaid enrollment and spending.
• By 2018, national health spending is projected to nearly double, reaching $4.4 trillion and consuming 20.3 percent of the gross domestic product, according to CMS analysts.

As the Obama administration and Congress begin the giant task of tackling health care reform, we must make sure that HME’s message is loud and clear. Try this message with your federal legislators, as well as your state government:

• An important message to policymakers concerned about health care system costs: Wellness and prevention start at home with a proper diet and exercise. Many illnesses can be treated on an outpatient basis with the patient returning home for rest and recovery. In those cases where tertiary level care is necessary, hospitals can discharge patients directly to their homes for rehabilitation and recovery. The chronic care patient prefers to be home, particularly if there are available family caregivers. In all cases, staying at home minimizes patient exposure to infection risks, which are always present in an institutional setting. Patients prefer to be home, costs are lower and the risk of infection is reduced. Instead of filling up emergency rooms with primary care visits, we need a national coverage plan that will cause patients and physicians to act in the most cost-effective manner.
• Promoting cost-effective health care settings such as home health care: Among other things, the president and Congress must demonstrate a commitment to reforming federal health care policy and programs by focusing on enhancing access and quality while controlling costs. Specifically, studies have indicated that reducing health care costs can start by limiting unnecessary hospital stays for patients with high-cost conditions and, instead, promoting more cost-effective post-acute care settings such as home care.

The payment system should encourage beneficiaries to utilize more cost-effective non-institutional settings of care, whether their needs are acute, sub-acute or long-term. An effective health reform plan will provide the appropriate incentives for physicians and consumers to utilize the most cost-effective care settings. It will also include overall payment reform to optimize cost-savings, rather than simplistic and arbitrary payment cuts to providers.

Advances in home-specific medical technology now make it possible to provide a hospital or nursing home room in the home, complete with family or nurse caregivers, at a substantially lower cost. A study published in the December 2005 issue of Annals of Internal Medicine showed the cost of treating similarly ill patients at home was one-third less than the cost of treating them in the hospitals. The average cost of treating patients at home was $5,801; the average cost to treat patients in the hospital was $7,480.

A similar study in 2006 by the American Academy of Family Physicians found that patients and families who chose home care were more likely to be satisfied with their relationship with physicians, with the comfort and convenience of care and with overall care compared with patients who were given care in a hospital setting.

As baby boomers retire, home care resources may prove to be one of the most effective mechanisms available in both reducing costs and improving quality. If our future health care delivery system is to remain sustainable, we must discourage traditional methods by the government to favor inefficient, costly care settings as the status quo and encourage more innovative practices such as home care that are in patients’ best interests.

There are tremendous benefits to promoting home care for aging patients. Not only is it the most cost-effective post-acute setting, but many families overwhelmingly prefer care in the home over institutional care.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her at 440/329-6226 or [email protected].