Home health care advocates point to what they see as an irony in efforts to contain medical costs. The highest-cost care is hospital care: The more days a patient stays, the higher the tab. With home health, the idea is to release the patient to the home where regular care can help prevent readmissions.
Outside the industry, though, there is less concern.
The Medicare Payment Advisory Commission, in its latest report to Congress, contended that there is sufficient access to home health care, with more than 12,000 agencies, that the quality of services is generally good, and that average provider profit margins are high enough.
Margins vary widely, according to the commission, with some negative and others above 20 percent. The average in 2011 was 14.8 percent. Smaller agencies didn’t fare as well as larger agencies, possibly because of economies of scale, and nonprofits didn’t fare as well overall as for-profit agencies.
That calculation doesn’t factor in all provider costs, however, and net margins are actually far smaller and declining, said William Dombi, vice president for law for the National Association for Home Care & Hospice. Decreasing reimbursements will lead to some providers going out of business, he said, and less access to care for some people.
The industry has also faced claims that some providers overcharge, or don’t provide the services they charge for.
When it’s done right, home health care is seen as good for all parties involved.
Home health is “not only cost-effective, but really helps patients maintain their independence,” said Barbara Ballard, a vice president with WellStar Health System, which operates WellStar Home Care.
Jennifer Schuck, who heads post acute care initiatives at Atlanta-based Emory Healthcare, said in an email, “From a hospital perspective, a patient’s treatment does not stop after being discharged from the hospital. The home health agency acts as an extension of the hospital to ensure the patient continues to progress in their healing process.”