On Tuesday, post-acute care leaders and advocates testified before the U.S. House Committee on Ways and Means regarding the importance of home health care. During the health subcommittee hearing titled “After the Hospital: Ensuring Access to Quality Post-Acute Care,” Empath President and CEO Johnathan Fleece and Dr. Dana Madison, owner of Compassion Home Health, were […] The post Fixing A ‘Badly Broken Medical System’: Home Care Leaders Testify Before Congress On Post-Acute Care appeared first on Home Health Care News.
On Tuesday, post-acute care leaders and advocates testified before the U.S. House Committee on Ways and Means regarding the importance of home health care.
During the health subcommittee hearing titled “After the Hospital: Ensuring Access to Quality Post-Acute Care,” Empath President and CEO Johnathan Fleece and Dr. Dana Madison, owner of Compassion Home Health, were among the speakers.
Also testifying before the committee were Paul Dongilli, CEO of Madonna Rehabilitation Hospitals; Lisa Grabert, a research professor from Marquette University and Eric Carlson, director of long-term services and supports advocacy at Justice in Aging. The hearing centered on concerns regarding proposed budget cuts to Medicaid and their potential impact on the quality of care patients receive in the future.
Representative Vern Buchannan (R-Florida) opened the meeting by discussing the benefits of home health care, noting that the model helps reduce hospital readmission rates and overall spending.
“We must focus on ensuring that patients receive the right care, in the right place, at the right time, at the right price,” Buchannan stated during the hearing. “Our Medicare program has evolved over the past decade, and we are here to ensure that patients have sufficient access to care. At the same time, we must oversee these services to ensure they are delivered in a timely manner.”
Lloyd Doggett (D-Texas) further emphasized the focus of the hearing by asking, “What happens to Americans after they’ve been treated at the hospital?” Acknowledging the various representatives of the health care ecosystem present to discuss post-acute care, he explained that any conversation about this topic must include Medicaid, as it is the primary payer for such services.
“It covers two-thirds of all nursing home residents and 60% of all home and community-based services,” he noted. “It funds long-term support for 9.3 million seniors and individuals with disabilities, and that care is now on the chopping block.”
He expressed concern that “this post-acute care plan amounts to a prescription for a mountain of medical debt and, for some, a preventable death sentence.”
Doggett shared stories from his constituents who rely on home health care and are fearful of what might happen without Medicaid assistance.
Madison spoke about her 31 years of experience running a home health agency, where traditional Medicare covered most patients. She highlighted how the Balanced Budget Act of 1997 changed the reimbursement model for home health care, leading to 70% of agencies in Texas and about 30% nationwide closing. She further explained how various payment models imposed by the Centers for Medicare & Medicaid Services (CMS) over the years have resulted in diminishing funds for home health care making it challenging for organizations like hers to deliver the high-quality care patients want and deserve.
Madison highlighted that Medicare Advantage (MA) plans often reimburse at rates lower than the costs incurred by providers and frequently limit or deny care. This creates significant challenges for her agency, especially since 50% of the Medicare-eligible patients they serve are covered by these plans.
She emphasized that a 60-day period of home health care is less expensive than a single emergency department visit, and most senior citizens prefer to receive care at home. She noted that reimbursement cuts worsen the existing nursing shortage, which has been further intensified by the COVID-19 pandemic. She advocated for telehealth and reminded the representatives that home health care must be reimbursable because those services are both cost-effective and essential for addressing the challenges of our aging population now and in the future.
Similarly, Dongilli emphasized how the prior authorization and denial practices of MA plans restrict access to post-acute care. These denials frequently result in a resource-intensive appeals process, which further delays patients from receiving the appropriate level of care. He urged Congress to motivate CMS to keep refining the post-acute care payment system to ensure that payments account for the uniqueness of each setting, case complexity and resource use.
Fleece illustrated these points by sharing an example of how hospice care assisted an Empath patient in avoiding emergency department (ED) visits and allowed her to pass away with dignity at home, surrounded by family members.
“Home-based care isn’t just for those actively dying,” he said. “It supports people managing chronic illness, recovering from surgery, navigating terminal diagnosis. Patients want it. Families need it and taxpayers benefit. Keeping patients at home prevents costly hospitalizations and reduces strain on the health care system. Today, in a time of financial and workforce challenges, we should be expanding access to care at home, not cutting it.”
Fleece urged the representatives to invest in home-based care, citing data that demonstrate improved patient outcomes and reduced Medicare spending. He advocated for expanding pay-for-performance to reward high-quality providers and emphasized the need to enhance effective value-based care models.
“These are not just policy decisions,” Fleece stated. “They represent urgent threats to access, quality and patient choice. The decisions made here will shape the future of home care. Let’s protect and expand access before it’s too late.”
Witness after witness came forward to discuss the significant harm that Medicaid cuts would inflict on the American health care system, arguing that such cuts would effectively dismantle home health care as we know it.
Overall, the representatives seemingly reached a consensus that post-acute care is a necessary component of the health ecosystem.
Now, the American people await the possible outcomes of this testimony.
In an ideal scenario, the testimony could prompt the creation of new legislation or regulations aimed at addressing concerns raised by home health leaders. These concerns may include improving reimbursement rates for post-acute care services and tackling issues related to MA plans. Additionally, Congress might launch further investigations or hearings to gather more information on specific matters related to home health care, potentially leading to greater scrutiny of MA plans and their effect on patient access.
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