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Sen. Collins: 'Home care can reduce cost and improve quality of life'

Published by St. John Valley Times
Senator Susan Collins
March 26, 2013

ST. JOHN VALLEY, Maine - The challenges facing our nation's health care system today are driven by demographics. The first member of the baby boom generation turned 65 last year. Our health care system now stands directly in the path of a tidal wave of aging baby boomers who will be retiring at the rate of 10,000 a day for the next 20 years. That system will clearly have to adapt and change if it is to survive that impact.

One of the most important things that we can do is to shift our orientation from institutional to community and home-based care. Advances in technology and infrastructure have made it possible for older adults - who previously would have been forced to move to a hospital or nursing home - to stay just where they want to be: in the comfort, privacy and security of their own homes. In fact, a survey conducted for the Maine chapter of the AARP found that nine out of 10 Mainers would prefer to receive services at home as opposed to a nursing home or other residential care facility.

Home care is not just the preferred choice for most patients, it is also the most cost-effective. It costs Medicare almost $2,000 per day for a typical hospital stay, and $559 per day for a typical nursing home stay. How much does Medicare pay for home care? Just $44 a day ... slightly more than two percent of the cost of a typical hospital stay.

That is why I find it so ironic - and troubling - that the Medicare home health and hospice benefits continually come under attack. The new health care law includes $40 billion in cuts to home care over 10 years and $8 billion in cuts to hospice. While home health represents just five percent of Medicare spending, it took a disproportionate 10 percent in Medicare payment cuts used to pay for the new health entitlement. Moreover, these cuts are a "double whammy" because they come on top of the more than $30 billion in cuts that have been imposed by the Centers for Medicare and Medicaid Services through regulation.

Issues affecting home care and hospice have been at the top of my priority list since I came to the Senate. Home health and hospice consistently prove to be compassionate and cost-effective alternatives to institutional care. Additional deep cuts in spending for these programs are completely counterproductive to our efforts to control overall health care costs.

I am also concerned that Medicare beneficiaries continue to face unnecessary barriers to getting needed home health services. To ensure that our Medicare patients get the home care they need when they need it, I will soon be reintroducing the Home Health Care Planning Improvement Act to allow advanced practice registered nurses and physician assistants to order home health services for their Medicare patients.

These health care professionals are playing increasingly important roles in the delivery of health care services, particularly in rural and medically underserved areas of our country where physicians may be in short supply. Medicare already pays them to provide physician services that are within their scope of practice. They can also certify that a Medicare patient is eligible for skilled nursing services. It simply makes no sense that they cannot order less costly home health services for their Medicare patients.

At best, this requirement adds more paperwork and a number of unnecessary steps to the process before medically-necessary home health care can be provided. At worst, it can lead to needless delays in getting Medicare patients the home health care they need simply because a physician is not readily available to sign the form.

I have had the opportunity to visit with a number of home health patients and providers around Maine. I have seen first-hand what a difference the highly skilled and compassionate care that these dedicated men and women provide makes to the lives of patients and their families. That is why I am such a passionate and committed advocate for home care, and it is why, as a leader of the Senate Special Committee on Aging, I will continue to work to ensure that our nation's seniors and disabled individuals have access to quality home health and hospice services.

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