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Brown University of Public Health Study Determines That Medicare Copays on Home Health Services Won’t Reduce Usage

Posted on Thursday, May 11, 2017 1:23 PM

According to a new study led by a professor from the Brown University of Public Health, that has been published in JAMA Internal Medicine, senior citizens do not use home-based health care less if they are charged a Medicare copay for it even though a copay policy would increase out-of-pocket costs for homebound seniors.

"We found no evidence that imposing a copayment reduced the use of home health care," said senior author Dr. Amal Trivedi, associate professor in the Brown University School of Public Health.

"If we are increasing the copay with little impact on utilization for certain services, essentially we are just adding to the financial burden of the patients," said lead author Qijuan "Emily" Li, a public health doctoral student.

Both President Obama and Republicans in the House of Representatives in 2016 attempted to reintroduce copays for the Medicare benefit, explaining it would save $1.3 billion over 10 years.

However, there is no evidence that introducing a copay would result in little or no decrease in usage.

The researchers gathered data from private Medicare Advantage plans that evaluated copays for the home health care benefit. The results concluded that 18 Medicare Advantage plans began charging copays from 2007 and 2011. Those plans were compared with 18 other similar plans that did not introduce copays. The researchers also gathered information for home care usage in each plan, following the year prior to the introduction of copays and the year after the copays were introduced.

In addition, the study looked at more than 290,000 anonymous senior citizens, with over 10,000 people in copay plans using home health care and over 11,000 using home health care in non-copay plans. The factors included age, income, race and gender were all measured.

The data concluded the following:
• Copays ranged from $5 to $20 per visit
• Estimated out-of-pocket costs were $165 to $660 per senior using the Medicare home health care benefit
• The added costs didn’t steer people away from these plans, instead some people decided to switch to a non-copay plan

“The study does show that seniors avoid the [Medicare Advantage] plan copay cost by dis-enrolling,” NAHC’s Vice President for Law Bill Dombi told Home Health Care News. “That is a strong indication that if that was not an option, patients would look to other ways to avoid the copay cost, including self-denial of care.”

“It’s very difficult for frail, homebound patients to cut back on their use of these services,” Dr. Trivedi said in a press release about the study. “If they were to get their care in other settings, such as nursing homes, there’d be substantial cost sharing there, too. Also a lot of the use of home care is driven by doctors’ decisions.”

Seniors continue to pay extremely high copays for home health services, proving how important these services are to patients.

"Seniors, particularly those who have multiple chronic conditions, spend a lot out-of-pocket on health care and face many financial burdens," Dr. Trivedi said. "This simply adds to that burden without reducing utilization in a meaningful way."

For the full article, click here.

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