The state plans to privatize its 50-year-old home health program, saying it’s been losing money for the past three years. The service provides skilled nursing, physical therapy, occupational therapy, speech therapy, medical social services, home health aides, and care and education for respiratory and other diseases to people who’ve been in the hospitalized or have temporary or chronic health problems. … Because there is at least one licensed home health provider in every county today, unlike when the program began, DHEC decided this week to “pursue the transfer of DHEC’s home health licenses to another qualified provider,” according to a statement. … DHEC Home Health employs 86 full-time staff and 38 part-time or hourly staff who cared for some 4,762 patients from July 2014 to May 2015, with an average daily caseload of 807 patients, the agency reports.
Almost all privatization deals are bad news for the public. The profit motive leads to higher costs, reduced services, and a whole lot of sleaze. Privatization Scam of the Year Awards shows link between privatization and sleaze The Privatization Scam of the Year Awards draw attention to the profiteering, lower standards and outright corruption that come with privatization. …
…The nominees for the 2014 “Scammie” are:
• Ontario’s P3 privatizations schemes that added $8 billion to the cost of public infrastructure
• British Columbia’s replacement of home care professionals with unpaid volunteers
• New Brunswick’s secret negotiations to privatize food and cleaning services in hospitals
• Replacing public employees with consultants in Saskatchewan — at double the cost
• Interpol called in to help with investigation of Montreal hospital P3 privatization scheme corruption
Source: William Cabin, Home Health Care Management Practice, Published online before print June 2, 2015
From the abstract:
This article explores the literature, including two recent studies, on whether home health agency (HHA) ownership type plays a significant role in agency quality, cost, and profitability. The literature is limited, except for the two recent studies that use a merged database created from the Medicare Home Health Compare and the 2010 Medicare home health cost reports databases. One study found statistically significant differences between proprietary and non-profit HHAs: Proprietary agencies have lower overall quality, higher profitability, higher costs per patient, and more visits per patient, with therapy visits accounting for a larger share of the total. However, the second study found that the explanatory value of ownership is limited, with the number of HHAs in the state and therapy visits as a percentage of total visits having a significant influence on cost and quality when combined with ownership compared with ownership alone. Policy, practice, and research implications are discussed.
Source: Avalere, May 2015
● The Medicare Payment Advisory Commission (MedPAC) annually issues its estimate of the Medicare margin for multiple provider sectors.
o MedPAC projects that home health agencies will have a Medicare margin of 12.6% in 2014 and 10.3% in 2015.
● Although MedPAC’s margin estimate is not a measure of a sector’s overall profit/loss, it is often interpreted as such.
● It is therefore instructive to compare MedPAC’s estimate with margin data calculated from the financial statements of publicly-traded companies. (Publicly-traded home health companies: Almost Family, Amedisys, Gentiva (acquired by Kindred Healthcare in February 2015), LHC Group)
…Across the country, state Medicaid programs, which operate with large federal contributions, have outsourced most of their care management to insurance companies like the ones in Tennessee. The companies cover poor and disabled Medicaid members in return for fixed payments from taxpayers. That helps government budgets but sets up a potential conflict of interest: The less care these companies deliver, the more money they make. Nationwide, such firms had operating profits of $2.4 billion last year, according to regulatory data compiled by Mark Farrah Associates and analyzed by Kaiser Health News. In an attempt to manage that tension, Washington regulators are about to initiate the biggest overhaul of Medicaid managed-care rules in a decade. Prompted by the growth of Medicaid outsourcing and concerns about access to care, the regulations are expected to limit profits and set stricter requirements for quality of care and the size of doctor networks…. Tennessee Medicaid contractors — operated by BlueCross BlueShield of Tennessee, UnitedHealthcare and Anthem — are among the most profitable Medicaid plans in the country, according to data from Milliman, a consulting firm….
Home health care workers who sued three D.C. employers for back pay are now seeking class-action status for what they say could ultimately grow to a $150 million case. The workers’ bid for class-action status was filed Tuesday afternoon in D.C. Superior Court. The initial lawsuit was filed in December and included about 150 home health workers. Named defendants include Nursing Enterprises Inc., Vizion One Inc. and Health Management Inc., the latter of which has filed a motion to dismiss the case. ….. The group hopes to also include other home health care companies they allege didn’t pay employees. …. According to the lawsuit, the workers claim they were forced to work without pay following an FBI sting last year that uncovered $78 million in fraudulent Medicaid billing and rocked the local home health industry….
When Clinton County was considering privatizing its home health-care service two years ago, County Legislature meetings were often packed with nurses who feared they could lose their jobs. Now, the fears and uncertainty have calmed down, and the transition with private firm HCR Home Care of Rochester appears to have been rather seamless. … Their fringe benefits are not as strong as they were with the county, but the pay is equal or better, and the company offers other benefits, Vicari said. …
Source: William Cabin, David U. Himmelstein, Michael L. Siman and Steffie Woolhandler, Health Affairs, Vol. 33 no. 8, August 2014
From the abstract:
For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome “avoidance of hospitalization” (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare’s market-oriented, risk-based home care payment system.
Even as public attention is focused on the Affordable Care Act, another health care overhaul is underway in many states: an ambitious effort to restrain the ballooning Medicaid cost of long-term care as people live longer and survive more disabling conditions. At least 26 states, including California, Florida, Illinois and New York, are rolling out mandatory programs that put billions of public dollars into privately managed long-term care plans, in hopes of keeping people in their homes longer, and expanding alternatives to nursing homes. …. In many cases, care was denied after needs grew costlier — including care that people would have received under the old system.
Source: Kaye Broadbent, Work, Employment & Society, Published online before print December 6, 2013
From the abstract:
The rise in nuclear family households and more married women engaging in paid work have forced governments to address the issue of aged care for the elderly to a greater degree. A good illustration is home care in Japan where the government introduced a Long Term Care Insurance scheme (LTCI) (2000) focused on offering affordable almost universal care by extending existing home care services. Japan’s home care services were privatized in 2006 and, while this is not unique to Japan, the combination of cost-cutting measures and the client-driven model encompassed in the LTCI has had a significant impact on employment conditions and the organization of work in home care services. This research assesses the impact on employment conditions and the organization of work in Japan’s former government-run home care sector compared with the pre-LTCI period and argues that privatization has resulted in work intensification and deteriorating employment conditions.