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. 2017 Jul 1;177(7):1012-1018.
doi: 10.1001/jamainternmed.2017.1058.

Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees

Qijuan Li  1 , Laura M Keohane  2 , Kali Thomas  3 , Yoojin Lee  1 , Amal N Trivedi  3
Affiliations

Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees

Qijuan Li et al. JAMA Intern Med. .

Abstract

Importance: Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy.

Objective: To determine the association of home health copayments with use of home health services.

Design, setting, and participants: A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans.

Exposures: Introduction of copayments for home health care between 2007 and 2011.

Main outcomes and measures: Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care.

Results: Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care.

Conclusions and relevance: We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Trivedi reports receiving consulting fees to edit the Merck Manual. No other disclosures are reported.

Figures

Figure 1.
Figure 1.. Unadjusted Monthly Rate of Home Health Days per Enrollee in the 12 Months Before and 12 Months After the Introduction of Copayments
Figure 2.
Figure 2.. Disenrollment Rates From Case and Control Plans by Duration of Home Health Care During the Year Before the Copayment Increase
See this image and copyright information in PMC

Comment in

  • Cost Sharing and Home Health Care.
    Grabowski DC. Grabowski DC. JAMA Intern Med. 2017 Jul 1;177(7):1018-1019. doi: 10.1001/jamainternmed.2017.1077. JAMA Intern Med. 2017. PMID: 28492828 No abstract available.

References

    1. Medicare Payment Advisory Commission (MEDPAC) Health care spending and the Medicare program, June 2011. http://www.medpac.gov/docs/default-source/data-book/june-2016-data-book-.... Accessed September 6, 2016.
    1. National Association of Home Care & Hospice President’s budget includes provisions for home health copays, additional payment cuts for post-acute care providers. http://www.nahc.org/NAHCReport/nr140305_1/. Accessed September 6, 2016.
    1. The National Commission on Fiscal Responsibility and Reform The moment of truth: Report of the national commission on fiscal responsibility and reform. Washington DC: The White House, December 2010.
    1. Medicare Payment Advisory Commission (MEDPAC) Medicare payment policy: Report to the Congress, March 2011. http://www.medpac.gov/docs/default-source/reports/Mar11_EntireReport.pdf.... Accessed September 6, 2016.
    1. US Department of Health & Human Services HHS FY 2017. Budget in Brief - CMS – Medicare. http://www.hhs.gov/about/budget/fy2017/budget-in-brief/cms/medicare/inde.... Accessed September 6, 2016.

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