COMMENTARY: Medicare cuts threaten access to home health care across Nevada

Ask pretty much any older person and they’ll tell you they want to stay in their home as they age. Nevadans are no different. National polling shows that 91 percent of seniors would prefer to receive short-term recovery or rehabilitation services in the comfort and safety of their own homes rather than in a nursing facility.

Despite this overwhelming preference, cuts to Medicare’s home health benefit — with persistent workforce challenges in the home health sector — are making it more difficult for older patients to transition to their homes after a hospitalization.

Disregarding these trends, the Centers for Medicare &Medicaid Services, the federal agency responsible for managing the Medicare program, has just finalized a permanent payment cut to home health totaling nearly 3 percent in 2024, with billions more in planned in future cuts. That’s on top of a nearly 4.36 percent cut that began in 2020.

In total, these home health program cuts will reach as much as $25 billion over the next decade.

In Nevada, home health stands to lose millions of dollars for patient care in 2024 alone.

In a time when the costs of caring for patients in their homes have grown significantly because of inflation, cuts such as these represent a major barrier to the hiring and retention of the skilled clinicians who are necessary for home health agencies to provide care. These clinicians include nurses, therapists and other care professionals. By finalizing these harmful cuts, CMS is undermining Medicare’s home health program and failing to recognize the detrimental effect its actions will have on patient access.

Lack of access to home health care translates to poorer patient outcomes, plain and simple.

Data show that Medicare beneficiaries who are referred to home health agencies but are not admitted within a week have statistically worse outcomes, including substantially higher rates of hospital re-admissions, emergency department utilization and mortality.

As it stands, Nevada’s home health community is competing with other care settings to attract and retain quality clinicians and caregivers. Facing a serious shortage of workers and historically high operation costs, it is already difficult for many home health agencies to stay afloat, particularly in rural communities where patients are farther away.

Furthermore, in the Las Vegas area, many patients referred to a home health agency — in some cases as high as 77 percent — are simply rejected. This local referral rejection rate is in keeping with the troubling national trend where referral rejections in 2023 are at 76 percent nationally, up from 54 percent in 2019.

As a result of these cuts, it will become even more difficult for Nevada patients — many of whom must currently wait in hospitals to be discharged — to access home health services that could help them heal and recover more quickly and comfortably.

Medicare payments that fail to keep pace with rising costs threaten to undermine the viability of home health agencies in Nevada and across the country, putting patient access to care at grave risk.

This is not a theoretical threat — uncertainty in Medicare payment levels and the inability of payments to keep up with inflation are already causing a wave of home health agency closures across the country.

If there are no local home health agencies available — or if existing ones are unable to take on new patients — then vulnerable patients are left without access to critical home health services.

Our leaders in Congress must intervene to stop these cuts before access to home health is eroded any further. Members of Nevada’s congressional delegation should voice their concerns over these proposed cuts and step up to support policies such as the Preserving Access to Home Health Act (S.2137/H.R. 5159) that would prevent these disastrous cuts from going into effect next year and help protect home health benefits for many Nevadans.

Jay Heiseler is a vice president of operations for Enhabit Home Health &Hospice in Las Vegas.