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When it comes to legislation aimed at expanding at-home care initiatives, most have learned to temper expectations from the jump.
That’s part of the reason why the new, sweeping Expanding Care in the Home Act (ECHA) casts such a wide net.
When the Washington D.C.-based advocacy group Moving Health Home was formed, two of the main policy-specific changes that it targeted were hospital at home and SNF at home. Those types of programs are generally understood by legislators and the general public at this point.
“The problem that we realized quickly is there are so many services that actually surround a patient’s hospital-at-home or SNF-at-home situation that we really needed more policies to change in order to truly offer seniors the ability to stay home,” Moving Health Home Founder Krista Drobac told Home Health Care News. “So we said, ‘OK, let’s just do a catch-all bill.’”
The ECHA would create a personal care services benefit in Medicare. That would allow traditional Medicare beneficiaries – who don’t also qualify for Medicaid – the ability to receive home care services without having to pay out of pocket.
It would also increase the accessibility and affordability of home dialysis for kidney care patients; increase access to lab testing and preventive screenings; and cover care for activities of daily living (ADLs) through Medicare.
Essentially, the bill is not so much a do-or-die piece of legislation, but an overall message from united members of the home-based care ecosystem that says, “If we really want to give patients the opportunity to stay home, these are the things that have to change,” Drobac explained.
Increasing access to home-based care
One of the main benefits of the proposed bill would be an expansion of all types of care in the home, no matter the acuity level.
By increasing access for Medicare patients, home-based care providers and supporting companies stand to benefit.
“This piece of legislation starts to paint the picture that there’s more care that can be performed in the home,” Kevin Riddleberger, co-founder and chief strategy officer at DispatchHealth, told HHCN. “All the way from low acuity to high acuity and last-mile services.”
The Denver-based DispatchHealth is an in-home medical care provider that serves over 50 markets across the U.S. The company has raised over $700 million in funding to date.
DispatchHealth’s vision, Riddleberger said, is to be able to deliver care in the home, whether it’s through its own services or its partners.
To that point, advocates believe the bill would create more avenues for partnerships, and for overall growth.
“This certainly provides more flexibility for us to add on services moving forward,” Riddleberger said. “The one that aligns with us well is in-home diagnostics. Today, we’re able to perform portable imaging studies and X-rays inside the home and can bill for that technical component, but there are transportation fees on top of that to be able to deliver that care.”
Under the ECHA, providers like DispatchHealth would be able to bill those transportation fees and ultrasounds to Medicare.
Home infusion, after all, is another major pillar of the proposed bill.
“If you take a closer look at what’s in the bill, these are things that really could and should be done in the home,” Drobac said. “If you have pneumonia as a senior, you have to stay in the hospital to get an infusion. My mom was in the hospital for three weeks with pneumonia when she could have been at home.”
While expanding these services into the home is a clear benefit to providers, it’s also convenient for patients.
“If you take a typical senior, having them go get their lab drawn or to get infusion services, it’s not an easy task,” Riddleberger said. “Depending on the day, their mobility or transportation situation, that could be a three- to five-hour process. This provides more flexibility for seniors to be able to receive greater access to these types of services.”
The bill doesn’t just push for more care types in the home, it would also help cover the costs involved with that care.
For instance, Doug Robertson — director of health care regulation and compliance at Right at Home — pointed to the travel and mail costs that come with in-home labs.
“This addresses not only in-home infusion services but also allows certain test results to be conducted, and then have those lab results shipped to a processing center where they would be able to evaluate the labs,” Robertson told HHCN. “There needs to be reimbursement for travel costs and mail costs associated with in-home labs. Medicare does not pay for that currently. Home dialysis needs to have Medicare reimbursement for staff assistance as well. This bill would do that.”
Right at Home is an Omaha, Nebraska-based home care franchise company with over 600 locations in the U.S.
The bill would also address staffing, which is top of mind for almost all home-based care providers today.
“A lot of this is about the workforce,” Drobac said. “The workforce has to be ready to be in the home and we have to give them more opportunities. For example, one of the main reasons that people aren’t using in-home dialysis is because there’s not the staff to support it. We talked a lot about the patients, obviously, but this is also about the caregivers and the people that have to stay in the hospitals with them.”
The bill would provide grants to home health agencies, health systems and other organizations to help build the pipeline for caregivers and also create a task force for nursing certification standards for home care.
Potential cost savings
Whenever new legislation is introduced, one of the chief concerns is whether it will save or cost money.
There is optimism that this proposed bill could lead to savings.
The ECHA has a targeted benefit that would allow for a maximum of 144 hours of ADL assistance for Medicare beneficiaries.
This part is key, Robertson said, because it targets those who don’t qualify for Medicaid, but also don’t have an income level that exceeds 400% of the federal poverty level.
“ATI Advisory and Long Term Quality Alliance discovered that Medicare beneficiaries with two functional impairments cost Medicare $26,000 a year, nearly twice as much as someone without functional impairment,” Robertson said. “If you can get some assistance with ADLs to this frail demographic shortly after discharge from a hospital — which this bill would do — you might be able to make sure that they have nutrition in the home, give them the reminders to take medication, assist them with bathing and dressing and be there to potentially save them from a fall. All of these add up and [patients] can avoid emergency room visits and hospital readmissions.”
That would also create new clients for home-based care providers.
“It opens up a new opportunity to gain clients that we don’t currently have,” Robertson said. “Because folks that have less than $78,000 worth of income who don’t qualify for Medicaid, they’re not going to be able to pay out of pocket for these various services. They’re going to need assistance, which Medicare would do if this bill were to pass.”
The bill’s future
There’s still a long road ahead for the ECHA.
The hope is that, because it is so wide-ranging, at least some of its provisions will pass.
“The likelihood of that it’s really unknown,” Riddleberger said. “You don’t know what the tenor is going to be when you go to D.C. and go on these types of lobbying trips. Especially coming out of the pandemic, some of us were wondering if we would hear legislators use the tone of resorting back to our traditional ways of delivering care. And I heard the opposite. Whether it was from a telehealth perspective or the positive feedback from the hospital-at-home waiver program, I was pleasantly surprised by the awareness of what we’re trying to accomplish.”
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