Enrollment in fee-for-service (FFS) Medicare has started to accelerate in recent years, as more members of the baby-boom generation age into the program.
At the same time, the number of individual home health agencies in the U.S. continues to decline.
That’s according to the Medicare Payment Advisory Commission (MedPAC), which reported on emerging Medicare trends and the latest post-acute care figures as part of its July 2021 data book.
As far as the overall program, Medicare remains the nation’s largest single purchaser of health care, with home health care services accounting for a decent chunk of spending. Of the $3.2 trillion spent on personal health care in 2019, Medicare accounted for 23% — or $743 billion — of that total.
“While Medicare’s share of total personal health care spending was 23% in 2019, its share of spending by type of service varied, from 17% of spending on durable medical equipment to 39% of spending on home health care,” this year’s data book explained.
The Medicare Trustees and the Congressional Budget Office (CBO) both project that spending for Medicare between 2019 and 2029 will grow at an average annual rate of 6.8%. Medicare spending will reach $1 trillion in 2022 under both sets of projections.
The total number of people enrolled in the Medicare program is projected to increase from about 62 million in 2020 to about 78 million in 2030, according to MedPAC.
“Beginning in 2030, when the entire baby-boom generation will have become eligible, Medicare enrollment will continue to increase, but more slowly,” the data book highlighted.
In addition to the increased health care expenditures associated with enrollment, that projection is also somewhat alarming due to the availability of health care workers. The number of workers per Medicare beneficiary has declined from 4.6 during the early years of the program to 2.9 in 2020.
Home health providers are among the Medicare organizations that have struggled most with workforce availability, with many industry leaders citing staffing as today’s No. 1 operational challenge.
“We want to be able to take on new business, but we’re limited by what we can produce, what we can accommodate within our nursing staff,” Trinity Health At Home CEO Mark McPherson told Home Health Care News in October. “Nursing, in particular, is the area where we are struggling the most to find adequate staff.”
Number of home health agencies
There were 11,456 home health agencies operating in 2020, according to MedPAC. That total is down slightly compared to the 11,571 agencies operating in 2019.
The number of home health agencies has actually been declining since 2013. Before that, the industry had experienced several years of substantial growth in terms of new agencies opening.
The decline in agencies has been most concentrated in Texas and Florida, two states that saw considerable growth after the implementation of the home health Prospective Payment System (PPS) in October 2000.
The number of skilled nursing facilities (SNFs) is also decreasing, though not quite as fast.
In its data book, MedPAC again emphasized that most home health episodes are not preceded by a hospitalization or institutional stay, reinforcing that the home health industry has moved away from an exclusively post-acute care role.
In general, community-admitted beneficiaries are more likely to be dually eligible for Medicare and Medicaid, according to the commission. They’re also more likely to have more home health episodes and to have more episodes with a high share of aide services compared with other users coming from a hospitalization or other institutional stay.
Community-admitted users typically have slightly fewer chronic conditions and tend to be older, often living with dementia or Alzheimer’s disease.
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