Dealing With The Reimbursement Issues By The Home Care Agencies

It requires a lot of resources and funds to provide the proper care to the older adults in any setting, whether it is in the hospital or in the homes of the patient. Typically, the home health care agencies need such resources and money even more in the forms of:

• Highly trained and dedicated home care nurses and aides to provide proper care and meet with the expectations of the patients and their families
• A properly trained and knowledgeable backend support staff to provide the required assistance to the hone caregivers, the patient as well as their families
• The proper tools and equipment to provide the care services just as required and recommended by the physician and
• Continual training to keep updated with the latest developments and changes made in the et guidelines for providing better home health care to the older adults.

All these need a lot of money and the prices they charge for their services is simply not enough. Therefore, the reimbursement issue has always been the primary concern of all home care agencies. In such a situation it is only the government sponsored programs that can come to the rescue of a home care agency allowing them to make up for their spending. 

The government-sponsored programs

According to research, the government sponsored programs ideally make up more than 52% of the entire amount spend by the people on healthcare. This therefore is one of the major sources of funding for the home care agencies.

It is all due to the ever-evolving US health system that has now reached an imperative juncture. According to the current scenario, it is found that:

• The Affordable Care Act or the ACA is yet to clear the latest legal hurdle to become the law of the land and even
• The 50^th anniversary of Medicare is also not helping the home care agencies in any way or the US population to become the healthiest in the world.

This remains the fact even though the people spend far more on their healthcare in the US as compared to any other nation. In fact, the US is ranked 42^nd in life expectancy at birth. What is even more alarming is the fact that US healthcare features at the last among a number of other developed countries in terms of other aspects of healthcare that include:

• Efficiency
• Quality and
• Accessibility to healthcare.

When it comes to home health care services, the points are even more critical. Ideally, the entire health system in all its forms has now reached to a point where for the first time the government sponsored programs now make up the major part of the healthcare spending in the US amounting to about 52%. 

Therefore, it can be concluded from these facts that the role of the government in the US health system is very important and has been steadily increasing for decades. It is also expected by the critics and experts in the industry that this trend will continue till 2023 which has typically started in the 1960s.

Reasons for such a situation

Now the question is how exactly did the health care and home care system reach to such a vulnerable position which has even put the existence of several home care agencies into jeopardy.

• Yes, it is ideally the ACA that literally pushed the US health care and home care industry to such a situation to reach the 50% mark. However, this is true only in the existing and well-established practice of filling the private gaps that exists within the taxpayer-funded public programs.
• Another significant reason is more historic. This is that the nation has mostly relied on its employers as the most significant and primary source of health insurance. Moreover, the Employer Sponsored Insurance or ESI was also exempted from income tax and wage controls specially to avoid labor strikes after the World War II.

However, over time, the governments have rooted this war-time tax policy in order to sustain the purchase of private insurance. 

According to a few specific researches it is seen today that more than 170 million people, which is about half of the entire population of the country, get their health insurance through an employer.

 It is ideally this specific approach that has resulted in and left a few significant gaps in the US health coverage. It is these gaps that are ideally filled up with the help of the many different government sponsored programs that has been created in the past few decades.

The final opinion

Today, in opinion, the elderly population has grown significantly as compared to that in the 1960s. this fact has made it very clear that neither the older citizens can afford to pay for their need health care, nor can the home care agencies afford to continue delivering home health care of the highest of standards on a continual basis. 

Therefore, the payment and reimbursement for such care services therefore remains the pertinent and constant issue, which is why these government programs were created.

• The Medicare programs was established which now covers nearly 54 million older adults and disabled American citizens and at the same time.
• Medicaid programs were also launched on the other hand as a so-called “safety-net” program and aimed to provide coverage to pregnant women, disabled people, older adults with low income and families with children.
• Apart from Medicare and Medicaid there is also a Children’s Health Insurance Program called CHIP available now that covers over 70 million children and adults.

Finally, the ACA’s Medicaid expansion has also helped to deal with the reimbursement issues in home care adding another 11 million persons to their specific program.

Medicaid is actually the largest single payer for births, personal care, maternity care, long-term care and even for mental health services. In some of the states, Medicaid even covers more than 65% of the expenses of all nursing home stays.

Therefore, the true scope of the health and home care programs of today though helpful needs to be well understood by the people.