[Updated] ‘Consumer Driven’ Choose Home Bill Could Pull 35% of Patients Away from SNFs

Of the two million patients admitted to nursing homes every year, an anticipated 35% could be diverted to home health care if the Choose Home Care Act of 2021 becomes law, according to Keith Myers, chairman and CEO of LHC Group.

Myers, along with Visiting Nurse Health System CEO Dorothy Davis, spoke about the legislation during Home Health Care News’ FUTURE conference last week.

“Those [700,000 patients] would become home health beneficiaries and added to the 3.3 million that we have now,” said Myers. “From a spending perspective, the SNFs spend currently is around $28 billion, and home health is $10 [billion]. Choose Home, if you do some quick math over a decade, could shift that dynamic where home health spend is higher than SNF spend.”

Choose Home was introduced to the House early Friday morning, led by Democratic Rep. Henry Cuellar and Republican Rep. James Comer; the bipartisan team are currently building co-sponsors for the bill, Myers added.

There continues to be “significant momentum” on the Senate side, led by Sens. Todd Young (R-Ind.) and Debbie Stabenow (D-Mich.).

Myers expects Congress will add the bill into a reconciliation or year-end package, or possibly moved to another package next year.

“With the momentum we have now, and engagement from leadership in both the House and the Senate, we feel pretty good about it,” Myers said. “Reconciliation may be a little bit of a stretch, but we feel really good if we talk about a year-end package.”

Davis and Myers run primarily home health care businesses out of Georgia and Texas respectively, while also offering hospice and palliative care service lines, among others.

The bill was introduced in the Senate toward the end of July, creating an add-on payment to traditional Medicare home health benefits for patients 30 days after their hospital discharge. A bipartisan effort, the legislation would give Americans more choices of where to recover following a hospital stay.

“To me this is a consumer-driven direction,” Davis said of the bill. “I think COVID has certainly accelerated it. I think about Choose Home really for our Medicaid waiver population — that population that we’re serving, about 5,000 are nursing home eligible and we’re keeping them at home through activities of daily living.”

One third-party analysis conducted by Dobson DaVanzo Health Economics Consulting found the bill could save Medicare $247 million annually; Myers added the bill also saves consumers $1 billion dollars in co-pays that would “go away.”

It’s also what Medicare beneficiaries want — about 94% of beneficiaries, nine in 10, prefer to receive post-acute care in the home rather than in a skilled nursing facilities, according to a September Morning Consult poll.

When asked about pushback from SNF operators and their associations regarding the legislation, Myers said he doesn’t think this is a bad thing for nursing homes, adding that they can take higher acuity patients, prospective residents that hospitals need to discharge but aren’t the right fit for home health.

“Those beds that had those [700,000] patients are going to be filled with higher acuity patients, many of them coming from hospitals who are trying to move their low acuity patients out and fill their beds with high acuity patients,” explained Myers.

Ignite Medical Resorts CEO Tim Fields said home health is a “complement” rather than a competitor, during SNN’s RETHINK conference in September. Ignite has taken on higher acuity patients, Fields confirmed, adding that industries across the care continuum have had to “step up their game.”

In a July statement, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) argued that the legislation neglects to clarify quality and safety provisions, supplants existing benefits, creates duplicative payments, confuses beneficiaries and increases out-of-pocket costs.

“We need proposals that add options to Medicare beneficiaries, not limit them,” AHCA/NCAL added in its statement.

LeadingAge, representing more than 5,000 nonprofit operators, supports Choose Home as it gives seniors more choice with their Medicare benefits.