WASHINGTON—In-home care brings value to patients and taxpayers and should be expanded—but instead, it’s facing drastic cuts, Empath Health CEO Jonathan Fleece told members of Congress at a hearing.
“Home-based care isn’t just for those actively dying,” he said. “It supports people managing chronic illness, recovering from surgery, navigating terminal diagnosis. Patients want it, families need it and taxpayers benefit. Keeping patients at home prevents costly hospitalizations and reduces strain on the health care system today. In a time of financial and workforce challenges, we should be expanding access to care at home, not cutting it.”
Fleece and other long-term and senior care advocates testified Tuesday before the House Ways and Means Subcmmittee during a hearing titled “After the Hospital: Ensuring Access to Quality Post-Acute Care.” They answered questions about access to post-acute and long-term care, especially in the face of proposed cuts to Medicaid that could tally $880 billion.
“Medicaid is the primary source of payment for long-term services and supports in this country,” said Rep. Judy Chu of California. “It is impossible to ensure quality care while gutting the very program that pays for long term care services for roughly 9.3 million older adults and people with disabilities.” (Watch the full hearing.)
Fleece said there were a wide range of pressures on homecare providers, including staffing pressures, reimbursement cuts and administrative and other burdens posed by programs like the Patient Driven Groupings Model (PDGM) and Medicare Advantage. He also called out the Hospice Special Focus Program and other threats to hospice care, specifically.
“Many hospice providers are also under immense pressure—thin margins and excessive audits, while other hospices work to actively dodge fraud detection and enforcement, and profit from this tactic. While legitimate providers face intense scrutiny, bad actors continue to exploit the system,” he said.
Late in the hearing, he responded to another speaker who had mentioned that some agencies achieve high profit margins.
“I am hard pressed, hard pressed to find a lot of homecare agencies as identified by MedPac with 20-plus-percent margins,” he said. “We’re operating at 2%—that’s 2%—net operating margin across Empath Haealth and the care continuum and our home health care division is operating at a net loss.”
Dr. Steve Landers, CEO of the Alliance for Care at Home, thanked Fleece for speaking and the committee for holding the hearing, which he said “provided an opportunity to amplify the voices of home health and hospice providers and reinforce the essential role they play in delivering high-quality, patient-centered care in the setting people prefer—at home.”