A Decline in Home Health and Long Term Care Providers

Hello and Happy birthday Medicare and Medicaid. You are now 56 years old. Medicaid was never supposed to be long-lasting or a primary insurance that it has become. Over 81 million citizens rely on Medicaid. President Lyndon Johnson signed both landmark social programs into law on July 30, 1965.

I have two newsflashes to discuss today. (1) Nursing homes will be targeted by audits because few surveys occurred during COVID, according to a newly published OIG Report; and (2) long-term care facilities, in general, are decreasing in number while the need escalates.

First, the OIG, Addendum to OEI-01-20-00430, published July 2021, “States’ Backlogs of Standard Surveys of Nursing Homes Grew Substantially During the COVID-19 Pandemic,” which is an audit of a mass number of nursing homes across the country.

Nationally, 71 percent of nursing homes (10,913 of 15,295) had gone at least 16 months without a standard survey as of May 31, 2021. By State, the backlogs for standard surveys ranged from 22 percent to 96 percent of nursing homes. Expect a surge of standard audits.

Insert chart.

Second, enrollment in fee-for-service (FFS) Medicare and Medicaid has skyrocketed in recent years, especially due to COVID and longer life-expectancies. This equates to more consumers. It means a need for more providers willing to accept the low reimbursement rates offered by Medicare and Medicaid. More providers plus more consumers equals more RAC and MAC audits. 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.

There were 11,456 home health agencies operating in 2020. 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. The number of skilled nursing facilities (SNFs) is also decreasing, though not quite as fast.

My humble opinion? The government needs to be more aware of how aggressive Medicare and Medicaid auditors are. How overzealous. Congress needs to pass legislation to protect the providers who accept Medicare and Medicaid. Like the military, we should be saying, “thank you for your service.”

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on August 2, 2021, in Federal Government, Federal Law, Health Care Providers and Services, Home Health Care Agencies, Home Health Services, Knicole Emanuel, Long Term Care Facilities, Medicaid, Medicaid Attorney, Medicaid Audits, Medicaid Providers, Medicare, Medicare and Medicaid Provider Audits, Medicare Attorney, Medicare Audits, Nursing Homes, Office of Inspector General, RAC Audits and tagged , , , , , , , , . Bookmark the permalink. 1 Comment.

  1. I respectfully disagree. I cannot imagine anyone with a loved one in long term care complaining about the inspections being “overzealous” and “aggressive.” It is simply too tempting to cut corners in the care of the elderly and disabled for those wanting to make more of a profit. Please do not compare the military members with healthcare workers. I have been a health care provider for over thirty years. Never have I been endangered by an IED. I have been endangered by infectious diseases and dangerous patients. I understand that these risks come with the territory. Keep on inspecting, Medicare and Medicaid. Our lives depend on it.

Leave a Reply

%d bloggers like this: