MEDICARE HOME HEALTH CARE PAYMENT REFORM—A SYSTEMATIC REVIEW

摘要

Medicare Home Health Care (HHC) provides in-home post-acute care for beneficiaries with a skilled care need. Home health care has been shown to be more cost effective and to be a major predictor of long-term health outcomes. However, the HHC reimbursement structure has been subjected to major reforms which authorized the rebasing of home health payments, ultimately affecting both providers’ ability to deliver health care and utilization of services by beneficiaries. The Balanced Budget Act and the Affordable Care Act both mandated rebasing changes to the Medicare HHC reimbursement structure generating substantial provider payment reductions. Current literature lacks a comprehensive review of the policy changes that occurred under these two acts. A systematic review of the peer-reviewed research literature was conducted for articles published between 1997 and 2017 with a focus on reimbursement policy. The following search terms were used: (1) “home health care” or “home health” or “home health care agencies”, (2) “payment reform”, “payment reduction”, “rebasing”, (3) “reimbursement structure”, “reimbursement changes”, “reimbursement reform” and (4) “Medicare policy”, “policy”, “legislation”. Forty papers that focused on reimbursement changes were included. These papers described seven major payment reforms that mandated changes to the HHC reimbursement structure, the impact of these changes on service delivery and beneficiary use, and their proposed and unintended consequences. The results of this systematic review will inform future policy changes and enhance our understanding of how policy may affect access to home health services by vulnerable Medicare beneficiaries.