MEDICARE SPENDING: Home Health Care Payments Plummet

      Medicare spending on home health care dropped 45% during the last two fiscal years, forcing many elderly patients to spend more time in hospitals and nursing homes, the New York Times reports. According to a report by the Congressional Budget Office (CBO), home health care payments decreased from $17.5 billion in 1997 to $9.7 billion in 1999. Nearly 3.6 million people received care at home in 1997, but that figure dropped to 3 million in 1998. Officials say that the number has continued to decline, although 1999 figures are not available. Many attribute the decline to changes made by Congress in 1997 that limited payments to home health care agencies in an effort to curb Medicare growth. According to 1997 CBO estimates, Medicare home health care spending between 1998 and 2002 would have totaled $127 billion. But revised estimates now indicate that spending for those years will total $58 billion -- more than four times the savings Congress anticipated.

Cuts Threaten Care
      The cuts have forced many home health care agencies to deny services to Medicare patients, particularly those needing long term care, such as stroke patients, or those with chronic illnesses like diabetes. Noting that some agencies have adopted stricter "admission criteria," Susan Pascoe, director of home care services for Ascension Health, one of the largest Roman Catholic health care systems in the country, said, "The most needy patients, those living alone with complex needs, are being eliminated from services." If Congress fails to take action, home health care services will face an additional 15% cut next year. However, experts indicate that it is unlikely that lawmakers, particularly in an election year, will fail to address the issue. Already, Sen. Susan Collins (R-Maine) has proposed a measure that would eliminate the 15% cut. Reps. Wes Watkins (R-Okla.) and William Jefferson (D-La.) have introduced similar legislation in the House (Pear, 4/21).