STUDY SHOWS HOME HEALTH CARE WORKERS DRIVE NEARLY FIVE BILLION MILES TO SERVE ELDERLY AND DISABLED PATIENTS

Nurses, therapists, home care aides, and others who serve elderly and disabled patients in their own homes drive nearly 5 billion miles each year. Caring for nearly 12 million patients annually with 428 million visits, the dedicated providers of home care and hospice services are health care’s version of “road warriors.”

The study showed that the number of miles driven reached 4.8 billion miles in 2006. With the expansion in the use of lower-cost home care services as the average age of the U.S. population rises, the estimated miles driven for 2008 should well exceed 5 billion.

Recent reports have surfaced in both national and local media describing the impact that rising gas prices has had on services to the elderly and disabled in their homes. In a June 5, 2008 online Wall Street Journal article, gas prices are blamed for creating a high risk that a “largely invisible population” will become victims as home support services face increasing transportation costs to deliver care.

With home care and hospices services delivered to the homebound elderly and disabled primarily through individual automobile-based travel, it is no surprise that the impact of rising fuel prices has been quick. Reports from all parts of the country that providers of home care have curtailed service areas to reduce driving, closed off care access in remote parts of a state, sustained the loss of caregiving staff who cannot afford commuting costs, and reduced face-to-face visits to patients to conserve limited resources. At the same time, these providers report that their patients cannot afford to travel to physician offices or diagnostic testing sites for needed care beyond that provided in their homes. These changes in patient service make home care even more essential as the primary caregivers.

Putting the miles driven in perspective highlights the magnitude of the undertaking in home care. The annual miles driven by the nurses, therapists, aides and others is the equivalent of 1,386,458 trips across the USA at its widest latitude, 192, 920 times around the Earth, 10,017 roundtrips to the moon, and 52 trips to the sun. UPS, an international delivery service, drives just over 2 billion miles every year globally.

While health care costs in general continue to rise, increasing gasoline costs (cost per gallon rose over $1 in the last year alone) has led to accelerating transportation costs for those caregivers traveling to their homebound patients. This study reviewed the number of miles driven by home health agencies, hospices, and other providers of in-home health care services. Most of this care is funded through Medicare and Medicaid programs where fixed payment rates have not been adjusted to accommodate the ever-increase cost of gasoline.

Increases in other expenses, such as insurance, salaries, and supplies, have also been on the rise. Further, in January 2008 the Administration imposed a regulatory cut of 2.75 percent on Medicare home health payments, nearly negating the market basket inflation update for this year. The Administration plans additional, similar cuts to home health payments in 2009, 2010, and 2011.

Small rural agencies have been some of the first to feel the brunt of increasing costs; as agencies in adjacent areas close, those that remain are unable to fill the service gaps that have been created. Access to home health services, particularly in remote areas, is increasingly threatened.

The findings underscore the need for a series of actions to address the growing crisis in home care. It is recommended that Congress take action now through the following steps to preserve access to home care and hospice services:

1. Commit to preserve the annual inflation updates for home health and hospice as provided under Medicare law;
2. Reinstate the 5 percent rural add-on for home health services delivered to patients residing in rural areas;
3. Require the Secretary of Health and Human Services to revise the method for calculating annual market basket inflation updates and establish a temporary fuel cost add-on;
4. Recognize home telehealth interactions as bona fide Medicare home health services;
5. Retract the Medicare regulatory cuts of nearly 12% facing home health care in 2008-2011;
6. Withdraw the Medicare regulatory proposal to eliminate the Budget Neutrality Factor in the hospice wage index; and
7. Grant home health providers priority access to fuel and supplies through “first responder” status in cases of public health emergencies and disaster situations.

In late 2000, as part of the Benefits Improvement and Protection Act (BIPA), Congress enacted a 10 percent add-on for care delivered in rural areas between April 2001 and April 2003. As part of H.R.1, The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the Congress restored the rural add-on at a 5 percent rate for the April 2004 through March 2005 period. In early 2006, Congress approved legislation (S. 1932, Public Law 109-362) to provide a reinstatement of the 5 percent payment differential for calendar year 2006. During 2007 legislation was introduced that would reinstate the 5 percent rural add-on, and, as part of H.R. 3162, the full House of Representatives approved a two-year extension of the 5 percent rural add-on for 2008 and 2009, but no further action was taken. The 5 percent payment differential expired at the end of 2006.

Here are some facts about rural home care services:

• Nearly one-fourth of U.S. citizens reside in rural areas.

• On average, about 23 percent of residents in rural areas are Medicare beneficiaries, as compared with 20 percent of residents of urban areas.

• Despite an overall growth in the number of home health agencies nationwide, rural areas of the country are not, generally, the beneficiaries of this growth rate. For example, Montana had approximately 65 home health agencies in 1996; the state currently has 36 licensed agencies. In Montana, there are 29 counties that do not have a home health agency, and residents in 14 of these counties (as many as 30 percent of the state’s population) have no type of home care services available.

• Rural home health agencies generally are smaller in terms of patient census and are less able to benefit from economies of scale. A rural agency with a small patient census is less able to sustain losses from higher cost patients. Rural agencies, on average, must travel farther per visit to deliver services. In addition, much rural travel is not “highway miles,” but on dirt and gravel roads, adding to mileage costs and general wear and tear. Inclement weather only increases the difficulties of service delivery.

Both Sens. Max Baucus (D-MT), chair of the Senate Finance Committee, and Charles Grassley (D-IA), ranking minority member, have recognized the need for maintenance of the annual inflation update for home health payments; they have also developed legislative packages that support reinstatement of the home health rural add-on. This study, which provides detailed analysis of miles driven by home care providers to deliver vital services, underscores the need for preservation of home health’s inflation update AND reinstatement of the add-on that was previously available for services to patients in rural areas.

The study results are set for below and are also available at www.nahc.org.

Miles Driven by the Home Health Care Industry

It is estimated that the home health industry drove over 4.78 billion miles in 2006. This includes home health and hospice care funded by the Medicare and Medicaid programs, other government programs, private insurance, and self-paid care.

Miles Driven by the Home Health Care Industry in 2006: National and State-Level Mileage

The data above were calculated from over 4,200 Medicare cost reports, as well as through an online survey of 1200 home care providers. From the cost reports and survey responses, NAHC calculated the average miles per visit on a state specific basis by dividing mileage costs by the IRS per mile set reimbursement rate.

Data from the 2006 Healthcare Information Set (HCIS) from the Centers for Medicare and Medicaid Services (CMS) and the CMS National Health Expenditures (NHE) survey data (2004) were used to calculate the home care and hospice visits made by agencies. The number of visits was provided for home health, and the number of covered days was provided for hospice, which was converted to “visits” based on an assumption of a 1:1 ratio. Non Medicare home care visits were calculated based on spending data for such care compared to average spending per visit.

Total visits were then multiplied by the state estimates for miles per visit. These were added together for a national estimate.