Does the Left Hand Know What the Right Hand is Doing?

According to the Census Bureau, the number of Americans aged 65 and older grew by 900,000 between 2009 and 2010. For the same year, the American Health Care Association reported that the number of nursing facilities in the United States dropped by nine. Granted, nine isn’t a very big number, but why is the number falling at all when our population of older people is rising so dramatically?

A recent article in the New York Times explains that this odd discrepancy is in part a result of financial pressure on facilities that care for residents who receive Medicare and Medicaid. The other part is a growing consensus among health care professionals that the 24-hour care provided by nursing homes is more than many older patients need.

So where are these patients getting the care they do need?

Some combination of community- and home-based care seems to be the answer. As Jason A. Helgerson, the Medicaid director for New York State says, “If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it’s a lower cost to taxpayers.”

Examples of federal government support for this shift are the Community First Choice Option for Medicaid and the Independence at Home Demonstration Program for Medicare.

States that participate in the Community First Choice Option receive a six percent increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution. The Independence at Home Demonstration Program encourages primary care practices to provide home-based care to chronically ill Medicare patients.

If all of this is true, then the question of the day is, “Why is the federal government gutting the home medical equipment (HME) sector?”

People who are chronically ill or who have mobility issues need more than care to remain independent and safe at home. They also need medical equipment like oxygen concentrators, wheelchairs, and infusion pumps.

According to information gathered by the American Association for Homecare, VGM, and other groups in the HME sector, more than 450 HME providers have closed locations, been sold to other companies or gone out of business entirely since the Centers for Medicare and Medicaid Services (CMS) implemented its bidding program in 2011.

Ostensibly designed to cut costs, the program has in fact made a mockery of market-based capitalism. A forced contraction in a sector that is experiencing increased demand defies logic. Add to that CMS’ claim that patients aren’t experiencing any negative effects, like reduced access to equipment and service, and your average reasonable person has to start wondering what the true goal of the bidding program really is.

However, before we subscribe to any sort of conspiracy theory, it might be worthwhile to keep in mind an adage that goes back at least as far as the 1700’s: Never ascribe to malice that which is adequately explained by incompetence. Or, in other words, does the left hand know what the right hand is doing?