Home Health & Hospice Week

Copays don’t curb utilization.

When law- and policymakers go looking for places to raise revenues, copayments for home health agency services is often a popular destination. But a new study gives the industry ammunition to fight that concept.

“We found no evidence that imposing a copayment reduced the use of home health care,” senior author Dr. Amal Trivedi, associate professor in the Brown University School of Public Health, says in a release about the study published in JAMA Internal Medicine. Instead, “what a copay policy would do is increase out-of-pocket costs for homebound seniors,” Trivedi asserts.

The study funded by the National Institute on Aging compared more than 290,000 seniors’

records, matching up 18 Medicare Advantage plans that instituted copays between 2007 and 2011 with 18 otherwise comparable plans that did not. They tallied data on home care usage in pairs of plans in the year before and the years after the copays were implemented, the release explains.

Despite costs of $5 to $20 per visit, adding up to $660 per senior, the seniors didn’t reduce their home health usage measuring by number of users, episodes, or days of care, the researchers found.

However, when beneficiaries did use more home care, they disenrolled from MA plans.

“Were a new federal copay policy to take hold, fleeing to a plan with no copay would no longer be possible,” the release says. But “the evidence still suggests that seniors would not reduce their home care usage.” Instead, they are more likely to cut back on non-medical expenses such as food, housing, transportation, and personal care.

“Seniors, particularly those who have multiple chronic conditions, spend a lot out-of-pocket on health care and face many financial burdens,” Trivedi says. A copay policy “adds to that burden without reducing utilization in a meaningful way.”

The results are “somewhat surprising” due to “a large health policy literature showing that cost sharing decreases use,” notes David C. Grabowski with Harvard Medical School’s Department of Health Care Policy, in a commentary on the study in the journal. Policymakers should be aware that copays are a “blunt instrument” that can discourage “high-value services,” Grabowski warns. Copays also may not influence home health utilization much because it is a “physician-driven service,” he adds.

See a free abstract of the study at http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2626195.