Did Anyone Notice?

The recently-enacted Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has been hailed by the medical community, patient advocates and the general public – and for good reason.  It is evidence that, notwithstanding many observers’ hand-wringing about “gridlock,” Congress can and does engage in substantive, bipartisan work.

That said, one provision within MACRA seems to have escaped the notice it deserves.

Section 210 of MACRA extends the Medicare rural home health safeguard in order to protect access to skilled home healthcare services for homebound seniors residing in rural parts of America. Medicare currently provides a “rural safeguard” payment of three percent to providers operating in rural communities to account for the higher transportation and related costs associated with treating patients in remote areas.

Without action by Congress, however, this safeguard was scheduled to expire at the end of this year.

Fortunately, the looming loss of this safeguard prompted action in both chambers and by members of both parties.  Many mobilized to seek extension of the rural safeguard, with Congressman Greg Walden (R-OR), Congressman Tom Price (R-GA) and Senator Debbie Stabenow (D-MI), along with the key Committees and Leadership offices, most directly involved.

Thanks to their efforts, MACRA formally extends the three percent rural home health safeguard through the end of 2017.

While three percent may not seem like a significant amount, it’s essential once you consider the higher operating costs associated with treating patients in rural areas.  For example, data show that the transportation costs borne by nurses as they travel to the homes of patients in rural communities are nearly 30 percent higher when compared to transportation costs in urban areas.

While technology has closed the virtual distance among us, those who proudly call rural communities home continue to face many challenges and disparities – particularly related to healthcare – that their urban counterparts do not.   For example, healthcare facilities that have historically been available in rural communities are rapidly disappearing due to the combination of higher operating costs and reduced Medicare funding. In fact, according to the National Rural Health Association, more than 470 rural hospitals across the country have closed their doors over the past 25 years because of waning reimbursement.

While it is widely regarded that our healthcare system is unprepared to meet the needs of America’s growing senior population, it is in even greater peril in rural America. A rapidly aging Medicare population is taxing an already stretched healthcare infrastructure. And although nearly a quarter of the U.S. population lives in rural areas, only about ten percent of physicians practice in rural communities.

These factors have made home healthcare even more crucial to rural communities, and they underscore why Congress’ action to extend the rural home health safeguard was so important.

To a significant and expanding degree, home healthcare is rural healthcare.  Home health services are meeting the needs of a growing population of seniors in rural communities who require the care of nurses and therapists. Home healthcare provides a clinically-advanced and cost-effective solution for patients who would otherwise have to leave the communities and travel great distances to receive treatment in more costly institutional settings. Skilled home health clinicians have also allowed thousands of our parents and grandparents to remain in the safety and dignity of their homes, all at a significant savings to taxpayers.

Nationwide, approximately one-fifth of home health agencies are dedicated to serving seniors in rural areas, who data by Avalere Health show are among the most vulnerable seniors in the Medicare population. In addition to residing in typically underserved areas, these Medicare home health beneficiaries are documented as being older, poorer, and sicker than the Medicare beneficiary population as a whole.

Congress deserves to be commended for the action it took in MACRA to protect rural seniors and disabled Americans. By extending the Medicare rural home health safeguard, lawmakers not only demonstrated that Congress can and does engage in substantive, bipartisan work – they did so in a way that ensures the delivery of quality care to America’s most at-risk patients.

And that deserves to be noticed!


Eric Berger is CEO of the Partnership for Quality Home Health, a coalition of community- and hospital-based skilled home healthcare agencies dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of skilled home healthcare for our nation’s seniors.

Morning Consult