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Our Mental Health Crisis is Getting Worse. New 988 Suicide Hotline Can be our Fresh Start.

USA Today | Dr. Jerome Adams

This column contains discussion of suicide. If you or someone you know might be struggling with suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255.

Before COVID-19, nearly 40 million people in the United States were identified in 2019 as having mental illness. Worse, fewer than half (45%) received treatment. The stress of the pandemic has exacerbated this crisis, with isolation, stress and worsening access to treatment. 

Across the country, mental illness and suicide rates are high and rising. Approximately 20% of adults reported in 2020 that they suffered from mental illness, and the share of adults reporting anxiety or depression disorders spiked to over 41% last year.

Deaths attributed to suicide

About 47,500 deaths were attributed to suicide in 2019, compared with more than 38,000 in 2010, according to the Centers for Disease Control and Prevention.

Mental illness and suicide are particularly pronounced among young people and those in rural areas. In rural America, higher suicide rates are further compounded by even greater challenges in accessing care.

Let's go nationwide: Our clinics meet mental health needs and lighten the load on law enforcement

July's launch of 988, a new mental health crisis response number, marks a historic opportunity to ensure that the growing number of people in crisis can get appropriate and more equitable access to mental health services – and that our broader emergency response infrastructure (which includes 911, emergency medical services and law enforcement) can guide people to the right places, at the right times.

By July 16, all telecommunications carriers must provide access to 988, which will direct calls to the National Suicide Prevention Lifeline, a switchboard that provides free crisis counseling and emotional support to more than 2 million callers a year and connects them to one of more than 180 crisis centers nationwide.

The new, easy-to-remember 988 will provide an alternate access point into care and help keep people in crisis from needlessly cycling through hospital emergency rooms and the criminal justice system. It will also provide minority communities that are often fearful of calling 911 for a loved one in mental health crisis, an option less biased toward a response based solely in law enforcement…

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Approaches to Improving Medicare’s Home Health Benefit: Lessons from Medicaid

The Commonwealth Fund

Medicare’s home health benefit is crucial to the welfare of beneficiaries, but its application in providing personal care leaves much room for improvement in terms of service availability and equity.

Drawing on insights from Medicaid programs’ experiences in providing personal care services, we found that: 1) a systematic approach to the referral and provision of personal care services is necessary to support equitable access; 2) separating the assessment and care plan development from the service provider helps to eliminate conflict in payment incentives; and 3) a fairly compensated direct-care workforce is required. While Medicaid programs help to fill gaps in Medicare’s coverage, restrictive and varying eligibility requirements limit its role.

Introduction

The Medicare home health benefit is designed to enable beneficiaries to receive care in their homes after hospitalizations or other acute events or for ongoing needs. It covers skilled services such as nursing and physical therapy, as well as home health aide services, including help with personal care activities like bathing, dressing, grooming, feeding, and getting around.

In practice, however, the home health benefit is falling short of its potential. Many beneficiaries are not aware of the benefit at all, many providers do not order these services for their patients, and home health agencies often do not provide the full range of services. Medicare home health visits have declined steeply over the past 20 years, and payment incentives affect who is served and how (Exhibit 1). Moreover, racial and ethnic disparities in access to these services have been documented for patients with postacute needs. When Medicare does not cover home health services, the burden of finding and paying for them is borne by individuals and their family members — often to the detriment of their health and finances.

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Geographic Variation in Medicare Home Health Expenditures

Am J Manag Care. 2022;28(7):In Press

ABSTRACT

Objectives: To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation.

Study Design: Retrospective study design analyzing US counties in which at least 1 home health agency served 11 or more beneficiaries in 2016. Several sources of 2016 national public data were used.

Methods: The key variable is county-level Medicare home health expenditures per home health beneficiary. Counties were grouped into quintiles based on per-beneficiary expenditures. Analyses included calculation of coefficients of variation, computation of the ratio of 90th percentile to 10th percentile in expenditures, and linear regression predicting expenditure. The control variables included characteristics of patients, agencies, and communities.

Results: Significant variation in home health expenditures was identified across county quintiles, with a 90th-to-10th-percentile expenditure ratio of 2.5. The percentage of for-profit agencies in the lowest quintile was 15.7 compared with 81.7 in the highest quintile of spending. Unadjusted spending differed by $3864 (95% CI, $3793-$3936), compared with $3611 (95% CI, $3514-$3708) in the adjusted model, between counties in spending quintiles 1 and 5. Although state fixed effects explained nearly 20% of the variation in home health expenditures, 42% of the variation remained unexplained.

Conclusions: Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed.

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What Home Health Providers Can Learn From Hospice OIG Audits

Home Health Care News | By Patrick Filbin

The home health industry should keep its collective eye on the U.S. Department of Health & Human Services Office of the Inspector General’s (HHS-OIG) recent audits on the hospice industry, because it soon could be next.
 
As the home health space continues to grow, federal oversight and the scrutiny attached to the industry have grown with it.
 
Experts at Husch Blackwell have followed this trend through the hospice industry, and have gleaned knowledge from that.
 
“As we have been following and reporting on those hospice audits, the OIG has been looking at the home health space as well,” Bryan Nowicki said this week on a podcast episode of Hospice Insights. “They’re very similar in overall structure with what we have been working on with hospice. They’re looking for certain kinds of errors that they’ve identified as being recurring or ‘top of mind’ in the home health field.”
 
When the OIG first began its hospice audits in 2021, the office was looking for things like whether beneficiaries met the definition of being confined to a home; whether they were truly in need of skilled services; whether the OASIS information was being submitted in a timely fashion; and whether services were properly documented.
 
Those were the four priorities being reviewed by the OIG, Nowicki said. Now the OIG is cranking up those efforts and focus areas, this time for home health agencies.
 
“Frankly, those are pretty recurring issues in home health,” Nowicki said. “We would expect more of the same, but [the audit process] is going to be guided by what they actually find. Audits are happening now and the OIG’s goal is to begin issuing final audit reports and publishing them on their website in 2023.”
 
Unlike many audits, results from the OIG audits are made public, which creates even more anxiety from the industry, according to Husch Blackwell attorney Meg Pekarske.

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