AOTA member researcher testifies to Congress on serious home health access issues in rural areas
AOTA member Tracy Mroz, PhD, OTR/L, FAOTA, University of Washington, presented testimony at a Congressional hearing and formally responded to questions posed by Senators on the vital role that home health plays on aging in place. She noted that home health access issues are especially acute in rural areas where less than 60 percent of Medicare beneficiaries who have a planned discharge from a hospital to home health ultimately receive that care. She also noted that even when rural residents are admitted to home health, many face disparities in access to rehabilitation services compared with beneficiaries in urban areas.
Mroz, an associate professor in the Department of Rehabilitation Medicine at the University of Washington School of Medicine, spoke before the Senate Finance Committee's Subcommittee on Health Care and formally responded to questions posed by Senators during that hearing. Congress is considering how home healthcare can support aging in place for the 3 million Medicare beneficiaries who use this benefit annually, and Mroz was invited to testify based on her experience as a health services researcher with a focus on home health care in rural areas.
Mroz has studied rural healthcare for more than a decade as an investigator with the Washington-Wyoming-Alaska-Montana-Idaho (WWAMI) Rural Health Research Center and the Center for Health Workforce Studies, both funded by the Health Resources & Services Administration. Her clinical background as an OT informs her research agenda based on her firsthand experience in helping older adults to regain their ability to care for themselves, maintain a household, and participate in work and leisure.
During her testimony, Mroz reported that beneficiaries in the most remote communities face significant home health access challenges related to workforce issues driven by travel times and recruiting and retaining staff. She also noted that the sunsetting of a special add-on payment to home health agencies for serving rural beneficiaries may exacerbate these challenges. "Rural agencies may refuse referrals for new admissions when they don't have adequate capacity," Mroz said, "so it's perhaps unsurprising that there's a growing body of evidence on rural-urban disparities in access to home health."
In her response to written questions from Senators, Mroz discussed changing current Medicare home health policy that OT cannot be ordered unless nursing or other therapy services are simultaneously ordered at the start of care which creates an unnecessary barrier for receiving OT services in the home. She explained that this restriction can reduce access to OT services for beneficiaries with certain conditions such as low vision, dementia, diabetes and COPD who may not also require nursing, physical therapy or speech services when home health orders are written. In such cases, some beneficiaries may not be able to access OT treatment at all and may face increased risk for falls, emergency room visits and hospitalizations. She recommended that Congress consider the Medicare Home Health Accessibility Act (MHHA) which would establish OT as a qualifying service for the Medicare home health benefit and enable OT to be ordered as a stand-alone home health service at start of care.
Dr. Mroz's tesimony is also available on the Senate Finance Committee's website.