HIDA 2018 Home Care Market Report
The market for home-based medical care (hospice, home health, home infusion, and home medical equipment), was valued at $144 billion in 2017, and is expected to increase 56.3% to $225 billion by 2024. From 2000 to 2016, the number of U.S. HHA visits increased 26% to more than 114 million. Over this time period, the number of HHA providers increased 62.1% to meet growing demand. As the U.S. population continues to age, adding more seniors to the market, home health providers are projected to experience increased volumes.
Medicare, Medicaid 80% Of Home Health Agency Payer Mix
With the largest share of home health agency payments coming from government sources, the industry is considered most vulnerable to legislative changes that would impact reimbursement. However, the industry is conversely insulated from broader economic shifts as fewer payments come from private insurance and self-pay.
• In 2016, Medicare spent $18.1 billion on home health services, and from 2001 to 2016, Medicare margins for HHAs remained flat.
• Medicaid spending on home health and personal care services totaled $60 billion in 2016, 11% of total Medicaid spend.
Hospice Utilization Up 180%, 2000-2016
There were 4,200 hospice providers nationwide as of 2017, with a combined market value of $18 billion. Hospices received an average of 4% of hospital discharges in 2017, and admitted approximately 300,000 patients each quarter beginning in Q1 2017.
From 2000 – 2016, the total number of hospice users increased 180% from 0.5 million to 1.4 million. The majority of hospice patients (95%) are over the age of 65, and half are over the age of 84. In 2017, the most likely principal diagnosis for hospice patients was cancer (27.2%) followed by cardiac and circulatory issues (18.7%), and dementia (18.0%).
Competitive Bidding Adds Pressure To HME Market
The U.S. market for home medical equipment (HME) totaled $51 billion in 2017, and is expected to reach $53.2 billion in 2018. Growth in this market is driven by increased utilization in home care services.
The Durable Medical Equipment Prosthetics Orthotics And Supplies (DMEPOS) Competitive Bidding Program continues to add financial pressure to HME suppliers. As of 2017, suppliers report reimbursements of approximately 80% of the cost of providing products to Medicare beneficiaries. Both suppliers and beneficiaries agree that the program increases difficulty in delivery of HME services and supplies.
The Centers for Medicare and Medicaid Services (CMS) has made a number of changes under the DMEPOS Competitive Bidding Program. The agency has finalized lead item pricing for the program, established single payer amounts using maximum winning bids, and created three temporary payment methodolities that are location-dependent.
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