Sarah Varney reports for Kaiser Health News that the for-profit sector will now be providing a program for all-inclusive care for the elderly (PACE). Click here to learn about PACE on Just Care. Until recently run exclusively by non-profit organizations and paid for by Medicare and Medicaid, PACE has provided valuable services. But it has reached only a small fraction of older adults. Are for-profit PACE programs cause for worry or can they reach more adults and deliver as good results as non-profit PACE programs?
Last year, Congress changed the law governing PACE to permit for-profit companies to run PACE programs. The alleged goal is to reach more people. And, now private equity firms are funding companies to deliver for-profit PACE programs, reaching many more people.
PACE is intended to help older adults age in place through comprehensive medical and social supports. Medicare and Medicaid pay for the services because they can save money on people in PACE who remain at home, do not need nursing home care and are not as likely to be hospitalized. But, only 40,000 people were enrolled in the program at the beginning of 2016.
With for-profits in the picture, more people will receive PACE services. And, that could have great value to patients who want to remain at home, as most do, and still be able to socialize and enjoy the services available in their communities. Without PACE, many would remain isolated and homebound, jeopardizing their health and well-being and putting them at increased risk of an early death.
PACE programs provide key services many older adults would not otherwise be able to afford or access. People may get comprehensive rehabilitation services. They also generally receive critical dental care that Medicare does not pay for outside the PACE setting. Dental care helps prevent infections that can land a person in the hospital. It also helps to ensure good nutrition.
And, PACE programs also help patients with basic services at home, such as housecleaning and laundering.
The question remains whether the for-profit sector will deliver the value that non-profit PACE programs have delivered. When for-profit companies began delivering hospice services, the U.S. Office of the Inspector General found that they were treating patients with less costly conditions, avoiding patients who would cost them more money, and they were holding back on services people needed.
The for-profit programs are paid a flat fee and lose money if PACE enrollees spend too much time in hospital or visit the emergency room frequently. So, for-profit PACE programs may try to avoid patients more likely to use these services, like the for-profit hospice agencies, avoiding patients who would cost them more money. To save money, they may also be more inclined to deliver care through telehealth rather than transporting patients to facilities, failing to recognize the negative health consequences of social isolation and the value of socialization.
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