Medicare Devalues Evidence-based Home Health Social Work and Nursing Practice

Medicare home health is a $19 billion annual business, generating a 19.4% profit margin, the highest profit margin among major Medicare provider types. The profitability has been generated due to a managed care model prospective payment system (PPS) implemented in October 2000. At the same time, the government has spent millions of dollars on randomized controlled trials of home and community-based care, generating significant evidence-based results. No studies have addressed whether these evidence-based studies are utilized in Medicare home health. The present study focuses on Medicare home health patients with Alzheimer’s disease and their caregivers. It is based on a survey of over 360 home care nurses and social workers in New York State. The findings indicate: (1) More than 90% of both nurses and social workers do not use evidence-based practices due to a lack of knowledge and lack of Medicare coverage despite their professional education in evidence-based practice and (2) More than 90% believe the lack of use of evidence-based practice decreases quality of care and the ability to meet patient and caring needs. Policy and practice implications are discussed.