By Barnaby J. Feder N.Y. Times News Service A decade of rapid
growth in home health care has forged a $15 billion industry with
more than 12,500 companies and not-for-profit services. Many
experts expect even faster growth in years to come as home
treatment proves effective for a growing range of acutely ill or
disabled patients whom doctors would once have insisted on
hospitalizing at great cost.
The services range from traditional visiting-nurse associations
to a host of entrepreneurial start-ups like Calldoctor Inc., a San
Diego-based mobile emergency-room service.
"We think it is going to be the fastest-growing business
segment from the mid-1990s until well into the next century," said
Gerald Celente, director of the Socio-Economic Research Institute
of America in Rhinebeck, N.Y. "Most products and services for the
home-health-care market haven't been invented yet."
Most home care continues to involve chronic problems that are
not life-threatening and are expected to affect more and more
Americans as the population ages. But physicians at the frontiers
of home health care are also expanding their work to include some
stunningly acute and complex cases.
In Chicago, a 6-month-old infant with spinal cord injuries so
severe that she cannot suck, cry, eat, breathe or move on her own
was discharged from a hospital intensive-care unit and sent home.
There, machinery run by nurses and her family has aided her growth.
Her doctor hopes new technology will one day restore some of her
Some of the home patients are being pushed out of hospitals
that need their beds for other people with more severe or immediate
problems. In other cases, patients whom hospitals would gladly keep
are going home to save money, recuperate faster and avoid exposure
to hospital-based diseases. Still others are relying on home care
to avoid going to hospitals for even initial treatment.
The home-care trend should be stimulated by recently proposed
changes in Medicare compensation that would more than double
government payments for doctors to visit Medicare patients at home.
But even without such incentives, health industry analysts say, the
double-digit growth of the last few years is likely to accelerate
as those born after World War II grow older.
The experts prefer to discuss trends rather than numbers
because dependable financial data are hard to come by. Only a
handful of companies publicly report earnings and revenue.
The $15 billion estimate for total spending on home
medical-care services and equipment last year is a projection based
on statistics from government-financed programs, like Medicare and
Medicaid, that serve patients who are elderly, disabled or
extremely poor. About one person in 10 who saw a doctor last year
needed some form of home care, according to the American Medical
The industry's growing pains have recently attracted more
attention than its prospects. In November, the Health and Human
Services Department moved to clamp down on abuses of the Medicare
system by medical equipment suppliers who sell their products for
More than 70 individuals and equipment companies have been
convicted of fraud and other crimes involving inflated equipment
costs, which total about $1.2 billion or roughly 2 percent of
Medicare's annual budget.
The government is also challenging a practice among some
home-care companies of paying doctors to monitor therapy for the
Caremark Inc., a Chicago-based subsidiary of Baxter
International Inc., is the subject of a criminal investigation
involving the practice. The government says the practice may have
operated as system to funnel kickbacks to Caremark.
Caremark has stopped such payments but defends them as legal
within the vague guidelines Washington and the states have given
the largely unregulated industry. …