In The News

Home Health Referrals Skyrocketed, Patients Became More Complex During Pandemic

Home Health Care News | By Patrick Filbin

As predicted by many at the onset of the pandemic, home health providers gained a larger share of post-acute referrals in recent years than they did prior to COVID-19.

At the same time, data shows that patients coming to post-acute care are sicker and have more complicated care needs than before, all while staffing shortages continue to put a strain on home health agencies.

A new report from the post-acute technology company WellSky shows that by May 2022, home health referrals were at 123% of what they were in 2019.

The COVID-19 emergency added value to, and demand for, home-based care delivery. The industry should expect that demand to stick.

“As you start to bring to bear science on the discharge dynamic, you will continue to see a growing number of patients moving into home-based care settings,” Tim Ashe, chief clinical officer at WellSky, told Home Health Care News. “Complex care plans can be safely delivered effectively and efficiently at home.”

Referrals staying near 123% of 2019 might not be a realistic expectation, Ashe said. But now that the industry is removed from the worst of the pandemic, there is still plenty of room for growth.

“I don’t know what the growth rates are going to be, but I personally anticipate continued growth,” Ashe said. “That’s going to take some investments in the infrastructure across the home health industry. How do we make sure the tide is rising so that all providers can provide care at scale to complex patients?”

One of those solutions could be the Choose Home Care Act of 2021, a piece of legislation that — among other things — supports in-home care alternatives to skilled nursing facilities (SNFs).

The bipartisan bill is currently in limbo in Washington D.C., but would be a vehicle of relief for SNFs and a boon for home health agencies.

That’s particularly relevant given the WellSky report also found that during the first quarter of 2022, referral rate rejection among home health referrals climbed to 71% due to a lack of staff.

“That’s a direct result of staff capacity,” Ashe said. “Those rejection rates are concerning. It goes back to enabling the industry to scale and incent professional and paraprofessional care providers to come into the industry because it is a really attractive space. We just need to solve some of those economic and potential safety issues that I think were highlighted during the pandemic.”

Even if home-based care demand rises, without the corresponding staff capacity, that demand could be all for naught.

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Given Regulatory Uncertainty, Hospital-At-Home Models Are Losing Momentum

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) gave health systems and providers the ability to take hospital at home as a concept and run with it during the public health emergency (PHE).
 
Those providers did so, and now they’re wondering what comes next. With regulatory uncertainty moving forward, the hospital-at-home momentum has been put on pause – but not because of patient preference or provider enthusiasm.
 
“There is over 250 hospitals and 100 health systems across 30-plus states that have now been granted CMS waivers,” Biofourmis CMO and co-founder Maulik Majmudar said on a Moving Health Home webinar Tuesday. “However, it is also clear that a sizable part of the country does not have any offerings today. And more importantly, the number of CMS waivers granted in the last few months has been on a decline.”
 
The Boston-based Biofourmis is a tech-enabled at-home care enabler. The startup recently reached unicorn status.
 
Indeed, there are plenty of hospitals that have been approved to provide hospital-level care in the home under the CMS waiver. But many have not begun to do so given the regulatory cliff they face. The Acute Hospital Care at Home waiver is tied to the PHE, which could be ending by the end of this year.
 
Some health systems have found other mechanisms to provide hospital-at-home care independent from the waiver. There is also introduced legislation that would extend the Acute Hospital Care at Home waiver by two years past the PHE. But nothing yet has been set in stone.
 
And thus leads to the halted momentum: only two hospitals in the country have treated more than 2,000 patients under the hospital-at-home waiver, according to Majmudar.
 
“The key point is that there’s a lot of opportunity and room for technology to drive both safe and effective deployment of these programs, but especially in a way that allows us to achieve scale,” he said.
 
The resulting hesitation from the regulatory holdup has spurned innovation, and also providers’ ability to learn from their mistakes on the fly as they scale.
 
At the same time, there are health systems – like Advocate Aurora Health, for example – that love the opportunity to provide this care in the home, but not exactly as its allowed right now under the waiver.
 
“We certainly support the continuation of the waiver,” Dawn Doe, the VP of value-based programs and continuing health at Advocate Aurora Health, also said on the webinar. “But we ask for more flexibility on the structure, and the entities that can provide the program, for us as an integrated health system.”
 
For instance, as currently constituted, the waiver makes it so Advocate Aurora Health is forced to have its 27 hospitals all have different hospital-at-home programs.
 
That, Doe said, just doesn’t make sense for Advocate Aurora based on how it’s structured.
 
“We would like to see reimbursement models that really provide patients the ability to stay in their home while avoiding expensive institutional care,” Doe said. “And that the waivers for telehealth and remote monitoring reimbursement be made permanent. This not only improves patient outcomes, but will also address the strain on staffing resources.”

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Updates From Your HHAC Lobbyists

Minimum Wage Information: The lobbyists met with the Governor’s Office on Sept. 7th to discuss Denver Min. wage and the impacts it will have on the home care workforce, specifically HCBS providers. They were very receptive to the challenges and will be working on getting some details from HCPF on utilization to start pricing out our ask. They understood the ask of 8.9% increase for Denver and 8.2% for the rest of the state. We chatted a bit about the opportunities for retroactive billing in HCBS which gives us more flexibility to keep providers whole. They appreciated the conversation and we plan to stay in touch.

 

Long-Term Home Health Stakeholder Engagement
OCL is initiating stakeholder engagement for Long-Term Home Health through an introductory meeting. The meeting will convene Long-Term Home Health stakeholders and Office of Community Living leadership. The discussion will include stakeholder engagement preferences, identify topic areas and priorities, etc.

The meeting will be held:
Thursday, Sept. 29, 2022 | 1:30-2:25pm MT

Join via Google Meet

Join by Phone:
1-336-948-0083, PIN: 528 778 875 #

Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at 303-866-3173 or [email protected] or the 504/ADA Coordinator at [email protected] at least one week prior to the meeting to make arrangements.
 

A Brief Explainer on the Preserving Access to Home Health Act

Home Care Magazine | By Kristin Easterling

HR 8581/S 4605
 
The annual proposed rule for Medicare home health services, which the Centers for Medicare & Medicaid Services (CMS) released in June, includes an estimated 4.2% or $810 million decrease in aggregate payments. The rule would apply to calendar year 2023.
 
An analysis of the rule from the National Association for Home Health & Hospice (NAHC) revealed that 44% of home health agencies would operate at a loss in 2023 if the rule moved forward as proposed. The home health industry reacted strongly to the news and jumped into action to halt the proposed cuts.
 
“The stability of home health care is at risk because of CMS proposing the application of a fatally flawed methodology for assessing whether the Patient Driven Groupings Model led to budget neutral spending in 2020 and later years,” said William A. Dombi, president of NAHC.
“In its actions, the administration is undermining providers’ ability to deliver these critical services. … CMS is unfairly assuming all providers are bad actors. This is not acceptable,” said Katie Smith Sloan, president and CEO of LeadingAge.
 
“Considering that access to home-based care has become increasingly important to the health and safety of American seniors, it is very troubling that CMS would propose such steep rate cuts for next year and potentially even deeper cuts in the future,” said Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare.
 
In late July, Sens. Debbie Stabenow (D-Michigan) and Susan Collins (R-Maine), introduced the Preserving Access to Home Health Act. A House version of the bill soon followed, initially sponsored by Rep. Terri Sewell (D-Alabama).
 
If passed, the act would freeze current Medicare reimbursement rates for home health through 2026, but requires any make-up payments discovered then to be paid by 2032 in order to keep everything within the current 10-year budget cycle. It focuses solely on the payment issue, not on other adjustments in the proposed rule. The bill is designed to be budget neutral.

Read Full Article

 
 

Hospice Star Ratings Released: Enroll in the National Employee Retention Project

Last week, the first Family Caregiver Survey Rating Summary Star Ratings were released as part of the Hospice Care Compare August 2022 refresh. This is a new, publicly reported metric for all hospices with 75 or more completed surveys over the reporting period. In this release, the data showed an average 3.42 Hospice Star Rating for qualified agencies.

Did you know? Results of the National Healthcare at Home Best Practices and Future Insights Study showed a direct correlation between hospice turnover rates and reported Hospice Star Ratings. Read Report Here. 
 
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