Home health care is an industry destined for growth

Healthcare costs are unsustainably high, and with the aging population those costs are being pushed even higher, excessively burdening taxpayers and private payers. Home healthcare is more affordable and of higher quality and patients are much happier receiving care at home.

According to Genworth’s Cost of Care Survey, the median cost of nursing home care ranges between $8,000 and $9,000 per month. In contrast, Home Healthcare comes in at about $5,000 per month based on an estimate for 44 hours of care per week. It is the most cost-effective post-acute care solution compared to skilled nursing care, inpatient residential care, and long-term care hospitals.

In light of these benefits, it should be an expectation for Medicare and other commercial payers – including Medicare Advantage plans – to promote home health care more aggressively. The industry will see growing demand in the number of patients wanting care at home by clinicians for decades to come. However, existing home health care agencies need help to meet this demand successfully.
Workforce shifts and clinician burnout

The attrition of nurses has been building for years. Multiple studies show that over 1 million new registered nurses (RNs) will be needed by 2030 to meet healthcare demands. This shortage is worse in the home health industry and more severe in rural areas. The COVID-19 pandemic and the government’s response have worsened matters. Nurses and other clinicians are opening their eyes to other career options and home healthcare administrators must take note of the competitive salaries, benefits, and training that other industries are giving their workers.

Nursing schools also do not train nurses on home health care regulatory compliance or the other nuances of delivering home care. Being a home health care nurse entails documenting at the point of care. During their first visit, known as an admission or Start of Care (SOC), field nurses must complete the Outcome and Assessment Information Set (OASIS) while interacting with the patients and delivering care. The clinician then develops a plan of care (POC/CMS 485) which includes the frequency and mix of clinical services to be provided over the next 60 days to the patient to improve their health.

The patient’s physician approves the POC at the onset of care. At the end of the episode, which lasts 60 days, the patient is either recertified for an additional 60-day period or discharged. Like the admission OASIS, the discharge OASIS is a critical piece of documentation. Add to that the complex Electronic Medical Records (EMRs) used by different agencies; it becomes apparent that there is an unreasonable expectation placed on nurses and therapists to become data administrators in addition to their patient care responsibilities.

Regulations and compliance are ever-changing and overwhelming

Medicare-certified home health care agencies have to stay compliant with many clinical and labor regulations like patients meeting specific eligibility criteria, from the Centers for Medicare & Medicaid Services (CMS) and state governments. It’s nearly impossible for owners and managers at smaller agencies to stay current with ever-changing regulations. It’s a full-time job requiring a multidisciplinary skillset which many agencies can’t afford, and even finding the qualified staff can be an enormous hurdle.

Accurate OASIS documentation is crucial to receive accurate reimbursements under the Patient-Driven Groupings Model (PDGM) and the recent nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model with CY 2022 as a pre-implementation year.

Quality of Patient Care (QoPC) Star Rating

Ensure that your nurses and therapists understand various process and outcome quality measures through ongoing education and clinician training. Timely initiation of care and improvement in ambulation, bed transferring, bathing, shortness of breath, managing oral medications, and reducing acute care hospitalization are critical to your Star Ratings.

Different payers require different workflows

Medicare Advantage (MA) Plan enrollments are increasing, making up one-third of total Medicare beneficiaries. Most MA plans don’t currently reimburse under PDGM, and many require pre-authorization in addition to meeting all the home health admission requirements.

Your responsibility is to help home health aides develop clinical pathways tailored for patients’ diagnosis and conditions, improving outcomes, and considering the patient’s insurance plan and its reimbursement rates and model.

Implementing clinical care planning and infrastructure programming and measuring positive outcomes can be instrumental in negotiating better contracts with commercial payers and MA plans. Demonstrating the efficacy of targeted programs can also help drive more referrals from doctors. When you can demonstrate the success and end-result of your care to patients, their family members, and payers, you’ll be able to grow and expand your business despite the forces acting against you.

Hoolime is here to help you

Hoolime’s corporate partner PathWell has been an operator of home healthcare agencies for several years and has been in your shoes. We’ve taken the time to understand what keeps you up at night and created an end-to-end solution that walks you through the process.

From handling your regulatory compliance and policy changes, ICD coding, OASIS reviews, and ensuring that you have clean claims, what else can we help you with today?

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