Certificate of Need Markets Can Mean Big Business for Home Health Buyers, But Opportunities Are Growing Scarce

Home health mergers and acquisitions got off to a slow start in 2020, then picked up considerably by year’s end. Home health insiders are now predicting a big year for M&A activity in 2021, especially after COVID-19 relief vanishes and economic realities become clearer.

The Patient-Driven Groupings Model (PDGM) will likewise play a part in the M&A landscape, as will other payment-related changes.

But another major factor will be Certificate of Need (CON) laws in some states and regions. Whether buyers want to enter into those precious territories — and whether prospective sellers are willing to give up their valuable position — will be an intriguing storyline in coming years for home health dealmaking.

A CON program is a state regulatory tool that controls the number of health care resources in a given area. It requires home health operators looking to enter a CON state to prove that there is an indisputable need for more home health services in an area.

In other words, an agency cannot exist in a CON state unless it holds a certificate.

The CON concept began with hospitals. The government wanted to make sure it wasn’t funding too many brick-and-mortar institutions in small geographic clusters.

Since then, the same logic has come to home health.

There are currently 18 Certificate of Need states, plus Washington, D.C. Entering these states organically, and not by way of M&A, may be harder than ever, Mark Kulik, the managing director of M&A advisory firm The Braff Group, told Home Health Care News.

“Today, in 2021, it’s extraordinarily difficult to get a certificate,” Kulik said. “They’re not issuing many, if at all. And when there is an application for a new CON, a home health agency has to go through a process that includes a public hearing.”

At that public hearing, other agencies in the area can argue against a new home health operator’s case that it should be allowed to open up shop. And it’s worth it to keep others out, for agencies already established in a CON state. Keeping supply lower as demand remains high is good for business.

In effect, CON-state providers have an artificial moat built around them in the marketplace. With regulation, there may be four or five providers in an entire county. Without it, there’s more likely to be dozens — or more.

“Agencies in those respective states have been contacted numerous times by myself, my competitors and by other agencies on a direct basis because they are so valuable,” Kulik said. “And I think that the demand is going to spike again for those agencies. It’s just a question of how the owners feel about exiting at that point in time.”

If an operator wants to enter into a CON state that has deemed itself “full” in 2021, it will have to buy in — and that won’t come cheap.

Hypothetically speaking, if there are two identical agencies — one in a CON state and the other in a non-CON state — the one in the CON state will garner a 30% to 75% higher selling price, Kulik said.

But that price hike may not be enticing enough for owners to sell. CON-state agencies are typically larger and healthier. They have a stable competitive landscape and are not forced to worry about new competitors coming into town year after year.

“Theoretically, if you’re in a CON state, you’ve got the same competitors — two, three, four, five years from now,” Kulik said. “If you’re in a non-CON state or area, that’s always top of mind. ‘Who’s moving into my service area? Who’s going out of business? Am I growing or shrinking?’ You have all sorts of other issues at play.”

Once the second phase of PDGM is more firmly underway, Kulik expects M&A activity to pick up considerably after the first quarter. When it does, the CON-state jockeying should be in full force.

Into the weeds of CONs

Buying options in Certificate of Need states are scarcer than they used to be.

Encompass Health Corp. (NYSE: EHC) is now the fourth-largest home health provider in the U.S., according to LexisNexis data. But it wasn’t always a large player.

As it added scale, other large home health players were buying up agencies where in CON states. As a result, there are fewer acquisition options for Encompass Health to go after now.

“I think we find ourselves, if anything, a little behind,” Luke James, the president of Encompass Health’s home health and hospice arm, told HHCN. “That’s somewhat intentional. But in terms of what’s left in some of these states that we’d like to be in, it’s certainly scarcer than it used to be.”

Birmingham, Alabama-based Encompass Health announced recently it is “exploring strategic alternatives” for its home health and hospice business, which brought in a total segment revenue of $1.09 billion in all of 2019, according to company financial filings.

Organic growth and non-CON state acquisitions were enough to get Encompass into the top-five of the home health world.

“We felt like, at the time, that was a better solution — for us to spend less and get a similar outcome, or at least an acceptable outcome,” James said.

But now Encompass Health is a home health behemoth, which gives it the ability to enter into CON states, even if they’re scarce. But the math and logistics look a lot different than they did five to 10 years ago.

Other home health competitors have a stranglehold in some CON regions and can opt to outbid everyone else for any agencies that come up for sale.

Still, if Encompass Health feels an acquisition is feasible and in line with its national strategy, it won’t be afraid to throw a lot of money at a seller to enter into an area it desires.

“Maybe the return metrics [on a CON acquisition] don’t look so good on paper compared to other opportunities we have, but we may think it’s the right long-term decision for our organization to go ahead and do it anyway,” James said.

Encompass Health’s main growth strategy continues to be prioritizing the overlapping of its businesses in areas where it is already present. For instance, if the company has hospitals or other facilities in an area, the home health and hospice arm would like to join them.

Some of those areas are in CON states, and some aren’t.

But James doesn’t entirely agree with the notion that it’s always better to be in a less competitive CON state or area. Encompass Health’s largest footprints are in Texas and Florida, for instance, where CONs are not required.

“In some cases, we enjoy the increased competition, because it allows us to really stand out,” James said. “And whenever there’s tough years — [like with] PDGM or RAPs going away, for instance — I think that what we’ll see is that more concentrated states have a lot more smaller providers trying to get out. With more disruption comes more opportunity for the larger, more sophisticated and better prepared providers in those states.”

Fulton County, Georgia, has about 35 home health providers, whereas Dallas County, Texas, has closer to 700. Encompass Health is located in both of those counties.

“Is it a lot more competitive in Dallas? Absolutely,” James said. “Is it harder to recruit and retain? Yeah, it is. … But in times of uncertainty and disruption, I think there’s more opportunity for a fallout in some of the lower-quality, less prepared providers in Dallas County than in Fulton County.”

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Consolidation Accelerates as Home Health Operators Crash from Stimulus ‘Sugar High’

The “sugar high” that some cash-strapped home health providers felt after receiving federal assistance linked to the COVID-19 pandemic is coming to an end, top executives from LHC Group Inc. (Nasdaq: LHCG) believe.

As a result, consolidation is beginning to ramp up again, setting the stage for a potentially record-setting year for dealmaking. Prior to the coronavirus, most industry insiders expected 2020 to be that historic year for M&A due to the Patient-Driven Groupings Model (PDGM).

“We have been anticipating this historic consolidation opportunity in our industry to materialize in home health as a result of PDGM,” LHC Group Chairman and CEO Keith Myers said Wednesday during a presentation at the annual JP Morgan Healthcare Conference. “While the pandemic and the stimulus funds forestalled it temporarily, the consolidation has unfolded in a multitude of positive ways that we didn’t originally anticipate.”

Headquartered in Lafayette, Louisiana, LHC Group provides home health, hospice and personal care services across 35 states and the District of Columbia. In addition to its wholly owned in-home care locations, the company is also a joint venture partner with nearly 400 hospitals and health systems.

Combined, the five largest home health providers — Kindred, Amedisys Inc. (Nasdaq: AMED), LHC Group, Encompass Health Corp. (NYSE: EHC) and AccentCare Inc. — still account for only 20% of the national market share.

On its end, LHC Group is working to carve out a bigger piece of that pie in 2021 by pulling multiple levers.

Those plans include launching de novos in new markets and maintaining organic growth across existing operations. The company also expects to continue negotiating better rates with payers outside of fee-for-service Medicare while adding new referral sources.

Overall, LHC Group saw a 22% increase in new physician referral sources in 2020 compared to the previous year.

“This is a highly fragmented industry,” Myers said. “And the market is ripe for consolidation.”

By the numbers: LHC Group’s ‘growth levers’

LHC Group has seen particularly strong growth across its JV operations. That’s partly due to the public health emergency, with hospital and health system partners leaning heavily on LHC Group as they shifted a wide variety of care into the home.

In the fourth quarter of 2020, for example, same-store admissions for LHC Group’s wholly owned home health business were down 0.7% on a year-over-year basis. JV same-store admissions were up 6.5%, in comparison.

Meanwhile, in the third quarter of last year, same-store admissions for the company’s wholly owned home health segment were up 2.8% on a year-over-year basis, with JV same-store admissions up 7.4%. Q1 and Q2 had a similar breakdown.

“We’ve never really presented data like this that breaks apart our organic growth between joint ventures and our wholly owned assets,” LHC Group President Joshua Proffitt said at the JP Morgan Healthcare Conference. “But I do think it really tells a pretty compelling story to further drive home that differentiated strategy we have with our JVs.”

When it comes to outside acquisitions, LHC Group’s M&A team has started to see more inbound calls, the executives noted.

That was the case in early 2020, too, until the market froze because of the COVID-19 virus.

“The pipeline was robust,” Myers said. “And we know by name many of those providers that should have consolidated this year.”

As for gains outside of traditional Medicare, LHC Group grew its non-Medicare episodic admissions by about 35% in 2020 over 2019. Additionally, the majority of those admissions were at Medicare-equivalent rates.

The company’s rate per visit on all non-Medicare payers improved by 8% in 2020 over 2019. It has improved almost 12% over the last three years, reflective of payers’ heightened recognition of home-based care.

“We have an unprecedented number of tailwinds ahead,” Myers said.

COVID-19 volume hits new high

After operating through COVID-19-related disruption last spring, LHC Group’s home health census has fully recovered, according to the company.

In the fourth quarter of 2020, LHC Group’s average daily home healthy census reached 83,686 patients, 6,700 more than in Q1. Hospice admissions were similarly up.

Although the company has recovered from coronavirus-related challenges, it can still feel the impact of the pandemic, which continues to take its toll on the U.S. A count from Johns Hopkins University shows that the country eclipsed 4,300 deaths on Tuesday alone — another single-day high.

In total, LHC Group admitted 7,046 COVID-positive home health patients during the first three quarters of last year. It then admitted 7,544 COVID-positive patients in Q4 alone.

“I think that really goes to drive home … the value proposition and what we’ve been able to prove throughout the [duration] of this pandemic of what the home health benefit can provide to the patients,” Proffitt said. “I think it also points to the spike that we’ve all seen and all the national numbers throughout the fourth quarter, even here starting into the first quarter. We’re really pleased and proud of our front-line workers for the work that they’ve been able to do, taking care of all of those patients who are struggling in their homes with the virus.”

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Allegheny Health Network Expands Hospital-at-Home Program as CMS Waiver Total Hits 80

The Acute Hospital Care At Home initiative from the U.S. Centers for Medicare & Medicaid Services (CMS) now has at least 80 participants, Administrator Seema Verma announced Wednesday.

Unveiled in November, the initiative has been growing rapidly, especially of late. On its end, CMS hopes the emerging hospital-at-home models can increase acute care capacity and keep patients where they’re most comfortable.

Allegheny Health Network (AHN) was the eighth organization to have its hospital-at-home program approved by CMS. It was given the go-ahead under an expedited process due to its experience with the model prior to the government initiative.

Pittsburgh, Pennsylvania-based Highmark Health is the parent company of AHN. Its businesses include a hospital and physician network plus home- and community-based services, as well as the Highmark Health Plan.

AHN’s “Home Recovery Care” program is facilitated by a joint venture with Nashville, Tennessee-based Contessa Health, a home-based care startup that has cut its teeth shifting hospital-level care into the home.

Now that its program is certified through CMS, it can be offered to Medicare beneficiaries in the regions that AHN serves.

“We’ve been looking at ways that we could provide high-quality, effective clinical care — in other places beyond the hospital — way ahead of the pandemic,” Christina Weir Ripley, VP of clinical transformation at Highmark Health, told Home Health Care News. “And as we were going through that evaluation process and looking for ways to get there, that’s when we landed on our JV partner, Contessa.”

Contessa was a logical match. It had worked with other hospital-at-home models before, including Mount Sinai Health System’s, which was one of the earliest in the U.S.

AHN began offering its program to Medicare Advantage beneficiaries in January 2020.

For AHN, patients can be admitted into the Home Care Recovery program in multiple ways. They can be admitted after an emergency room visit or in-patient visit, as well as upon observation in the hospital — or without going to the hospital at all.

The organization had already treated dozens of patients in the program before it applied for a waiver from CMS. That led AHN to believe that the transition to the Acute Hospital Care at Home Initiative would be seamless.

AHN also had a natural advantage: It owns and operates its own in-house home care services, which play a key role in the hospital-at-home concept.

“As far as the home health agency piece of it, we certainly had an advantage here as an enterprise, because we own and operate a number of different home care businesses,” Weir Ripley said. “So we were able to utilize a pretty strong and structurally organized home health network to assemble and deliver the care.”

Before the newly launched CMS program, a major barrier to hospital-at-home models was reimbursement. Reimbursement will likely continue to be a challenge moving forward, considering CMS has only made its new waiver available during the public health emergency.

“I think probably our biggest hope is that through the CMS waiver, there’s a demonstration of the value of this type of program,” Weir Ripley said. “We clearly believe in it. We implemented this ahead of the pandemic. We’re hopeful that CMS is going to codify a more permanent reimbursement path so we can continue to offer this once we get past the public health emergency.”

There were just 56 hospitals approved by CMS as of Jan. 4.

Working with patients at home

AHN’s capabilities within the home are extensive, Dr. Harshit Seth, the medical director of the Home Recovery Care model, told HHCN.

When AHN does treat patients within the home, it most often deals with COPD, pneumonia, asthma, acute renal failure and other conditions. Recently, that list also includes COVID-19.

Currently, AHN is working on treating COVID-19 patients with more advanced therapy treatments and expanding its overall offerings.

“With the program, we can decompress our hospitals, which have censuses that are blowing up,” Seth said. “I’m glad that we did this because of the pandemic, and because we can take some of these patients and keep them away from the infection. But the other reason why we started this was because the overall patient satisfaction and overall quality of care has been shown to be better — and the complications happen less.”

U.S. hospital beds were over 70% filled as of Jan. 13, with nearly 18% of them occupied by a COVID-19 patient, according to data from the U.S. Department of Health and Human Services (HHS).

The preliminary results of AHN’s program from a patient-satisfaction perspective have been good, one of the most promising aspects thus far, Seth noted.

“Everybody loves when they can be at home and get the care there, and we also have quality protocols and escalation protocols in case of an unforeseen event,” Seth said. “There’s no visitations in the hospital, which patients don’t like. So there’s a lot of mental health problems happening in patients, especially our older patients.”

Alternatively, at home, loved ones can even help with the recovery process.

In Pennsylvania, over 75% of in-patient beds were filled as of Jan. 13, with over 20% of those filled by COVID-19 patients. Nearly 80% of all ICU beds were also occupied, according to the HHS data.

As hospital-at-home models become more popular and more beneficial to both patients and health care organizations, those that have recognized the perks of home-based care prior to the COVID-19 crisis may have the upper hand.

“This is, for us, the beginning of starting to extend the type of care that we can provide in the home,” Weir Ripley said.

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Top Home Health, Home Care Legal Concerns for 2021

Wage-and-hour litigation, confusing state-level regulations and an increase in federal audits were among the biggest legal trends of 2020. While many of these issues will remain in the year ahead, 2021 will also bring several more legal hurdles for home-based care providers.

The decision of whether to mandate COVID-19 vaccinations for home health and home care workers is toward the top of that list. Other emerging legal battles that will shape 2021 include telehealth dos and don’ts.

To keep in-home care operators in the legal loop, Home Health Care News reached out to four attorneys who specialize in the field. The group of legal experts offered their take on the biggest focus areas of 2021.

Their responses are below, edited for length and clarity.

* * *

An enormous challenge home care and home health providers face is remaining compliant with the myriad of federal, state, and local laws and regulations that continue to change at a record pace. It is critically important that providers have a comprehensive legislative tracking process and adopt proactive compliance strategies to both identify changes and modify their policies and procedures to conform appropriately. Providers that operate in multiple jurisdictions or states are especially confronted with this challenge.

One of the most straightforward examples is ensuring compliance with the payment of varying minimum-wage rates. The federal minimum wage is currently $7.25 per hour. However, the Biden administration will likely seek a $15 federal minimum wage. Many states already require a higher minimum wage, such as Colorado’s $12.32 requirement. Some states — such as California — have local jurisdictions, each with its own unique minimum wage requirements that often depend on the number of employees within a given business.

Another major trend to watch out for is the enactment of Domestic Workers Bills of Rights (DWBRs) across the nation. These laws provide specific requirements that employers within a given jurisdiction must adhere to with regard to minimum wages, overtime wages, discrimination and harassment complaints, training requirements and much more. Last year, Philadelphia became the 10th jurisdiction to enact employment legislation to protect domestic workers — and some may recall the federal DWBR legislation sponsored by Kamala Harris in 2019.

We can anticipate a revival of that effort under the Biden administration.

Angelo Spinola, co-chair of the home health and home care industry group at Littler Mendelson

* * *

If I had to pick one legal issue to watch in 2021, it would be health care payment and coverage reform. While the Affordable Care Act was enacted over a decade ago, its wake continues to make waves in the health care sector. Legal challenges remain unresolved in the courts. Twelve states have not expanded Medicaid. Over 10% of Americans remain uninsured. Federal agencies continue to use their broad regulatory authority to push providers toward value-based reimbursement.

With the inauguration of Joe Biden, I anticipate seeing significant efforts to build on the ACA and, potentially, legislative attempts to expand coverage. While Democrats will control the White House and both chambers of Congress, their razor-thin margin in the Senate makes “Medicare for All” proposals unlikely.

Although the regulatory proposals have been overshadowed by recent events, the Trump administration has proposed or finalized rules that could have a significant impact on provider payment and oversight. A significant theme in 2021 will be the extent to which the Biden administration alters or replaces those rulemaking efforts

As we emerge from the pandemic — hopefully soon — federal and state governments and private payers will examine the many regulatory waivers and flexibilities granted during the public health emergency. Which ones will stay? Which will go? Only time will tell.

— Matt Wolfe, partner at Parker Poe

* * *

2020 shined a spotlight on the importance of home health care, as in-person doctor visits were no longer accessible to seniors and facility-based providers dealt with depleted resources and fewer available beds. As access to services dwindled and remote care began to flourish, a massive inequity affecting home health care was revealed.

Remote care services are frequently not reimbursable in a home health setting — and any home health visits delivered via telehealth do not count toward LUPA thresholds during an episode of care. That policy essentially punishes these home health providers that use telehealth to supplement in-person care. In an environment swiftly moving toward value-based outcomes and technology-driven efficiencies, this disparity became evident to policymakers, who are now working toward a remedy.

For those companies who rely on fee-for-service income, the motivation to transform businesses using new technologies will continue to lag unless we figure out a way to increase financial incentives to enable such transformation. We should expect to see innovative home health companies form or participate in value-based enterprises under the newly published Anti-Kickback Statute safe harbors as a way to compensate for the current lack of reimbursement for virtual services.

— Rebecca Gwilt, partner at Nixon Gwilt Law

* * *

The first half of 2021 will keep providers occupied with getting their employees and patients vaccinated. The pandemic has caused, in many respects, the reduction of home care hours as patients are concerned about aides bringing COVID-19 into the home.

The vaccine offers providers the opportunity to reassure their patients that the aides are not bringing the virus into the home. In turn, it’s a way to increase hours. Therefore, we anticipate that providers will launch wide-scale efforts to get their workers vaccinated. This will involve helping the caregivers understand the importance of being vaccinated and, in some cases, conditioning future and continued employment on the employees’ agreement to become vaccinated.

— Emina Poricanin, managing attorney of Poricanin Law

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National Expansion of Home Health Value-Based Purchasing Model Estimated to Create $6.3B in Savings

In somewhat of a surprise move, U.S. health care policymakers unveiled plans last week to expand the Home Health Value-Based Purchasing (HHVBP) Model, a nine-state Medicare demonstration designed to better align reimbursement to quality of care.

Despite backing from most of the home health industry, the HHVBP Model — first implemented in 2016 — had seemingly hit a speedbump in recent years. Apart from a handful of minor modifications, the model only remained active in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee.

With more than one-quarter of its home health agencies currently located in HHVBP states, the Baton Rouge, Louisiana-based Amedisys Inc. (Nasdaq: AMED) has been among the biggest supporters of value-based purchasing. The company has persistently urged the Center for Medicare & Medicaid Innovation (CMMI) to expand the model for over a year.

“There’s still a perception out there that there is a high level of fraud in home health care — and that’s simply not true,” Amedisys CEO and President Paul Kusserow told Home Health Care News. “I think having to prove ourselves on the quality front and being willing to take risk on quality is absolutely the right thing for us.”

So far, even just the limited HHVBP Model has been able to achieve overwhelmingly positive results.

Since implemented, the model has contributed to a 4.6% improvement in home health agencies’ quality scores, in addition to average annual Medicare savings of $141 million, federal statistics show. On top of those points, agencies in HHVBP states have been able to significantly lower the costly utilization of hospitals and skilled nursing facilities (SNF).

“This has been extremely good,” Kusserow said.

As part of its push for an expanded HHVBP Model, Amedisys brought in Washington, D.C.-based research and consulting firm The Moran Company. The home health giant asked Moran to dig deeper into past results and explore what a nationwide rollout would eventually look like.

After cranking the numbers, the research firm estimated that a 50-state HHVBP Model would result in about $6.3 billion in savings over a 10-year period, using Congressional Budget Office (CBO) scoring methodology.

“We engaged in a very long dialogue [with CMMI] and exchanged a lot of data to push this forward,” Kusserow added.

Inside the advocacy process

Besides the whopping $6.3 billion in savings, Moran also determined that a nationwide rollout of the Home Health Value-Based Purchasing Model would lead to better post-acute care outcomes for Medicare beneficiaries and more ways for the U.S. Centers for Medicare & Medicaid Services (CMS) to identify high- and low-quality providers.

In many ways, the advocacy efforts around HHVBP were so effective because they were driven by “the power of a good idea,” according to David Kemmerly, the chief legal and government affairs officer at Amedisys. Instead of having to artfully persuade CMS and CMMI to expand the model, his team’s job was more about giving policymakers the objective information they otherwise lacked.

“They have to go make their case with the actuaries before they can expand something,” Kemmerly told HHCN. “So we helped arm CMS with the data and information they needed.”

It took more than facts and figures, however.

To help advance HHVBP, Kusserow communicated regularly with CMMI Director Brad Smith, the former CEO of home-based palliative care provider Aspire Health who joined the CMS Innovation Center in early 2020. Kusserow and Smith had already “known each other a long time,” thanks to their shared experiences in Nashville, Tennessee, and standing as Rhodes scholars.

“When [Smith] went to Washington, he called me up and said, ‘What should I be thinking about?’” Kusserow said. “Obviously, he was asking a lot of people that. I said, ‘I really think there’s something to value-based purchasing in home health. I’d really like you to look at it.’”

At first, CMMI decision-makers were concerned about home health provider buy-in.

While Amedisys and others sought to advance HHVBP, others were slightly skeptical, especially early on. More than a few home health operators believed HHVBP was just another piece of government regulation, with others too preoccupied with the Patient-Driven Groupings Model (PDGM) to worry about alternative payment mechanisms.

On its end, Amedisys worked hard to boost the industry’s understanding and acceptance of HHVBP, Kemmerly said.

“There’s a bit of politics involved,” he noted. “[Smith] asked us early on, ‘Where is the industry on this? And can you bring the industry to the table?’”

Unanswered questions

CMMI and CMS are committed to expanding the Home Health Value-Based Purchasing Model, but there are plenty of questions left to answer and improvements that can be made.

On a basic level, it’s still unclear whether policymakers will try to expand HHVBP through a standalone proposal or through the annual rulemaking cycle. Additionally, it’s not yet known whether that future expansion will be national or more incremental, possibly adding another dozen or so states to the current nine-state mix.

Scott Levy, the senior vice president of government affairs at Amedisys, was in the trenches for most of Amedisys’ advocacy battle on HHVBP. In all likelihood, CMS will pursue a 50-state expansion and implementation through the annual rulemaking cycle, Levy speculated.

“I’m just merely reading between the lines, but our discussions [with CMS] and our data presented to them was all based on the idea of a nationwide expansion,” he told HHCN.

Along with answers to those questions, Amedisys is also pushing for improvements to the HHVBP Model itself.

In 2020, home health providers were exposed to 6% upside and downside risk, depending on their quality performance. That figure increases to 7% and 8% in 2021 and 2022, respectively.

But it’s almost impossible to come close to that full upside or downside as the model is currently structured.

“The upside has been good for us. It’s generally quite positive,” Kusserow said. “But we feel the curve is too clustered toward the center. It is very hard to get the full rewards or to get the full penalties.”

In 2018, the payment adjustment in HHVBP ranged from a 1.5% penalty for providers in the lowest-10th percentile to a 1.5% bonus for providers in the highest-10th percentile, according to an investment note from Bank of America. CMS previously stated that the average adjustment was a 0.85% bump in 2018.

“Companies out there with good technology, good tracking systems, good checklists, good verification processes and very good clinical operations are the ones that are going to continue to do well and thrive under this, for sure,” Kusserow said.

A possible complication to HHVBP expansion plans could have been the transition to a new Biden administration, which is guaranteed to bring changes to CMMI, CMS and throughout the U.S. Department of Health and Human Services (HHS).

Yet the team at Amedisys doesn’t see that as an issue, considering the model’s origins.

“[HHVBP] was actually rolled out by the Obama administration,” Levy said. “It was proposed during the fall of 2015 for a January 2016 implementation.”

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CVS Health Partners with National Oncology Network to Offer In-Home Chemotherapy

CVS Health (NYSE: CVS) is partnering with the Cancer Treatment Centers of America (CTCA) to offer in-home chemotherapy to cancer patients. The partnership is a significant next step for at-home cancer care in the U.S., which has lagged behind other countries in the area.

Initially, the two entities will provide chemotherapy to clinically eligible and fully insured CTCA patients through a pilot program in the Atlanta area. The partnership will leverage Coram — a specialty CVS branch that delivers infusion therapy services — as well as CTCA’s experience as a top oncology care provider.

The main goal of the pilot is to keep immunocompromised patients away from the COVID-19 virus. But it could also lay the groundwork for future cancer care in the home.

Although it will begin solely in Atlanta, the program is set to expand geographically over “the next few months.”

“The program is a major advancement in in-home cancer care because it leverages CVS Health’s Coram home infusion capabilities and CTCA’s expertise as a top oncology care provider to give patients who may have delayed their care due to COVID-19 the flexibility to receive treatment from the safety and comfort of home,” Sree Chaguturu, the SVP of CVS Health and CMO of CVS Caremark, told Home Health Care News in an email.

CVS Health is a diversified health care company that employs nearly 300,000 individuals across its network. Coram, on its own, is able to reach 97% of the U.S. population.

Meanwhile, CVS Caremark is the prescription benefit management subsidiary of CVS Health.

On its end, CTCA is a national oncology network of hospitals and outpatient care centers that offers an integrated approach to cancer care. As part of its mission, the organization combines surgery, radiation, chemotherapy and immunotherapy, among other services, to care for patients.

“There is a critical need for providing in-home therapy where possible to safely treat patients who are immunocompromised,” Chaguturu said. “As this program expands to other geographies, we anticipate home-based cancer care as being more widely available to patients seeking treatment during and beyond the pandemic.”

The CVS-CTCA program will be available to patients with breast cancer, lung cancer, prostate cancer, colorectal cancer, and head and neck cancers, as well as a few others.

In April, CVS Health partnered with UCLA Health to ease the burden on hospitals during the COVID-19 crisis by increasing its home-based care capacity. That move specifically allowed Coram to increase its capabilities.

The specialty branch now serves more than 205,000 patients in home-based and outpatient settings per year.

Moving forward, Coram will use its nurses and technology to begin administering chemotherapy cycles. Patients will still begin their first cycle of infused chemotherapy in the hospital or an outpatient care center. After that, however, a patient can transition home and continue receiving those services.

The program will also provide regular telehealth visits and digital therapeutic check-ins from both Coram and CTCA staff.

Ultimately, the goal is to leverage the partnership and appropriate technology to continue delivering critical cancer care, while increasing patient satisfaction and reducing emergency room visits and COVID-19 exposure.

The program will likewise help ease anxieties that currently come with receiving health care. The public health emergency has kept patients — with cancer or other conditions — from receiving the care they need.

“For a variety of reasons, COVID-19 has caused far too many people to skip or delay treatments,” Dr. Chevon Rariy, the CTCA telehealth program director, said in a press release. “We’re seeing a 50% reduction in infusions, and, while a slight delay in treatments may have been appropriate at the pandemic’s onset, data is now pointing to increased mortality risk with every month of delayed care.”

Cancer care is often far more complex than other care delivered at home.

That’s why cancer care’s advancement to home-based settings has largely stalled, Rachel Cannady, the strategic director of cancer caregiver support for the American Cancer Society, told HHCN in November.

“You can’t bring a radiation machine to somebody’s house to do proton therapy. You just can’t,” Cannady said then. “The top three cancer treatments are surgery, radiation and chemotherapy. Maybe there are times when you can get chemo infusions, but for the most part, those are in very controlled settings.”

But the partnership between CVS Health and CTCA does offer a glimmer of hope. The more cancer patients are treated at home, the more likely it is that the industry will hone in on the possibilities of expanding that care further in the future.

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59% of Health Care CFOs See Home Care as Key Investment Area

The majority of health care financial leaders view home care as a key area of investment.

That’s according to a recent survey from BDO, a Chicago-based accounting, tax, financial advisory and consulting organization. Released Monday, the survey includes the responses of 100 CFOs at U.S. health care organizations, including home health providers, with revenues ranging from $250 million to $3 billion.

Specifically, 12% of the CFOs surveyed were leaders at home health or hospice organizations.

The COVID-19 virus is among the drivers making home care a priority. One of the impacts of the public health emergency is that it forced many health care organizations to reevaluate their areas of focus and specialties in order to address patient needs.

When looking toward 2021, 59% of surveyed CFOs identified home care as a priority investment.

This finding further suggests that home-based care providers demonstrated their value in delivering care during the past several months. As the U.S. still faces ongoing COVID-19 surges, the demand for home-based care will likely continue to grow.

“The home health setting has seen many significant contributions to the value-based care supply chain,” Steven Shill, partner and national leader of the BDO Center for Healthcare Excellence & Innovation, told Home Health Care News in an email. “I think the pandemic has just served to confirm an already valuable process.”

Aside from home care, 56% of surveyed financial executives identified elder care as a priority investment.

Another 77% of CFOs said they’re looking to fund primary care.

“A significant number of in-home primary care users are the elder population,” Shill said. “As there is a transition to Medicare Advantage, you will see an acceleration of in-home primary care. The reason is that, when a physician, nurse or [physician’s assistant] visits higher-risk patients in their homes, patients are less likely to need emergency room visits, acute care hospitalizations or institutionalization in a [skilled nursing facility] for example. This will likely reduce the overall costs.”

In addition to identifying key investment areas, the survey also touched on emerging trends. From an M&A perspective, for example, 42% of surveyed CFOs said they believe the COVID-19 emergency will cause increased consolidation throughout health care.

In fact, many health care organizations went into the public health emergency with already weakened balance sheets, according to Shill.

Many have been able to stay afloat thanks to the Paycheck Protection Program (PPP) and CARES Act funding, but eventually, those wells will run dry.

“The focus on consumerism, the move towards value-based care and a major drive toward digitization in health care — trends that existed prior to the pandemic — all contributed to consolidation,” Shill said. “Many health care organizations pre-pandemic did not have the resources to address these trends, which in turn caused them to have weakened positions in the marketplace, increasingly inefficient operations and significant losses to patient volumes, all ultimately resulting in them becoming financially weakened and forcing them to either merge, be acquired or shut down.”

Additionally, BDO’s survey found that partnerships will likely take center stage in 2021.

About 31% of surveyed CFOs said they had plans to acquire physician practices. Another 28% said they planned on merging with another organization, with 24% planning to form a joint venture.

In the home-based care space, this move toward partnerships could be a business opportunity for providers.

“The home health sector has historically been heavily fragmented, often lacking professional leadership and appropriate levels of capital investment,” Shill said. “That is why, in the few years prior to the pandemic, it was getting a lot of attention from private equity. As institutional health care continues focusing on value-based care and overlaying it with the impact of the pandemic, it would seem that this type of partnership will likely see an acceleration.”

BDO’s survey was conducted by Rabin Research Company, an independent marketing research firm.

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COVID-19 Has Affected Home Health Therapy Utilization in Multiple Ways

Heading into 2020, therapists working in the home health world were concerned over the effects that the Patient-Driven Groupings Model (PDGM) might have on their profession.

Then COVID-19 hit, forcing them to rush into action. A year later, the true impact of the new payment model on therapy utilization is still not clear.

“I’m not really sure we’re ever going to have clean data to be able to figure out what the direct effect of PDGM on therapy utilization was,” Cindy Krafft, the owner and founder of Kornetti & Krafft Health Care Solutions, said on a recent Home Health Care News webinar.

Krafft is a licensed physical therapist and has been in the home health space for 27 years. Her company advises agencies on both operational and clinical issues.

There were some inklings of what the impact of PDGM may be heading into 2020 and during the first couple months of last year. But that was mostly from agencies struggling with how to manage the concept of therapy visits not being tied directly to reimbursement anymore, Krafft said.

Nearly half of home health agencies planned to decrease therapy utilization in 2020, according to a mid-2019 survey conducted by the National Association for Home Care & Hospice (NAHC).

“I know, as a therapist, my brothers and sisters in the therapy universe get a little antsy … thinking that [PDGM] is going to be the death knell for therapy and that therapists are all going to lose their jobs,” Krafft told HHCN in 2019.

But COVID-19 threw a wrench in every agency’s plans. Experts warned that decreasing therapy recklessly would be potentially dangerous for patient outcomes.

It’s likely true that PDGM did have some influence on therapy utilization, but finding out how much could be an unrealistic task.

“We got through a couple months and then the pandemic began, and utilization took a completely different hit with respect to trying to determine how to manage the initial crisis mode of saving lives and minimizing risk,” Krafft said. “I think PDGM did have some influence, but I don’t think we’re going to ever really be able to say it was the sole thing that impacted utilization in 2020.”

Before the public health emergency, there was a wariness attached to scheduling therapy visits because of the onset of PDGM.

But after it, there was a shift in thinking, Dr. Monique Caruth, the CEO of Fyzio4u Rehab Staffing Group, said on the webinar.

“At the beginning of the year with PDGM, we were being questioned when we put visits at twice per week for four weeks, for instance, or three times per week for four weeks,” Caruth said. “We had clinical managers sending back messages saying, ‘We have to be careful because of PDGM.’ And then COVID hit. Then it went back to giving the therapist control of determining frequency.”

Caruth has been a licensed physical therapist in Maryland since 2008. She also serves as the southern district chair of the state’s American Physical Therapy Association (APTA) organization.

She was recently elected to lead the home health section of APTA. Her term begins in February.

The post-public health emergency shift in thinking didn’t last forever, however. Utilization patterns changed again once COVID-19 infection became a larger concern around therapy usage.

“[Agencies] were very careful and trying to limit the spread of COVID to clinicians, so if a patient was COVID positive, they wanted you to do one visit in person and one telehealth visit,” Caruth said. “I didn’t find that very accommodating for patients who were highly deconditioned. So I would base my frequency or recommend that all clinicians based their frequency on how the patient presented at the time of the evaluation.”

Caruth and her team have not yet seen any pushback from that practice, which is to diagnose the amount of appropriate visits strictly based on how the patient’s condition is.

It’s a positive example of how therapy should be utilized in a post-PDGM world, Krafft said.

“I think it becomes a crisis mode [reaction], and then a standard is set that we’re going to do one visit in person and then one telehealth visit,” Krafft said. “And we know that patient care does not work well as a one-size-fits-all. I think sometimes as therapists we dig in our heels about what we think our frequency should be, just because it’s what we’ve always done, too.”

Instead, the entire industry should be flexible to setting visits strictly based on what the patient’s condition and level of acuity is, she suggested.

It could be true that, after PDGM, some agencies began to undervalue therapy. But COVID-19 may have re-emphasized the importance of it, particularly in home health care.

In the recent $1.4 trillion spending bill passed by the U.S. government, occupational therapists (OTs) — for instance — were given the right to open home health cases.

The American Occupational Therapy Association sees that as an opportunity to change the perception around OTs generally — and now prove their worth further moving forward.

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New York Moves Up COVID-19 Vaccination Eligibility for Home Care, Hospice Workers

Home care and hospice workers are now part of the pool of New Yorkers eligible to receive the COVID-19 vaccine.

The New York State Department of Health originally announced that home care and hospice workers would be eligible to receive the first dose of the vaccine starting on Jan. 11. This placed these individuals in the Week 5 group of the state vaccination program.

The department updated that plan last Monday, moving home care and hospice workers to the Week 4 group receiving the vaccine starting on Jan. 4. 

This development didn’t just happen overnight. In fact, it was the result of a significant push from New York home-based care associations, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News.

“I would say that is a huge development, and it’s something that we’ve been pushing for several weeks to ensure that there was a prioritization in Phase 1A for home care and hospice workers,” he said. “It took a lot of conversations with the state department of health and the city department of health.”

HCA-NYS is a state trade organization that represents nearly 400 home- and community-based care providers and organizations.

Noyes noted that — because of the infrastructure currently in place, which involves the 10 regional hubs of New York overseeing the vaccination system — the distribution-planning process involved multiple conversations with various agencies and players. 

Home Healthcare Workers of America was also part of the overall advocacy push. The organization, which represents over 26,000 in-home care workers, saw firsthand the need for urgency when it comes to vaccination.

“During this time, tragically, we have lost 12 aides from the start of this to the present,” Joe Pecora Jr., the organization’s vice president, told HHCN. “Our members were desperately asking for access to the vaccine. We’re happy that the governor’s office and the department of health have agreed to move up their eligibility. This is a lifeline.”

New York state employs more than 210,000 home care aides, labor statistics show.

Home Healthcare Workers of America is a part of the International Union of Journeymen and Allied Trades (IUJAT). The organization represents workers primarily located in the five boroughs of New York City.

Throughout the COVID-19 emergency, visibility has been a major challenge for home-based care organizations. At times, this resulted in these organizations being overlooked.

Being prioritized for vaccine eligibility represents a shift, according to Noyes.

“Whether it was [personal protective equipment] status or authorization to visit patients in their own homes when there were travel restrictions in place, this has been an issue,” he said. “To now have, at this pivotal stage of the vaccination rollout, home care and hospice workers in early, that is an important accomplishment.”

For now, HCA-NYS has been keeping its members updated on the logistics and procedures for actually getting the vaccine.

It’s a process that has run the gamut, according to Noyes.

“For instance, some agencies, I understand, have ordered the vaccine, and I don’t know whether they’ve received it yet, but they have plans to vaccinate their own staff — to actually have their own agency be the point of dispensing a vaccine for their workers,” he said.

Meanwhile, other agencies have opted to instruct their staff to essentially make their own appointments with the various dispensing hubs that are being set up across the state.

In these cases, HCA-NYS has provided instructions around what information workers need to bring to these appointments in order to prove they’re Phase 1A. Similarly, it has helped its members understand what documentation they need to retrieve from the vaccination site.

So far, New York City’s mass vaccination efforts have gotten off to a rough start.

Despite a surge of new COVID-19 cases, few people have been vaccinated. This has left public health experts concerned, according to reports from The New York Times.

Overall, only 167,949 of 489,325 doses of the vaccine — roughly 34% — have been administered as of Friday. The rate for New York state overall is over 40%, according to The New York Times.

The vaccination rollout potentially creating hiccups that would impact home care and hospice workers is a concern, according to Noyes.

“Home care and hospice workers are now in priority 1A,” he said. “But if there’s concern that the vaccine is not being administered to health care workers at the rate it should be because of hesitancy, … then there’s going to be a big impetus to push through to the other phases. Certainly, there are other priority groups that need the vaccine quickly, but my concern is whether or not this push could squeeze out access for home care and hospice workers.”

Elsewhere, early last week Los Angeles County’s home care companies received confirmation that non-medical caregivers are part of the first group eligible for vaccination.

Prior to this confirmation, home care companies weren’t clear on whether their employees were part of this group, which includes their home health counterparts.

Home health leaders and clinicians in various parts of the country have also begun to highlight their vaccine experiences on social media. That group includes Dr. Steve Landers, president and CEO of the Visiting Nurse Association Health Group Inc.

Senior living operators have ramped up their vaccination efforts as well.

On Dec. 21, for example, Brookdale Senior Living Inc. (NYSE: BKD) announced it had held its first community vaccine clinics, with plans to schedule more across the company’s 726 communities.

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HHS Announces Plans to Expand the Home Health Value-Based Purchasing Model

Home health providers are getting one of their biggest wishes granted.

The U.S. Department of Health and Human Services (HHS) announced Friday that it is expanding the Home Health Value-Based Purchasing (HHVBP) Model. First implemented in 2016, the HHVBP Model is currently active in just nine states: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee.

HHS Secretary Alex Azar has already signed off on an expansion, the department noted. Friday’s announcement did not specify the extent of the expansion, but clarified that HHS would execute the implementation through rulemaking no earlier than Jan. 1, 2022.

“The CMS Office of the Actuary has certified, based on its independent assessment of the model’s performance over the first three years of the Model, that an expansion would reduce, or not result in any increase in, net Medicare spending,” the announcement stated.

This is a developing story. Please check back later for additional updates.

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Senior Housing Occupancy Hits Record Low, Suggesting More Tailwinds for ‘Aging-in-Place’ Providers

Senior housing occupancy in the U.S. hit a record low in the fourth quarter of 2020, according to the National Investment Center for Housing & Care (NIC).

The record downturn is further proof that seniors and their families are looking for alternative long-term care options, at least until a vaccine is widely distributed and concerns about congregate living are lifted. The numbers out of NIC similarly suggest that tailwinds for home-based care providers are likely to persist — and maybe even grow stronger.

The final quarter of 2020 brought another decrease in senior housing occupancy, from 82% in Q3 to 80.7% in Q4. The 1.3% drop brought the total loss in occupancy up to 6.8% since Q1 of 2020.

Declining occupancy in senior housing was the story for nearly all of 2020, with no month standing as the main culprit. Occupancy fell steadily each month after March, according to NIC data.

While the drop in Q4 wasn’t as drastic as Q2 and Q3, it’s likely that the trend isn’t yet over.

“Senior housing occupancy declines were less pronounced in the fourth quarter than the previous two quarters, though the fourth quarter decline is still quite large from a historic perspective,” NIC’s chief economist, Beth Burnham Mace, said in a press release. “The surge in COVID-19 cases following Thanksgiving and Christmas suggests further disruption lies ahead. That said, the recent distribution of the vaccines should soon provide some relief.”

NIC conducts intra-quarterly occupancy rate updates, covering 31 major metropolitan markets. Within those markets, there is some degree of disparity, NIC notes.

For instance, in California, San Jose and San Francisco all remained right around or above 85% occupancy — as did Seattle in neighboring Washington. On the other hand, Houston, Cleveland and Miami all checked in below 77% in terms of occupancy rates, with Houston falling all the way to 73.5%.

That is the lowest out of all markets reviewed by NIC.

“The COVID-19 pandemic has impacted move-ins and move-outs across senior living properties,” Chuck Harry, chief operating officer of NIC, said in the release. “Move-ins slowed as operators enacted moratoriums to keep residents safe and as safety protocols limited new leasing activity, while move-outs have been affected as residents moved to higher-acuity care settings.”

Assisted living occupancy also fell another 1.3%, to 77.7% in Q4. Independent living occupancy dropped to 83.5%, falling by 1.4%. Those occupancy numbers have fallen at a similar rate to senior housing, around 6% to 7%.

There are home-based care operators involved in senior housing, such as BrightStar Care.

But BrightStar’s senior living segment hasn’t experienced the same headwinds

In September, BrightStar CEO Shelly Sun told Home Health Care News that she had seen significant growth in the company’s communities in 2020. She credited that to the more personal space that BrightStar had created in its brick-and-mortar locations.

“The concept of a lot of personal space has really resonated in the community,” Sun said. “There’s very strong interest in [them]. And I think a lot of that is because a lot of the choices around assisted living or memory care tend to be hundred 200- to 300-room formats.”

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Quincy Medical Group Goes All In on Hospital-at-Home Program

When Quincy Medical Group (QMG) began developing a hospital-at-home program over a year ago, it recognized the concept as a way to reduce costs and risk, while simultaneously increasing hospital capacity and supporting a seamless transition of care.

But in a broader sense, QMG wanted to stick to its commitment to “transform health care” — and that’s why it began investing in the home. That’s also why the organization is clear about its hospital-at-home program’s origins.

QMG had been looking to implement something similar for at least three years. The program is coming to fruition at the peak of the COVID-19 pandemic, but that is merely a coincidence.

After a sit down with Dr. Tom Price — who formerly served as the secretary of the U.S. Department of Health and Human Services (HHS) — its physician-led board decided to pursue what was then an out-of-the-box option and invest in hospital-level care at home.

“The board has had a main purpose of delivering quality health care more cost effectively,” QMG Interim Chief Medical Officer Dr. Rick Noble told Home Health Care News. “We realized the federal government was looking at all out-of-the-box options on being able to deliver quality care, … and that’s when we started looking at the hospital-at-home model.”

Quincy, Illinois-based QMG has over 155 doctors, nurse practitioners and physician assistants that offer care to about 250,000 people in 16 locations throughout Illinois, Iowa and Missouri.

Hospital-at-home models have always made sense, at least from cost-savings, comfortability and logistical standpoints. What was lagging was a reimbursement method from the U.S. Centers for Medicare & Medicaid Services (CMS) that made it worth it.

That has begun to change, and CMS has now approved over 50 hospitals under its new hospital-at-home initiative. Dubbed “Acute Hospital Care at Home,” the initiative is designed to give hospitals unprecedented flexibilities to treat hospital patients where they live.

“We thought that the federal government may at some point in time be moving toward this type of a program,” Noble said. “And so we stuck to it.”

John Hopkins and others pioneered the model in the 90s, with Mount Sinai and others hopping on board since.

QMG will be doing the same. It has entered into a licensing agreement with Johns Hopkins to facilitate its own version of the organization’s hospital-at-home model.

“This way, we won’t have to reinvent the wheel,” Noble said. “We basically purchased their best care protocols that we’re going to implement.”

It’s been a process that’s taken over two-and-a-half years to materialize. QMG is hoping to be fully operational with its program by mid- to late-2021.

“I think we were way out ahead of the curve,” Noble said. “We started it for the right reasons. And then all of a sudden, here’s a situation that shows not only us — but hopefully others such as CMS — that these programs are really needed and that they should be reimbursed. Because this isn’t going to be the last health issue that’s going to occur in the next 50 years and put a burden on our health care system.”

QMG put out a press release announcing its hospital-at-home efforts in November, though the program is not fully operational yet.

It did so because it wants to accomplish a few things first through awareness, Noble noted.

“What we want people to know is that they can expect change to occur, that we in the health care community are fluid, and we’re willing to change and look outside the box,” Noble said. “We don’t want to feel like they only have one option. I want them to know that we are proactively looking at a way to [make sure they have options] in the future.”

Generally, the hospital-at-home program is set to treat low-acuity patients that would normally have shorter hospital stays. For instance, patients who have mild congestive heart failure, shortness of breath, COPD, emphysema, skin infections or pneumonia, among other conditions.

Those patients, if they qualify and would like to be treated in the home, will be overseen by a team of physicians, therapists, nurses and rehab specialists when applicable.

“If we can really refine this and allow physicians to lead, it will just show how much we can change the scope of healthcare delivery,” Noble said. “And it’ll benefit us down the road as well.”

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Interim’s New Recruitment Campaign Targets Job Candidates Looking to Make a Career Transition

Finding enough workers has been a longstanding pain point for in-home care providers. With the launch of a new national recruitment campaign, Interim HealthCare wants to take a proactive approach to address those persistent challenges.

Interim is a Sunrise, Florida-based in-home care franchise with more than 530 locations across the U.S.

The company recently launched “Made for This,” a recruitment campaign that focuses on placing job candidates in careers in the home-based care industry.

“We are innovating again,” Jennifer Sheets, president and CEO of Interim, told Home Health Care News. “We’re at the table realizing that the health care industry is facing critical shortages. We’re all focused on recruiting — and we always have been.”

In part, in-home care providers have struggled with recruiting enough workers simply because consumer demand is so high. The overall employment of home health and personal care aides, in fact, is projected to grow 34% from 2019 to 2029, much faster than the average for all other occupations, according to the U.S. Bureau of Labor Statistics (BLS).

But being an in-home care worker is also a difficult job, one that’s sometimes overshadowed by similar caregiver roles in other settings.

As part of its new recruiting efforts, Interim’s campaign includes opportunities for professional expansion, professional development and specialized training, Sheets said. All of those points are critical for cultivating a new candidate pool.

“What we’re trying to do here is create a new pool of candidates who are different from anybody we’ve recruited in the past,” Sheets added.

In some ways, the current climate has laid out the groundwork for Interim’s recruiting campaign.

For starters, the COVID-19 emergency has resulted in a surge in unemployment. About 25% of adults in the U.S. report that they or someone in their household have lost their job, according to the Pew Research Center.

Job loss was especially prevalent among individuals working in service industries in the months following the onset of the pandemic.

Roughly 1.9 million store-based retail workers were unemployed as of June, according to BLS. The leisure and hospitality industry had lost 7.7 million jobs as of May.

Additionally, 5.5 million food service workers experienced job loss.

People working in these service-oriented industries often already possess the qualities that providers are looking for when it comes to job candidates, home care experts believe.

This creates the opportunity for a career change for these workers and gives the in-home care industry a recruitment boon, according to Sheets.

“We really wanted to highlight the open door for a professional career change,” she said. “There are a lot of people out of work. There are a lot of people who are already in a customer service-facing industry. These people already have a heart for servant leadership and may not even realize that they’re actually perfect for — or made for — health care. That was the idea behind it.”

Aside from trying to reach individuals who have a background in other service-related industries, Made for This also targets individuals who are looking for “purpose-driven” work. A desire to transition into a mission-driven job is a common goal for individuals following economic recessions.

Interim’s campaign is also setting its sights on individuals who are already working in health care and interested in transitioning into the home-based care side.

“If somebody wants to go from a restaurant employee to a CNA, or from a CNA to an LPN or therapist, we can support them along the way,” Sheets said. “It’s about pathways to help them go from that setting to a health care setting, or to go from a hospital setting to a home care setting.”

In order to help someone transition into home-based care, the campaign tailors training and education based on an individual’s background and experience.

“You can’t just go from one setting to the other, so this program is about helping people fill those gaps through education, through mentoring, through a very defined onboarding and orientation process,” Sheets said. The biggest thing to keep in mind, from my perspective, is what Interim brings to the table.”

Sheets is referencing Interim’s 54-year history of training people to be successful in the health care space.

Carolina Lobo, the company’s chief people officer, calls this ability the organization’s “lifeline.”

Amid the public health emergency, Sheets points out that there are a number of reasons the home setting may have a new appeal for those currently working in hospitals.

“We find that nurses and therapists are getting burned out in the hospital setting — especially in the midst of the pandemic,” she said. “They want more control in their lives. They’re looking for flexibility. A lot of them are also heads of household. They’re looking for ways to work around their kids’ virtual learning environment, and they want autonomy to make a long-term impact.”

For Sheets, helping clinicians who want to switch lanes career-wise comes from personal experience. She is a former ICU nurse who would go on to hold a leadership position running several hospitals, before ultimately landing in her current position.

“I realized I wanted to be a part of home care after I had my own story,” she said. “I had my father and my grandmother on home care, home health and hospice services at the same time, and I wanted to be a part of that setting. I realized that [this setting] was driving the real quality of life that people want and deserve.”

Although it’s still early in the new year, looking ahead, Sheets believes the industry will continue to see critical shortages as it relates to the 2021 labor landscape.

“Hopefully, a lot of health care workers will get the vaccine, but we’re still going to deal with people who are out because of an exposure,” she said. “This environment is extremely hard for the health care worker, … so we’re going to see a higher burnout — even more than we are seeing now.”

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Amedisys Adds New Board Member; UVMHN Tabs New President

Samuels joins the Amedisys board

Amedisys Inc. (Nasdaq: AMED) has named Ivanetta Davis Samuels to its board of directors. She became officially active in her role on Dec. 15.

“I am excited to welcome Ivanetta and her vast leadership experience to our Board of Directors,” Amedisys CEO and President Paul Kusserow said in a statement. “Her unique legal and public policy experience will provide our leadership team with a new and broader perspective as we continue our journey to becoming the solution for those who want to age in place.”

Baton Rouge, Louisiana-based Amedisys is a provider of home health, hospice and personal care services. It operates in 39 states and Washington, D.C.

On Samuels end, she has a vast law background and is excited about the opportunity to operate on a board with various forms of voices on it.

“I am honored to join the Amedisys Board of Directors,” Samuels said in a statement. “As a woman of color who understands the importance of diverse perspectives, I am especially thrilled to be a part of a leading healthcare organization with a board composed in its majority by women, that is intentionally providing equitable and inclusive quality care to all of its patients.”

Currently, Samuels is the senior VP, general counsel and corporate secretary for Meharry Medical College. She oversees legal affairs and transactions, including litigation management, policy management, immigration services, compliance, risk management and environmental health and safety, according to the Amedisys release.

UVMHN announces new president

The University of Vermont Health Network (UVMHN) announced that Adrianne Johnson Ross had been named the next president of Home Health & Hospice as well as COO. Johnson Ross will take over for Judy Peterson, who is retiring from her post after eight years.

“For decades and throughout this pandemic, home health and hospice professionals have played a crucial role in the delivery of essential care,” Johnson Ross said. “I believe home health is central to the future of health care delivery and will continue to expand and reach more families, ensuring patients will remain as comfortable as possible while receiving care.”

UVMHN Home Health & Hospice previously operated under the name The Visiting Nurse Association of Chittenden and Grand Isle Counties. The brand changed when it joined UVMHN in January 2018. It’s the first affiliate of the network to provide post-acute, community-based care.

The nonprofit organization delivers home health and hospice care to individuals of all ages across two dozen towns in Vermont.

“Adrianne brings an innovative mindset to help us think about our services and care delivery to our community,” Tara Pacy, chair of the home health and hospice arm’s board of directors, said in a statement. “I am excited about her energy and passion for our organization.”

Griswold Home Care’s names director of marketing

Griswold Home Care has created a new position — the director of marketing — and has hired Shelly Kanther to serve in the role.

The Blue Bell, Pennsylvania-based company offers home care, personal care and respite care services as well as companion care to patients. Its network consists of 200 locations spanning 30 states.

Kanther has wide-ranging knowledge of digital marketing, most recently serving as a marketing and digital strategy consultant at the New England Appliance & Electronics Groups (NEAEG).

“Our goal to elevate and modernize the Griswold Home Care brand requires fresh eyes and a digital-first mindset,” CEO Michael Slupecki said in a statement. “Shelley’s familiarity in online strategy for local small businesses provides experience similar to working with a franchise network, while bringing innovative ideas and the shift in perspective we’ve been looking for.”

Axxess adds home care expert to senior leadership team

Axxess, the Dallas-based home health technology company, has bolstered its leadership team by hiring a non-medical, private-pay home care expert.

Patricia Drea joins the Axxess team after serving as COO of home care company Visiting Angels for 12 years. Drea also served as chair of the organization’s board of directors during that time.

“Pat will be an invaluable resource for our home care clients,” John Olajide, founder and CEO of Axxess, said in a statement. “She has more than 30 years of experience in private duty and skilled nursing, including owning and managing home care organizations and working with franchises.”

In addition to her background at Visiting Angels, Drea was the former chair of the National Association for Home Care & Hospice’s (NAHC) Private Duty Home Care Association and the CEO of At Home Total Care.

Home Care Alliance elects VP for trade group

The Home Care Alliance of Massachusetts recently elected Home Health Foundation President and CEO Karen Gomes as vice president of the board of directors.

Boston-based Home Care Alliance is a nonprofit trade association of home care agencies.

“Karen’s experience and expertise will be most welcome around our board table as we navigate these most challenging times in home care,” Pat Kelleher, executive director of the Home Care Alliance of Massachusetts, said in a statement.

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Amedisys Lands Infusion Partnership with Option Care Health to Keep COVID-19 Patients Out of the Hospital

Amedisys Inc. (Nasdaq: AMED) is leveraging its staff and expertise to deliver infusion services to COVID-19 patients — wherever they may live.

The Baton Rouge, Louisiana-based home health, hospice and personal care services provider announced on Tuesday that it has partnered with Option Care Health Inc. (Nasdaq: OPCH), the largest independent home- and alternate-site infusion services provider in the U.S.

The goal of the partnership: to enter into long-term care facilities in select locations and deliver COVID-19 infusion therapy to vulnerable populations. Broadly, infusion therapy is the delivery of medication intravenously, often through a special infusion pump.

Strategically, the newly announced collaboration will help meet the immediate needs of the country’s seniors during the public health emergency. It will also, however, set Amedisys up for more infusion administration to certain patients in alternate sites in the future.

“They had a need that we felt like we could fill, which was providing personnel that could assist in actually administering the infusion,” Dr. Amy Moss, Amedisys senior vice president of clinical for hospice, told Home Health Care News. “And we just took it from there.”

Amedisys currently delivers in-home care services across 500 care centers in 39 states and Washington, D.C.

The company was partly able to make its new partnership with Option Care possible thanks to the work of Operation Warp Speed, a public-private partnership initiated by the U.S. government.

In December, the National Home Infusion Association (NHIA) announced it had launched a pilot program with Operation Warp Speed and the U.S. Department of Health and Human Services (HHS) to expand access to the drug Bamlanivimab for some COVID-19-positive patients residing in long-term care facilities.

Option Care Health — a member of NHIA — agreed to participate in the program. It then tabbed Amedisys as a partner.

“Rightfully so, much of the focus during the pandemic has been on acute care and the burden that system is feeling,” Moss said. “But we all know that there are millions of people who are dealing with mild to moderate symptoms of COVID at home, or wherever they call home. And a large portion of those individuals are seniors that live in communal-living centers.”

Long-term care facilities have been hit especially hard by COVID-19 in the U.S. Well over 100,000 staff and residents have died since the beginning of the pandemic due to the virus, according to the COVID Tracking Project.

“We are proud to collaborate with Amedisys, a leader in home health and hospice services, along with NHIA and leaders of Operation Warp Speed, to expand access to vital therapies for one of the most vulnerable populations,” John Rademacher, CEO of Option Care Health, said in a statement. “Combining the extraordinary capabilities of two industry leaders to solve a critical health care challenge is truly humbling.”

Generally, staffing is a major issue across long-term care. That’s why Amedisys staffing resources are valuable to programs like the one Option Care Health is launching along with the NHIA.

The program will initially be piloted in Indianapolis and Valparaiso, Indiana. There is potential to scale the program to other markets if successful. Moss suggested Amedisys is open to that, especially if Option Care Health is also willing.

“This is one of the most novel arrangements that I’ve seen in my career,” she said.

In initial trials, the investigaitonal medicine Bamlanivimab has proven to help manage COVID-19 symptoms in positive patients.

Home-based care organizations such as Amedisys have been aiming to reduce hospital visits, particularly during the pandemic. Helping to administer Bamlanivimab seemed like a logical task for Amedisys to carry out.

“What they were hoping to demonstrate — and it does appear to be coming to fruition in the clinical trials — is that the use of this infusion reduces the need for hospitalizations or emergency room visits for these patients,” Moss said. “And that’s huge.”

Amedisys will oversee the care coordination through its hospice division and overall clinical team.

On its end, Option Care Health will leverage its pharmacy network to distribute Bamlanivimab.

The partnership will help seniors get treatment they may not have otherwise been able to get, all while staying at the place they live. It also reflects the power of these sort of partnerships, Moss said.

More broadly, the partnership could set the stage for more home- and community-based involvement for Amedisys in the infusion arena — or elsewhere — even after COVID-19 subsides in the U.S.

“It very much aligns with our overall mission at Amedisys, which is expanding the capacity to deliver full service care in the home or wherever the patient may be,” Moss said. “It’s very much in line with our mission prior to COVID, which was looking for novel ways to do that. This is something that I would anticipate continuing after the public health emergency is over. And it may not necessarily just be limited to infusion opportunities. I think it really sparked some creativity about how else we could collaborate with other providers out there.”

The U.S Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUAs) for neutralizing antibody therapies to treat mild to moderate COVID-19.

The goal, ultimately, is to tame symptoms in order to keep patients out of institutional-based settings.

“We have experience from being on the front lines and caring for more than 12,500 COVID-19-positive patients,” Amedisys President and CEO Paul Kusserow said in a statement. “We know how important innovative solutions are for caring for those who need our services the most, and this is exactly the type of partnerships in which Amedisys wants to be involved to help our country make it through this pandemic.”

A home infusion benefit for 2021 was initially announced in 2019 as part of the home health final payment rule by the Centers for Medicare & Medicaid Services (CMS).

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MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers

Under the Trump administration, federal health care policymakers have long been vocal about the ability of Medicare Advantage (MA) to lower costs and improve outcomes among vulnerable populations.

A recent report from the Washington, D.C.-based Better Medicare Alliance (BMA) and consulting firm Avalere Health is now putting hard numbers on that claim, particularly around home health services and post-acute care.

“The hallmark features of Medicare Advantage — risk-adjusted capitated payment, strong value-based performance incentives and flexibility in benefit design — enable health plans to offer care management interventions that meet complex care needs of vulnerable beneficiaries in ways that produce robust positive outcomes and greater value for high need, high cost beneficiaries,” the report states.

To study cost and outcomes differences between MA and traditional fee-for-service (FFS) Medicare, Avalere and BMA analyzed data tied to more than 1.4 million MA enrollees and 7.9 million FSS beneficiaries. Researchers pulled data from 2015 to 2017.

Broadly, the findings show that MA enrollees spend far fewer days on home health services compared to their FSS peers. For every 1,000 individuals, home health days on service were nearly 20% lower in MA than in traditional Medicare, with an even greater difference among certain subpopulations.

For every 1,000 individuals under the age of 65 living with a disability, for example, home health days on service were about 27% lower in MA than FFS. For every 1,000 individuals living with a major complex and chronic condition, home health days on service were again 27% lower.

The smallest gap in home health agency days came in the frail elderly subpopulation, according to the report. For every 1,000 frail and elderly individuals, home health days on service were about 10% lower in MA than in traditional Medicare.

“The data … show that home health utilization is lower for all three populations in Medicare Advantage compared to traditional FFS Medicare,” the report notes. “One possible explanation is that inappropriate use of these services is minimized in Medicare Advantage relative to traditional FFS Medicare, but further research is needed to evaluate differences in use of home health services.”

High-need, high-cost MA beneficiaries had lower rates of post-acute utilization across all settings compared with those in traditional Medicare. Skilled nursing facility (SNF) days were 16% to 41% lower in MA, for instance.

In general, differences in post-acute care costs were similarly aligned with differences in utilization of post-acute care.

Across all populations, home health agency costs were about 38% lower in Medicare Advantage compared to FSS Medicare.

The Congressional Budget Office (CBO) forecasts that 47% of all Medicare enrollees will be Medicare Advantage beneficiaries by 2029.

“This study finds that overall Medicare Advantage delivered robust positive outcomes for high-need, high-cost beneficiaries compared to similar populations in traditional FFS Medicare,” the report continues. “Higher utilization of preventive screenings, preventive therapy and post-acute care follow-up in Medicare Advantage suggests that care management results in higher quality of care for this vulnerable population.” 

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30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021.

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare

Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and selectivity of these models are outperforming AI models built at a single institution, even when there is copious data to train with. As an added bonus, researchers can collaborate on AI model creation without sharing confidential patient information. Federated learning is also beneficial for building AI models for areas where data is scarce, such as for pediatrics and rare diseases.

AI-Driven Drug Discovery: The COVID-19 pandemic has put a spotlight on drug discovery, which encompasses microscopic viewing of molecules and proteins, sorting through millions of chemical structures, in-silico methods for screening, protein-ligand interactions, genomic analysis, and assimilating data from structured and unstructured sources. Drug development typically takes over 10 years, however, in the wake of COVID, pharmaceutical companies, biotechs, and researchers realize that acceleration of traditional methods is paramount. Newly created AI-powered discovery labs with GPU-accelerated instruments and AI models will expedite time to insight — creating a computing time machine.

Smart Hospitals: The need for smart hospitals has never been more urgent. Similar to the experience at home, smart speakers and smart cameras help automate and inform activities. The technology, when used in hospitals, will help scale the work of nurses on the front lines, increase operational efficiency, and provide virtual patient monitoring to predict and prevent adverse patient events. 


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Omri Shor, CEO of Medisafe

Healthcare policy: Expect to see more moves on prescription drug prices, either through a collaborative effort among pharma groups or through importation efforts. Pre-existing conditions will still be covered for the 135 million Americans with pre-existing conditions.

The Biden administration has made this a central element of this platform, so coverage will remain for those covered under ACA. Look for expansion or revisions of the current ACA to be proposed, but stalled in Congress, so existing law will remain largely unchanged. Early feedback indicates the Supreme Court is unlikely to strike down the law entirely, providing relief to many during a pandemic.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Brent D. Lang, Chairman & Chief Executive Officer, Vocera Communications

The safety and well-being of healthcare workers will be a top priority in 2021. While there are promising headlines about coronavirus vaccines, we can be sure that nurses, doctors, and other care team members will still be on the frontlines fighting COVID-19 for many more months. We must focus on protecting and connecting these essential workers now and beyond the pandemic.

Modernized PPE Standards
Clinicians should not risk contamination to communicate with colleagues. Yet, this simple act can be risky without the right tools. To minimize exposure to infectious diseases, more hospitals will rethink personal protective equipment (PPE) and modernize standards to include hands-free communication technology. In addition to protecting people, hands-free communication can save valuable time and resources. Every time a nurse must leave an isolation room to answer a call, ask a question, or get supplies, he or she must remove PPE and don a fresh set to re-enter. With voice-controlled devices worn under PPE, the nurse can communicate without disrupting care or leaving the patient’s bedside.

Improved Capacity

Voice-controlled solutions can also help new or reassigned care team members who are unfamiliar with personnel, processes, or the location of supplies. Instead of worrying about knowing names or numbers, they can use simple voice commands to connect to the right person, group, or information quickly and safely. In addition to simplifying clinical workflows, an intelligent communication system can streamline operational efficiencies, improve triage and throughput, and increase capacity, which is all essential to hospitals seeking ways to recover from 2020 losses and accelerate growth.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Michael Byczkowski, Global Vice President, Head of Healthcare Industry at SAP,

New, targeted healthcare networks will collaborate and innovate to improve patient outcomes.

We will see many more touchpoints between different entities ranging from healthcare providers and life sciences companies to technology providers and other suppliers, fostering a sense of community within the healthcare industry. More organizations will collaborate based on existing data assets, perform analysis jointly, and begin adding innovative, data-driven software enhancements. With these networks positively influencing the efficacy of treatments while automatically managing adherence to local laws and regulations regarding data use and privacy, they are paving the way for software-defined healthcare.

Smart hospitals will create actionable insights for the entire organization out of existing data and information.

Medical records as well as operational data within a hospital will continue to be digitized and will be combined with experience data, third-party information, and data from non-traditional sources such as wearables and other Internet of Things devices. Hospitals that have embraced digital are leveraging their data to automate tasks and processes as well as enable decision support for their medical and administrative staff. In the near future, hospitals could add intelligence into their enterprise environments so they can use data to improve internal operations and reduce overhead.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Curt Medeiros, President and Chief Operating Officer of Ontrak

As health care costs continue to rise dramatically given the pandemic and its projected aftermath, I see a growing and critical sophistication in healthcare analytics taking root more broadly than ever before. Effective value-based care and network management depend on the ability of health plans and providers to understand what works, why, and where best to allocate resources to improve outcomes and lower costs. Tied to the need for better analytics, I see a tipping point approaching for finally achieving better data security and interoperability. Without the ability to securely share data, our industry is trying to solve the world’s health challenges with one hand tied behind our backs.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

G. Cameron Deemer, President, DrFirst

Like many business issues, the question of whether to use single-vendor solutions or a best-of-breed approach swings back and forth in the healthcare space over time. Looking forward, the pace of technology change is likely to swing the pendulum to a new model: systems that are supplemental to the existing core platform. As healthcare IT matures, it’s often not a question of ‘can my vendor provide this?’ but ‘can my vendor provide this in the way I need it to maximize my business processes and revenues?

This will be more clear with an example: An EHR may provide a medication history function, for instance, but does it include every source of medication history available? Does it provide a medication history that is easily understood and acted upon by the provider? Does it provide a medication history that works properly with all downstream functions in the EHR? When a provider first experiences medication history during a patient encounter, it seems like magic.

After a short time, the magic fades to irritation as the incompleteness of the solution becomes more obvious. Much of the newer healthcare technologies suffer this same incompleteness. Supplementing the underlying system’s capabilities with a strongly integrated third-party system is increasingly going to be the strategy of choice for providers.


Angie Franks, CEO of Central Logic

In 2021, we will see more health systems moving towards the goal of truly operating as one system of care. The pandemic has demonstrated in the starkest terms how crucial it is for health systems to have real-time visibility into available beds, providers, transport, and scarce resources such as ventilators and drugs, so patients with COVID-19 can receive the critical care they need without delay. The importance of fully aligning as a single integrated system that seamlessly shares data and resources with a centralized, real-time view of operations is a lesson that will resonate with many health systems.

Expect in 2021 for health systems to enhance their ability to orchestrate and navigate patient transitions across their facilities and through the continuum of care, including post-acute care. Ultimately, this efficient care access across all phases of care will help healthcare organizations regain revenue lost during the historic drop in elective care in 2020 due to COVID-19.

In addition to elevating revenue capture, improving system-wide orchestration and navigation will increase health systems’ bed availability and access for incoming patients, create more time for clinicians to operate at the top of their license, and reduce system leakage. This focus on creating an ‘operating as one’ mindset will not only help health systems recover from 2020 losses, it will foster sustainable and long-term growth in 2021 and well into the future.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

John Danaher, MD, President, Global Clinical Solutions, Elsevier

COVID-19 has brought renewed attention to healthcare inequities in the U.S., with the disproportionate impact on people of color and minority populations. It’s no secret that there are indicative factors, such as socioeconomic level, education and literacy levels, and physical environments, that influence a patient’s health status. Understanding these social determinants of health (SDOH) better and unlocking this data on a wider scale is critical to the future of medicine as it allows us to connect vulnerable populations with interventions and services that can help improve treatment decisions and health outcomes. In 2021, I expect the health informatics industry to take a larger interest in developing technologies that provide these kinds of in-depth population health insights.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jay Desai, CEO and co-founder of PatientPing

2021 will see an acceleration of care coordination across the continuum fueled by the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access rule’s e-notifications Condition of Participation (CoP), which goes into effect on May 1, 2021. The CoP requires all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. Due to silos, both inside and outside of a provider’s organization, providers miss opportunities to best treat their patients simply due to lack of information on patients and their care events.

This especially impacts the most vulnerable patients, those that suffer from chronic conditions, comorbidities or mental illness, or patients with health disparities due to economic disadvantage or racial inequity. COVID-19 exacerbated the impact on these vulnerable populations. To solve for this, healthcare providers and organizations will continue to assess their care coordination strategies and expand their patient data interoperability initiatives in 2021, including becoming compliant with the e-notifications Condition of Participation.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kuldeep Singh Rajput, CEO and founder of Biofourmis

Driven by CMS’ Acute Hospital at Home program announced in November 2020, we will begin to see more health systems delivering hospital-level care in the comfort of the patient’s home–supported by technologies such as clinical-grade wearables, remote patient monitoring, and artificial intelligence-based predictive analytics and machine learning.

A randomized controlled trial by Brigham Health published in Annals of Internal Medicine earlier this year demonstrated that when compared with usual hospital care, Home Hospital programs can reduce rehospitalizations by 70% while decreasing costs by nearly 40%. Other advantages of home hospital programs include a reduction in hospital-based staffing needs, increased capacity for those patients who do need inpatient care, decreased exposure to COVID-19 and other viruses such as influenza for patients and healthcare professionals, and improved patient and family member experience.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jake Pyles, CEO, CipherHealth

The disappearance of the hospital monopoly will give rise to a new loyalty push

Healthcare consumerism was on the rise ahead of the pandemic, but the explosion of telehealth in 2020 has effectively eliminated the geographical constraints that moored patient populations to their local hospitals and providers. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their convenience through the growing use of consumer-grade wearable devices, patients are more incentivized in 2021 to choose the provider that works for them.

After the pandemic fades, we’ll see some retrenchment from telehealth, but it will remain a mainstream care delivery model for large swaths of the population. In fact, post-pandemic, we believe telehealth will standardize and constitute a full 30% to 40% of interactions.

That means that to compete, as well as to begin to recover lost revenue, hospitals need to go beyond offering the same virtual health convenience as their competitors – Livango and Teladoc should have been a shot across the bow for every health system in 2020. Moreover, hospitals need to become marketing organizations. Like any for-profit brand, hospitals need to devote significant resources to building loyalty but have traditionally eschewed many of the cutting-edge marketing techniques used in other industries. Engagement and personalization at every step of the patient journey will be core to those efforts.


Marc Probst, former Intermountain Health System CIO, Advisor for SR Health by Solutionreach

Healthcare will fix what it’s lacking most–communication.

Because every patient and their health is unique, when it comes to patient care, decisions need to be customized to their specific situation and environment, yet done in a timely fashion. In my two decades at one of the most innovative health systems in the U.S., communication, both across teams and with patients continuously has been less than optimal. I believe we will finally address both the interpersonal and interface communication issues that organizations have faced since the digitization of healthcare.”


Rich Miller, Chief Strategy Officer, Qgenda

2021 – The year of reforming healthcare: We’ve been looking at ways to ease healthcare burdens for patients for so long that we haven’t realized the onus we’ve put on providers in doing so. Adding to that burden, in 2020 we had to throw out all of our playbooks and become masters of being reactive. Now, it’s time to think through the lessons learned and think through how to be proactive. I believe provider-based data will allow us to reformulate our priorities and processes. By analyzing providers’ biggest pain points in real-time, we can evaporate the workflow and financial troubles that have been bothering organizations while also relieving providers of their biggest problems.”


Robert Hanscom, JD, Vice President of Risk Management and Analytics at Coverys

Data Becomes the Fix, Not the Headache for Healthcare

The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued crises in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure.

Looking to the future, it is critical to engage beyond the day to day to rise above the persistent risks that challenge safe, high-quality care on the frontline. The good news is healthcare leaders can take advantage of tools that are available to generate, package, and learn from data – and use them to motivate action.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Steve Betts, Chief of Operations and Products at Gray Matter Analytics

Analytics Divide Intensifies: Just like the digital divide is widening in society, the analytics divide will continue to intensify in healthcare. The role of data in healthcare has shifted rapidly, as the industry has wrestled with an unsustainable rate of increasing healthcare costs. The transition to value-based care means that it is now table stakes to effectively manage clinical quality measures, patient/member experience measures, provider performance measures, and much more. In 2021, as the volume of data increases and the intelligence of the models improves, the gap between the haves and have nots will significantly widen at an ever-increasing rate.

Substantial Investment in Predictive Solutions: The large health systems and payors will continue to invest tens of millions of dollars in 2021. This will go toward building predictive models to infuse intelligent “next best actions” into their workflows that will help them grow and manage the health of their patient/member populations more effectively than the small and mid-market players.


Jennifer Price, Executive Director of Data & Analytics at THREAD

The Rise of Home-based and Decentralized Clinical Trial Participation

In 2020, we saw a significant rise in home-based activities such as online shopping, virtual school classes and working from home. Out of necessity to continue important clinical research, home health services and decentralized technologies also moved into the home. In 2021, we expect to see this trend continue to accelerate, with participants receiving clinical trial treatments at home, home health care providers administering procedures and tests from the participant’s home, and telehealth virtual visits as a key approach for sites and participants to communicate. Hybrid decentralized studies that include a mix of on-site visits, home health appointments and telehealth virtual visits will become a standard option for a range of clinical trials across therapeutic areas. Technological advances and increased regulatory support will continue to enable the industry to move out of the clinic and into the home.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Doug Duskin, President of the Technology Division at Equality Health

Value-based care has been a watchword of the healthcare industry for many years now, but advancement into more sophisticated VBC models has been slower than anticipated. As we enter 2021, providers – particularly those in fee-for-service models who have struggled financially due to COVID-19 – and payers will accelerate this shift away from fee-for-service medicine and turn to technology that can facilitate and ease the transition to more risk-bearing contracts. Value-based care, which has proven to be a more stable and sustainable model throughout the pandemic, will seem much more appealing to providers that were once reluctant to enter into risk-bearing contracts. They will no longer be wondering if they should consider value-based contracting, but how best to engage.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Brian Robertson, CEO of VisiQuate

Continued digitization and integration of information assets: In 2021, this will lead to better performance outcomes and clearer, more measurable examples of “return on data, analytics, and automation.

Digitizing healthcare’s complex clinical, financial, and operational information assets: I believe that providers who are further in the digital transformation journey will make better use of their interconnected assets, and put the healthcare consumer in the center of that highly integrated universe. Healthcare consumer data will be studied, better analyzed, and better predicted to drive improved performance outcomes that benefit the patient both clinically and financially.

Some providers will have leapfrog moments: These transformations will be so significant that consumers will easily recognize that they are receiving higher value. Lower acuity telemedicine and other virtual care settings are great examples that lead to improved patient engagement, experience and satisfaction. Device connectedness and IoT will continue to mature, and better enable chronic disease management, wellness, and other healthy lifestyle habits for consumers.


Kermit S. Randa, CEO of Syntellis Performance Solutions

Healthcare CEOs and CFOs will partner closely with their CIOs on data governance and data distribution planning. With the massive impact of COVID-19 still very much in play in 2021, healthcare executives will need to make frequent data-driven – and often ad-hoc — decisions from more enterprise data streams than ever before. Syntellis research shows that healthcare executives are already laser-focused on cost reduction and optimization, with decreased attention to capital planning and strategic growth. In 2021, there will be a strong trend in healthcare organizations toward new initiatives, including clinical and quality analytics, operational budgeting, and reporting and analysis for decision support.


Dr. Calum Yacoubian, Associate Director of Healthcare Product & Strategy at Linguamatics

As payers and providers look to recover from the damage done by the pandemic, the ability to deliver value from data assets they already own will be key. The pandemic has displayed the siloed nature of healthcare data, and the difficulty in extracting vital information, particularly from unstructured data, that exists. Therefore, technologies and solutions that can normalize these data to deliver deeper and faster insights will be key to driving economic recovery. Adopting technologies such as natural language processing (NLP) will not only offer better population health management, ensuring the patients most in need are identified and triaged but will open new avenues to advance innovations in treatments and improve operational efficiencies.

Prior to the pandemic, there was already an increasing level of focus on the use of real-world data (RWD) to advance the discovery and development of new therapies and understand the efficacy of existing therapies. The disruption caused by COVID-19 has sharpened the focus on RWD as pharma looks to mitigate the effect of the virus on conventional trial recruitment and data collection. One such example of this is the use of secondary data collection from providers to build real-world cohorts which can serve as external comparator arms.

This convergence on seeking value from existing RWD potentially affords healthcare providers a powerful opportunity to engage in more clinical research and accelerate the work to develop life-saving therapies. By mobilizing the vast amount of data, they will offer pharmaceutical companies a mechanism to positively address some of the disruption caused by COVID-19. This movement is one strategy that is key to driving provider recovery in 2021.


Rose Higgins, Chief Executive Officer of HealthMyne

Precision imaging analytics technology, called radiomics, will increasingly be adopted and incorporated into drug development strategies and clinical trials management. These AI-powered analytics will enable drug developers to gain deeper insights from medical images than previously capable, driving accelerated therapy development, greater personalization of treatment, and the discovery of new biomarkers that will enhance clinical decision-making and treatment.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Dharmesh Godha, President and CTO of Advaiya

Greater adoption and creative implementation of remote healthcare will be the biggest trend for the year 2021, along with the continuous adoption of cloud-enabled digital technologies for increased workloads. Remote healthcare is a very open field. The possibilities to innovate in this area are huge. This is the time where we can see the beginning of the convergence of personal health aware IoT devices (smartwatches/ temp sensors/ BP monitors/etc.) with the advanced capabilities of the healthcare technologies available with the monitoring and intervention capabilities for the providers.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Simon Wu, Investment Director, Cathay Innovation

Healthcare Data Proves its Weight in Gold in 2021

Real-world evidence or routinely stored data from hospitals and claims, being leveraged by healthcare providers and biopharma companies along with those that can improve access to data will grow exponentially in the coming year. There are many trying to build in-house, but similar to autonomous technology, there will be a separate set of companies emerge in 2021 to provide regulated infrastructure and have their “AWS” moment.


Kyle Raffaniello, CEO of Sapphire Digital

2021 is a clear year for healthcare price transparency

Over the past year, healthcare price transparency has been a key topic for the Trump administration in an effort to lower healthcare costs for Americans. In recent months, COVID-19 has made the topic more important to patients than ever before. Starting in January, we can expect the incoming Biden administration to not only support the existing federal transparency regulations but also continue to push for more transparency and innovation within Medicare. I anticipate that healthcare price transparency will continue its momentum in 2021 as one of two Price Transparency rules takes effect and the Biden administration supports this movement.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Dennis McLaughlin VP of Omni Operations + Product at ibi

Social Determinants of Health Goes Mainstream: Understanding more about the patient and their personal environment has a hot topic the past two years. Providers and payers’ ability to inject this knowledge and insight into the clinical process has been limited. 2021 is the year it gets real. It’s not just about calling an uber anymore. The organizations that broadly factor SDOH into the servicing model especially with virtualized medicine expanding broadly will be able to more effectively reach vulnerable patients and maximize the effectiveness of care.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Joe Partlow, CTO at ReliaQuest

The biggest threat to personal privacy will be healthcare information: Researchers are rushing to pool resources and data sets to tackle the pandemic, but this new era of openness comes with concerns around privacy, ownership, and ethics. Now, you will be asked to share your medical status and contact information, not just with your doctors, but everywhere you go, from workplaces to gyms to restaurants. Your personal health information is being put in the hands of businesses that may not know how to safeguard it. In 2021, cybercriminals will capitalize on rapid U.S. telehealth adoption. Sharing this information will have major privacy implications that span beyond keeping medical data safe from cybercriminals to wider ethics issues and insurance implications.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Jimmy Nguyen, Founding President at Bitcoin Association

Blockchain solutions in the healthcare space will bring about massive improvements in two primary ways in 2021.

Firstly, blockchain applications will for the first time facilitate patients owning, managing, and even monetizing their personal health data. Today’s healthcare information systems are incredibly fragmented, with patient data from different sources – be they physicians, pharmacies, labs, or otherwise – kept in different silos, eliminating the ability to generate a holistic view of patient information and restricting healthcare providers from producing the best health outcomes.

Healthcare organizations are growing increasingly aware of the ways in which blockchain technology can be used to eliminate data silos, enable real-time access to patient information, and return control to patients for the use of their personal data – all in a highly-secure digital environment. 2021 will be the year that patient data goes blockchain.

Secondly, blockchain solutions can ensure more honesty and transparency in the development of pharmaceutical products. Clinical research data is often subject to questions of integrity or ‘hygiene’ if data is not properly recorded, or worse, is deliberately fabricated. Blockchain technology enables easy, auditable tracking of datasets generated by clinical researchers, benefitting government agencies tasked with approving drugs while producing better health outcomes for healthcare providers and patients. In 2021, I expect to see a rise in the use and uptake of applications that use public blockchain systems to incentivize greater honesty in clinical research.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Alex Lazarow, Investment Director, Cathay Innovation

The Future of US Healthcare is Transparent, Fair, Open and Consumer-Driven

In the last year, the pandemic put a spotlight on the major gaps in healthcare in the US, highlighting a broken system that is one of the most expensive and least distributed in the world. While we’ve already seen many boutique healthcare companies emerge to address issues around personalization, quality and convenience, the next few years will be focused on giving the power back to consumers, specifically with the rise of insurtechs, in fixing the transparency, affordability, and incentive issues that have plagued the private-based US healthcare system until now.


Lisa Romano, RN, Chief Nursing Officer, CipherHealth

Hospitals will need to counter the staff wellness fallout

The pandemic has placed unthinkable stress on frontline healthcare workers. Since it began, they’ve been working under conditions that are fundamentally more dangerous, with fewer resources, and in many cases under the heavy emotional burden of seeing several patients lose their battle with COVID-19. The fallout from that is already beginning – doctors and nurses are leaving the profession, or getting sick, or battling mental health struggles. Nursing programs are struggling to fill classes. As a new wave of the pandemic rolls across the country, that fallout will only increase. If they haven’t already, hospitals in 2021 will place new premiums upon staff wellness and staff health, tapping into the same type of outreach and purposeful rounding solutions they use to round on patients.


30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

Kris Fitzgerald, CTO, NTT DATA Services

Quality metrics for health plans – like data that measures performance – was turned on its head in 2020 due to delayed procedures. In the coming year, we will see a lot of plans interpret these delayed procedures flexibly so they honor their plans without impacting providers. However, for so long, the payer’s use of data and the provider’s use of data has been disconnected. Moving forward the need for providers to have a more specific understanding of what drives the value and if the cost is reasonable for care from the payer perspective is paramount. Data will ensure that this collaboration will be enhanced and the concept of bundle payments and aligning incentives will be improved. As the data captured becomes even richer, it will help people plan and manage their care better. The addition of artificial intelligence (AI) to this data will also play a huge role in both dialog and negotiation when it comes to cost structure. This movement will lead to a spike in value-based care adoption


$1.4 Trillion Spending Package Extends Sequestration Holiday, Grants Home Health OTs More Authority

As different health care stakeholders combed through the new $1.4 trillion spending package approved by Congress on Monday, many likely felt a mix of excitement and disappointment.

Included in the nearly 6,000-page spending package was a $900 billion COVID-19 relief bill, changes to home health therapy rules, certain hospice provisions and more. That’s really just the tip of the iceberg, too, as it’s unlikely that even the lawmakers who voted on the package read it in its entirety.

Home-based care insiders are in the process of doing so. So far, there’s reason to be happy about the relief package, which now awaits President Donald Trump’s signature.

“We are grateful that Congress recognized the need to support home care and hospice during the pandemic,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News in an email.

In addition to the previously noted items, Dombi called attention to the package extending the Medicare sequestration holiday, which was initially set to expire at the end of this month. More CARES Act grants, an extension of the Medicaid Follows the Person (MFP) program and extra spousal impoverishment relief are likewise victories for home health and hospice operators, NAHC’s president said.

“[There is also] the expanded SBA Paycheck Protection Program (PPP) and more that will help keep [home health] and hospice operational,” Dombi added.

Specifically, $284.5 billion more has been added for a second round of PPP loans for businesses with less than 300 employees and a demonstrated revenue loss greater than 25%.

The extended sequestration suspension is a major win for all Medicare-reimbursed health care providers, which have faced a 2% cut since 2014. Providers across the country continue to deal with new, previously unexpected expenses and erratic revenue patterns.

The new pause on sequestration runs through March 31.

Additionally, the spending package and COVID-19 relief includes nearly $70 billion to purchase and distribute vaccines, plus funds to help states conduct testing. About $20 billion of that funding will be dedicated to making the vaccine available at no cost for certain individuals.

Other COVID-19 specifics include $22.4 billion for testing, contact tracing and other prevention practices necessary for combatting the virus. Another $3 billion was included for additional grants for health care providers to be reimbursed for expenses or lost revenues tied to COVID-19.

For Medicare-funded home health businesses, $175 billion more has been put into the Provider Relief Fund, which could grant them a lifeline until the pandemic subsides.

Therapy changes

Similar to NAHC, the American Occupational Therapy Association (AOTA) celebrated certain provisions on the $1.4 trillion spending package.

In what AOTA called a “historic home health victory,” the package includes language from the Medicare Home Health Flexibility Act that enables occupational therapists (OTs) to open home health therapy cases. The U.S. Centers for Medicare & Medicaid Services (CMS) will have one year to implement a rule allowing for that change.

“Today we celebrate hard-fought victories for occupational therapy scope of practice and payment, following extensive AOTA-led advocacy initiatives,” the advocacy organization wrote in a statement.

OTs were granted the flexibility to open up home health cases during the public health emergency, but this bill will allow them to do so moving forward. AOTA said it has worked for “decades” on this measure.

The bill also made COVID-19-related telehealth flexibilities permanent.

Funding for hospice providers, small businesses

The “Rural Access to Hospice Act” and the “Helping our Senior Populations in Comfort Environments (HOSPICE) Act” were also included in the spending package.

Rural health clinics and federally qualified health centers cannot currently bill under Medicare Part B for hospice, which often becomes a barrier to caring for remote populations. With the Rural Access to Hospice Act in place, providers will be able to receive payment for services to patients in hospice, which will help those populations.

The National Hospice and Palliative Care Organization’s (NHPCO) was happy with the hospice provisions.

“NHPCO appreciates this bi-partisan, bi-cameral agreement,” NHPCO President and CEO Edo Banach said in a statement. “Hospice patients and families will benefit from improved access in rural and underserved communities as well as needed relief during this public health emergency. This legislation will enable hospice providers to continue providing uninterrupted care during this unprecedented time.”

Adult day providers weren’t as lucky. There were no specific provisions aimed at helping those operators during the public health emergency.

Katie Smith Sloan, the president and CEO of the aging-focused organization LeadingAge, previously discussed how Congress has fallen short in its efforts when it comes to helping adult day centers around the country.

What may help these providers, as well as other home care organizations, is the new round of PPP money that’s included in the package. If they are able to qualify, which most should be able to, that will at least ease some of the payroll burden that they’ve faced amid the public health emergency.

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AccentCare, Seasons Finalize Merger Aimed at Streamlining Patient Care

AccentCare and Seasons Hospice & Palliative Care have cleared all regulatory hurdles and officially merged, the post-acute care providers announced Tuesday.

The Dallas, Texas-based AccentCare is ranked as the fifth-largest home health provider in the nation in terms of overall market share, according to LexisNexis statistics. Similarly, the Rosemont, Illinois-based Seasons is listed as the fifth-largest hospice provider in the U.S.

The two providers — along with AccentCare’s private equity sponsor, Advent International — were able to finalize their merger agreement in a little over a month’s time. The companies initially unveiled their industry-shaping plans on Nov. 16, with AccentCare CEO Steve Rodgers digging into the strategy during the Home Health Care New Capital+Strategy event on Dec. 8.

“We’ve had a very successful hospice business internally at AccentCare,” Rodgers said at the event. “But it hasn’t necessarily been one at scale.”

Prior to the merger, those operations formed “about a $70 million hospice business,” the CEO noted. That number will grow substantially with Seasons, which offers compassionate care through 31 programs in 19 states.

AccentCare leadership began identifying areas to invest in last year. After deciding to “go big” on hospice, the company weighed tuck-in options while also reviewing some of the larger, high-quality providers up for grabs.

Seasons’ reputation, investment in its workforce and geographic footprint made it a natural fit, Rodgers said.

“From a culture standpoint, they’re very culturally aligned with AccentCare, which is one of the No. 1 things we always look for,” he said. “The second piece, though, really had to do with them being in big urban marketplaces, just like AccentCare tends to be in larger urban marketplaces.”

Together, the combined organization will operate more than 225 sites of care across 26 states, employing nearly 30,000 workers.

Additionally, the merged enterprise will maintain several dozen joint ventures and partnerships with health systems, physician practices and payers.

The combined AccentCare-Seasons will be headquartered in Dallas, with its hospice division still based out of Rosemont. It will care for more than 175,000 patients and families each year.

“Season gives us the whole continuum of care, kind of across the board, in addition to being able to supplement these partnerships we have out there in the marketplace,” Rodgers said. “We can bring new services into [those partnerships].”

Seasons subsidiaries included in the merger include Health Resource Solutions, a home health provider in Illinois, Nebraska and Indiana with a patient census of about 2,500. Gareda, a personal care business in Illinois that serves about 4,500 clients a year, is also included.

“The last piece, I’d say, that got us excited about [Seasons] is they have a very mature palliative care group,” Rodgers added. “And I think we all know that the complexity of the patients we are responsible for taking care of is increasing.”

Guggenheim Securities served as the exclusive financial advisor to Seasons Hospice & Palliative Care in the transaction.

“We’re thrilled to head into the New Year as one organization,” Seasons CEO Todd Stern said in a Tuesday press release. “The impact that we’re able to have together, with combined resources and new technologies, will only enhance the patient experience and quality of care for the individuals we serve and the partners who count on us.”

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Beyond the Pandemic: 9 Overlooked Stories from 2020

The ongoing COVID-19 pandemic dominated headlines in 2020 — and rightfully so.

But there were plenty of other storylines that defined the year, including the launch of the Patient-Driven Groupings Model (PDGM), the conclusion of a hotly contested presidential election and the execution of multiple industry-shaping transactions.

These are nine of the most overlooked stories from 2020, as determined by Home Health Care News. All of these stories were popular amongst our readers, but HHCN considers these stories “overlooked” because they didn’t capture quite the same attention they would have in any other year.

1. “NAHC’s Dombi: Agencies Aren’t Panicking in the Streets Over PDGM”

It was relatively early into PDGM’s first year, but it nonetheless became clear in March that the overhaul wasn’t as devastating as many initially predicted. “We’ve not heard anything about large closures of agencies or any kind of panic in the streets,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told HHCN at the time. “And strangely enough, the one thing we’re surprised we haven’t heard so far is the cash flow impact.”

Yes, PDGM presented numerous challenges — and the model certainly still has its flaws. For the most part, though, home health providers large and small met those difficulties with a combination of creativity and perseverance.

2. “Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021”

Related to PDGM is the plan by the U.S. Centers for Medicare & Medicaid Services (CMS) to phase out Requests for Anticipated Payment (RAPs) entirely in 2021. While home health operators knew about this plan way back in 2019, new details emerged about stiff financial penalties for late no-pay RAPs moving forward. If an agency submits a no-pay RAP one day late next year, the result could be a 20% reduction to its 30-day payment amount.

3. “Aging-in-Place Company Amedisys to Acquire AseraCare Hospice for $235 Million”

The pandemic may have delayed some home health, hospice and home care M&A activity, but it didn’t stop it entirely. In fact, there were multiple industry-shaping deals that took place in 2020, including Amedisys Inc.’s (Nasdaq: AMED) $235 million deal for Compassionate Care Hospice, announced in April. This was a huge acquisition for Amedisys, which now ranks as a top-five home health and hospice provider in terms of market share. “AseraCare is a great hospice company,” Amedisys CEO and President Paul Kusserow told HHCN. “When we decided that hospice was a business line we wanted to move forward in back in 2016, we actually approached AseraCare. But they weren’t for sale.”

4. “AccentCare, Seasons Hospice to Merge”

Another M&A blockbuster from 2020: the planned merger between AccentCare Inc. and Seasons Hospice & Palliative Care. After joining forces, the combined AccentCare-Seasons enterprise will be among the five largest home health and hospice providers in the nation. “This is incredibly complimentary to our own approach toward strategic markets and being very focused on working with large health systems,” AccentCare CEO Steve Rodgers told HHCN in November.

5. “LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity”

Over the past four years, the home health industry has steadily advanced its position in Washington, D.C., and within the administration of President Donald Trump. Come January, there will be a new team in the White House that’s led by President-elect Joe Biden. While his administration will bring plenty of new perspectives on health care policy, home health providers will likely maintain their standing.

6. “Caregiver Turnover Rate Falls to 64% as Home Care Agencies ‘Flatten the Curve’”

Turnover remained a trouble spot for most home care agencies, though the overall turnover rate actually improved year over year, according to Home Care Pulse. Better pay and benefits, plus stronger training programs that enable career advancement, are just some of the reasons caregivers are staying in their positions for longer.

7. “Medicare Advantage Startup Clover Health Slated to Go Public in a $3.7 Billion SPAC Deal”

There could be multiple headlines here at No. 7. The main takeaway? This year was the year of the special purpose acquisition company (SPAC), or blank-check company. In October, Clover Health announced it was going public through a SPAC. Most recently, Deerfield Healthcare Technology Acquisitions Corp. (Nasdaq: DFHT) announced it was acquiring CareMax Medical Group and IMC Medical Group Holdings, then combining them in a blank-check company of their own. There were other SPAC plays, too, with 2021 certain to bring several more.

8. “Senior Helpers, BrightStar Are Venturing Out of the Home to Serve Seniors. Here’s Why.”

Home care operators continued to take bold steps in 2020, thinking outside the box and expanding into new services lines. Senior Helpers and BrightStar Care were two good examples of that trend, with each making progress on its home care-adjacent businesses. For Seniors Helpers, that is its Town Square franchising model. For BrightStar care, it’s the company’s senior living franchise strategy. “We saw that many of our clients, as they progressed and had a change in condition, had higher-acuity needs,” BrightStar Care CEO Shelly Sun said during an HHCN event. “The family wanted to be able to move them out of the home to something with more socialization. They were looking for recommendations from us for assisted living facilities or, in many cases, dementia and memory care communities in their area.”

9. “In-Home Care Agencies May Look to Cut Costs by Scrapping Brick-and-Mortar Offices”

To be fair, this one definitely has to do with COVID-19. But it’s somewhat of an overlooked and indirect aspect of the pandemic. In 2020, businesses across industries shifted operations from physical offices to remote setups, typically without any major problems. Moving forward, it will be interesting to see if cash-strapped home care agencies decide to cut costs and jettison the traditional office.

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NAHC, NHPCO, Others Release Vaccine Guidance for In-Home Care Providers

The dichotomy in the U.S. right now is evident, especially for those in health care: While vaccines and coinciding hope are being injected into Americans, the number of new COVID-19 cases each day continues to climb.

And while every home-based care provider and worker keeps reading that the vaccines — both Pfizer’s (NYSE: PFE) and now Moderna’s (Nasdaq: MRNA) — are here, they’re wondering where.

Vice President Mike Pence and his wife, Karen Pence, were both vaccinated on video Friday. Senate Majority Leader Mitch McConnell (R-Ky.) tweeted out a picture of himself post-vaccination as well. Hospital workers have danced on TikTok celebrating the Pfizer-BioNTech vaccine’s arrival at the Boston Medical Center.

But for the home-based care world, key information regarding the vaccines is still hard to find.

“We don’t know not only when but where,” David Totaro, the chairman of the Partnership for Medicaid Home-Based Care (PMHC), told The Philadelphia Inquirer last week. “We don’t even know how we’re going to be notified.”

Over the last week, most of the major home-based care trade organizations have released guidance for providers on how to handle vaccinations in the workplace.

Home-based care workers have been labeled 1a — or highest priority — to receive the vaccine in most states.

The National Association of Home Care & Hospice (NAHC), for instance, is telling providers to “encourage all home care and hospice staff to receive a COVID-19 vaccination at the earliest possible time consistent with vaccine guidance.”

The national association suggests providing the support necessary to help workers gain access to the vaccine as soon as possible as well as access to comprehensive and fact-based information regarding immunization. It also reiterated the importance in following safe protocols throughout the pandemic in the meantime.

The Home Care Association of New York State released similar guidance, and the National Hospice and Palliative Care Organization (NHPCO) released a statement of its own.

“Hospice and palliative care professionals are on the front lines of health care delivery in this country. Not only are they serving the most vulnerable population with complex medical needs, but they are caring for people in their homes, interacting with family caregivers, and traveling throughout the communities they serve,” NHPCO President and CEO Edo Banach said. “For their own protection, the safety of those under their care, and the welfare of their families and communities, NHPCO encourages these dedicated professionals to receive the COVID-19 vaccine.”

Each state’s plan to roll out the vaccine is different, so organizations that work in multiple states will have to do their due diligence in each region to ensure that their workers have access to one of the two vaccines as soon as possible.

Still, the home-based care organizations stopped short of encouraging mandatory vaccinations for workers, despite their assurance that immunization will be safe and effective in stopping the spread of COVID-19.

“The next thing that we’re trying to address right now is whether or not vaccines should be mandatory among our staff,” Totaro said during Home Health Care News’ Capital+Strategy event earlier this month. “And that’s a very, very complex issue. We’re taking it very seriously.”

San Francisco-based law firm Littler Mendelson released a client alert to home-based care organizations this week regarding that issue.

For many reasons, Littler is urging providers to wait before taking a firm position on mandatory vaccinations for workers.

“Employers really cannot make vaccinations completely mandatory,” Angelo Spinola, a shareholder at Littler Mendelson, wrote. “They must always allow exceptions based on health and religious beliefs.”

Spinola urged home-based care clients to consider a handful of questions: Firstly, are there exclusions regarding who should receive the vaccination, from a medical perspective?; Will there be side effects to the vaccine that could hurt employees?; Are your employees reticent or or enthusiastic about the vaccine?; And how are others in the industry responding?

Those questions all suggest that providers should wait before making the call. In some states, health care workers are required by the government to receive flu shots, for instance. If the government could make vaccines mandatory, Spinola urges providers to let lamakers do it first.

Plus, there are other things to consider.

“Mandatory vaccinations may lead to potential workers’ compensation claims from employees who suffer an adverse reaction to a potential vaccine,” he wrote.

In any case, encouraging vaccination, but stopping short of mandating them, seems to be the resounding guidance right now from industry insiders.

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Stimulus Money, Therapy Changes and COVID-19 Strategies: Top Home Health Stories of 2020

The Patient-Driven Groupings Model (PDGM) was supposed to define home health care in 2020.

Instead, this year was almost entirely shaped by COVID-19, a point that’s reinforced by the most widely read stories on Home Health Care News. Of the top-10 stories on HHCN in 2020, eight were related to coronavirus coverage.

From the first outbreak in Kirkland, Washington, to the latest developments in government support for health care providers, HHCN was on top of it all. Reflect back on this unprecedented year in home health care by browsing through the content below.

“House Stimulus Package Sets Aside $200 Billion for Front-Line Worker Hazard Pay” (May 13)

There have been several different federal COVID-19 stimulus packages passed since spring, with the House and Senate often locked in tense political debates on the details. HHCN’s top story of 2020 was an inside look at a May House proposal — the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act.

While nothing came of the Democrat-backed bill, it did highlight the growing recognition of front-line health care workers. Specifically, the proposed relief package included a $200 billion fund for essential-worker hazard pay.

As of Thursday, lawmakers were reportedly close to signing off on a roughly $900 billion relief deal that would include another round of stimulus checks and other much-needed financial benefits for Americans. Liability protections for businesses — something Republicans have pushed for — are likely not included in the deal.

“AOTA, APTA Sound Off on PDGM’s ‘Terrifying’ Therapy Consequences” (Feb. 3)

Going into this year, one of the main storylines of PDGM was the reimbursement overhaul’s impact on in-home therapy services.

After the Patient-Driven Payment Model (PDPM) was implemented in the skilled nursing facility (SNF) space in October 2019, many operators opted to cut or furlough therapy staff. Some industry experts expected home health agencies to do the same.

Certainly, some providers did shift their therapy strategies. But it’s almost impossible to identify whether home health therapy cuts were tied to PDGM or the ongoing public health emergency.

“Home Health Providers Likely to Face Future COVID-19 Fallout” (May 6)

Early on, home health providers had to adapt to care for a surge of COVID-19-positive patients. Quickly, though, it became clear they would have to respond to other challenges as well.

Among those challenges: the influx of non-COVID patients that were getting discharged from hospitals faster to maintain acute care capacity. By not recovering in the hospital for longer, patients discharged to home health care in 2020 have been weaker and more deconditioned than in the past.

A similar trend has emerged — higher patient acuity levels — as referral sources looked to avoid congregate care settings like SNFs.

“Loopholes in COVID-19 Unemployment Program Threaten to Deplete Home Care Workforce” (April 7)

On one hand, labor experts predicted that a depressed economy and the closure of certain businesses would lead to a larger worker pool for in-home care agencies. On the other, initially robust unemployment benefits meant some caregivers could get paid more by opting out of work.

In conversations with HHCN, most home health and home care executives have said the recruitment and retention of workers remains extremely difficult.

“Calm Before the Storm: In-Home Care Providers Brace for COVID-19 Surge” (April 16)

Although COVID-19 outbreaks started to surface in mid-March, home-based care agencies didn’t start feeling pandemic pressures until mid- to late-April. Leading up to that time, operators scrambled to secure enough personal protective equipment (PPE) and educate their patients on the safety of their services.

“‘No Strings Attached’: CMS Sending $30 Billion to Home Health Agencies, Other Medicare Providers” (April 9)

In April, CMS announced that it was sending a first tranche of $30 billion to all Medicare-reimbursed health care organizations, with funding coming from the Public Health and Social Services Emergency Fund under the CARES Act. More tranches followed, with HHS releasing another $1.1 billion in direct aid to nursing homes on Wednesday.

“CMS Announces $165M to Support Home Care, Reduce ‘America’s Over-Reliance’ on Nursing Homes” (Sept. 23)

In September, CMS announced the availability of up to $165 million in supplemental funding to states operating Money Follows the Person (MFP) demonstration programs. While that news was exciting, it was related comments from Administrator Seema Verma that really piqued home-based care agencies’ interest.

The tragic devastation wrought by the coronavirus on nursing home residents exposes America’s over-reliance on institutional long-term care facilities,” Verma said at the time. “Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible.”

“Home Care Careers ‘Are Suddenly on the Map,’ But Recruiting Remains a Challenge” (Nov. 4)

Staffing continues to be a challenge for home-based care providers. Even as unemployment rose to record-highs during the COVID-19 crisis and demand for home-based care skyrocketed, providers found it hard to find qualified workers.

But one undeniable tailwind was how spotlighted home care careers became during the public health emergency. President-elect Joe Biden outlined a plan to boost the caregiver workforce, politicians vied for home-based care on both sides of the aisle, and everyday Americans become more aware of what home-based care workers did on a daily basis.

“One positive thing that I think came out of COVID — and I think this is just a real positive thing for the whole industry — is home care careers are suddenly on the map,” Brandi Kurtyka, the CEO of myCNAjobs told HHCN. “Senior care just got the biggest ‘Got Milk’ campaign that we’ve ever seen.”

“[Updated] House Passes CARES Act, Fast Forwarding Home Health Care Innovation Beyond COVID-19” (March 27)

Efforts have certainly stalled since, but when the initial relief packages came out in March, home-based care providers could not get enough of the details — of which there were many.

When the record-breaking $2 trillion stimulus package known as the CARES Act passed, providers were granted monetary and regulatory relief. It was the first shoe to drop in a litany of changes ultimately made to the home-based care space.

It created the Provider Relief Fund and made temporary, beneficial changes to reimbursement. But it also created a more virtual industry, rendering face-to-face requirements and other traditionally in-person practices as relics of the past.

As Confirmed Cases Rise, Home Health Industry Turns Its Attention to Coronavirus” (March 4)

This is the story that kicked everything off — the first time that HHCN reported on the coronavirus in 2020. “People have been asking me, ‘Where are we with the coronavirus?’” National Association for Home Care & Hospice (NAHC) President William A. Dombi was quoted saying. “It’s scary.” Those fears would soon turn out to be well founded.

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Backed by Harpeth Capital, Industry Veteran Launches HomeFirst Home Healthcare

Backed by investment bank Harpeth Capital, a home-based care veteran recently threw his weight behind a new home health venture. The new company is called HomeFirst Home Healthcare, led by James Happ, who serves as president and CEO.

If Happ’s name sounds familiar, it’s because he spent some time at the leadership level of SunCrest Home Health, which is now an LHC Group Inc. (Nasdaq: LHCG) joint venture. Happ brings all of his past experiences to this next chapter, he told Home Health Care News.

“While at SunCrest, I was involved in business development,” Happ said. “We had made several acquisitions during my time there. I basically implemented a strategic planning process at SunCrest and [the company] grew very quickly and successfully. It was really all because of very effective executive leadership and operational leadership.”

As far as HomeFirst, the company was formed to buy certificates of need and state licenses of two home health agencies that served 24 counties in Tennessee. HomeFirst’s services lines include skilled nursing, private-duty care, physical therapy, occupational therapy, speech-language pathology and medical social work.

The road to HomeFirst has been a long one for Happ.

He first met with Harpeth Capital in 2007 when he was coming off of a successful run at Tender Loving Care, a home health company that would later be acquired by Amedisys Inc. (Nasdaq: AMED). At the time, he was looking to acquire a home health agency.

“We weren’t actually successful there, but [Harpeth Capital] continued on and got themselves involved in following the industry and became really impressed with the success that Suncrest had,” Happ said.

By the time Happ approached Harpeth Capital again, the investment bank was very keen on entering the home health space.

“When this opportunity presented itself here in Nashville, I approached the folks at Harpeth and they were very interested in getting involved through their Harpeth Ventures Opportunity Fund,” he said. “This is a relatively new fund that’s going to invest in health care opportunities. This is their first investment. Had they not been very comfortable with the senior leadership and their experience in the home health industry, they may have not been as excited.”

When Happ first eyed what would eventually become HomeFirst, the industry was on the verge of a major reimbursement shakeup with the upcoming Patient-Driven Groupings Model (PDGM).

“Last October, we were made aware that these two licenses were for sale,” Happ said. “We kind of slowed the acquisition process because PDGM was on the horizon. We wanted to get a feel for how that was going to be received and how that would play out within the industry.”

Five months later, the industry began seeing the impacts of the COVID-19 emergency. This only further slowed down the acquisition, according to Happ.

But then two months later, acquisition talks picked up again.

“It became clear that it was still a great opportunity for us,” Happ said. “The assets that we acquired were distressed assets. It provided an opportunity for us to acquire — at what we felt was a very attractive price. After quite a bit of due diligence, we closed on the transaction on Sept. 15.”

As HomeFirst moves forward as a company, private-duty home care is an area where Happ sees a lot of opportunities.

“Tennessee has a program called TennCare, which is a state Medicaid program, which has been popular for many years,” Happ said. “The Tennessee Medicaid program just continues to renew and improve. There are lots of other opportunities in private-duty as well, whether it’s long-term care insurance providers, or even out-of-pocket private-pay-type services. We see those opportunities expanding across the country on a daily basis.”

As a veteran in the home-based care arena, Happ’s years of experience have given him an interesting perspective.

One key change he’s seen over the years is the way the federal government both views and reimburses home health.

“The government, in the past, never really recognized efficiency,” Happ said. “They paid based upon the cost that you incurred, as long as you were under certain caps. Over the last 20 years, they’ve very slowly moved towards outcome-based reimbursement.”

Happ has also seen more overall awareness of the benefits that care in the home setting can provide.

“The home is now viewed as a place where you have to be serious about focusing on delivering care,” he said. “We’ve been in this industry now, all these years, we’re in a great position to be able to assist the government and all other health care providers that are seeing their patients at home.”

Now 90 days in, Happ is already looking to the future and thinking about expansion opportunities.

“As we get our foundation and our structure completely built down, which we’re in the midst of, then we’ll be looking for opportunities to expand in neighboring territories and states,” Happ said.

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National Home Health Spending Reaches All-Time High of $113.5 Billion

National home health spending soared to a whopping $113.5 billion in 2019, according to a new analysis from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary published Wednesday in the journal Health Affairs. 

While that figure marked another all-time high for home health care, the U.S. government still spent far more on nursing care facilities and hospital care last year.

That may change in 2020 due to the ongoing COVID-19 pandemic and a need to decentralize health care services, though it’s probably still too soon to draw any long-term spending conclusions. 

Overall 2019 health care spending in the United States was $3.8 trillion, up 4.6% compared to the previous year, the CMS Office of the Actuary estimates. The share of the economy devoted to health care spending, as measured by the GDP, was 17.7%.

“Health care spending in 2019 increased at about the same rate as it had in 2018 and was similar to the average annual growth since 2016,” Anne Martin, an economist in the CMS Office of the Actuary and first author of the Health Affairs article, noted. “This relative stability in health care spending growth over the last four years preceded the COVID-19 pandemic in 2020. The full impact of the pandemic on the health care sector is still not known, but it will certainly have profound consequences on the provision and consumption of health care in 2020 and perhaps beyond.”

National spending on home health care services has grown by at least 5% annually since 2015. From 2018 to 2019, spending increased by 7.7% — the biggest year-over-year jump since at least 2013.

Wednesday’s analysis does not go into the reasons driving that substantial increase, but there are several likely factors.

On a demographic level, the country’s universe of Medicare beneficiaries is becoming more medically complex, with older individuals often living with four or more chronic conditions and functional limitations. At the same time, more and more hospitals and community-based referral sources are opting to send their patients to home health providers instead of skilled nursing facilities (SNFs).

Accountable care organizations (ACOs), health plans and others are similarly recognizing the value of home-based care more than ever.

These and other trends have only accelerated during the public health emergency in 2020.

“The biggest thing that we will see in home health care is that we’re given a seat at the ‘big kids’ table,’” Beau Sorensen, COO at First Choice Home Health & Hospice, told Home Health Care News earlier this week. “The recognition from COVID-19 that the country needs to move away from keeping people in congregate living and post-acute settings, combined with the expertise that we have developed through decades of caring for people at home, will lead to a much larger role for home health and hospice in the care continuum.”

Total Medicare spending grew by 6.7% in 2019 to $799.4 billion. Comparatively, that accounted for 21% of total national health care expenditures.

Meanwhile, total Medicaid spending grew by 2.9% to 613.5 billion. That accounted for 16% of total national health spending.

Government spending on hospital care hit an estimated $1.2 trillion last year, according to the CMS Office of the Actuary. Put differently, roughly one out of every three dollars spent on health care in 2019 was tied to hospital-based care.

Spending on “nursing care facilities and continuing care retirement communities” was an estimated $172.7 billion in 2019 — nearly $60 billion more than spending on home health care. While home health expenditures grew by more than 7% from 2018 to 2019, however, spending in this area only grew by 3.3%. 

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Home Health Executive Forecast for 2021: Reserving a Seat at the Big Kids’ Table

Going into 2020, many home health executives predicted that the Patient-Driven Groupings Model (PDGM) would kick off a wave of consolidation and agency closures. Others believed the phase out of Requests for Anticipated Payment (RAPs) would have a similar effect.

For the most part, that didn’t happen. The COVID-19 pandemic — and all the policy developments that came with it — reshaped this year in impossible-to-anticipate ways.

As has become an annual tradition, Home Health Care News caught up with 10 industry leaders to chronicle their predictions on the coming year. Despite all the uncertainty still swirling around the public health emergency, these brave CEOs and C-suite executives took a shot at identifying trends, challenges and opportunities that will define home-based care in 2021.

You can find their predictions below, lightly edited for length and clarity.

* * *

In my opinion, 2021 will be the year that 2020 was supposed to be prior to the COVID-19 pandemic. The disruption from the implementation of PDGM and impact from the reduction (and in 2021 the full elimination) of the RAP was largely mitigated by Cares Act funds that helped to support the broader health care space. Once the Public Health Emergency is over and there is no more Cares Act or additional government support, the impact that we thought we would see in 2020 will play out in 2021 – fewer players with more market share.

COVID-19 has also helped to catalyze a number of trends that we have been talking about for years, including: Seniors’ desire, now greater than ever, to be cared for in the home; flexibility from CMS for the utilization of telemedicine in care planning; and reimbursement for higher acuity care provided in the home. We believe these trends will stick well beyond the pandemic and will only continue to highlight just how important and impactful care in the home is to health care costs but also, most importantly, to patient outcomes, quality and safety.

Additionally, the CMMI Value Based Purchasing demo should go nationwide, but might get lost in the transition of administrations. This is an opportunity to drive quality that might potentially be lost.

— Paul Kusserow, President and CEO of Amedisys Inc. (Nasdaq: AMED)

* * *

Successful agencies in 2021 – and the next few years for that matter – will be successful because of a true investment in human capital. The totality of recent changes, as well as those we anticipate in the coming year (No-pay RAP, the current Public Health Emergency uncertainty and eventually OASIS-E) all weigh on the people making our agencies run. And our clinicians are bearing the brunt of this weight. The successful agency is prepared now to invest in talent management, clinical education and professional development, so our clinicians and staff are prepared to face the challenges that continue to come our way and feel engaged in the work.

— Jason Growe, CEO of Apollo Medical

* * *

The pandemic has brought unprecedented challenge and change to the home care market. At Elara Caring, the key lesson learned this year was agility and teamwork. As we look to 2021, we believe clear communication and agility at every level will remain key to success. In addition, the ability to address a multitude of patients’ needs has become even more important in 2020. As a home care company providing a full suite of services – skilled home health, hospice, behavioral and personal care – we believe Elara Caring is well positioned for the year and decade ahead in home care.

We also remain steadfast in our efforts to build one Elara Caring across the 16 states we offer services in. Lastly and most importantly, COVID-19 has brought home care workers to the forefront — and they are more appreciated and desired than ever. We are proud of the work we have done this year to prioritize worker safety and health to ensure our workers and our patients receive the highest-level care.

— Scott Powers, CEO of Elara Caring

* * *

The biggest thing that we will see in home health care is that we’re given a seat at the “big kids table.” The recognition from COVID-19 that the country needs to move away from keeping people in congregate living and post-acute settings combined with the expertise that we have developed through decades of caring for people at home will lead to a much larger role for home health and hospice in the care continuum. Additionally, as we add in the booming wearable and IoT market, these services will transform the delivery of care, giving agencies real-time access to create plans of care that respond to patients’ conditions in a way that more closely resembles a “hospital at home.” This will be a driving force over the next several years to transform where home health care is in the care continuum.

— Beau Sorensen, COO at First Choice Home Health & Hospice

* * *

COVID-19 has accelerated many of the trends that were already underway in health care, particularly in regard to care delivered in the home. We see three factors driving this: increased demand by patients, increased adoption by health care providers and greater flexibility from CMS.

We’ve seen exponential growth in telehealth this year. We’re finding that most Medicare patients are open to virtual care, especially if they already have a doctor they’re comfortable with. This trend is here to stay.

Where I see the most acceleration going forward is in higher-acuity home care. Physicians are starting to embrace the delivery of hospital-level and skilled nursing care in the home. In the past, physicians were more inclined to refer a patient to a facility setting. Now, given the increased risks, physicians are referring more patients into home-based models, which are able to deliver safe and effective care leveraging home visits, virtual care and remote-monitoring technology, often producing better health outcomes for patients. Consumers prefer it, too, as it reduces burdens on caregivers, provides immediate access to their care team, helps them maintain independence and allows them to heal in the comfort of their home.

We appreciate the additional flexibilities CMS extended as a result of the pandemic and encourage them to go even further. Many of the people we serve are low-income seniors who do not have access to devices such as smartphones or tablets. We are taking advantage of recent CMS changes that permit us to loan patients tablets to connect with their care manager or physician, but there are limitations to what we can make available on those devices. We think there’s an opportunity to load the devices with additional content and tools that address mental health and other social determinants, and also allow patients to connect with their loved ones. Isolation was already a big factor for our patients, and social distancing and other limitations on their ability to socialize have only exacerbated this situation; further flexibility would allow us to fully leverage innovation in support of our members’ health.

— Susan Diamond; home care business president, Humana Inc. (NYSE: HUM)

* * *

Just as QR codes are here to stay in the place of traditional restaurant menus, we can expect to see the need for skilled home health and hospice continue to grow, driven by the COVID-19 pandemic. I anticipate strong demand for our services will exacerbate existing staffing challenges, testing our industry’s ability to recruit enough registered nurses to meet increased demand. As clinically appropriate, our paradigm will need to attract experienced RNs who have not previously considered home health and hospice, implement comprehensive orientation and peer mentor programs to support candidates without post-acute experience and new graduates, and continue providing robust offerings to support the paraprofessional nurse. The shift of health care services to the home setting will facilitate the ongoing focus of reducing health care costs while delivering quality outcomes. The value of care delivered at home will be on full display in 2021 and beyond.

— Paul McMullen, COO at Intrepid USA Healthcare

* * *

For 2021, I’m looking forward to gaining traction on tangible change. Home health will continue to innovate, but much of the planning and work has been done in 2020. For 2021, it will be the year of implementation. I believe we’ll see unprecedented speed in bi-partisan Congressional action on the home health reimbursement front. Soon after, we’ll see new government regulation across health care. Don’t be surprised to see a new government agency, czar or department head create rigorous health care accountability measures that will impact our daily delivery of care.

While the nursing shortage will continue, I anticipate increased enrollment in medical, therapy and nursing programs nationwide. We won’t see these new recruits on the front lines for a few years, but they’re going to bring fresh perspectives to home health after living through a world-wide pandemic.

For Josephine At Home, 2021 will be a year of insane growth. We’re excited to be part of the national solution to improve care and patient safety. But this can only happen if home health is an equal partner in the continuum of care. Home health has been providing clinical excellence since its inception. And we’re long overdue to have recognition in the form of comprehensive reimbursement from CMS. From a leadership standpoint, I’ll be focusing on advocating for expanded home health reimbursement on the state and national level. And most importantly, I will be hyper-focused on staffing. A healthy work culture has a positive correlation to optimized patient outcomes. Leaders willing to have difficult conversations, be vulnerable and accept change will find success in the 2021 home health landscape.

— Leslie Palmer, executive director of Josephine At Home

* * *

There was a seismic shift in how Mission Healthcare operated to mitigate the COVID-19 crisis and create a safe environment for staff, patients and families. We will continue to face challenges and changes to the home health landscape well into 2021. First, the pandemic is far from over, and we expect business impact from the coronavirus to linger well into the first part of the year. As cases continue to climb, more people are valuing and shifting to care in the setting of the home as an alternative. Furthermore, home health providers will be a tremendous vehicle for the administration of the COVID-19 vaccine for many patients who are high risk, homebound, and unable to get to doctors or clinics.

Additionally, the largest swooping change of PDGM continues to impact the industry. We will keep our eyes peeled on the way PDGM shakes providers across the country as government programs come to an end, including the sequestration holiday, Cares Act funds, PPP loans, deferred payroll tax and advance payments. PDGM’s intersection with the coronavirus accelerated technology trends and innovation. Our industry is more than ever embracing technology as we enter a new era of health care.

Lastly, M&A activity continues to surge in both hospice and home health as we come out of the pandemic and travel begins to open back up. While the industry has shown signs of a strong rebound, it is certainly not without challenges. Given the rapidly changing market, Mission Healthcare continues to take our COVID-19 response and processes very seriously to adapt to the current environment. The safety and well-being of our patients and colleagues remain our priority.

— Paul VerHoeve, CEO of Mission Healthcare

* * *

2021 will be a tale of two halves.

We expect to see another COVID-19-driven stimulus package in the first half of the year. As that wanes off, we’ll see a glut of M&A in the second half — smaller operators struggling with overbearing regulations, inadequate reimbursements, and increasing labor costs and shortages will look to sell. Many may go out of business.

The need for home-based care is at an all-time high, and it will only grow. We think the HEAT Act will be passed by Congress, driving up telehealth utilization for nursing and therapy visits. Doctors will look to home health care agencies for assisted-telehealth-visits to have eyes and ears on the ground and to help implement remote patient monitoring devices.

Productizing operations using data and proprietary technology will be key to building structurally sound home health care agencies in 2021.

— Raman Brar, CEO of PathWell Health

* * *

As the nation’s COVID-19 response is analyzed, the value of home care as a way for COVID patients to be treated at home — allowing hospitals to discharge COVID patients to open up beds — will become apparent, driving an increased focus on the need for governmental and payer financial support of home care programs.

— Dan Savitt, executive vice president and CFO of the Visiting Nurse Service of New York (VNSNY)

*Editor’s note (Dec. 15, 2020): VNSNY CFO Dan Saviitt will step into the CEO role on Feb. 1, 2021, after the planned departure of current CEO Marki Flannery.

* * *

With the continued push to provide care in the home setting, the home health vertical will be an even more integral factor in the goal to provide our mutual patients with quality care in the right setting. Home health agencies that are innovative in their abilities to combat social determinants of health as well as streamline effective communication pathways with their up- and downstream providers will be the strongest players within their market, ultimately positioning themselves to be strong partners with MCOs, ACOs and acute care.

— Jennifer Levy, chief strategy officer at V&V Management Solutions

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Brookdale Senior Living Reportedly Exploring Sale of Home Health and Hospice Businesses

After falling short on Q3 projections and seeing revenue dip year over year, Brookdale Senior Living (NYSE: BKD) is reportedly considering divesting its home health and hospice segments.

COVID-19’s impact on the company has created financial pressures that it hopes to mitigate, PEHub Reported Monday. Those pressures could feasibly be made up, in part, through a home health and hospice business sale when valuations remain at jaw-dropping highs.

The Brentwood, Tennessee-based aging services operator — which offers home health, hospice and outpatient therapy services to over 17,000 patients nationwide — is reportedly being provided with guidance by Bank of America and exploring various options. Those options include finding a private equity buyer, a pure-play strategy buyer or even a combination of the two, according to PEHub.

The company declined to comment on the rumor when contacted by Home Health Care News, citing a standing policy not to engage in dealmaking speculation.

Brookdale is a leading operator of senior living communities in the U.S. The company operates and manages independent living, assisted living, memory care and continuing care retirement communities (CCRCs), totaling 726 communities spanning 44 states.

Overall, Brookdale’s total revenue totaled $706 million in Q3 2020, down 13.3% compared to $815 million in Q3 2019. The company estimated that $71 million was lost in revenue in Q3 due to COVID-19.

Likewise, its home health revenues had been down. In 2019, home health accounted for $327 million in revenue for Brookdale. Through Q3 of 2020, revenues had not yet hit $185 million.

Still, its home health and hospice business was strong enough to begin considering this sort of move. Brookdale is the largest senior living provider in the United States and also the sixth-largest home health provider, data from LexisNexis suggests.

“Brookdale has significant assets, [including] owned real estate, home health and hospice business,” investment banking company Jefferies wrote in a note after Brookdale’s Q3 earnings call. “Those are able to be monetized and could unlock shareholder value.”

But total home health revenue in Q3 2020 was just over $61 million, which was down 23.6% compared to Q3 2019. Its average daily census went from 15,357 in Q3 2019 to 13,146 in over the same time period this year.

In the same note, Jefferies also commented that “monetizing the [home health and hospice] assets would be an effective strategic decision” to counteract the cash burn due to COVID-19.

Brookdale isn’t alone, if the rumored reports hold true.

Encompass Health Corp. (NYSE: EHC) — the fourth-largest home health provider in the U.S., according to LexisNexis — announced last week that it was “exploring strategic alternatives” for its home health and hospice business.

Birmingham, Alabama-based Enccompass Health’s home health and hospice segments brought in $274.5 million in revenue over Q3 2020 and over $1 billion in all of 2019, according to company financial filings. Overall, its U.S. footprint includes 242 home health locations and 83 hospice locations.

“The strategy in terms of building a coordinated post-acute care provider — that is, with IRF, home health and hospice — I think has actually been successful,” William Blair analyst Matt Larew said during HHCN’s Capital+Strategy event. “I think Encompass Health has done a really nice job.”

Brookdale hasn’t gone public with any of its strategies yet, and there’s likely going to be some hurdles, if a sale is the goal.

For one, Brookdale’s home health and hospice line is tied to its senior living side of the business, and its revenues are affected by that built-in relationship.

The company has also been the beneficiary of over $100 million in federal and state relief since the beginning of the public health emergency, including a whopping $67.5 million from the U.S. Department of Health and Human Services (HHS) via the Provider Relief Fund.

Monday isn’t the first time rumors have swirled around a sale of Brookdale’s home health and hospice operations. In May 2019, Stephens analyst Dana Hambly also suggested a sale could make sense due to the demand for quality in-home care assets.

“Given the valuations in the home health and hospice industries, we believe Brookdale has explored strategic alternatives for the health care services segment,” Hambly told HHCN at the time. “With the home health business seemingly on the upswing and the steady growth in the hospice business, this is now a more attractive asset than it was 12 months ago.”

While home health has been an up-and-down business for Brookdale, the company’s hospice operations have consistently performed well.

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Mission Healthcare Hires Two New Executives; Lifesprk Names New President

Mission Healthcare adds to executive team

Mission Healthcare has made new additions to its executive leadership team.

The company named JoAnn Mack its chief operating officer and Damien Weston its chief growth officer.

Mission Healthcare — which has more than 600 employees — is a San Diego-based home health and hospice services provider with 10 locations serving the Southern California region.

The hiring of Mack and Weston is part of Mission Healthcare’s broader growth strategy. Both executives were brought on to guide the organization with its overall expansion plans.

Prior to her appointment, Mack held leadership positions at VNA Health of Santa Barbara, Vitas and Interim Healthcare. She is also a member of the National Hospice & Palliative Care Organization (NHPCO), California Hospice & Palliative Care Association (CHAPCA) and California Association for Health Services at Home (CAHSAH).

“JoAnn’s deep involvement in the industry and years of experience will prove invaluable to the Mission Healthcare team as we continue our 10-year track record of growth and success,” Paul VerHoeve, CEO of Mission Healthcare, said in a statement. “Her leadership will be instrumental in ensuring we consistently deliver high-quality care and strengthen our company culture as we expand into new markets. We feel very fortunate to attract great talent that will be instrumental as we continue to expand into more western states.”

Before joining Mission Healthcare, Weston held leadership roles at Compassus, Gentiva and Kindred Healthcare.

“We are thrilled to put Damien at the helm of our expansion efforts. His experience will be integral to helping us scale strategically and expand our quality care offerings,” Verhoeve said.

Lifesprk appoints new president

Lifesprk has announced that Elmer Baldwin has been named company president. Baldwin has a history with Lifesprk — having served as the company’s long-time advisor.

Lifesprk is a Minnesota-based health care provider with a suite of home-focused services.

Baldwin steps in for former president Tom Schmitt, who will now serve as executive director of value-based payment strategy and growth at Lifesprk.

In his new role, Baldwin will oversee the development of Lifesprk’s business model, as part of the company’s overall growth strategy.

“We are growing in all our lines of business, including community-based in-home services, Medicare skilled home care, property management, primary care, acute care at home and hospice, while investing in our value-based, tech-enabled alternative delivery system designed to help seniors age magnificently,” Baldwin said in a press release.

Baldwin has been a Lifesprk advisory board member for the past decade. Prior to his latest appointment, he served as senior executive director of technology investment banking with Minneapolis-based Cherry Tree & Associates.

Caring People names brand ambassador

Caring People has added Jo Alch as a brand ambassador to its team.

A portfolio company of private equity firm Silver Oaks Services Partners, home care company Caring People currently operates in New York, New Jersey, Connecticut, Florida and Texas, serving an average of 1,700 clients per day.

Alch has joined Caring People to support its plans in relation to leveraging new opportunities, partners and PR efforts.

“Establishing and fostering relationships with industry leaders in a variety of spaces will ultimately benefit our seniors tremendously,” Alch said in a press release. “I, and Caring People, truly have a heart for the elderly. This role will provide fresh opportunities for new organizational partnerships with a unified goal: compassionate and highest-quality senior care.”

Before joining Caring People, Alch founded Acappella — a Texas-based home care agency — in 2006.

Caring People also noted that Alch is a thought leader and prominent figure in the Texas health care community.

Additionally, she has served on the board of directors of the Texas Association for Home Care and Hospice and was the committee chair for the Dallas Area Agency on Aging Advisory Council.

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The Care Team Expands Footprint with InTeliCare Purchase; CareFinders Buys Union Home Care

The Care Team acquires InTeliCare

Private equity-backed The Care Team has acquired InTeliCare Home Health & Hospice. The financial terms of the deal were not disclosed.

Farmington Hills, Michigan-based The Care Team is a home-based care provider that delivers a variety of services including nursing, therapy and hospice services across central and eastern Michigan. The Care Team is a portfolio company of the Denver-based PE firm Revelstoke Capital Partners.

InTeliCare Home Health & Hospice is a Michigan-based care provider that operates in Standish, Gaylord and Traverse City.

For The Care Team, the deal was an opportunity to join forces a company that closely aligns with its goals in terms of care delivery, Jason Laing, CEO and founder of The Care Team, said in a statement.

“The Care Team and InTeliCare share similar cultures and a strong commitment to patient care, clinical excellence and compliance,” Laing said. “We see a tremendous opportunity to combine the strengths and capabilities of both companies.”

The deal expands The Care Team’s footprint and places the company in a stronger position to negotiate with payers and referral partners moving forward.

“With the acquisition of InTeliCare, The Care Team will have the ability to treat patients across the entire lower peninsula of Michigan, which will allow us to be better partners to our payer and referral relationships,” Jonny Miller, vice president at Revelstoke, said in a statement.

CareFinders Total Care purchases Union Home Care

CareFinders Total Care has purchased Union Home Care, a Pennsylvania-based home care services provider.

Founded in 1995, Hackensack, New Jersey-based CareFinders provides in-home care services to more than 8,500 patients throughout New Jersey, Pennsylvania and Connecticut. It has 26 offices in total.

For CareFinders, the deal is another opportunity to expand its Pennsylvania footprint. Currently, the company has six offices in the state.

“Union Home Care is a high-growth, premier home health agency in the Philly market offering Medicaid personal care services,” CareFinders CEO Jim Robinson said in a press release. “This newest member of the CareFinders family of companies has an impeccable reputation for high-quality personalized care. With our expanded footprint in Philadelphia, this acquisition takes us one step closer to our goal of becoming the No. 1 home care services company in the Northeast.”

Both organizations align when it comes to values and an overall mission, Mila Mendel, the founder of Union Home Care, said in a statement.

“This is an exciting change that will benefit our clients, our caregivers and our health care partners, and I am excited to help lead this charge,” Mendel said.

Moving forward, Mendel will serve as the executive director of CareFinders’ Philadelphia division. She will also oversee growth plans in that market.

Home-focused health care organizations receive approval to merge

Florida health systems Empath Health and Stratum Health System have been granted formal approval to merge from their board of directors. The organizations’ originally announced plans to merge back in February.

Both organizations provide care in the home setting through their networks. Stratum Health System oversees and supports both Approved Home Health and Avidity Home Health, two agencies with multiple locations in southwest Florida.

Meanwhile, Empath Health offers home health care as a part of its wide-ranging services. The company also focuses on patients with advanced or chronic illnesses.

The merger will create the country’s largest not-for-profit health system, according to the two organizations. Combined, the enterprise will serve more than 6,000 patients daily.

In total, the organizations would have an estimated annual gross revenue of $300 million.

Empath Health and Stratum Health System will continue to operate under their current banners.

Additionally, Rafael Sciullo, president and CEO of Empath Health, will continue in this role. Jonathan Fleece, president and CEO of Stratum Health System, will serve as president.

“As the saying goes, bigger does not automatically make you better,” Sciullo said in a press release. “It is what we do with that opportunity that will allow us to create meaningful change while continuing to excel at doing what we do best, … providing compassionate care to our patients and their families.”

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As FDA Nears Authorization, Home Health Industry Still Evaluating Vaccine Mandates

A panel of U.S. Food and Drug Administration (FDA) advisers voted on Thursday to recommend that the Pfizer-BioNTech vaccine be authorized for emergency use during the coronavirus pandemic.

Originally, it was believed the FDA — which typically follows the guidance of its advisers — would move forward with authorization on Saturday. That timeline has likely been pushed up to even sooner now, with the White House reportedly pressuring FDA’s leader to give the greenlight to the vaccine or step down.

Early Friday, President Donald Trump compared the FDA on Twitter to “a big, old, slow turtle,” and urged the agency’s commissioner, Stephen Hahn, to “stop playing games and start saving lives.”

While the general public is following those developments closely, home health operators are paying particularly close attention. Many are currently in the process of crafting their COVID-19 vaccine protocols, including whether or not to mandate employee vaccinations.

David Totaro, chairman of the Partnership for Medicaid Home-Based Care (PMHC), touched on the issue Thursday during the Home Health Care News Capital+Strategy event.

“The next thing that we’re trying to address right now is whether or not vaccines should be mandatory among our staff,” Totaro said. “And that’s a very, very complex issue. We’re taking it very seriously.”

Broadly, home health stakeholders agree that their patients — especially high-risk seniors with multiple complex medical conditions — should be prioritized for early vaccine access as part of the first wave. That is in line with U.S. Centers for Disease Control and Prevention (CDC) recommendations finalized last week

Ultimately, decisions around prioritization come down to the state level.

In a similar vein, decisions around mandating vaccinations for home health staff will likely be made by individual providers, Totaro said.

“We’re evaluating from the standpoint of legal implications there,” he said. “There are state regulations, religious considerations — so many things to consider. But I think in the long term, and we haven’t made a decision yet [as an industry], I think it’ll be up to individual providers.”

As home health operators debate vaccines mandates, there’s little legal precedent to consider.

In fact, some of the organizations that health care providers would normally look to for clarity have been quiet on the issue thus far.

“The Equal Employment Opportunity Commission (EEOC) has not yet spoken to whether employers may mandate that all employees take a COVID-19 vaccine when one becomes available,” Elaine Turner, a shareholder at the national law firm Hall Estill, told HHCN in an emailed statement. “However, during the H1N1 public health crisis, the EEOC determined that, during an influenza pandemic, employers could not mandate that all employees take a flu vaccine regardless of employee medical conditions and religious observances.”

While home health operators wait for the EEOC and other government entities to speak to the vaccine question, employers should evaluate whether their businesses are legitimately in need of a mandatory COVID-19 vaccine policy, Turner noted.

For some, encouraging workers may be a better alternative to mandatory vaccinations.

“Under federal law, employers must have a reasonable belief that a mandatory vaccine policy is required because an employee’s ability to perform essential job functions will be impaired by COVID-19 or an employee will pose a direct threat due to COVID-19,” she said.

If home health providers do mandate or strongly encourage COVID-19 vaccination for staff, it could end up shaping the attitudes of their patients.

In a Transcend Strategy Group survey of 599 individuals, 65% of respondents said a provider’s COVID-19 status will have “some” or a “significant” impact on their willingness to receive care from them.

Home health operators still have time to hammer out their strategies around staff vaccinations.

Once the FDA authorizes the vaccine for emergency use, the federal government can start distributing the vaccine to states. But even then, additional steps would still need to be taken by the CDC before actual vaccinations can start.

Additionally, it’s important to note that, once that happens, it’s not the end of America’s battle with the coronavirus. In actuality, the worst of the public health emergency is likely coming up, with many home health agencies preparing for a post-Thanksgiving spike that may only become exacerbated after the winter holidays and family gatherings.

“At least the first quarter of the new year is going to continue to be a very COVID-challenged environment,” Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare (PQHH), said during the Capital+Strategy event. 

The two-shot Pfizer-BioNTech vaccine has already been cleared by Britain, Canada, Bahrain and Saudi Arabia, according to The Washington Post.

It has been shown to be 95% effective in randomized trials.

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Senior Helpers, Reliant at Home, Others Crack 2020’s Best Workplaces in Aging Services List

On Thursday, Fortune unveiled its annual Best Workplaces in Aging Services list. The list features several home-based care providers that made a mark when it comes to company culture.

Last year, Senior Helpers and 24 Hour Home Care cracked the list’s top five. These companies make a return appearance on 2020’s top workplaces list, compiled by analytics firm Great Place to Work. Other companies that earned a spot on the list include Reliant at Home, Assistance Home Care and Constellation Health Services.

To compile this year’s list, Great Place to Work analyzed survey results from 189,159 employees working in the U.S. senior care and aging services sector. Those surveyed were asked about their experiences working at their current company.

The questions stem from the Great Place to Work’s Trust Index, which measures a number of factors, including respect of management, fairness, credibility, camaraderie amongst colleagues and pride in the work.

The companies that make up the list meet the Great Place to Work-Certified standard, Activated Insights CEO Jacquelyn Kung told Home Health Care News.

Oakland, California-based Activated Insights is a Great Place to Work subsidiary focused on senior care.

Companies that have earned a spot on the list have a competitive edge over other home care agencies when it comes to recruiting caregivers. Even companies that didn’t make the list, but are Great Place to Work-certified have found success when it comes to these efforts, according to Kung.

“In our research, we found that just getting certified, which is the baseline, increases the number of applicants to your organization by an average of 19.7%,” she said. “That’s huge for our industry, especially this year when turnover has gone up for a variety of reasons. Recruiting has always been important. There’s always been a talent shortage coming into the sector.”

One noteworthy takeaway Great Place to Work identified was that in-home care employee engagement is higher in comparison to providers on the congregate settings side.

The COVID-19 emergency had a significant impact on companies this year. The way companies responded to the public health emergency influenced their performance on the list. During this time, many providers embraced “servant leadership,” according to Kung.

“They, No. 1, put their employees and their safety first,” she said. “They did everything they could to make sure their employees were protected. This meant sending packs of PPE out to homes, making grocery deliveries to their employee’s homes, if a grocery delivery service wasn’t available. Executives would actually drive groceries around and drop them off with employees.”

Kung also noted that quick response from leadership teams and transparency were greatly valued by employees.

One company that made the list, Reliant at Home, partnered with the North Texas Food Bank and Shiftsmart as part of its COVID-19 response. The company also implemented health care screenings for workers.

“Local community and employee-centered benevolence is a culture priority for Reliant at Home,”

Jana Lightfoot, the company’s CEO, said in a statement. “We made hundreds of meal kits for our employees who are front-line health care workers and for patients [and] families that had trouble getting food on their table due to long days caring for others and mitigated access to groceries.”

Allen, Texas-based Reliant at Home provides a number of services, including personal care, home health and hospice.

Another company on the list, Senior Helpers, leaned on training and education when it came to keeping workers safe.

“We continue to offer updated protocols in weekly communications to our system on COVID-19 so that all feel comfortable and prepared,” Peter Ross, CEO and co-founder of Senior Helpers, said in a statement. “Additionally, we offer extensive staff training with courses that include topics such as hand hygiene, infection control, influenza prevention and transmission-based precaution — all aimed so that our clients can age safely and gracefully in the comfort of their own home.”

Senior Helpers is an international home care franchise with more than 320 locations worldwide.

Overall, Care to Stay Home (No.1), Assistance Home Care (No. 2), Senior Helpers (No. 3), Sunland Home Care (No. 4), 24 Hour Home Care (No. 5), Constellation Health Services (No. 6), Compass Care (No. 7), Elite Home Health Care (No. 8), Sunshine Homecare (No. 9) and Reliant at Home (No. 10) rounded out the top 10 home-based care providers.

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No Funding, Closures and Limited Capacity: Adult Day Providers in Dire Need of Help

In late November, the aging-focused advocacy organization LeadingAge wrote a note to Congress, calling for relief on behalf of the 5,500 adult day service providers across the country and the vulnerable patients they serve.

“Adult day services providers across the country urgently need dedicated federal funding to ensure they are able to continue providing services during and after the COVID-19 pandemic ends,” the letter read.

It was signed by LeadingAge President and CEO Katie Smith Sloan and Donna Sizemore Hale, the executive director of the National Adult Day Services Association.

Unlike other health care providers across the care continuum, adult day providers haven’t been the benefactors of any major funding from the federal government. Meanwhile, state mandates have kept adult day operators completely closed, or opened at just 30% or 50% capacity.

A lack of government relief and a major loss in revenue due to limited capacity or complete closures has left the adult day world in deep trouble.

“I think we definitely do need to appreciate that operating at 30% to 50% capacity — or whatever the capacity limit is — is going to have a huge financial impact on any organization over a long period of time, whether they are adult day operators or a business in any other industry,” Brendan Flinn, the director of home- and community-based services at LeadingAge, told Home Health Care News.

Operators are prioritizing safety as they open. That frequently means reopening at reduced capacity, which means a reduced bottom line as well — and sometimes an unsustainable one.

It also means additional expenses, even with a greatly reduced number of members. For smaller adult day operators, those expenses consist of purchasing safety equipment such as PPE and plexiglass in lower quantities — and, thus, at higher prices.

LeadingAge’s letter to Congress included an asking price of $422.5 million to support providers and the over 260,000 individuals they serve.

Worst of all, a lack of support means that the vulnerable individuals that frequent adult day centers are left behind. Reduced capacity squeezes out members in need of care and socialization.

“I was on a call with some of my providers last week that had recently reopened, … and they were talking about their members, and how they had lost a ton of weight, how they’ve declined cognitively,” Flinn said. “Whatever health conditions they had, they had been exacerbated.”

Those providers had also reported that once they had reopened and welcomed members back, all of those aspects had begun improving.

But that’s for the ones lucky enough to return to adult day centers amid the ongoing public health crisis. For the ones that haven’t, those conditions are likely to continue worsening, bringing stress to them and their families.

Adult day centers are a great resource for lower- and middle-income families. They offer care and socialization to seniors at an often lower, more feasible price.

According to Genworth Financial, the 2020 national median cost of adult day services was $1,603 per month. Comparatively, the assisted living cost was over $4,300 per month, while nursing home care was about $7,750.

“It’s similar to anything else we’ve learned from data, research or anecdotal reporting … we’re seeing the effects to a greater degree for lower-income families and communities,” Flinn said. “We know that adult day services are a great way for [these] families and individuals to receive some type of services if they are not eligible for Medicaid and can’t afford something like a nursing home, but need some sort of care.”

The distribution of funds

It’s not that the Provider Relief Fund, for instance, cut out adult day providers. Instead, it’s that once those funds were released to the U.S. Department of Health and Human Services (HHS), the agency did not include them among the providers who would receive relief.

Phase Two of the Provider Relief Fund — for the most part — was the only phase that adult day providers were able to access. Even then, it was designated for providers that had billed Medicaid, and resources were extremely limited.

“These funds were turned over to HHS, and it made the decision about where those funds went,” Flinn said. “So [HHS] were the ones who decided that Phase One would include Medicare Part A, they were the one that decided what providers would get what type of relief.”

So, if there is another relief package coming down the pike, it’s likely to be distributed the same way. And that would still likely leave adult day providers behind. Some states have been better than others when it comes to adult day relief funding, but it has not been enough to make up for the lost ground from a federal standpoint.

To make matters worse, in the recent and initial federal recommendations for vaccines, adult day providers and their members were not included in the highest priority group.

Stunted growth

Elder-Well, a non-medical social model for adult day care, had high hopes in January of this year.

The Framingham, Massachusetts-based company was founded in 2014 by home health veterans Kara and Ken Harvey.

The Harveys were set to begin growing their business by franchising locations in Massachusetts and Florida, offering discounts for potential franchisees. The couple hoped to add 10 in 2020.

“Adult Day is — and is going to be — a very preferred long-term care option,” Kara Harvey told HHCN. “And so before the pandemic hit, we had many people throughout the country interested in joining the franchise system, and then that halted.”

The Harveys have noticed the recession sparking more interest from entrepreneurs of late, but have held back on opening up a slew of new locations given the uncertain regulatory climates in the two states. While they recently opened a new Elder-Well location, they’ve fallen short of their aspirations for obvious reasons.

Adult day centers were also labeled non-essential in both Florida and Massachusetts.

“That was painful,” Harvey said.

In Florida, however, they were allowed to open back up in May. In Massachusetts, adult days weren’t allowed to reopen through the summer.

Elder-Well wasn’t eligible for larger Paycheck Protection Program (PPP) loans. And because it is a social model that does not receive money from Medicare and Medicaid, the only way they were able to recoup some revenue during the public health emergency was to offer virtual solutions.

“It was difficult, I think, for all service providers in the senior care industry, but particularly for adult day,” Harvey said. “Those that weren’t able to pivot instantly and set up a virtual option really took a hit.”

Elder-Well has leveraged a partnership with the cognitive assistance company MapHabit, as well as Zoom and Facebook Portal, to stay in touch with its members.

After keeping its head above water virtually in 2020, the company has tempered its expectations. Now, it hopes to open six locations in 2021.

“Whether it be a social or a medical model, adult day centers are key in order for seniors to continue living at home in each community,” Harvey said. “There needs to be more insight provided for the lawmakers to understand that, and to appropriate funding and support for programs.”

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Care Finders, Lyft, LogistiCare Partner to Give Caregivers COVID-19 Transportation Support

Care Finders Total Care announced Wednesday it has teamed up with LogistiCare, a non-emergency medical transportation company, to provide transportation services to caregivers working in the home. Ride-hailing giant Lyft Inc. (Nasdaq: LYFT) is also involved with the partnership.

Founded in 1995, Hackensack, New Jersey-based Care Finders provides in-home care services to more than 8,500 patients throughout New Jersey, Pennsylvania and Connecticut. It has 26 offices in total.

Meanwhile, LogistiCare is one of the largest managers of non-emergency medical transportation programs for state government agencies and managed care organizations. The company’s service lines include call center management, transportation provider network development, ride management and credentialing.

Under the partnership, CareFinders’ caregivers can request Lyft rides through LogistiCare.

The services offered through the partnership are a response to the public transportation challenges that stem from the COVID-19 emergency. The aim is to make sure that caregivers have safe and reliable access to transportation, according to Care Finders leadership.

“As the largest home care services provider in the state of New Jersey, transportation is always top of mind for us,” Martha Stuart Williams, chief operating officer of Care Finders, told Home Health Care News in an email. “LogistiCare and Lyft brought a technology-centric and patient-centric solution for what is a persistent issue for many home care providers, particularly during a time as challenging as the pandemic.”

The partnership has its roots in a contract between LogistiCare and the New Jersey Department of Human Services.

“This partnership began when LogistiCare started delivering food to those in need during the pandemic,” Kenneth Wilson, chief operating officer at LogistiCare, told HHCN. “This was in addition to our New Jersey state contract to provide non-emergency transportation for Medicaid patients to their medical appointments.”

LogistiCare learned about CareFinders’ transportation needs via conversations with New Jersey’s Medicaid director, Wilson noted.

“We reached out to CareFinders, and they expressed an interest in working together, so we agreed to create and launch a pilot program, which has been very successful,” he said.

For CareFinders, LogistiCare’s willingness to work with front-line care teams in communities hardest hit by COVID-19 made the company an attractive partner, according to Williams.

“They stepped up as a willing partner, providing reliable transportation for some of our most vulnerable caregivers in the midst of the COVID-19 shutdown,” she said. “That’s super important to us, because Total Care at CareFinders is about supporting our caregivers first and foremost so they can care for our clients.”

Overall, Williams believes that the partnership between LogistiCare, Lyft and Care Finders has allowed them to provide consistent care services.

“At the end of the day, this partnership allows us to provide care to patients who otherwise might have been unable to receive care,” she said. “As a company dedicated to changing lives day in and day out, this partnership has become a tremendous asset for us.”

Additionally, LogistiCare is in talks with other home care providers about potential partnerships.

On its end, Lyft has increasingly gotten involved in the health care space, especially around home-based care. Many home-based care agencies use Lyft to coordinate transportation services for both caregivers and clients.

In total, Care Finders employs more than 7,.600 certified home health aides, plus more than 180 RNs and LPNs.

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Encompass Health Exploring ‘Strategic Alternatives’ for Home Health, Hospice Segment

There may soon be a major shakeup of the home health and hospice markets.

Encompass Health Corp. (NYSE: EHC) announced Tuesday it is “exploring strategic alternatives” for its home health and hospice business, which brought in total segment revenue of $274.5 million in the third quarter of 2020 and $1.09 billion in all of 2019, according to company financial filings.

The Birmingham, Alabama-based Encompass Health currently ranks as the fourth-largest home health provider in the nation, LexisNexis data suggests. Overall, its U.S. footprint includes 242 home health locations and 83 hospice locations.

“Since joining together with Encompass Home Health and Hospice in 2015, we have generated substantial growth in both our business segments, and we continue to deliver high-quality, cost-effective, integrated care to a growing number of our patients,” President and CEO Mark Tarr said in a statement.

The company is considering “a range of options” for its home health and hospice business, including a full or partial separation from Encompass Health through an initial public offering, spin-off, merger, sale or other transaction.

Tuesday’s news has apparently been in the works for a while, as Encompass Health’s board of directors has been evaluating an array of alternative strategies and structures for some time. The board has elected to make an official announcement as it proceeds with a more formalized process, the company noted.

No timetable has been established for the completion of the strategic review. Encompass Health does not intend to disclose further developments with respect to its strategic review process.

“Our primary focus this year has been to ensure Encompass Health’s best possible response to this unprecedented global pandemic,” Lee Higdon, chairman of the company’s board of directors, said. “This notwithstanding, the U.S. health care delivery system continues to change, and we believe the time is appropriate for us to further reassess the corporate structure that may optimize the strategic positioning and growth of our businesses.”

This is a developing story. Please check back later for further updates.

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Bayada CEO David Baiada: The Surge Is Real — And It’s Happening to Us

At one point during the spring COVID-19 surge, Bayada Home Health Care and its in-home care workers burned through a year’s worth of personal protective equipment (PPE) in a single week.

Since then, the Moorestown, New Jersey-based home health, hospice and personal care services provider has largely mastered the PPE problem. Now, its biggest challenge is battling through COVID-19 fatigue — a daunting task as new infection numbers continue to climb.

To get an update on Bayada’s current operations, Home Health Care News recently caught up with CEO David Baiada. In addition to the coronavirus, Baiada also touched on a few highlights of 2020 while looking ahead at strategic priorities for next year.

One of the largest in-home care providers in the U.S., Bayada employs more than 26,000 nurses, home health aides, therapists, medical social workers and other professionals. Its global footprint spans 345 locations, with international locations in Canada, Germany, India, Ireland and three other countries.

You can HHCN’s conversation with Baiada below, edited for length and clarity.

HHCN: How is your team at Bayada doing as we speak here toward the end of November?

Baiada: I’d say we’re doing as well as we can, given the circumstances. There’s clearly a lot happening in the community, a lot happening in organizations like ours. But more than ever, we feel a sense of purpose and commitment to playing our part in keeping people safe, healthy and independent at home. The current environment only shines a brighter spotlight on that opportunity and responsibility.

Everyone has seen the headlines about daily new infection numbers across the U.S. Are you seeing that impact on the ground within your operations?

Oh, yeah. We see all the same formal data, of course, that is available to everyone. But we also have lots of informal indicators that we keep an eye on, whether it’s activity with our referral sources or volume through our COVID command center. We look at the volume going into our call center teams, people with questions about exposure and protocols, etc. We’ve seen increases in these informal indicators that are consistent with what you’re seeing in the news and in the formal data.

How does what you’re seeing now compared to what you saw in March and April?

Well, I think the data feels similar. The surge is real — and it’s happening to us. I think, though, there are a lot of things that are very different. Clearly, we feel more prepared for what to do about that surge. We feel like we’re in a much better position around our understanding of protocol, around PPE availability, sourcing and distribution. We now know how to adapt our business and communication processes to navigate periods of surge. So, I’d say on the one hand, we’re seeing all the same indicators. But we do feel better prepared.

The only thing that advantage of preparation and experience might be offset by is just a sense of fatigue. In society at large and in an organization on the front lines like ours, I think there’s a sense of fatigue. You know, “Wow! We got to go through this again? It was hard enough the first time.” That’s something we spend a lot of time thinking about.

The No. 1 challenge early on seemed like getting enough personal protective equipment. I think you guys pointed out that you had gone through a year’s worth of PPE in a week. How’s that situation now?

We feel quite good about our supply levels and distribution, in addition to access to future supplies through our vendors. Clearly, we’re still concerned about the cost burden. We’re also not a supply-chain organization. Real-time fulfillment and distribution to our clinicians in the home is a constant learning experience. But relative to the spring, we feel much more prepared and well-supplied than we were then.

What would you say the No. 1 challenge is then? Is it staffing and making sure that those folks who are feeling the fatigue are supported?

Yes. Again, I think it’s the, very broadly stated, sense of fatigue. That fatigue is rooted not just in the constant unpredictability of the care situation we face with our clients, partners and our staff, but also the situations that our team members are facing in their personal lives. I’m talking about, for example, having kids and the unpredictability of school situations. People may have friends and loved ones facing COVID-19 in one form or another. There’s unpredictability around whether it’s okay to go to a restaurant or not outside of work. I mean, these sorts of things create a lot of energy-drain on people.

As a nonprofit, Bayada is a very mission-focused organization. I know the financial impact of COVID-19 isn’t your top concern. Still, can you talk a little more about the financial challenges?

Financially or otherwise, this has been anything but what we expected 2020 to be. Like most organizations that provide home- and community-based services of any type, we faced a lot of financial ambiguity and stress early on, particularly as we saw volumes drop precipitously over the course of just a few weeks. But I do think the bigger story here is a long-term view on how the spotlight is being shined on the importance of staying safe and healthy at home. That’s everything we represent and stand for.

So in the long run, we’re seeing more opportunities to be a meaningful part of the future health care delivery system. That’s real and important. Being the driving force in health care’s future, to me, is huge. It’s a beneficial long-term financial story, but more importantly a beneficial long-term societal health and wellness story.

What have been the most helpful federal or state-level measures enacted for Bayada? The Provider Relief Fund? Certain Medicare waivers?

We operate in 23 states and eight countries. We’ve experienced all the interesting flavors of federal and local support. I think the thing that has been most important but least consistent is the recognition that our front-line workers are our most important resource in the fight against COVID-19. I’m talking about thinking creatively about how to ensure organizations have the funding to be able to adequately pay front-line workers and recognize them for rising above, for answering the call of duty to help people at home in a period of uncertainty.

Bigger picture, a lot of attention is being paid to how you virtualize health care. Everyone is trying to figure out how to, you know, improve outcomes and experiences at a lower cost through use of virtual care and telemedicine. I think the spotlight that COVID-19 is placing on the opportunity to be more creative around virtual care — and the ways in which the government is creating regulatory relaxation or reimbursement structures to support that — is super, super important.

Can you talk a little bit more about that international presence? I can’t really imagine how difficult it must be to manage U.S. operations across multiple states, then have to think about what’s going on in India, for example.

It clearly adds a level of complexity. Every town, city, state, country is different, whether it’s domestic or international. But at Bayada, we really think about running our various locations at the local level. We have a lot of great social entrepreneurs. Whether they’re in Indiana or India, it’s all about having a team that’s committed and aligned with a common purpose. All of our locations have had to be creative, flexible and determined to figure out how to adapt to a crazy environment.

Let’s press pause on COVID-19 for a second. And I want to talk about some of the bright spots for Bayada in 2020. What are your highlights of this year? For example, I know Bayada recently announced a big JV partnership with Baptist Health in Florida.

Yeah, we’re proud of the Baptist relationship. I think it’s an amazing organization and a part of Florida where Bayada doesn’t currently have a presence. We’re also excited by how that relationship is a positive indication of something that we’ve been helping foster for many years — really strategic thinking by health systems. Systems are more often thinking about the ways in which we can align with them, strategically. They want to bring best-in-class home- and community-based capabilities into their networks.

It’s hard to predict the future right now, but what’s in store for Bayada in 2021, in terms of priorities, growth plans and other strategic initiatives?

I will try to set COVID aside, though, it is an undercurrent that runs through everything that we’re doing and thinking about.

Our first and most important priority is people. How do we continue to attract, engage, develop and support amazing people and teams committed to delivering amazing services? We’re hugely focused on talent — all things talent.

The second is that we’re thinking a lot about digital transformationI. In addition to what’s instigated by COVID, how do we begin to accelerate how we invest in things like automation and artificial intelligence? How do we invest in the clinical virtual health tools and technology to really transform the way our services are delivered over the next 10 years?

Then third, how do both of those first two things — talent and digital transformation — support our continued growth as a mission-driven social entrepreneurial growth company.

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On Heels of CDC Vote, Home Health Providers Grapple with COVID-19 Vaccine Mandates

On Tuesday, the CDC’s Advisory Committee on Immunization Practices (ACIP) — in an overwhelming majority — voted to recommend that health care workers, among others, get first priority on a COVID-19 vaccine when one is authorized.

In light of this latest development, the question now becomes: Should home health providers mandate vaccinations for employees?

The news of the federal advisory committee’s vote should come as no surprise, given the significant toll COVID-19 has taken on the health care community, including home health workers.

More than 200,000 U.S. health care workers have now contracted the virus. More than 800 have died from COVID-19, according to the CDC’s latest count.

Vaccinating health care personnel — which the CDC defines as those working in home health, hospitals, long-term care facilities, outpatient clinics, pharmacies, emergency medical services and other settings — supports the principle of maximizing benefits and minimizing harms, Dr. Kathleen Dooling, a medical officer at the CDC, said during a recent ACIP meeting.

“Protection of health care personnel leads to preservation of health care capacity — and better health outcomes for all,” she said. “Vaccinating health care workers promotes justice because health care personnel put themselves at risk and will be essential to carry out the vaccination program.”

If home health providers were to mandate vaccinations for employees, the move would not be unprecedented.

Over the years, many providers have mandated flu vaccinations, but when it comes to COVID-19, some companies have expressed concerns.

“There are a number of home care companies that have mandated flu vaccines, but in talking to some of those companies, they’re hesitant to mandate this vaccine,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News. “And lawyers could come up with a whole series of reasons to go after a health care provider that mandates a vaccine. I’ve even heard some lawyers talking about various Constitutional rights under the First Amendment.”

Indeed, providers could potentially land in legal hot water if employers don’t navigate this action carefully.

“The research that I’ve done on this one leads me to a position of, there’s no real solid advice, in the absence of specific legislation that lawyers can give, other than to tell people, ‘It’s going to create risk for you.’” Dombi said. “It created risk with the flu vaccine, but this one may create even more risk because of the clinical aspects of this vaccine.”

A major factor for providers: Some employees are still likely to be skeptical despite promising results from Pfizer and Moderna on their COVID-19 vaccine trials.

About 79% of health care workers said they haven’t received enough information about the COVID-19 vaccine, in terms of safety, side effects and administration, according to a recent survey conducted by the American Nurses Foundation.

On the flip side, there are many home health providers that are hopeful about the vaccine and applaud ACIP’s recent vote.

“I’m very pleased that home health care workers are in that conversation … and part of the front-line workers,” Cleamon Moorer Jr., president and CEO of American Advantage Home Care Inc., told HHCN. “Oftentimes, hospitals, of course, are the top priority, and then outpatient clinics. But I’m glad that home health care workers are included on the front end.”

Dearborn, Michigan-based American Advantage Home Care Inc. is a provider of home health care and rehab services, plus specialty care and medical social work. The agency operates across nearly a dozen Michigan counties.

Moorer also believes there are a host of reasons why it may be difficult for providers to mandate vaccinations for employees.

“Some of our home health care workers could be pregnant or planning for a family,” he said. “In that event, we’re often concerned about the impact of vaccines on pregnant women. Secondly, there are some individuals who for religious and/or ethnic purposes find themselves averse to vaccines. We definitely want to be sensitive to this.”

For context, Pfizer and Moderna’s vaccine trials haven’t included people who are pregnant.

Still, for people who don’t fall into the previously mentioned categories, strongly encouraging and incentivizing employees to take the vaccine — rather than mandating — might be the best option for providers.

“[Providers could potentially] offer a monetary incentive, for those that take on a high volume of patients, especially for those that continuously see patients who have been diagnosed with COVID-19,” Moorer said.

In cases where an employee may decide to forgo the COVID-19 vaccine, there are administrative actions that providers can take.

“They could take the staff that’s refusing to be vaccinated and only assign them to patients who are low risk and are not in a position to transfer the virus from patient to provider,” Dombi said.

Typically during flu season — October through March — American Advantage Home Care Inc. makes multiple in-services available to employees. This means providing education around the flu vaccine and presenting the option for workers to receive the shot or decline, as well as keeping documentation of this information.

The company plans to approach the COVID-19 vaccine in a similar manner, once it’s available. Moorer urges providers to lean on educating workers in the coming weeks and months.

“I think that education is of the utmost importance for health care workers,” he said. “It tends to be one of those forks in the road where a person considers what is the lesser of the two burdens, perhaps contracting COVID-19 versus experiencing some unknown side effects of the vaccine. I think many who have seen the death toll, as related to the virus, would perhaps look at the vaccine as the less of two burdensome outcomes.”

Ultimately, the COVID-19 vaccine could serve as another safety tool.

“The best thing that I’ve heard from anybody so far, is the vaccine … becomes another tool, but you don’t drop your guard on everything else that you’re doing in infection control,” Dombi said. “It doesn’t mean you stop wearing the mask. It doesn’t mean you start gathering with large numbers of people or start getting reckless.”

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Providers Attempt to Absorb COVID-19 Expenses, Keep In-Home Care Costs Down

Most in-home care operators and other aging services providers have tried to absorb costs related to the COVID-19 pandemic. But that hasn’t always been feasible, causing the cost of care to rise substantially for consumers.

That’s according to the latest annual Cost of Care Survey from Richmond, Virginia-based Genworth Financial Inc. (NYSE: GNW), a Fortune 500 insurance holding company. To compile this year’s survey, Genworth contacted nearly 60,000 in-home care agencies, assisted living facilities, adult day health providers and nursing homes.

“[Providers] told us that the same factors responsible for the continuing increase in long-term care costs in recent years — a shortage of workers in the face of increasing demand for care, higher mandated minimum wages, higher recruiting and retention costs, and an increase in the cost of doing business, including regulatory, licensing and employee certification costs — were made even worse by the pandemic,” Gordon Saunders, senior brand marketing manager at Genworth, said in a press release announcing the news.

Overall, the survey found that the cost of homemaker services increased 4.44% to an annual median cost of $53,7681 in 2020. Genworth defines “homemaker services” as assistance with tasks such as cooking, cleaning and running errands.

Meanwhile, the cost for home health aide services increased 4.35% to an annual median cost of $54,912, the survey found. “Home health aide services” includes assistance with activities of daily living (ADLs).

For both categories, the annual median cost is based on 44 hours of care per week for 52 weeks. In other words, those costs are linked to individuals who require mostly full-time home-based care.

Despite challenges and rising costs, home-based care operators have had plenty of tailwinds in 2020. More than ever, the U.S. health care system is recognizing the value that in-home care plays in keeping people healthy and happy — normally at a far lower cost than institutional care.

Additionally, many in-home care agencies have embraced various technologies this year, a fact that could help them become more efficient and lower costs for consumers down the road.

“The pandemic has shined a bright spotlight on the value of home care,” Jeff Huber, CEO of Home Instead Senior Care, said in the release. “We can increase the capacity of the health care delivery system. The hospital of the future looks a lot like your living room. As a part of a value-based care package, we can reduce costs, admissions, readmissions and overall usage of the health care system.”

Omaha, Nebraska-based Home Instead Senior Care is a home care franchise company with more than 1,200 independently owned and operated offices worldwide.

In the senior living space, assisted living facility rates in 2020 increased by 6.15% to an annual national median cost of $51,600 per year, according to Genworth.

The national median cost of a semi-private room in a skilled nursing facility (SNF) rose to $93,075, an increase of 3.24%. The cost of a private room increased 3.57% to $105,850.

Many of the aging services providers Genworth talked to said they were trying to absorb new COVID-19 costs, such as personal protective equipment (PPE), hazard pay and more. But over half predicted they would eventually be forced to raise rates in the next six months.

“Providers have been competing with higher-paying, less-demanding jobs for years, but with COVID-19, they told us it has become much more difficult to recruit and retain care professionals because of factors such as concerns about exposure to COVID-19 and parents needing to stay home with school-age children,” Saunders said.

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Led by Uber Health Veteran Dan Trigub, MedArrive Launches with $4.5M in Funding

Dan Trigub — the recent head of Uber Health and a former member of Lyft’s health care arm — has always been passionate about home care

Before joining Uber (NYSE: UBER), Trigub owned his own startup focused on the aging population. For the past 15 or so years, his family has even operated one of the largest privately owned home care agencies in the San Francisco Bay Area, From the Heart Home Care.

Trigub, who left Uber in September, is now launching an in-home care startup of his own: MedArrive.

“At the end of the day, Uber is a massive technology company with lots and lots of competing priorities,” Trigub told Home Health Care News. “I don’t think anyone would disagree, but it’s really not a health care company as its primary initiative. For me, I really wanted the opportunity to do more in health care.”

Along with co-founder Inna Plumb, Trigub officially unveiled MedArrive to the world on Thursday.

Backed by Redesign Health, Kleiner Perkins and Define Ventures, the San Francisco-based startup is built to be a bridge between increasingly popular telemedicine services and in-person, physical care.

With the launch, MedArrive likewise announced $4.5 million in seed funding.

“Our core belief is that clinical care is moving away from the traditional four walls of a clinical setting or a hospital setting, with more and more care being delivered into the home,” Trigub, the CEO of MedArrive, told Home Health Care News. “And frankly, [care] has to, given the environment we’re in with the pandemic.”

As part of its business model, MedArrive is looking to help payers and traditional health care providers extend more services into the home. That includes vaccinations, testing, urgent care, chronic care management and more.

The main labor force in MedArrive’s model is made up of EMTs, paramedics and other emergency medical service (EMS) professionals.

“For a variety of reasons, we think it’s one of the most underutilized, understaffed resources in health care,” Trigub noted

In addition to its in-person, hands-on care, however, MedArrive will also coordinate physician-led telemedicine services in the home.

“Telemedicine has grown at an exponential rate because of the pandemic,” Trigub said. “But telemedicine can’t do everything. There’s no physical contact. There’s no, as we like to say, ‘humanity.’ MedArrive is a bridge between on-site clinical care and telemedicine.”

Bringing services into the home

In part, MedArrive’s entrance into the in-home care market reflects the success of similar startups.

Since its inception in 2013, for example, DispatchHealth has grown from mostly an on-demand urgent care company to a diversified home-based care provider that has raised more than $203 million.

The new startup’s launch is also emblematic of the wave of health care innovation brought on by the COVID-19 pandemic, especially around the home.

The Andreessen Horowitz-based Tomorrow Health launched in April with its sights set on becoming an Amazon-like service for in-home medical equipment. Papa, Ready and Honor have all raised millions of dollars in recent months.

Looking back at this year, Trigub said, it’s likely that 2020 accelerated innovation around in-home health care by years — maybe even decades.

“There’s always going to be a need to go into a hospital setting. Obviously, you’re not going to get a surgery done in your home,” he said. “We see the ‘health hub’ being the home environment, where people are comfortable, where they feel safe. And certainly, many of our underserved populations lack transportation or lack the ability to go to see a primary care physician, so we want to bring those high-quality services into the home.”

Currently, MedArrive — which already has more than 20,000 EMS providers in its national network — is targeting Florida as its first market. Its $4.5 million in seed funding will allow the startup to continue building out its platform while expanding into additional markets in months to come.

“We hope to be live with a handful of payers and providers by the middle of or early Q1 of this coming new year,” Trigub said.

In the nick of time

Timing wise, it was important to get MedArrive up and running sooner rather than later. Among its early goals, the startup hopes to assist health care organizations looking to distribute flu vaccines and, when available, COVID-19 vaccines.

As recommended by the Centers for Disease Control and Prevention (CDC), older adults and high-risk populations are among those who will get priority access to a vaccine. Some health care experts have argued that “the home” should be the primary vaccination site.

“[For this population], just going to the clinics, to the hospitals, to the drive-thru testing centers, wherever the COVID-19 vaccine is going to be made available, is a challenge,” Marc Rothman, chief medical officer of Signify Health, previously told HHCN.

On his end, Trigub is walking away from Uber Health after a highly successful run.

Over the past few years, Uber Health has made major inroads with Medicare Advantage (MA) plans looking to address social determinants of health. It has also steadily added to the list of home health and home care organizations it works with.

“I always believed in the concept of creating marketplaces and efficient platforms, especially in health care,” Trigub said. “When most people think of Uber, they think of an Uber picking up a millennial at a bar on a Friday night or delivering a burrito. But frankly, we had a tremendous impact on our most underserved populations.”

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New CMS Hospital-at-Home Program Could Boost Business for Home Health Agencies

In its initial announcement, the U.S. Centers for Medicare & Medicaid Services (CMS) went out of its way to clearly state its new hospital-at-home waiver program was not designed for home health agencies.

But that doesn’t mean there isn’t any upside for them, industry insiders say.

Unveiled on Nov. 25, CMS’s new hospital-at-home waiver program gives approved acute care facilities more freedom to provide — and get paid for — medical services in the home setting at a time when in-patient capacity is severely limited.

A record-high 96,039 COVID-19 patients were hospitalized in the U.S. as of Monday night, according to data from the COVID Tracking Project.

“CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols,” agency officials noted in their announcement.

At least seven confirmed hospital systems have received hospital-at-home waivers.

While home health agencies have experience caring for patients with these and other complex conditions, they are somewhat restricted from taking ownership of a CMS-approved hospital-at-home program of their own.

“A program does not have to be physically administrated within a hospital, but a hospital must accept responsibility for the program in order to satisfy the Conditions of Participations for this level of patient care,” CMS noted. “Additionally, the program must be integrated within a hospital to a sufficient degree to ensure that rapid escalation of care is seamless.”

That language suggests there may be ample hospital-at-home opportunities for home health agencies that are already housed within larger health systems, though that size of that group continues to shrink. In the late 1990s and early 2000s, many hospitals decided to close their agencies or spin them off as freestanding entities, partly due to reimbursement pressures.

Home health operators with pre-established joint venture relationships with health systems may likewise be well-positioned for the hospital-at-home opportunity, according to Stephens Inc. analyst Scott Fidel.

And that group, in contrast, is rapidly growing.

“Just conceptually, the most logical area that we would think about as being an opportunity here would be around areas where there’s already momentum around JVs,” Fidel told Home Health Care News.

Staffing shortages

Fidel — a veteran health care analyst who was brought in to lead Stephens’ health care services division in 2018 — described the hospital-at-home waiver news as an “encouraging” common-sense response to ongoing COVID-19 challenges.

“My gut reaction is that this is CMS trying to respond as actively as they can to the impact of COVID,” Fidel said. “I think these are changes to regulatory structures that they can deliver relatively easily to compensate for some of the pressures acute care hospitals are facing.”

Most headlines focus on bed capacity, but many hospitals are dealing with some degree of staffing shortages, too. In fact, a mid-November tally conducted by STAT and the American Hospital Association found that hospitals in at least 25 states were critically short of nurses, doctors and other staff members.

That situation has only grown more dire since then, with Thanksgiving travel and family gatherings projected to cause an even large spike in new infections.

One of the latest White House coronavirus task force reports sent to states included a warning that “the COVID risk to all Americans is at a historic high,” NBC news reported.

“Hospitalizations themselves are now reaching record levels from during the crisis,” said Fidel, who follows the managed care space as well as the post-acute and acute care sectors. “And there just seems to be a lot more pressure on staffing, in particular. I think staffing is the real big story here, frankly.”

With the staffing shortages, hospitals with new CMS waivers may look to enlist home health agencies as they shift patients into the home setting.

Agencies have historically faced their own staffing challenges, but their ability to care for new  patients is currently greater than that of hospitals.

Additionally, industry data on patient volume and new admissions suggests home health agencies are hovering around pre-pandemic norms — not record-breaking figures.

“Then connecting into that home health staffing apparatus, to me, it feels like there is still capacity,” Fidel said. “Home health volumes have improved quite markedly in terms of a recovery, but we’re still really just sort of back to pre-COVID levels. It feels like there’s a lot more volume, a lot more capacity that home health agencies can take on at this point.”

Putting ‘meat on the bone’

Apart from getting a piece of hospital-at-home action for staffing support, home health agencies may also eventually see a trickle-down effect as hospitals deliver more services in the home.

“I think the other area that we’ve also gotten some feedback from the companies on, where they see an opportunity, is just around whether this could actually end up supporting or codifying more of an ability for these types of services in the home to actually get reimbursed,” Fidel said.

For now, most agencies are in “wait-and-see mode,” however.

More information on the hospital-at-home waiver program will likely emerge in weeks to come, especially as more hospital systems complete the application process.

“There’s a lot of meat that needs to be put on the bone,” Fidel said. “As I’ve done checks with some of the home health companies about this, that’s the type of feedback that I’m getting from them already. I think everyone is encouraged by the thrust of what CMS is announcing here, but it still does feel quite preliminary.”

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Legislation Aimed at Expanding Advance Care Planning Introduced in Senate

On Wednesday, Sen. Richard Blumenthal (D-Conn.) introduced the Compassionate Care Act, a bill that would support advance care planning and end-of-life care.

For home health providers with existing hospice service lines or ambitions for expanding into palliative care, the news is encouraging. If passed, the Compassionate Care Act places more resources behind public awareness campaigns for these services.

Specifically, the legislation would throw federal support behind a public education campaign that promotes the importance of advance care planning, something that often goes overlooked. This would include grants and pilot initiatives aimed at educating medical, nursing and social work students.

Additionally, the Compassionate Care Act focuses on the development of end-of-life quality measures and expanding access to advance care planning through telehealth.

“This bill will help Americans have the difficult but necessary conversations about end-of-life care,” Blumenthal said in a statement. “The COVID-19 pandemic has reminded Americans of all ages of the importance to have a plan in place in case of severe illness or death. By promoting end-of-life care through public awareness, expanding telehealth services and working with physicians, we can ensure that not one more person is robbed of making critical life or death decisions for themselves during this pandemic and beyond.”

If enacted, the Compassionate Care Act would also, among other things, establish guidelines for advance care planning and develop continuing education criteria for health care providers in the arena. It would further allow physicians to recertify hospice stays through telehealth, which could reduce paperwork and administrative burdens.

It’s become increasingly common for home health providers — with hospice, palliative care and other services in place — to function as an almost one-stop-shop for aging services.

Companies such as LHC Group Inc. (Nasdaq: LHCG), Amedisys Inc. (Nasdaq: AMED), Addus HomeCare Corporation (Nasdaq: ADUS) and several others have viewed hospice care as part of a larger strategy to encompass multiple care capabilities.

On the palliative care front, reimbursement remains a challenge, however.

So far, the legislation has garnered support from a number of health care advocacy organizations including LeadingAge, the Coalition to Transform Advanced Care (C-TAC), National Partnership for Healthcare & Hospice Innovation (NPHI), the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC).

“Consumer awareness of the importance of advance care planning, as well as an understanding of the array of care options at the end of life, is critical, a truth we have only seen magnified by the COVID-19 pandemic,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement, “This important legislation provides much-needed resources to develop educational programs, initiatives and strategies for both consumers and providers that will ensure greater access to and understanding of advance care planning and end-of-life care.”

In addition to her role at LeadingAge, Sloan also serves as acting president and CEO of Visiting Nurse Associations of America and ElevatingHOME.

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Business Is Booming, But Home Care Demand Is ‘Probably at a Midpoint’

The non-medical home care industry has slowly carved out an important position within the larger health care continuum over the past several years. It has done so thanks to the home care’s documented ability to improve health outcomes and cut costs.

The COVID-19 pandemic has only solidified home care’s role, especially as caregivers continue to provide critical care on the front lines of the public health emergency.

“COVID-19’s impact has really put us, as an industry, front and center. It has really solidified our place in that continuum of care, overall,” Jeff Bevis, CEO of FirstLight Home Care, said last month at the Home Health Care News Franchise Forum. “[There have been] evolutionary changes [in the past], but COVID-19 has actually helped us.”

Headquartered in Cincinnati, Ohio, FirstLight is a national home care franchise company that operates in more than 30 states. Among their services, FirstLight agencies offer companion care, personal care, dementia care services and more.

Michael Slupecki — CEO of Blue Bell, Pennsylvania-based Griswold Home Care — echoed that idea.

For the last 20 years, the home care industry has predicted that “the home” would serve as the future center of the health care continuum, Slupecki said at Franchise Forum. But before 2020, the industry was just taking “baby steps” toward making that reality.

“There was an opportunity there, but it looked like it was going to take about 50 years for that prediction to come true,” he said. “One pandemic later, and the prediction has become reality. People have been made aware of the value of care in the home — and not only the value but the possibility. I think all of us have learned so much.”

Griswold currently provides personal care services across 200 locations in 30 states. As part of its business mix, the franchiser also offers hospice care at some of its locations, plus an array of other services aimed at enabling aging in place.

While the demand for home care services is at an all-time high this year, the industry itself has yet to reach its full potential.

Yes, COVID-19 has accelerated the need for in-home care, but there’s still the “silver tsunami” to watch out for. In-home care providers have hardly felt the impact of America’s rapidly aging population at this point.

“We talk internally and see indications that demand is probably at a midpoint,” Bevis said. “We still have a good 10 to 15 years ahead of us, where demand is going to go higher.”

For FirstLight, the past five years have been a time of dramatic growth. The company has seen revenue growth of 318% during this time period, with new-unit growth of roughly 95%. Currently, the company is in over 260 markets.

Plus, the company has seen steady growth in its number of clients and caregivers, according to Bevis. Even after the current public health emergency subsides, FirstLight will continue to be bullish when it comes to expanding its footprint, he noted.

“We’re probably pretty aggressive minded,” Bevis said. “We really expect to have even a bigger and faster growth element to our national footprint. That’s for both opportunity markets and for growth in our national alliances and third-party payers.”

Similarly, Griswold has its sights set on expansion, but plans to take the slow-and-steady route.

“We do want to expand geographically, but we also want to be selective,” Slupecki said. “[We want to] be measured by the number of successful franchisees, not by the number of franchises sold. We want to be thoughtful around it.”

Recently, Griswold has seen an uptick in individuals looking to join a franchise system. This is potentially influenced by the current COVID-related recession and job uncertainty, according to Slupecki.

“There have been people impacted by the slowdown, economically, and people that have lost their jobs and are looking for something that they control their own destiny on,” he said.

Moving forward, Bevis and Slupecki believe that more and more will be expected of home care providers. Home care’s role as “the eyes and ears” in the home will serve as a vital tool for its counterparts working in skilled home-based care.

For example, that includes home health providers that are looking to set up SNF-at-home product lines. Such models need to have a strong home care component for constant monitoring and support with ADLs.

Additionally, with news that COVID-19 vaccine manufacturers Pfizer and Moderna filed for emergency use authorization with the Food and Drug Administration (FDA), Bevis hopes that caregivers will be recipients of the vaccine.

“We sure hope that home care is part of the health care worker component there … we do need to protect our employees, who then can make sure we protect our clients and their families too,” he said.

To this end, seven national home-based care advocacy organizations recently petitioned the CDC’s Advisory Committee on Immunization Practices to ensure that home care workers are included in the health care workers that the committee determined should be first to receive the vaccine.

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Hoping to Prevent Community Spread, Home-Based Care Advocates Vie for ‘Critical’ Vaccine Access

A number of national home-based care advocacy organizations have come together to address the CDC’s Advisory Committee on Immunization Practices (ACIP). In a new letter penned to ACIP Chairman Dr. José Romero, the group called for the inclusion of in-home caregivers when it comes to priority access to the COVID-19 vaccine.

The letter was born out of a collaboration between seven organizations, including the Home Care Association of America (HCAOA), the National Association for Home Care & Hospice (NAHC), the Partnership for Medicaid Home-Based Care (PMHC) and the Partnership for Quality Home Healthcare (PQHH).

“I’m really thrilled that all of the home care associations got together and are speaking in one voice on such an important issue as vaccines,” Vicki Hoak, executive director of HCAOA, told Home Health Care News.

Last week, ACIP specified which groups should be granted priority access for Phase 1 of vaccine distribution.

ACIP determined that health care workers and residents of nursing homes should be on the list. The CDC committee also said that essential workers, older adults and individuals with underlying medical conditions should also be granted priority access to a vaccine.

During a Tuesday meeting, ACIP voted 13 to 1 in favor of those recommendations.

Vaccine distribution has garnered national attention since last month’s news that COVID-19 vaccine manufacturers Pfizer and Moderna filed for emergency use authorization with the Food and Drug Administration (FDA). Oxford and AstraZeneca are also close to rolling out a vaccine.

In their letter, the national home-based care advocacy organizations commended ACIP’s recommendations but urged the committee to be specific in its definition of health care workers in order to ensure that all caregivers are included. That includes home health aides, hospice aides, personal care aides, home care workers, direct support professionals and others.

“Our concern is that under the most recent CDC COVID-19 Vaccination Program Interim Playbook for COVID-19 Vaccination Program Jurisdiction Operations, home care workers, specifically personal care aides and home health aides, are not explicitly mentioned as Phase 1 or Phase 1A critical populations for vaccinations,” PMHC Chairman David Totaro told HHCN in an email.

The distinction is important because caregivers working on the non-medical side of home-based care are sometimes overlooked when it comes to federal policy, according to Hoak.

“Sometimes when you think of COVID, you think ‘medical,’ and a personal care aide helping people with activities of daily living doesn’t always come to mind,” she said. “But they are just as critical, especially during this pandemic.”

In the letter, the group also stated that the home care population should be afforded high-priority status for access to the vaccine.

The letter also stressed the importance of the adoption of these recommendations at the state and local levels. ACIP recommendations will serve as a guideline, but ultimately the decisions happen at a state level.

In Massachusetts, for example, physicians and community leaders on the Massachusetts COVID-19 Vaccine Advisory Group have expressed that front-line workers such as caregivers should be early recipients of the vaccine.

Texas has also placed home health workers in its “Tier 1” prioritization category, along with hospice staff.

“What we’re doing next is encouraging all of our members to send letters to their various state officials who are developing these plans,” Hoak said. “Now that we have tried to encourage the federal agency to adopt our recommendations — making sure that they’re all-inclusive — the next step is to advocate at the state levels to make sure that same message is carried forward.”

In addition to the previously mentioned organizations, the American Network of Community Options and Resources; the Council of State Home Care & Hospice Associations; and the National Hospice and Palliative Care Organization also signed the letter.

Combined, the seven organizations represent in-home care providers caring for over 12 million individuals annually. Collectively, those home-based care providers have served “tens of thousands of patients with active COVID-19 infections,” according to the letter.

Over 60% of home care and hospice providers are currently reporting COVID-19-infected patients on service, with many of those patients often living in facility-based settings.

“We want to emphasize that the individuals we serve often have complex service needs and are

at high risk for COVID-19,” The letter reads. “While we recognize the need for vaccinations for those that live in long-term care facilities, it is important to remember that our workforce, on a daily basis, frequently goes to multiple homes. They also provide care in other health care settings, including nursing homes, assisted living facilities and in-patient hospice facilities. The greater protection that both the workforce and individuals receive, the less likely there will be a community spread of the virus.”

U.S. nursing homes are experiencing the worst outbreak of weekly new COVID-19 cases since last spring due to community spread among the general population, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) announced on Tuesday.

Nursing home cases have officially surpassed the previous peaks since the Centers for Medicare & Medicaid Services (CMS) started tracking cases in nursing homes.

“Our worst fears have come true, as COVID runs rampant among the general population and long-term care facilities are powerless to fully prevent it from entering due to its asymptomatic and pre-symptomatic spread,” Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement.

Additional reporting by Tim Regan.

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Payer Credibility Helps Propel Home-Based Care Company Prospero Health into 16 New States

Home-based care company Prospero Health announced Tuesday it is expanding into 16 additional states to serve 8,000 new patients in 2021.

That vastly increases the company’s footprint. Previously just in 10 states, the move now puts Prospero into 26 states total, allowing it to serve 25,000 patients on behalf of its partners, namely the Medicare Advantage insurer UnitedHealthcare.

The Boston-based company offers both non-medical home care and home health care services through a team of doctors, nurses and social workers. It also provides telehealth support for its patients and helps mitigate environmental hazards for seniors, such as fall risks at home.

“The pandemic accelerated the need for the services we provide,” Prospero President Dr. Dave Moen told Home Health Care News. “And our ability to do work virtually, as well, allowed us to expand into geographies that were previously not reachable by an in-person model.”

Founded in 2019, Prospero’s original plan was not to move this fast. But as of July, the average age of the patients Prospero was serving was 83 years old.

COVID-19 brought with it extenuating circumstances that kept seniors in their homes and insurers scrambling to figure out ways to keep them healthy.

“UnitedHealthcare, our biggest customer, saw that our results were solid,” Moen said. “And they were very confident that we had a team in place to actually be able to deliver a high-quality product. It was really about building trust and credibility with our customers.”

“It was about them seeing results that met their goals of high member satisfaction, and decreases in unnecessary hospitalization and ER visits,” he added, noting there are ample tailwinds for all forms of home-based care.

Rapid expansion

Prospero is based in Boston, but a large chunk of its employees are based in Memphis, Tennessee. This past summer, it began expanding in southern states, including Alabama. The company does not open brick-and-mortar offices when it expands, but instead leverages scheduling software programs that match patients’ needs with the right clinicians in their area.

When it did begin serving Alabamans, the company was already working on its next move and surveying the landscape for what came next. Now, Prospero is set to be in nine more states by Jan. 1 — and the majority of states in the U.S. by the end of 2021.

When considering expansion, Prospero is “very informed” by UnitedHealthcare’s membership data, as well as its own algorithm identifying the types of patients that are best served by its offerings, Moen said. Its virtual capabilities have given the company the confidence to move into markets that have less dense populations, but still have seniors with qualifying needs.

“When we look at [strictly] in-person visits, there’s a certain density that allows us to reach a certain number of people that allows us to staff appropriately,” Moen said. “The virtual model allows us to reach a lower-density geographies.”

An example of lower-density geographies is rural areas, which have traditionally dealt with issues when it comes to access to health care.

Earlier in 2020, Prospero partnered with the technology company GrandPad, which provides tablets specifically built for people over the age of 75. GrandPad helps Prospero facilitate its live video chats with patients.

In Memphis, the company has also invested heavily in its Care Support Center.

Addressing staffing

In order to expand as quickly as it has, Prospero has had to build goodwill with staff across the country in a hurry.

As part of its care plan strategy, nurse practitioners do all the initial evaluations on patients, either virtually or in person. After that, an interdisciplinary team comprised of physicians, nurses and social workers meets to discuss the patients’ needs.

“We assign patients based on their needs, and then we risk stratify and segment them,” Moen said. “Some patients are followed by a nurse practitioner, some are followed by an RN. And those two roles are supported by a physician or social workers who were brought in as appropriate for those patients.”

The key to any company’s growth is to be able to build and sustain workers across the country.

Moen is bullish on the tailwinds for home-based care persisting, especially when it comes to staffing. It’s his belief that building a workforce will be easier moving forward due an increased interest for working in what he’d call “a purpose-built care delivery model” for the elder population.

“We’re big enough that workers can now talk to our team members who have worked with us long enough to give them a true report of what it’s like to work in a company like this,” Moen said. “And we’re fortunate that we are off to a good start.”

Prospero is still in a position where it’s fielding multiple applicants for its open positions, which is a welcoming sign for the company in terms of its future outlook.

“I think, professionally, lots of people are interested in finding a career that has a deeper meaning and a deeper connection to what they care about,” Moen said. “The mission is compelling because people see the need. I think as we continue to establish credibility and tenure in the space — and people see it not as an under-supported career, but a very intentional, purposeful career — I do think that it’ll create more momentum in attracting more workers into this part of care delivery.”

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Non-Physician Certification in Home Health Care Blocked by State-Level Barriers

Over the past several years, it seems as though the home health industry has been inching closer and closer toward the elimination of Medicare’s strict physician-certification policy. Now — thanks to the CARES Act — nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) are able to certify eligibility for home health.

While Congress paved the way for non-physician certification in March with support from the Centers for Medicare & Medicaid Services (CMS), a closer inspection reveals that states ultimately have the final say when it comes to this matter.

Home health industry insiders have long been vocal about Medicare’s physician-certification policy — a rule many see as antiquated and overly rigid. Generally, those critics argue the policy created roadblocks that made it more difficult for older adults to gain access to home health care, in turn impacting providers’ bottom lines.

Before the CARES Act, home health services had to be certified — and recertified — by a physician. That process often resulted in heavy delays, especially when physicians were busy.

PAs, in particular, are fairly autonomous in terms of their ability to practice. They are often not in the same location as the physician with whom they collaborate or work with, according to Michael Powe, vice president of reimbursement and professional advocacy at the American Academy of PAs (AAPA).

“For that reason, it’s important for PAs to have the ability to take care of the complete range of services their patients need,” Powe said. “If you’re a PA in a satellite clinic, that might be 25 miles away from the collaborating physician. You don’t want to have to run to that physician to have them sign-off on a certification for home health.”

AAPA is an Alexandria, Virginia-based nonprofit advocacy organization that represents more than 131,000 PAs across the U.S.

When patients aren’t able to get home health care services in a timely manner, those delays drive up costs and result in negative health outcomes.

“They may be in another situation, such as being in a hospital for an extra day or two if can’t get the home health services they need,” Powe said. “That simply runs up the cost of health care for the entire system. If those [home health services] aren’t being provided in a timely manner, then you’re more likely to have a patient who suffers an adverse medical consequence.”

The CARES Act was an attempt to course correct and avoid those issues. It pulled from the April 2019 Home Health Care Planning Improvement Act, which previously sought to give NPs, PAs and CNSs the ability to certify home health permanently.

“It makes it a much more manageable relationship between the home health agency and the attending practitioner for the patient,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News. “Everything from the original plan of care, to changing orders, to signing the documents on a timely basis in order to then submit and get payment — it really reduces some administrative and care roadblocks.”

Despite federal regulations, there are a number of state-level challenges that stand in the way for NPs, PAs and CNAs.

For example, the scope of practice for NPs is an issue in some states. NPs are divided into two classes: independent practice and collaborative practice with a physician. Less than half of states allow for full, independent practice, according to Dombi.

Meanwhile, most states require PAs to work under the supervision of a physician. PAs are allowed to take on the tasks of ordering care and certifying eligibility, provided that supervisory status exists.

Another issue comes by way of licensure in the states, according to Dombi.

“[About] 35 states have full-blown licensure for home health agencies,” he said. “That licensure generally is fashioned consistent with the Medicare Conditions of Participation (CoPs). While the [CoPs] for Medicare have changed, states have to take the step of changing and updating their own licensure standards to mirror those.”

Another challenge comes from the Medicaid side. There are many states where the Medicaid payment rules need to be updated to allow for a practitioner — and not just a physician — to authorize plans of care and certify eligibility.

Dombi pointed out that the issues surrounding Medicaid payment rules and state CoPs likely have more to do with timing, meaning state governments may just be slow to catch up with federal changes, than a difference of opinion in regard to policy.

On the flip side, Dombi stresses that the scope of practice issues are more serious.

“Some states may never allow non-physician practitioners to have independent practice, and that’s within the state authority to do so,” he said.

As things stand, larger providers that run multi-state operations will have the major task of figuring out the rules and regulations in each state.

“They definitely carry a lot of risks, if they think that a non-physician practitioner can do everything in all of the states,” Dombi said. “Having to manage that on a state-by-state basis creates a burden, of sorts, for them. If you’re in a single state, as a small company, find out what the rules are — and follow them.”

Moving ahead, Dombi believes advocacy will continue to be important to help get state policies to catch up with federal law.

“We’ve worked with many of the state home care associations, which are taking the step to do that,” he said. “Those voices within home health care and the non-physician practitioner community have to step up … and initiate the advocacy to make that happen.”

Overall, 30 states have recently taken temporary or permanent actions to authorize NPs to order home health services. In the last week alone, both California and New Mexico updated their regulations to permanently authorize NPs to order home health services, according to the American Association of Nurse Practitioners (AANP).

Austin, Texas-based AANP is a national advocacy organization that represents the interests of more than 270,000 NPs.

So far, NAHC has worked with state associations in Massachusetts, New York and California, according to Dombi.

Additionally, organizations such as NAHC, AAPA, the American Academy of Home Care Medicine, LeadingAge, Visiting Nurses Association of America and others collaborated on a letter addressed to the National Governors Association, encouraging policymakers to recognize the federal change and provide flexibility.

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Public Perception of In-Home Care Is ‘Through the Roof’

Most home health predictions for 2020 were marred by COVID-19. But now that the industry has dealt with a public health emergency for over eight months, insiders are trying their hand at 2021 — and hoping for less unpredictability this time around.

Next year will undoubtedly be shaped by COVID-19’s effects. Specifically, the virus will likely lead to less siloed care delivery while shifting the home health industry more toward technology.

Additionally, the year’s events will likely turn caregiving into a sought-after career and drive more care to the home overall, AlayaCare founder and CEO Adrian Schauer told Home Health Care News.

The concept of more care entering the home is something that providers in both the personal care and home health industries have been pushing for a while. Now, for better or for worse, COVID-19 has accelerated that migration.

That shift will create tailwinds for providers in 2021, but it could also create some challenges.

“Even most personal care providers have a level of clinical oversight,” Schauer said. “But I think the role of the nurse supervisor is poised to become twice as important as it was pre- pandemic.”

Montreal-based AlayaCare is a cloud-based home care technology provider that serves more than 3,000 agencies across the U.S., Canada and Australia.

Hospital-at-home and SNF-at-home models have both become far more popular during the COVID-19 crisis. Each provides a new opportunity for home health agencies to help deliver care in the home, but providers also need to ramp up their capabilities if they’re intrigued by either concept.

“As higher acuity levels of care shift to the home, it makes it even more important to coordinate that care — home care — with the rest of the health care system,” Schauer said.

Breaking down silos

The coordination of care and less siloed care delivery will lead to a more holistic system of care management moving forward, Schauer believes.

Clinical care and personal care will continue to merge as Medicare Advantage (MA) becomes more popular and more plans begin offering home care as a benefit to address social determinants of health.

“It’s really the continuation of a trend with addressing social determinants of health and the payer evolution,” Schauer said.

In addition to MA plans, managed care organizations (MCOs) are assuming more risk-oriented contracts and also looking at social determinants of health to stratify risk, Schauer noted.

Technology-enabled to technology-centric

A study conducted by HHCN and AlayaCare found that 28% of providers weren’t using technology at all to deliver care.

Times are changing, though, and COVID-19 has forced a lot of agencies to get out of their comfort zone when it comes to advancing their technological capabilities.

“Every agency is at a different point in its technological evolution,” Schauer said. “But a lot of the [transformation] has been about digitizing existing workflows and eking out more efficiency from existing ways of doing business. That’s what I would call the technology-enabled phase.”

“Technology-centric is more about, okay, ‘How is the data and the system of intelligence around that data, really driving how I think about my patient population and what interventions I do?’” he added.

Additionally, contact between caregivers and employers has become almost totally virtual. If agencies want to conquer one of the toughest challenges in home-based care — staffing — they’ll need to be more mindful from a technology perspective moving forward.

Rise of caregiving

Millions of jobs will need to be filled in the home-based care world over the next 10 years due to demand. While staffing remains a challenge, caregiving jobs are on the map more than they have ever been due to COVID-19.

As the economy adjusts to a post-COVID-19 world that has left behind a lot of jobs that Americans formerly held, it presents an opportunity for agencies to turn the corner on their recruiting and retention efforts.

“The public appreciation for what professional caregivers do in our communities has gone through the roof thanks to COVID,” Schauer said. “The other aspect, particularly on the home health side, is that the economy has shed a lot of service jobs. … Unfortunately, the competition is not as fierce from many segments of the economy now. Not only do you have a profession that is much more respected and valued than it was before, but its relative attractiveness has gone up as well.”

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CMS’s Stark Law Changes Could Mean More Value-Based Business for Home Health Operators

In an effort to boost value-based care, the U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that it has finalized changes to the Physician Self-Referral Law — often referred to as the Stark Law.

For home health providers, the changes could mean more opportunities for value-based care arrangements moving forward, experts believe.

Broadly, the Stark Law was originally intended to prevent physicians from self-dealing and making compromised medical decisions based on financial incentives.

Under previous rules and regulations, physicians were prohibited from making referrals for “certain designated health services payable by Medicare to an entity with which he or she has a financial relationship.” In some instances, this meant home health providers.

In CMS’s statement announcing the recent change, the agency called the law an “outdated” regulation that “burdened” health care providers during the U.S. health care system’s shift toward quality.

“These reforms under the Stark Law and Anti-Kickback Statutes are historic reforms and come as part of the regulatory sprint to coordinated care that I led over the past few years,” said U.S. Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan. “Too often, ‘sorry, Stark’ or ‘can’t do it, AKS’ have been watchwords in American health care.”

In value-based care arrangements, physicians and other care providers typically form interdisciplinary teams to manage patients as their needs change, sometimes sharing upside and downside risk. Discouraging a physician from referring within that internal team makes little sense.

There has long been an effort to make changes to the law, Matt Wolfe, a partner at law firm Parker Poe, told Home Health Care News.

“Since the enactment of the statute, there have been a whole host of different regulatory efforts to better define and narrow the scope of the law, recognizing that there are a number of times where it would be appropriate for a physician to refer a patient to designated health care services,” Poe said.

Other legal experts echoed those sentiments.

The update to the Stark Law now creates exceptions that make room for innovation and value-based compensation structures, according to Danielle Sloane, a health care attorney at Bass, Berry & Sims.

“For home health agencies that want to participate in value-based arrangements, I think it provides more avenues to work together with hospitals and physician groups — and to share in the savings from any efficiencies,” Sloane said. “[It provides more avenues] to share in the bonuses from a quality perspective.”

Additionally, CMS provided guidance on requirements of the exceptions to the Stark Law and technical compliance requirements.

Still, Sloane warned that despite the flexibility the changes provide, it’s important for home health providers to continue to devote time and energy to compliance. First and foremost, providers must ensure they have appropriate arrangements with physicians.

“There are certainly some flexibilities here for those ‘oops’ scenarios, but I don’t think it changes best practices of making sure you have a contract in place,” she said.

The overall impact of the update will depend on things ranging from existing arrangements with physician practices, health systems and payers, but most providers will be impacted in some way, according to Wolfe.

Similar to Sloane, Wolfe stressed that providers should take inventory of their existing contractual arrangements.

“Even though one of the goals of this regulatory action is to reduce regulatory burdens, I think, in the short run, providers are going to have to put some resources into making sure that their current arrangements comply with the new iteration of the laws and regulations,” he said.

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States Starting to Prioritize Home Health, Hospice Workers in Vaccination Plans

Pfizer, Moderna and the University of Oxford are among the organizations to tout highly effective COVID-19 vaccines this month. With “the cavalry coming,” the focus is now shifting to how, when and where vaccines should be distributed.

In September, the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) urged state leaders to prioritize nursing homes and assisted living communities for vaccine distribution, pointing to the tragic deaths among both residents and staff. In-home care advocates and other aging services stakeholders have made similar overtures.

Early policies out of Texas suggest those outreach efforts are paying off.

Workers in long-term care settings serving high-risk, vulnerable populations should be part of the first group to receive COVID-19 vaccines, according to new recommendations from Texas’ COVID-19 Expert Vaccine Allocation Panel. That includes home health workers.

“These guiding principles established by the Expert Vaccine Allocation Panel will ensure that the State of Texas swiftly distributes the COVID-19 vaccine to Texans who voluntarily choose to be immunized,” Governor Greg Abbott, a Republican, said in a statement.

In addition to long-term care workers, hospital staff members and emergency medical responders directly caring for COVID-19 patients will likewise receive early access to a vaccine.

Specifically, home health workers are included in Texas’ “Tier 1” prioritization category, along with hospice staff. “Tier 2” includes outpatient settings where health care providers are treating patients exhibiting COVID-19 symptoms.

Nearly 3,700 health care providers and institutions in Texas have signed up to receive vaccine shipments, The Dallas Morning News reported, attributing the information to a spokesman from the Department of State Health Services.

“This foundation for the allocation process will help us mitigate the spread of COVID-19 in our communities, protect the most vulnerable Texans, and safeguard crucial state resources,” Abbott’s statement continued.

While Texas is one of the only states so far to directly call out home health workers, others have broadly identified “health care workers” as early vaccine recipients.

In California’s framework unveiled Monday, for example, state officials said the goal is to first vaccinate the state’s 2.4 million health care workers, including first responders and those who work in congregate care settings.

Full Phase 1 distribution recommendation will be ready by Dec. 1, according to Democratic Governor Gavin Newsom, who recently had to quarantine with his family after his children were exposed to the coronavirus.

“The first tranche of vaccinations will be extraordinarily limited,” Newsom clarified.

Considering the developments in Texas, it’s likely that even more states will focus on in-home care workers in days to come. Doing so certainly makes sense from a numbers standpoint, as home health and hospice agencies employ millions of workers who deliver care to even more high-risk individuals each year.

In 2018, the country’s network of roughly 11,500 home health agencies cared to 3.4 million Medicare beneficiaries, according to the Medicare Payment Advisory Commission (MedPAC). In doing so, they delivered roughly 6.3 million visits.

Most of those beneficiaries suffered from multiple chronic conditions and had trouble eating, bathing or dressing.

In 2019, home health agencies employed an estimated 1.5 million workers, according to the Alliance for Home Health Quality and Innovation’s 2020 Chartbook, produced in conjunction with Avalere Health.

While Texas is clearly prioritizing home health and hospice workers, it is unclear whether “health care workers” also includes front-line professionals in the non-medical home care field.

How government officials define “home care” has been an issue throughout the COVID-19 pandemic, especially in regard to paid-leave rules outlined in the Families First Coronavirus Relief Act (FFCRA).

Even if states prioritize home health and home care agencies for a COVID-19 vaccine, it’s not a guarantee that workers will opt for one, especially with all the unknowns and potentially unpleasant side effects.

Participants in Moderna and Pfizer’s coronavirus vaccine trials told CNBC in September, for instance, that they experienced “high fever, body aches, bad headaches, daylong exhaustion and other symptoms” after receiving the shots.

For the 2019-2020 flu, vaccination coverage among health care personnel was 80.6%, according to the U.S. Centers for Disease Control and Prevention (CDC). By occupation, flu vaccination coverage was highest among physicians, nurses, pharmacists, nurse practitioners and physician assistants.

Flu vaccination coverage was lowest among health care aides and non-clinical personnel, the CDC notes.

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With Hospital Beds in Short Supply, Avera Health Turns to Versatile Home-Based Care Program

The idea that the home setting could serve as an alternative care site — taking the pressure off of hospitals facing over-capacity challenges — really took flight in the midst of the COVID-19 emergency.

In some ways, large health systems with home-based care arms were able to navigate this shift more seamlessly.

As another COVID-19 surge sweeps across the U.S., Avera Health’s [email protected] COVID Care Transitions program, for example, has been an asset when it comes to providing care and preventing adverse health events.

Sioux Falls, South Dakota-based Avera is a health system with more than 19,000 employees and physicians. The company — South Dakota’s largest private employer — has over 300 locations across five states.

For Avera, caring for patients in the home setting has long been part of the company’s toolbox. The company first established its [email protected] Care Transitions program eight years ago, with the goal of reducing hospital readmissions and emergency room visits.

Under the program, the company provided skilled nursing services, physical therapy, telehealth, occupational therapy and more.

When the public health emergency continued to worsen, Avera, like most health care organizations, looked to preserve hospital resources such as personal protective equipment (PPE). Creating its [email protected] COVID Care Transitions program, which leverages telehealth, allowed the system to do this.

“When COVID came about, we were concerned about PPE limitations,” Dr. Chad Thury, medical director of [email protected], told Home Health Care News. “We still service our patients at home that need it, … but for the most part, we are monitoring our COVID patients through home monitoring, software products, phone calls and virtual visits. That has allowed us to ramp up and make our home care team much more efficient.”

Being a large health system gave Avera the resources the company needed to get its program off the ground immediately, according to Thury.

“We had a strong home health division with our [email protected] business unit,” he said. “We also have [home medical equipment] stores throughout our region, so we were set up to get patients oxygen, pulse oximeters and stuff like that.”

Avera’s prior efforts to increase home monitoring among its post-discharge patients — congestive heart failure, in particular — also ensured that the company had the infrastructure in place to care for COVID-19 patients at home.

The [email protected] COVID Care Transitions program focuses on monitoring and caring for patients categorized as “moderately sick.”

“As they progress in their symptomatology, we can get them an oxygen monitor. We can even get them oxygen,” Thury said. “We can have them on oxygen for a number of days, being monitored at home, instead of having to put them in the hospital.”

Ultimately, that allows Avera to save hospital beds for patients who have more severe symptoms and require higher levels of care.

In addition to its [email protected] COVID Care Transitions program, Avera set up a 24-hour COVID-19 hotline in March. The hotline allows patients to call for information on testing and treatment.

Overall, Avera has treated 3,000 COVID-19 patients through its [email protected] COVID Care Transitions program. Just 5.3% of those patients have required hospitalization.

“Every day our nurses get a list of their patients,” he said. “They know which ones are Tier 1, meaning high-risk, symptomatic, a lot of comorbidities, oxygen is going down. Then you have Tier 2, meaning moderate risk, maybe a little symptomatic. Tier 3 patients are high-risk, but they’re maybe not having symptoms yet, or they’re just mildly symptomatic.”

Another thing that benefited the program was utilizing a language line to provide interpretation services. Roughly, 26% of Avera’s COVID-19 patients spoke languages other than English.

“In South Dakota, part of our initial rise in COVID cases was related to a protein plant,” Thury said. “A lot of the workers there are people that have immigrated to the United States, so they speak multiple different languages.”

As part of these efforts, the health system also worked with its marketing team to develop medical information materials in multiple languages for patients.

Another population Avera needed to navigate caring for was the local homeless community, according to Thury.

“Providing home-based care to the homeless population was difficult,” he said. “We have a community health center in Sioux Falls that we were able to work with. We developed relationships with the city, county, within different regions. Some places had, for instance, hotels that we could ultimately put a homeless patient in. We had the ability to monitor them while they had COVID and then keep them isolated as well.”

As the public emergency continues, Thury believes that health systems should strongly consider implementing a program that allows them to provide care in the home.

“For places that aren’t doing something like this — I think it is greatly beneficial,” he said. “I get emails or messages almost every day from patients that we care for, and they are just amazed at the service and are just so happy that they were able to stay home.”

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COVID-19 Patients Discharged from Home Health Care Often Have ‘Excellent’ Symptom Improvement, Functional Outcomes

So far, there’s been a lack of information on the characteristics and outcomes of patients hospitalized with COVID-19 who are discharged to the home setting. Researchers Kathryn Bowles and Margaret McDonald — both with the Visiting Nurse Service of New York (VNSNY) — are working to change that.

For the past few months, Bowles and McDonald have been analyzing OASIS data and other information tied to hundreds of patients recovering at home following coronavirus-related acute care stays. The goal of their analysis, Bowles told Home Health Care News, is to showcase the value of in-home care at a time when new infections are skyrocketing and hospital beds are in short supply.

Only one in 10 patients hospitalized with COVID-19 are discharged home with home health services, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

“We knew that, nationwide, only 11% of [hospital discharges] are getting home health care services after COVID-19 — and that seems really low to us,” said Bowles, who serves as vice president and director of the VNSNY Center for Home Care Policy & Research. “We were hoping that we might show the value of home health care, bringing attention to the fact that home health care is a resource that could be used to help support recovery in the community.”

On top of her role at VNSNY, Bowles is a professor and the van Ameringen chair in nursing excellence at the University of Pennsylvania School of Nursing. McDonald, the associate director of VNSNY’s policy and research hub, echoed those sentiments.

The researchers’ findings on COVID-19 patient characteristics and outcomes were officially published in the Annals of Internal Medicine on Monday.

“We’re continuing to face this [emergency] and the hospitalizations are now going back up,” McDonald said. “I’m really happy this is being released at this point.”

‘They were very sick’

Bowles and McDonald have helped turn VNSNY’s Center for Home Care Policy & Research into a well-known research powerhouse, one that has spent millions of dollars on dozens of groundbreaking projects focused on in-home care over the past three decades.

Like most of their past work, their newly published look at COVID-19 in the home setting leverages VNSNY’s vast data infrastructure and position as the nation’s largest nonprofit home-based care organization. Focusing their COVID-19 analysis on the New York-based VNSNY was particularly insightful, considering New York City and the surrounding area once stood as the pandemic’s global epicenter.

New York reported its first confirmed COVID-19 case on March 1. Since then, the state has had more than 601,000 total cases, including more than 33,000 deaths.

“Given that we were located in the epicenter of the pandemic and with the largest, not-for-profit home care agency in the country, we knew we had access to terrific data on patients coming out of the hospitals,” Bowles said.

As part of their latest project, Bowles and McDonald conducted a retrospective, observational cohort study, analyzing medical information from 1,409 COVID-19 patients admitted to VNSNY’s home health services between April 1 and June 15 following a hospitalization. Referrals came from 64 hospitals, with the average age of patients being 67 — much younger than the typical Medicare home health patient.

In fact, about 43% of the patients were younger than 65. The somewhat surprising age of patients was likely linked to COVID-19 devastating impact on older populations, McDonald noted.

“We do think the influence was that, you know, we were meeting with hospital survivors,” she said. “And unfortunately, the oldest of the ‘older population’ were not surviving [hospital stays], especially in the early times.”

Upon being admitted to home health services, the bulk of patients had multiple comorbidities and risk factors for re-hospitalization, such as difficulty adhering to medical instructions or exhaustion on admission. The most common comorbid conditions were hypertension, diabetes and chronic pulmonary disease.

Pain was present daily or all the time for 42% of the patients Bowles and McDonald looked at, with 84% reporting trouble breathing with any exertion and 50% reporting symptoms of anxiety. The vast majority of the 1,409 patients had severe functional limitations, with 85% needing help with four or more activities of daily living (ADLs).

“They were very sick when they entered home health care,” Bowles said.

That changed in a remarkable way after in-home services were delivered.

After an average of 32 days of care, 94% of patients with COVID-19 referred to home health care were discharged off services. Exactly 1,241 patients — or 88% of the overall sample — were discharged without any adverse health events, such as re-hospitalization or death.

In contrast to the poor symptom and functional profile of patients at home health admission, by the time of discharge, most patients had “statistically significant improvements” in pain, ability to breathe, cognition and anxiety. Functional gains were common with most patients, too, Bowles and McDonald noted.

“I was happily surprised about the recovery, which took place in a relatively short period of time,” McDonald said. “After 30 or 32 days, we were able to see that people were recovering.”

The value of home health care

Moving forward, Bowles and McDonald said they hoped home health agencies could use their findings to better prepare for delivering care for COVID-19 patients in the community.

One key takeaway they flagged is how similar COVID-19 patients are to sepsis survivors.

“Admission characteristics of COVID-19 survivors are very similar to those of sepsis survivors admitted to HHC (home health care) nationally,” their research in Annals of Internal Medicine states. “Recent evidence suggests that early home health visits, coupled with outpatient follow-up in Week 1, decreased re-hospitalizations among sepsis survivors.”

Another takeaway from their research was the balance of in-person visits to telephonic and video visits.

In total, the 1,409 patients cared for in the home received 13,926 home health visits. More than 75% of those visits were carried out in person, with 16% and 8% being conducted by telephone and video, respectively.

“[The care team] valued the in-person visits, and they continued to make use of them as much as they possibly could,” Bowles said. “And they were allowed into the home by the patients.”

Registered nurses provided 52% of the visits, with physical therapists providing 37% of visits. The remainder were provided by social workers, plus occupational and speech therapists. Patients received an average of 11 visits.

In addition to home health agencies, Bowles and McDonald said they hoped the health system at large will use their findings to continue shifting care into the home whenever possible.

“A key recommendation to prepare for post-acute care surges due to COVID-19 was to expand HHC use to provide skilled nursing and rehabilitative services in the home, thereby preventing transmission to other patients, as may occur in in-patient facilities,” they wrote. “This advice was prescient, because our study shows that COVID-19 survivors discharged from HHC had excellent symptom improvement and functional outcomes, highlighting that post-acute support through HHC affords an opportunity to aid the recovery of future patients with COVID-19.”

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LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity

Keith Myers has seen his fair share of change in Washington, D.C.

Since co-founding the business with his wife, Ginger, in 1994, Myers has helped lead LHC Group Inc. (Nasdaq: LHCG) through parts of five presidencies as chairman and CEO. A new administration with Joe Biden in the White House would make that six.

Although President Donald Trump has yet to formally concede due to his team’s ongoing legal challenges to the 2020 election, Myers’ roles at LHC Group and the Partnership for Quality Home Healthcare mean he must plan ahead for all outcomes. Since last year, he’s been working to make sure home health care maintains its rising position, regardless of the political landscape.

Home Health Care News sat down with Myers for an inside look at those policy efforts. In addition to the 2020 election, LHC Group’s top executive also touched on recent COVID-19 vaccine news, emerging post-acute care trends, the future of the Center for Medicare & Medicaid Innovation (CMMI) and more.

Highlights from HHCN’s conversation with Myers are below, edited for length and clarity.

HHCN: Looking back, what have the past four years meant for in-home care?

Myers: I think the data speaks for itself. Pre-COVID, we had a significant, measurable tailwind. Policy has been moving in our direction. I think that was influenced heavily by all the investments we’ve made in data-driven policy work in D.C., especially over the last decade.

When COVID happened, it took those tailwinds and put them on steroids.

We’re already going in the direction of shifting more care into the home. We’ve been able to bring that shift about thanks to the industry’s work, paired with the insights from Dobson DaVanzo & Associates and the others we’ve brought in as objective third parties. These groups have looked at the claims data, proving beyond a shadow of a doubt the efficacy of the home health benefit and our ability to create favorable outcomes at much lower costs.

Apart from demonstrating the value of home health care over the years, the industry has also been able to improve its standing with the U.S. Centers for Medicare & Medicaid Services (CMS). Providers have drastically lowered improper payments, for example.

I think back to the late 90s. There was a group of us — some of the original home health pioneers — who got together and decided to invest in data. We had the courage to invest in data to not only show where the opportunity was, but how we could improve. We looked at who the bad actors were.

Rather than the whole industry being viewed as problematic, we started holding those bad actors accountable. I think we gained a lot of credibility from that.

Those efforts helped CMS hone their skills on what to look at. They’re much more targeted now in their approaches, and I think that’s good for everyone.

Looking ahead, what are some of the things that might change? What could a potential Joe Biden administration mean for LHC Group and other in-home care providers?

Well, historically, Democrats have been more favorable to health care, generally. I think that is still true today. If we’re positioned with reliable data to give us a seat at the table going in, I think that’s important.

At the Partnership for Quality Home Healthcare, we started preparing for this potential outcome last year. LHC Group is represented by former U.S. Senator John Breaux, who is a former board member of ours. He’s still very active. I talk to Senator Breaux every other day.

We reached out and brought in former Senator Blanche Lincoln during the summer. We started orienting her specifically for this potential outcome. She’s at Lincoln Policy Group, as is Tom Scully, a former CMS administrator who also represents the Partnership. Another name is former U.S. Representative Joe Crowley. We’re working with him as well.

We have the right story. We have the right messengers, people who know President-Elect Biden and all the likely players who will be in his administration. I think we’ve positioned ourselves very well.

And we weren’t just planning for this outcome. We had strategies for both potential outcomes.

One of the things Biden has talked about is “Medicare at 60.” What would that mean for the home health industry?

The obvious impact is volume. Volume would be increased.

But I do believe we’re going to have a divided government, so I don’t expect to see anything too big happen. I don’t think we’re going to see anything transformative.

You’ve been in this business a long time. You and your wife, Ginger, started the business from your kitchen table. How disruptive is it when there’s an administration change?

It’s a great feeling to be able to say what I’m about to say — and mean it 100%. Today, I don’t think it’s that big of a deal. That’s because the data and the policy momentum are already on our side.

Back in the 1990s, we didn’t have much of a position. We just had, you know, some people who would support us. For me, that was folks like Senator Breaux and others. We were cobbling together data and support for home-based care, but we didn’t have overwhelming evidence gathered by independent, third-party experts like we do today.

This is going to be my sixth president. I’ve seen all the different political landscapes. I’ve seen a White House controlled by Democrats. I’ve seen Republicans having both the House and Senate. I’ve seen all the different combinations.

In our experience, the highest risk has been when one party controls both the House and Senate, never mind who’s in the White House. But listen, I think we have a favorable landscape right now. Yes, we have some Senate races that still make things very tight. But Democrats in the House are seeing their numbers go the wrong way, so it’s unlikely they’ll do anything way out there.

And Biden is largely considered a moderate, someone who works across the aisle, much like Senator Breaux did.

CMMI has tested out a number of alternative payment models over the past four years. Overall, it has launched 54 since its formation, with officials often citing the Home Health Value-Based Purchasing Model as one of the most successful. How has LHC Group performed under that?

We’ve performed well in the nine initial states where we’ve had the opportunity.

There’s also the Comprehensive Care for Joint Replacement (CJR) model. We’ve done significant work there with Ochsner and had great success. That has informed a lot of our strategies around skilled nursing facility (SNF) diversion and other efforts to move patients downstream. 

I would also point to our broader and deeper experience with accountable care organizations (ACOs). We’re very proud of that. We’ve really come a long way with ACOs. I’d say the two biggest levers we’re pulling in that regard are preventative measures and care management on the front end, then, when patients do need care, leveraging home health care to the greatest extent possible.

Would you support a nationwide expansion of the Home Health Value-Based Purchasing Model?

Yes. The details are always important, but given a choice between strict fee-for-service versus some sort of value-based purchasing, we’re always going to take the value-based option.

What do you think a Biden administration would mean for value-based care? Would it be more of the same — or would there be a drastic difference?

I haven’t seen any evidence or indicators where I’d say “drastically different.” I think Democrats tend to lean into provider-based care. They’re not as much in favor of Medicare Advantage as Republican administrations, in my view.

I’m a big believer that providers should have — if not full control — a more meaningful stake in the risk pool. I think some of the CMMI demonstrations support that. You get the best of both worlds when providers have that seat at the table. You get lower costs and quality outcomes.

Earlier this week, Biden’s transition team unveiled members of its COVID-19 task force. It includes Atul Gawande, a former FDA commissioner and several others, but no in-home care experts. What are your thoughts on that?

I think we’ve learned over the years that there are a lot of ways to influence the process without having somebody officially named to a particular position. We know this through our experience with the Medicare Payment Advisory Commission (MedPAC).

I think there are more people favorable to home-based care policy than one might think. But, sure, we’d love to have somebody on the task force who’s directly involved with the home health industry.

If you had to look in your crystal ball right now, what’s one prediction for home health, hospice and personal care moving forward?

I think care in the home, across the board, is going to be the “ask” of patients. It’s also going to be the very first inclination of referral sources.

In the past, home-based care hasn’t been an afterthought, but it wasn’t always at the top of the list. Let’s take SNFs, for example. In the past, if a patient qualified for SNF, then they would typically get referred to SNF. Referral sources would automatically think it was the safest route for them, from a risk perspective.

But now, they see the risks associated with going to an in-patient setting. I’ve seen patients, families and referral sources acknowledging that risk more than ever. They’re saying, “You can be cared for at home, if that’s what you want to do.”

That conversation is happening with discharge planners and referral sources everywhere. It’s happening at a level that we weren’t seeing pre-COVID. I don’t think we’re going to go backwards on that. It’s a new normal.

Pfizer and Moderna came out and said they’re very close on COVID-19 vaccines. Once those are ready to distribute, what role should home health providers play?

Well, it’s almost not fair for me to answer that. Of course I think home health workers should play a role. And we’re all familiar with the phrase “social distancing” now. What better place to bring the vaccine to people than in their homes? Why would you bring everyone to a centralized location for a vaccine?

I think our front-line workers and the people they care for, including the elderly, should also be among the first to receive a vaccine. I’d like to hear arguments against that.

What has you excited about 2021?

There’s a lot to be excited about. Having been in the industry as long as I have been, I don’t know if 20 years ago I really believed I would see the day with this much opportunity.

I couldn’t see it from where we were back then. We were just fighting for survival. To see this opportunity intersect with our preparation as an industry and our ability as individual providers to care for patients downstream, it’s incredible. It’s what dreams are made of.

I couldn’t be more excited for or proud of our industry. It puts some pep in my step and makes me want to keep doing this for a really long time.

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New Data Confirms More Patients Are Being Discharged to Home Health Agencies

Patients discharged from hospitals are increasingly headed to home health agencies, a new analysis from ATI Advisory shows.

In May 2019, of the 801,464 patients discharged from short-term acute care hospitals (STACHs), 11% were sent to home health agencies. In May 2020, of the 558,296 patients discharged from STACHs, 19% went to home health agencies.

The analysis took into account Medicare fee-for-service claims data incurred from January through May, then paid through June.

On a basic level, these latest figures confirm the role home health agencies have played during the COVID-19 pandemic. They also support comments made by the several home health executives who have said their referral partners have turned to in-home care more readily than in the past.

Yet it’s unclear if the shift toward home health is here to stay, according to Anne Tumlinson, founder and CEO of ATI Advisory.

“We don’t know yet how permanent this disruption in post-acute care discharge patterns will be,” Tumlinson told Home Health Care News in an email. “If it holds, it will be positive for home health when the pandemic eases and if hospital volumes return – even when the waivers go away. In other words, if they hold onto the size of their slice of the pie and the pie increases, that’s good for the industry overall.”

Of the 104,886 patients diagnosed with COVID-19 that were discharged from STACHs from January to May of 2020, 8% went to home health agencies. In comparison, 25% went to skilled nursing facilities (SNFs), with another 29% discharged directly home without services.

Of the 3.21 million STACH discharges to take place from January through May 2020, 17% were for home health care, according to the ATI Advisory analysis.

“I would say that we are very lucky that the Patient-Driven Payment Model (PDPM) and Patient-Driven Groupings Model (PDGM) were in place because they allow for the appropriate reimbursement for what is probably a more complex patient population overall,” Tumlinson said.

The ATI Advisory analysis is also noteworthy from a SNF-diversion perspective.

In May 2019, for instance, SNFs received 19% of all patients. But in May 2020, SNFs only received 15%.

Agencies have been bullish on SNF-to-home diversion since the outset of the COVID-19 pandemic. Still, SNFs are hopeful that the SNF-to-home trend will subside once the pandemic eases.

While these trends look good for home health agencies, they’re not necessarily indicative of the status quo moving forward.

Additionally, the analysis only takes into account Part A reimbursement for home health agencies — community-admits are not considered in the data.

“We would caveat this analysis by saying that it’s the claims data from just the first three months of the pandemic,” Elizabeth Burke, an analyst at ATI Advisory, told HHCN in an email. “We’ll have a better understanding of what this all means as we examine the data over time – when the next few quarters come in.”

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An ‘Awkward Transition Year’: Why 2021 Will Look Different in Home Health with New RAP Adjustments

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its final 2021 home health payment rule in late October. When it came out, some providers were less than pleased.

On one hand, the Patient-Driven Groupings Model (PDGM) wasn’t substantially altered to balance out its flawed behavioral assumptions. On another, there are also a few “quirks” in the rule that will make 2021 a unique, potentially complicated year.

Overall, the final rule adds an estimated $390 for home health agencies next year, roughly equal to a payment increase of 1.9%. Those figures are less than the $540 million boost and 2.6% increase initially floated in CMS’s proposed rule.

Since the final rule came out, providers have additionally learned more about the fines tied to late Requests for Anticipated Payment (RAPs). Although RAPs are being phased out next year, providers will still be required to submit a “no-pay RAP” within five calendar days of the start of care.

Under the Prospective Payment System (PPS), agencies could receive 50% to 60% of their payment up front. This year, that was lowered to 20% for existing agencies, with new agencies being shut out from RAPs.

In 2021, there will be no payment tied to the RAPs for anybody. Once RAPs are fully phased out in 2022, the Notice of Admission (NOA) will take its place.

“So this was a pretty standard annual update from Medicare, especially if you consider what we went through last year with the transition to PDGM,” Matt McGowan, a consulting manager at McBee Associates, said on a recent webinar. “But we have to go through this kind of awkward transition year with the RAP in 2021, which is a blend between the RAP that you’re used to and what the process will be under the NOA in 2022.”

Wayne, Pennsylvania-based McBee Associates is a health care services and consulting firm that offers financial, operational and clinical help to health care providers across the continuum.

Despite RAPs being phased out, submitting them is still a way for CMS to keep track of home health patients and whether they can be funded exclusively through Medicare’s home health benefits. The agency has incentivized providers to keep submitting these RAPs by instituting those fine measures, which count all the days after the first day as a fine if a provider misses the five-day window.

In other words, a RAP fine only comes after the fifth day, but if providers submit on the sixth day, they will be docked one-thirtieth of the payment for each of those five days as well, which comes out to a 20% fine.

That — and other quirks in the final rule — will put a couple of landmines in home health providers’ way in 2021.

For instance, because RAPs are no longer providing payment, but RAP submissions are still required, that changes the entire coding process for providers.

“Now that there’s no money tied to the RAPs, Medicare is telling us that we don’t need to wait until the OASIS and the coding are completed in order to submit the RAP,” McGowan said. “Once you have that order in and the first visits completed, just go ahead and submit the RAP.”

That marks a significant change in agencies’ operational processes and workflow. But there are still certain coding requirements tied to the RAP in 2021.

“Here’s where we get into that awkward transition issue, because the RAPs still need to have a primary diagnosis code on them and the HIPPS code,” McGowan said. “Medicare is not going to be using that primary diagnosis code on the RAP or the HIPPS code for anything, so we can submit a generic primary diagnosis code — like hypertension — on all RAPs.”

So, because the code will be less important up front, agencies can submit a generic HIPPS code like 1AA11 on all RAPs.

But that’s not where the quirkiness ends in the 2021 submission process. After the first visit, RAP submission, ICD-10 coding, OASIS QA and documentation are all completed, there is one more element to pay attention to.

“When you do submit that final claim, it has to have the same HIPPS code that was used on the RAP — the HIPPs code on the RAP and the final claim still needs to match,” McGowan said.

Even though CMS is not using that HIPPs code for anything, that’s a rule that will be carried on in 2021, so it’s imperative that a provider keeps those codes aligned.

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LHC Group Sees Progress with ACOs, Direct-Contracting Entities

LHC Group Inc. (Nasdaq: LHCG) continues to make progress with its accountable care organization (ACO) relationships while making inroads with direct-contracting entities (DCEs), company leadership said Thursday. At the same time, the Lafayette, Louisiana-based home health giant is building more new referral channels. 

Those and other home-based tailwinds have LHC Group’s leadership team bullish about the business going forward.

“We really feel like we got a lot of good tailwind momentum in all of our channels of growth,”

LHC Group President Joshua Proffitt said during investment banking company Jefferies’ London Healthcare Conference. “Our organic growth, historically, has been at 6% to 8%, year over year. I’m pretty bullish right now that [it] could be 8% to 10% in the next three years.”

LHC Group is a provider of home health, hospice and personal care services. Its 32,000 employees deliver care in 35 states and Washington, D.C.

While its home health segment represents its primary service line, the company has emphasized growth in its home- and community-based services department over the past few years.

That’s in an effort to reach that “tri-level of care” in the home, LHC Group CEO Keith Myers said, also speaking at the conference. That tri-level represents home health, hospice and personal care.

“We’re really trying to create a health care ecosystem within the home environment,” Myers said. “It’s like a health system in the home, as opposed to a health system within four walls.”

Reaching that tri-level care has become a trend in the industry. Frisco, Texas-based Addus, for instance, has traditionally been a personal care services powerhouse, but is now investing heavily in home health and hospice in markets where it’s already present.

On LHC Group’s end, its organic growth in admissions has persisted through the COVID-19 crisis, Proffitt said.

“Once we got past that first real dip in the April and May timeframe, … we’ve outpaced our peers in admissions growth,” Proffitt said.

The company recorded 36,786 admissions in October, up from the 27,984 it recorded in April.

LHC Group believes that 2020 would have been a historical year for consolidation due to the implementation of Patient-Driven Groupings Model (PDGM) had it not been for COVID-19. The relief that came out of the public health emergency has camouflaged struggling providers that may have been looking for a buyer, Myers believes.

Proffitt echoed that idea.

“There’s just a lot of market-share gains to be had through market disruption,” Proffitt said. “We’re going to see more acquisitive growth than we’ve seen over the past several years, just because of all the market dynamics in play.”

But the lessons learned from COVID-19 have also been beneficial to LHC Group.

It hasn’t just been about internal learning when it comes to areas like infectious disease protocols. It’s also been about external learning and outside sources realizing the value of home-based care, which has led to more referral sources.

Elsewhere, Proffitt also expressed his excitement on new contracting entities that are forming, particularly on the Medicare side.

“Historically, there’s been this discussion around Medicare Advantage (MA) [plans] … and about how you are doing on contracting with those,” Proffitt said. “But I would tell you, there is more and more contracting ability — even to become preferred providers in the Medicare side of the business — that is really exciting right now.”

Most notably, those contracting opportunities include DCEs, an area where LHC Group is very involved.

“Those are actually directly narrowing networks and contracting on the Medicare business,” Proffitt said. “And they will put in performance measures where you can earn up to even greater than the Medicare rate if you achieve certain quality outcomes.”

In addition to DCEs, Proffitt said that the amount of ACOs LHC Group engages with is steadily growing.

When LHC Group acquired Almost Family in 2018, it simultaneously bought Imperium Health Management, one of the country’s largest ACO management firms.

“I believe that there is an acceleration, in terms of years, that the coronavirus pandemic has brought to shifting more volume into the home, in general,” Proffitt said. “So you’ve got all those macro dynamics in play that lead to this real bullish outlook on growth.”

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‘They’re Calling Us Up, Asking for Help’: How Health System Struggles Factored into the AccentCare-Seasons Merger

The coronavirus didn’t directly lead to the recently announced merger between AccentCare Inc. and Seasons Hospice & Palliative Care, but it played a pretty prominent role.

On Monday, Dallas-based AccentCare and Rosemont, Illinois-based Seasons revealed they’ll soon join forces to create a new post-acute care powerhouse. While the decision to merge made sense due to the companies’ similar geographic footprints, their complimentary services and a variety of other reasons, it was also a strategic response to the changing needs of the U.S. health care system.

“I think there are a few overlying trends that are taking place in the marketplace that we’ll … be better positioned to take advantage of,” AccentCare CEO Steve Rodgers told Home Health Care News.

Since the start of November, the United States has had more than 2 million new coronavirus infections, bringing the nation’s grand total to more than 11 million cases since spring. Health systems and hospitals are once again nearing a breaking point, with many already at max capacity or stretched dangerously thin on the staffing front.

In fact, just a day before AccentCare and Seasons unveiled their merger plans, Rodgers was on the phone with the COO of a major health system in the Upper Midwest. During the call, the health system executive noted how one of its hospitals had dozens of incoming COVID-19 patients at a time when 35 ICU nurses were out because of community-related coronavirus exposure.

“They’ve got about 35 to 40 patients they need to get out of the hospital that they’re asking for help with,” Rodgers said.

To extend capacity and redirect patients, more and more health systems are turning to in-home care providers like AccentCare, Seasons and others. Their pursuit of innovative home-based care models started to pick up in 2019, but it has since intensified due to the coronavirus.

For proof, one need only look at the several hospital-at-home programs that have popped up over the past eight months, with the latest example being Quincy Medical Group in Illinois, which has its own program in the works. “A number of” health systems have specifically asked AccentCare to accelerate their hospital-at-home activities, Rodgers confirmed.

“[COVID] has elevated the complexity of the patients coming out of the health systems,” he said. “And what you need is a greater and a wider breadth of capability to be able to take care of those patients.”

Alone, AccentCare and Seasons were already two of the biggest post-acute care players in the home health and hospice spaces, with each delivering a wide range of services. Together, though, they’ll be better able to care for those high-acuity patients coming from their health system partners.

The two companies expect to finalize their merger before the end of 2020, pending regulatory approval. Once they do, the combined enterprise will offer home health, hospice and personal care services across 225 sites of care in 26 states, employing nearly 30,000 workers.

Overall, the AccentCare-Seasons combination will have more than 60 partnerships with health systems and physician practices, collectively providing care to more than 175,000 patients and families annually.

“Health systems are beginning to feel it,” Rodgers said. “And they’re calling us up, asking for help.”

Moving forward, in-home care providers with a breadth and depth of services will be best positioned for hospital-at-home models and similar opportunities related to shifting care away from acute settings. In all likelihood, the merger between AccentCare and Seasons will be followed by even more industry-shaping deals to come, with technology also factoring into the equation.

“The other thing that you’re going to continue to see is just an acceleration of technology into the home,” Rodgers said. “If you’re a larger organization, you’re more able to make the investments in the technology and the services that you can use to support your strategic partners out there.”

In addition to strengthening its ability to take on complex patients from acute settings, AccentCare’s merger with Seasons gives it newfound access to physician services, another advantage in today’s health care ecosystem.

“One of the more difficult areas for us to coordinate is physician services,” Rodgers said. “Seasons brings a very advanced medical group practice in each state they do business in. Although that practice is very hospice-focused now, we see it as an opportunity to be able to expand our capabilities into more complex populations, to supplement the community-based physician services that are available.”

Internally, AccentCare is beginning to once again feel the impact of the COVID-19 virus across some of its markets, particularly around staffing. The company — backed by private equity firm Advent International — currently operates across more than 179 locations in 17 states.

It was among the very first home health providers to speak publicly about the coronavirus and its response strategy.

“We’re beginning to see pickup in a number of marketplaces, especially with those that have positive diagnoses above 50 per 100,000, or 100 per 100,000,” Rodgers said. “You’re seeing an increase in employee absenteeism associated with positive cases out there.”

Seasons Hospice & Palliative Care is also feeling the effects of the current surge, CEO Todd Stern told HHCN. Continued access to patients in facility-based settings has been one specific challenge, he noted.

“We’re seeing a little bit more of the restricted access,” Stern said. “But the demand continues to be there.”

Seasons offers end-of-life care services to more than 30,000 patients a year, with operations spanning 19 states and 31 Medicare-certified programs.

“There’s no shortage of need for our services,” Stern said. “It’s quite the opposite.”

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Doctors Making Housecalls CEO: COVID-19 Has Placed an ‘Exclamation Mark’ on House Call Services

Private equity-backed Eventus WholeHealth recently acquired Doctors Making Housecalls (DMHC), a home-based primary care provider. The deal further highlights the growing interest in home-based primary care seen throughout 2020.

Charlotte, North Carolina-based Eventus is a physician-led medical provider for residents and patients of skilled nursing and assisted living facilities. Aside from North Carolina, the company operates in Indiana, Ohio, Kentucky and South Carolina.

Founded in 2002, DMHC is a Durham, North Carolina-based provider that makes 160,000 visits annually to homes, assisted living communities and individual businesses. The company is a multi-specialty group of physicians, physician assistants and nurse practitioners.

Once merged, the two organizations will have over 550 clinicians and employees. The company will provide primary care, specialty care and behavioral health in long-term care facilities — and in the home.

Currently, the combined companies have 42,000 patients across the five markets.

Eventus CEO Dr. Grace Terrell saw an opportunity in the “house calls” model, especially in light of the COVID-19 emergency. The acquisition will help Eventus expand its delivery of care and help control patient populations wherever they reside.

“Our mission is that we are providing holistic care for medically vulnerable adults, and [this population] doesn’t all reside in skilled nursing or assisted living facilities. Some of them are in independent senior care facilities — and, of course, the vast majority live at home in private residences,” Terrell told Home Health Care News. “We were quite interested in this before the pandemic. But particularly with the pandemic, it’s become clear that the ability to provide care to patients in their homes … needs to be expanded.”

DMHC is one of the organizations that has truly honed in on the home-based primary care model, she added. One of the main reasons the company was an attractive acquisition target for Eventus was DMHC’s long-time reputation.

DMHC is one of 15 organizations that was chosen to participate in Medicare’s Independence at Home Demonstration Project.

Launched in 2019, Independence at Home is a CMS Innovation Center model that tests the effectiveness of delivering primary care services at home.

“Look at the Medicare Independence at Home Demonstration Project. They had some of the best results in the country, in terms of superior quality and lowering the cost of care and outcomes,” Terrell said. “They are in North Carolina, where we obviously also have a large presence. We see the type of care they provide firsthand.”

Another distinguishing characteristic of DMHC’s practice is the role the company plays as primary care providers, according to Dr. Alan Kronhaus, CEO of DMHC.

“We become the primary care clinician for our patients, as opposed to seeing them, for example, for a limited period of time in the ‘post-acute space,’” he told HHCN. “We get to know our patients very well. We form a close relationship with them and their family. I think that has been instrumental in our ability to be effective, both in providing clinically excellent services and in our ability to reduce the cost of care rather dramatically.”

Indeed, Kronhaus credits a focus on what he called the “pre-acute” space and providing proactive primary care for DMHC’s ability to lower costs.

“If you’re focused on the post-acute space, which so many … practices seem to be these days, the horse is already out of the barn,” he said. “The real key to reducing costs and providing great services is to provide, what I like to call, proactive primary care. This keeps people on an even keel and avoids crises, which reduces unnecessary ER visits and hospitalizations.”

The deal expands DMHC’s ability to provide crucial services to complex older patients on a broader scale — tripling the company’s capacity to promulgate their practice model, according to Kronhaus.

Additionally, the acquisition allows both companies to combine support resources and operate more efficiently.

Moving forward, Kronhaus thinks the public health emergency has put an “exclamation mark” on the benefits of DMHC’s services that keep people away from doctor’s offices.

“Whenever a patient goes to a waiting room with a lot of other sick people, … they’re obviously exposed to various pathogens and are at risk for nosocomial infections,” he said.

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‘Taking Advantage of Home-Based Provider Workforce’ Will Be Key to Vaccine Delivery

After nine months of the public health emergency, a major breakthrough took place last week when Pfizer announced that one of its experimental COVID-19 vaccines was more than 90% effective in trials. Similarly promising results from a Moderna vaccine soon followed.

Both vaccines still need to be authorized for emergency use by the U.S. Food and Drug Administration (FDA). Once that happens, the home should be one of the central points of vaccine delivery, experts believe.

Roughly 2 million seniors are permanently homebound, according to the American Academy of Home Care Medicine. For seniors that fall under this category and certain others, receiving care outside of the home can be difficult — or out of the question entirely.

“[For this population], just going to the clinics, to the hospitals, to the drive-thru testing centers, wherever the COVID-19 vaccine is going to be made available, is a challenge,” Marc Rothman, chief medical officer of Signify Health, told Home Health Care News.

Signify Health is a Dallas, Texas-based tech-enabled provider of at-home care solutions. The company is one of the largest providers of house calls in the U.S., conducting more than 1 million house calls annually.

Not being able to receive the vaccine at home could create avoidable barriers to delivery for a population that already faces the highest risk of adverse events associated with contracting COVID-19, according to Rothman.

For added context, 80% of COVID-19 deaths have been adults who are 65 and older, according to the Kaiser Family Foundation.

Now more than ever, there’s an incredibly large home-based care workforce in patient’s homes. Rothman believes that utilizing this workforce for the purposes of administering the vaccine to patients who receive care in the home is a crucial next step.

“Even in the days of Marcus Welby that people harken back to, there was not remotely the same sheer number of providers in patients’ homes as there is today,” he said. “As we try to deliver what, I think, is supposed to be 300 million doses to the U.S. population over the next six to …12 months, we really should be taking advantage of the home-based provider workforce.”

Aside from increasing access, administering vaccines in the home setting — a safe and private environment — could also help ease fears.

“Just because the vaccines have been politicized, there has been a little fear put out there that it’s been rushed,” Dr. Thomas Cornwell, executive chairman of the Home Centered Care Institute (HCCI), told Home Health Care News. “I can tell you that this is being done in the most scientific, safe ways.”

Schaumburg, Illinois-based HCCI is a nonprofit organization that advocates for the expansion of home-based primary care.

More than half of surveyed Medicare beneficiaries recently expressed that they felt comfortable getting a vaccine when one is made available, according to a recent poll from eHealth. That means 47% felt uncomfortable.

A reluctance to take even the most well-known vaccines, such as the flu vaccine, is not uncommon, Rothman noted.

“We know that vaccination rates for things like influenza, which is really just a routine annual vaccination, are only in the 40% ranges,” he said. “There’s a concern that people will fear the COVID-19 vaccine and then not want to go get it. In our minds, what better way to ensure that people feel that they can trust this potentially life-saving medication then to have it potentially delivered in their home by someone they trust.”

Still, one challenge will be figuring out how to administer the vaccine in the home setting on a wide-scale.

Rothman again cited the difficulties of administering the flu vaccine as an example of what providers might be up against.

“We know that home health care organizations — lots of home-based primary care organizations — have not been giving annual flu vaccines to all of their patients because, logistically, it’s complicated,” he said. “There’s transport issues, packing issues, cold-chain storage issues. Many organizations have backed off from making that part of their daily work, knowing that a lot of people will eventually make it to the doctor’s office or to the local grocery store.”

In the case of the Pfizer vaccine, for example, the medication needs to be stored at about minus 75 degrees celsius. This is about 50 degrees colder than any vaccine currently used in the U.S. As Rothman pointed out, doctors’ offices, pharmacies and state labs don’t have freezers that go that low.

One move for providers may be forming strategic partnerships in order to accomplish this. Home-based primary care providers, in particular, might consider working with pharmaceutical companies, biopharma companies and logistics companies.

But providers may need to make these moves sooner rather than later.

Out of the 30 or 40 companies that began to develop vaccines back in the spring, there are now 11 that are in large-scale trials with broad populations, according to Rothman.

Last week, Pfizer said their messenger RNA-based vaccine is estimated to be 90% effective. This is based on an interim analysis of a study of 43,000 patients. On Wednesday, the company said updated results showed their vaccine to be 95% effective.

Pfizer plans to file for authorization with the FDA “within days.”

“Nothing’s ever guaranteed until it happens, but it is looking so positive based on this Pfizer vaccine,” Dr. Cornwell said.

This week, Moderna announced that its vaccine was more than 94% effective at preventing COVID-19. The company conducted a 30,000-patient study.

“If even one or two of the other organizations are successful, because of decisions made to ramp up productions facilities even before the vaccines were approved, we could potentially have millions of doses of vaccines circulating by the spring,” Rothman said.

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CMS: Home Health Improper Payments Down by $5.9B Since 2016

Home health providers continue to make serious progress in reducing improper payments under fee-for-service Medicare, the U.S. Centers for Medicare & Medicaid Services (CMS) announced Monday.

Since 2016, improper payments to home health providers have dropped by an estimated $5.9 billion, according to CMS. All improper payments in fee-for-service Medicare are down by an estimated $15 billion compared to four years ago.

“From the beginning, this administration has doubled down on our commitment to protect taxpayer dollars,” CMS Administrator Seema Verma said in a statement. “This year’s continued reduction in Medicare improper payments is a direct result of those actions.”

The government has paid out an estimated $25.74 billion in Medicare fee-for-service improper payments in 2020, with an overall improper payment rate of 6.27%. Last year, the government paid out $28.91 billion in estimated improper payments, with a rate of 7.25%.

Source: CMS

Improper payments are occasionally tied to fraud, waste and abuse, but that’s not always the case. Improper payments are often payments that simply did not meet certain regulatory or administrative requirements, perhaps due to unintentional documentation mishaps.

Additionally, improper payments do not necessarily represent expenses that should not have occurred, according to CMS.

CMS attributed to this year’s decrease in improper payments to the ongoing corrective actions it has taken over the years. The agency’s Review Choice Demonstration (RCD) is one example of those actions specific to home healthy care.

“Health care costs are skyrocketing; by 2026, one out of every five tax dollars will be spent on health care,” CMS noted in its Monday announcement. “To constrain unsustainable cost growth, CMS must continue to ensure payments are made according to the rules.”

On top of CMS actions, the home health industry has worked diligently over the past several years to police itself and weed out bad actors. The hard look in the mirror has helped the industry slash its improper payment rate drastically compared to 2015, when it checked in at an astronomical 58.95%.

“The value of home care is well established with proven cost savings, better outcomes and innovations in patient care being demonstrated every day,” Amedisys Inc. CEO and President Paul Kusserow wrote to Home Health Care News in April 2019. “We look forward to working with CMS and others to ensure the rate of improper payments continues to decline.”

Source: CMS

Improper payments to skilled nursing facilities (SNFs) are also down in 2020.

Specifically, SNFs saw a $1 billion reduction in estimated improper payments in the last year, according to CMS. The agency said the reduction is largely due to a policy change related to the supporting information for physician certification and recertification for SNF services, as well as CMS’s Targeted Probe and Educate efforts.

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How Home Health Agencies Can Build Stronger Relationships with Senior Living Operators

During the COVID-19 crisis, senior living communities and long-term care facilities have sometimes been wary about letting outsiders onto their premises, including home health and hospice clinicians.

That has repeatedly been a major challenge and point of concern for home health providers over the past several months, at times even leading to significant dips in revenue and worsening health conditions for patients.

In some cases, however, COVID-19 has been a catalyst to better relationships between home health and senior living operators. The keys to those successful relationships have been communication and a commitment to best practices.

“We do stay in constant communication with our partners,” Izzy Porter, a senior living program manager for Bayada Home Health Care, told Home Health Care News. “That coordination and collaboration is, I think, what really helps us stay successful in keeping our clinicians [and residents] safe.”

Moorestown, New Jersey-based Bayada is one of the largest nonprofit providers of home health and post-acute care services in the U.S. The company provides a range of in-home care services to adults and children across 345 locations in 22 states as well as seven other countries.

Its senior living partnerships have grown stronger throughout the pandemic, according to Porter.

While Porter’s job has intensified with COVID-19, the results of her work have gone a long way.

With less exposure to the outside world, senior living residents have been more susceptible to muscle weakness and subsequent falls. That’s why, on Bayada’s end, it has worked so hard to keep its employees safely entering facilities to see patients.

“We are seeing a lot of residents who aren’t necessarily impacted with COVID itself,” Porter said. “But what we are seeing is some of those secondary effects due to different communities adjusting their visitation schedules or disallowing residents to go and see family. So we’re seeing a lot of people who are a little bit deconditioned because they’re not engaging in the activities that they used to.”

Karen Garland — the regional director of Exton, Pennsylvania-based Vantage Point Retirement Living — has witnessed similar issues, she told HHCN.

“[Seniors] have been quite isolated,” Garland said. “They have been limited in their ability to have people visit because of certain restrictions or safety measures. And obviously, when you live in one of these areas, or one of these settings, it’s supposed to be about family involvement.”

Vantage Point Retirement Living provides residential options to seniors in Pennsylvania, Delaware and Maryland. As a part of its network, the company offers active adult, full service retirement and senior living communities.

Garland will serve as the executive director of Arcadia at Limerick Pointe, one of Vantage Point’s newest senior living communities. Limerick, Pennsylvania-based Arcadia at Limerick Pointe is a faith-inspired senior living community offering independent living, supportive personal care and memory care.

It is set to open later this year, with support from Bayada to facilitate home health services.

Instead of accepting the emotional and physical toll that comes with COVID-19 as just another reality during a pandemic, Bayada and Vantage Point employees have worked hard at making their relationship work for the betterment of their seniors’ situations.

“With COVID, we wanted to partner with people who have really been right in the trenches like Bayada has,” Garland said. “Whether it’s been in home health, assisted living or personal care, they’ve been right there [through it all].”

When looking at home health providers to partner with, Vantage Point considers many things, but especially staffing. That way, when things get tough, the home health provider is able to fill staffing gaps with ease and has the resources to keep caring for seniors inside of communities in a safe manner.

Vantage Point also wants home health workers to understand — and be a part of — the senior living community.

Bayada’s openness to sitting down with senior living providers’ executives and finding out how they can service their communities better has been “very important” to Vantage Point, Garland said.

“We have certain policies and procedures in place to ensure the safety of our members — and that is very, very big,” Garland said. “So we’re looking to partner with people who are open minded, who are aware of best policies and best practices, and who will be excited to learn about our community and our company.”

From Porter’s standpoint, that means reaching out to Bayada’s senior living partners on a daily basis.

“For me, it makes me feel a lot better when, if there’s a small change,” Porter said. “I get an email from the community itself, because then everyone is on the same page.”

Bayada’s goal is to be the eyes and the ears of its senior living partners’ communities. Its caregivers and clinicians strive to be there to help with anything, from personal assistance to screenings.

Its methods have enabled it to maintain its partnerships with facility-based providers nationwide — and more importantly, keep prioritizing seniors’ health within those communities.

“Our plan isn’t to be just a provider,” Porter said. “Our plan is to make it so that residents see us and they feel like we are part of the community, because we have dedicated teams that are in these communities. We’re limiting people’s visits between different places, which does help to prevent the spread. But it also helps to make people feel a little bit more at ease.”

Senior living providers have become more interested in home- and community-based care themselves over the years. Over half of the U.S.’s largest nonprofit senior living organizations now offer some sort of home- and community-based services, according to a recent report from LeadingAge and Ziegler.

Nearly 65% of the largest 25 providers offered some sort of home- or community-based service.
Garland and Porter will discuss COVID-19’s impact on aging services providers and seniors during a Wednesday webinar.

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In-Home Care Workers Increasingly Prefer Virtual Training

Virtual tools have quickly turned into the preferred method of training for in-home caregivers since the start of the COVID-19 public health emergency. That trend will likely continue beyond 2020 as well.

That’s according to a new survey conducted by Medflyt, a HIPAA-compliant web-based workforce management platform for home care agencies. The Forest Hills, New York-based company works with more than 100 providers and 100,000 caregivers across the U.S.

As part of the survey, released Tuesday, Medflyt gathered data from roughly 11,000 in-home care workers across the U.S. Overall, the survey found that 60% of surveyed caregivers would rather be trained online instead of in person.

“This pandemic kind of flipped the way agencies were operating on their backs, with agencies saying, ‘We should think broader. We should think smarter,’” Levi Pavlovsky, COO and co-founder of Medflyt, told Home Health Care News.

In addition to caregivers’ preference for virtual training, a key finding of the survey was that 38% of respondents wanted to onboard remotely. This percentage is much higher than before the public health emergency began, Medflyt noted.

Throughout the COVID-19 emergency, technology has been a critical tool in facilitating the delivery of care, a point reflected in the rise in telehealth utilization among home-based care providers.

But technology has also played a significant role in the operations side of the in-home care business as well. Since spring, many providers have shifted existing training and onboarding processes into the virtual realm.

“It’s an ever-changing environment. We’re going more to tech,” Pavlovsky said. “Technology is bringing efficiency. Now agencies can really focus on improving the quality of care for their patients.”

Another important finding from the survey: When it comes to retention, accessibility of staffing and onboarding processes plays a huge role. In fact, 62% of caregivers said that easy and quick onboarding staffing functions are deciding factors when considering one agency versus another.

For providers that have historically struggled with retention, these findings should encourage them to throw their efforts behind streamlining the recruitment and onboarding process, according to Pavlovsky.

Agencies that aren’t moving fast enough may find themselves unable to keep up with their competition, he added.

“Agencies that are not able to quickly pivot, quickly adapt technologies, they’ll be out of the game,” Pavlovsky said. “They won’t be able to continue to fight with agencies that are pivoting and adapting into the new era of this unfortunate pandemic.”

In addition to the previously aforementioned findings, the survey also revealed that 44% of caregivers believe “better communication and flexibility” from agencies would improve training.

On top of that, 54% of respondents said they want to be educated on topics related to the public health emergency such as social distancing, regulations and sanitation, in relation to their work.

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How TRU Community Care Used Telehealth to Revamp Its Palliative Care Program

Despite a vital need for palliative care in community settings, home-based care providers have been slow to invest in such services. Providers have often cited financial concerns as a roadblock.

Yet those providers that have turned their attention to palliative care frequently see positive returns. TRU Community Care, for example, saw its palliative care segment grow by 103% over the course of nine months, partly due to the implementation of new telehealth tools.

Founded in 1976, Lafayette, Colorado-based TRU Community Care is a Medicare- and Medicaid-certified, nonprofit health care organization. The company’s service lines include home health, hospice, assisted living and palliative care.

At the end of 2019, TRU Community Care began its process of revamping its palliative care program. This meant expanding the programs to include physicians, NPs, RNs, social workers, chaplains and care navigators.

It also meant forming a partnership with Boulder Community Health, which created a strong referral pipeline.

But the secret sauce was adopting remote patient monitoring technology, enabling TRU Community Care to transition from in-person to virtual visits in December, according to Michael McHale, the company’s president and CEO.

“More and more people are living with advanced illness. And now because of COVID-19, people are feeling so isolated from their health care resources,” McHale told Home Health Care News. “I think that our expansion into telemedicine enabled them to have a connection back to the health care community.”

Currently, TRU Community Care serves roughly 820 patients across Boulder, Broomfield, Adams, Jefferson, Denver and Weld counties in Colorado.

Typically, palliative care services provide specialized treatment focused on relieving symptoms, often for patients with serious illnesses.

“When you look at traditional palliative care, obviously providers and social workers going out and making visits, we do it based on acuity, whether that be weekly, monthly or bi-monthly,” Chad Hartmann, director of palliative care at TRU Community Care, told HHCN. “With the remote patient monitoring, it gives us the opportunity to oversee those patients and what’s going on with those patients every single day.”

Since providing palliative care through telehealth, TRU Community Care has completed over 15,000 minutes of virtual visits.

Prior to adding virtual visits, nurses entering patients’ homes were able to complete a maximum of five visits per daily. This number jumped to nine patients daily after adding virtual visits.

The new process allowed TRU Community Care to more easily track and trend patients’ disease progression over time, but it also was an added benefit in responding to the COVID-19 emergency.

“It’s really a mutual desire to limit folks coming into the home and then limiting exposure to COVID-19,” McHale said. “Right now, as in most of the country, Colorado is seeing an uptick in COVID diagnoses. We’re finding that more and more people don’t want someone coming into their home.”

Last year, TRU Community Care participated in a mHealth Impact Lab, University of Colorado study. The study found that TRU Community Care was able to save $40,000 through the use of virtual visits.

Historically, palliative care has not been associated with strong reimbursement, however.

Last month, the National Association for Home Care & Hospice (NAHC) publicly stated the organization’s plans to push for the recognition of palliative care as one of the services provided under the Medicare home health benefit.

TRU Community Care went the telehealth route because of the Centers for Medicare & Medicaid Services (CMS) “Patient Care First (PCF) – Seriously Ill Population (SIP)” demonstration. The payment model, part of the Primary Care First initiative, has yet to publicly announce which providers have been accepted to participate.

Still, the organization saw the program — and use of telehealth — as a way to achieve cost-effectiveness.

“The only way that we could see it make sense is if the majority of our visits were done telephonically,” McHale said. “Once you start putting in travel time, your visit cost increases. You have to pay that nurse or social worker that hourly rate for the time that they’ve traveled to the patient’s home and the cost of care that’s delivered while they’re in the home.”

Looking ahead, TRU Community Care is reaching out to other nonprofits in hopes of forming potential partnerships.

“The infrastructure that we’ve set up potentially could benefit them at a much lower cost and enable them to do more of this supportive service out in the community,” McHale said.

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‘Hundreds of Millions of Dollars’ Being Put Toward At-Home Testing Efforts, HHS Says

On Monday morning, Moderna (Nasdaq: MRNA) announced that its COVID-19 vaccine trials showed a near-95% effectiveness rate. That news comes just a week after Pfizer (NYSE: PFE) reported its own vaccine was about 90% effective.

That’s all good news. But it coincides with a much harsher reality in the U.S.: the virus’ spread is more rampant than ever; health care providers are becoming overwhelmed; and testing is becoming an inadequate mitigator.

Over 50 million tests have now been sent out by the U.S. Department of Health and Human Services (HHS). As of late October, 632,480 COVID-19 Abbott BinaxNOW diagnostic tests had been sent to home health and hospice agencies, an HHS spokesperson told Home Health Care News in an email.

But testing alone will not be an antidote to the troubles that COVID-19 presents agencies.

“This is not like a few Ebola cases that you can test and trace. We cannot test our way out of this,” HHS Assistant Health Secretary Adm. Brett Giroir said on a call with reporters Monday. “We have to do the large-scale mitigation efforts.”

Last week, the U.S. hit multiple record-breaking highs in new daily cases. Overall, there have been nearly 11 million total cases of COVID-19 reported since the pandemic began, with nearly 255,000 total deaths, according to the Centers for Disease Control and Prevention (CDC).

While tests are being shipped out by the government to home health providers, having them hasn’t been the godsend that some thought it may be.

In a survey of nearly 600 providers conducted by the Washington, D.C.-based advocacy organization LeadingAge, respondents listed a slew of reasons for that.

For one, Abbott’s BinaxNOW tests — which are the kind home health care providers have mostly received — are perceived to be less reliable than PCR tests. Of the health care providers that LeadingAge surveyed, over one-third of them were not using the BinaxNOW tests they had been sent at all.

That could be because the providers already have testing protocols in place, so they don’t need to use the BinaxNOW tests. But other reasons include the reporting requirements being too “cumbersome” or that the BinaxNOW tests have only recently been sent to the agencies.

The general feeling from providers on BinaxNOW tests is that they are a good supplement to already in-place testing measures, but not sufficient enough as a front-line testing strategy, according to the LeadingAge survey.

Nearly 340,000 more BinaxNOW tests are set to be sent to home health and hospice providers this week, Giroir said.

BinaxNOW tests are “intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct nasal swabs from individuals suspected of COVID-19 by their health care provider within the first seven days of symptom onset,” according to the U.S. Food and Drug Administration (FDA).

A key caveat, however, is that “negative results do not rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment or patient management decisions, including infection control decisions.”

In other words, the BinaxNOW tests help agencies, but they’re not a full-blown solution — or even close to it.

While Giroir pushed COVID-19 protocols hard on Monday’s call, including physical distancing, mask-wearing and avoiding large indoor crowds — including during the holidays — he also suggested government-led at-home testing was on the horizon.

“[We’re] trying to solicit, with hundreds of millions of dollars behind it, more availability of tests that could be used at-home,” Giroir said.

Companies such as on-demand health care startup Ready have already been administering COVID-19 tests in the home for months. Ready is using that experience and at-home flu vaccinations to prepare itself for when a COVID-19 vaccine is available and able to be deployed to individuals’ homes.

That could be sooner rather than later.

“We remain extremely encouraged by the news reported by Pfizer last week that their vaccine is safe and has a greater than 90% effectiveness at preventing symptomatic COVID infection,” Giroir said. “If these data are confirmed by the transparent, non-political, evidence-based process leading to an EUA, we would have enough vaccines from Pfizer to potentially protect up to 20 million people in 2020.”

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AccentCare, Seasons Hospice to Merge

AccentCare Inc. and Seasons Hospice & Palliative Care are merging.

Dallas-based AccentCare — owned by global private equity firm Advent International — is among the five largest home health providers in the country, according to industry data. The Rosemont, Illinois-based Seasons holds the same distinction in the U.S. hospice market.

“Accentcare is doing very, very well,” Todd Stern, CEO of Seasons, told Home Health Care News. “Seasons was not out, determined to find a partner. This is a marriage of opportunity.”

Once finalized, the merger between AccentCare and Seasons will reshape the post-acute care market, with the combined entity being one of the deepest around in terms of geographic footprint and portfolio of services. The companies are expected to publicly announce their agreement late Monday, with financial terms of the deal not disclosed.

There are several advantages to the merger, AccentCare CEO Steve Rodgers told HHCN.

By teaming up, AccentCare and Seasons will be better equipped to serve patients and referral sources as individuals’ needs change, for example. The move is likewise “extremely complimentary,” with AccentCare’s home health footprint closely matching Seasons’ hospice footprint, especially in major metropolitan areas.

“This is incredibly complimentary to our own approach toward strategic markets and being very focused on working with large health systems,” Rodgers said. “Todd and I both have a focus on being in large urban marketplaces. If you just go down the list of cities where we have a very significant presence now, we’re in the top cities in the United States. We’re in Boston, Chicago, Dallas, Houston, San Francisco, Los Angeles, Denver — and the list goes on.”

AccentCare delivers home health, hospice, personal care and care management services to more than 145,000 patients and clients annually, doing so across more than 179 locations in 17 states. In addition to growing organically, the company has landed several strategic partnerships with payers and health systems over the past few years, with its latest being a sizable joint venture with Fairview Health Services in Minnesota.

Advent International acquired AccentCare in May 2019 from its former PE backer, Oak Hill Capital Partners.

“Advent is a world-class private equity organization,” Rodgers said. “They’ve been incredible partners of ours, both in continuing to shore up the base infrastructure in the organization over the last 16 months as well as in preparing us to faze into a very significant opportunity like this.”

Seasons Hospice & Palliative Care offers end-of-life care services to upwards of 30,000 patients a year. Its current operations span 19 states and 31 Medicare-certified programs, inclusive of 22 facility-based and freestanding in-patient centers.

“Together, we can deliver a superior patient and family experience, ultimately serving our continuum of care partners even better, many of which want multiple service lines and multiple forms of care,” Stern said. “Our ability to take multiple service lines in common markets and innovate with the collective expertise made this a marriage worth doing.”

The combined AccentCare-Seasons enterprise will operate over 225 sites of care across 26 states, employing nearly 30,000 workers. It will have over 60 total partnerships with health systems and physician practices, collectively providing care to more than 175,000 patients and families each year.

AccentCare and Seasons expect to finalize the merger before the end of 2020, pending regulatory approvals. While they wait for that to happen, leaders from both organizations have started to execute upon their integration strategy, which will likely require ample time and resources considering the transaction’s sheer size.

Rodgers will serve as CEO of the new AccentCare-Seasons enterprise, which will keep AccentCare’s current headquarters of Dallas.

Stern will lead the hospice department — operating out of Rosemont — once AccentCare’s hospice services are combined with Seasons’ existing operations. He will also serve as executive vice chair of the combined organization.

On a broader level, Monday’s news adds to what has been a red-hot stretch for post-acute care dealmaking, particularly for hospice assets, which have typically come with hefty price tags. Last week, for instance, Addus HomeCare Corporation (Nasdaq: ADUS) announced a $192 million acquisition of Queen City Hospice and its affiliate, Miracle City Hospice.

AccentCare looked at many of the hospice businesses that came on the market, Rodgers said. Its leadership team started talking with Seasons toward the end of last year, however, and a merger seemed to make perfect sense.

“Todd and I got to know each other over the course of the year,” he added. “I think we had a mutual respect for each other and our organizations. I think we started getting excited about what we could do together. As we got into the late summer and early fall, things started taking off for us.”

While both CEOs declined to comment on financial details, Rodgers noted that the combined company should have annual revenues somewhere in the range of Encompass Health Corporation (NYSE: EHC) and LHC Group Inc. (Nasdaq: LHCG), which were ranked as fourth- and third-largest home health providers in 2019 by LexisNexis Risk Solutions.

“Let’s just say we’ll be fast approaching that general size and breadth,” Rodgers said.

For context, Encompass Health’s home health and hospice segment reported $1.09 billion in net services revenues in 2019. LHC Group, meanwhile, recorded $2.08 billion in net services revenues last year.

Until the merger is completed, all patients will continue to have access to their same care routines and will continue to use their current insurance plans. Each organization will share updates with patients and partners before any changes taking place, Rodgers and Stern noted.

In addition to Fairview, AccentCare’s existing joint ventures include partnerships with Asante, a large health system based in Oregon. That list also includes relationships with Baylor Scott & White Health, UCLA Health and several others.

With more than 30 strategic partnerships, Seasons has similarly made a name for itself with health systems, hospitals and payers. Moving forward, the merger should only benefit those partnerships, according to Stern.

“The hope that this is only positive,” he added. “There are some customers in the continuum of care that want all services, right? And there are some that just want parts. For those that want parts, nothing will change. For those that want more, I think we have a lot of opportunity to offer more to existing customers and care partners on both sides of the care aisle.”

Subsidiaries covered in the agreement include Health Resource Solutions, home health provider in Illinois, Nebraska and Indiana with a patient census of about 2,500. Gareda, a personal care business in Illinois that serves about 4,500 clients a year, is also covered.

This is a developing story. Please check back shortly for additional updates.

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Home Health Patient Demographics Continue to Shift

Individual and clinical characteristics of home health patients continue to shift, reflective of both America’s aging population and providers’ ability to handle more acute cases.

That’s according to the latest Home Health Chartbook, an annual overview of the home health landscape put together by the Alliance for Home Health Quality and Innovation and Avalere Health.

In addition to highlighting the industry’s ever-changing patient population, the Chartbook also details the economic contribution of home health providers on the U.S. economy.

Compared to the overall Medicare population, home health patients tend to be older and slightly more economically vulnerable, the Chartbook suggests. Home health patients additionally tend to reside in rural areas and live alone at slightly higher rates than the broader universe of all Medicare beneficiaries.

“The Chartbook helps to conceptualize the home health landscape via data and charts that roughly sketches home health care in the United States,” Jennifer Schiller, executive director of the Alliance for Home Health Quality and Innovation, told Home Health Care News in an email. “We continue to see the value of home health care to patients and the health care system, writ large.”

When it comes to the health status of patients, home health users are far more likely to suffer from several chronic conditions.

Nearly half of the home health patient population suffers from five or more chronic conditions, with another 19% suffering from four chronic conditions, according to the Chartbook. In comparison, just 22.4% of the overall Medicare population suffers from five or more chronic conditions.

The apparent imbalance is partly attributable to the rising population of dual-eligible beneficiaries in home health care, Schiller noted.

“We continue to see a small but fairly steady increase in dual eligibles receiving home health care,” she said. “Dual-eligible home health users tend to have more chronic conditions and need assistance with more activities of daily living (ADLs) than home health users as a whole.”

On top of needing more assistance with ADLs and their chronic conditions, home health patients also often need more support for a severe mental illness, such as depression, bipolar disorder or schizophrenia.

More than one-third of the home health patient population suffers from a severe mental illness, the Chartbook shows. But just 28.9% of the overall Medicare population suffers from such an illness.

Apart from basic demographic information, the Chartbook also highlights the most common diagnosis-related groups for beneficiaries discharged from the hospital to home health providers under Medicare Part A.

In order, the most common diagnoses of patients referred from the hospital to home health are: septicemia or severe sepsis; major hip and knee joint replacement; heart failure; hip and femur procedures; and pneumonia.

In 2019, 6.93% of all home health claims were coded for Type 2 diabetes, with another 6.47% coded for orthopedic aftercare.

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‘We’re Looking for the Best of the Best’: Why Dementia-Focused Home Health Provider Tender Rose Cherry-Picks Top Caregivers

As the number of Americans living with Alzheimer’s and other forms of dementia rises, more in-home care providers are rolling out specialized services lines focused on memory care and disease-specific needs. Some providers are even building their entire businesses around dementia.

One such in-home care company is Tender Rose Dementia Care Specialists, which has been the largest one-on-one dementia care provider in its market since 2009.

“All of our clients have dementia. All of our caregivers are highly trained memory care professionals,” Jim Kimzey, the company’s founder and CEO, told Home Health Care News. “Our mission is to improve the quality of life of people living with dementia and their families. It’s not just about keeping them safe and taking care of their physical needs.”

San Rafael, California-based Tender Rose’s service lines include personal assistance, companion care, “couples care” and live-in care. The company — launched by Kimzey and his siblings after their mother passed away following her own battle with Alzheimer’s disease — currently has eight locations across the state.

Nationally, there are more than 5 million people age 65 and older living with Alzheimer’s disease — a number that is estimated to grow by roughly 14 million by 2025, according to statistics from the Alzheimer’s Association. Alzheimer’s disease is the most common form of dementia, with others including vascular dementia, Lewy body dementia and more.

While dementia is prevalent across the general U.S. population, it’s especially present in the home-based care space. One home care provider, for example, recently told HHCN that almost 80% of its clients have a primary or secondary diagnosis of Alzheimer’s or another form of dementia.

As the CEO of Tender Rose, Kimzey believes that there’s value in a company that specializes in delivering dementia care in the home setting. When it comes to caring for seniors with dementia, Tender Rose takes what it calls a “person-centered, activity-based care approach.”

“The biggest difference, I see, between what we do, and what traditional home care does is … we get to know the person who has dementia,” he said. “We engage them in activities that bring them joy and meaning, at whatever level they can still participate. What traditional home care tends to do is focus on the physical needs of the client. Everything is about activities of daily living (ADLs) or instrumental activities of daily living (IADLs).”

One example of keeping a person with dementia engaged, Kimzey said, might be introducing an activity that’s both task-oriented, but one that also allows the individual to flex his or her “creative muscle.”

That kind of approach is generally far more effective than dictating commands or carrying out a random assortment of activities to simply pass time, according to Rachael Wonderlin, a dementia care consultant and author.

“I’m thinking something small, like bringing a little wooden birdhouse to your client’s home and saying, ‘Hey, we’re going to be putting this out in the garden. I could really use your help painting this,’” Wonderlin told HHCN. “That’s a whole hour-long activity where they’re engaged, doing something fun and purposeful. There’s a clear reason why they’re doing it.”

Although home care providers frequently serve individuals impacted by dementia, their expertise is sometimes limited. In fact, in cases where a senior living with dementia doesn’t suffer from any physical limitations, traditional in-home care can fall short.

“One of the things that happens is the person with dementia may actually be physically healthy and they don’t need that much help with ADLs,” Kimzey said. “If a traditional caregiver walks through the door and thinks, ‘My job is to help you when you need to go to the bathroom, bathe, eat or get dressed,’ the person with dementia is like, ‘I don’t need help with any of that. You can leave.’”

The majority of Tender Rose’s clients have had previous bad experiences with traditional home care agencies or with the private caregivers who they’ve hired. Specifically, issues arise when the caregiver hasn’t received training to deal with dementia, according to Kimzey.

“The caregiver who isn’t trained in dementia care — one who doesn’t really focus on quality of life or person-centered activity-based care — has a much higher probability of triggering agitation that creates behavioral problems,” he said.

While many companies have dementia-education programs for their caregivers, these programs are not always comprehensive.

“Giving one day, or half of a day, to a slideshow about dementia is not enough to actually teach people and encourage a dementia-positive environment — or even the ability to market [that an agency has] trained in dementia care,” Wonderlin said. “A two-hour presentation on dementia is not enough for somebody to be able to go into a situation and provide care.”

To that end, Tender Rose trains its caregivers based on methods popularized by Teepa Snow, the owner of Positive Approach to Care and a thought leader in the dementia care space. Positive Approach to Care is an Efland, North Carolina-based company that provides dementia care training, services and products across the globe.

Snow’s methods emphasize the importance of in-person and hands-on training that utilizes roleplaying and interactive discussions.

For Tender Rose, training is only a small part of differentiating itself from traditional home care providers. Tender Rose is also highly selective when it comes to recruiting its caregivers.

“Our labor strategy is to cherry-pick the best dementia caregivers in the industry,” Kimzey said. “We’re looking for the best of the best. We’re not looking for housewives who want a part-time flexible job to get a little extra spending money. We’re looking for professionals who need to work, who love doing dementia care and are good at it.”

In order to retain caregivers, the company offers a higher-than-average pay rate of $23.62 an hour. In comparison, caregivers earned a median hourly wage of $12.80 in 2019, according to PHI data.

Additionally, Tender Rose’s benefits package for caregivers includes health insurance, 401(k) plans, paid-time off and consistent hours with long-term clients.

For providers looking to truly take on dementia care, Kimzey reminds them that it’s crucial to constantly work to improve these care services.

“No matter how good you are at dementia care — you still have room for improvement,” he said. “We’ve been doing this for 11 years and we think that we do it better than just about anybody. And we aren’t nearly as good as we’re going to get. Don’t ever get complacent about how good you’re doing.”

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Home Health Agencies Carving Out Bigger Role in US Economy

The home health industry continues to carve out a bigger role in the overall U.S. economy, with agencies creating more jobs and paying more in wages than ever before.

Overall, home health agencies created more than 2.22 million jobs in 2019, employing more than 1.51 million workers in the process. That workforce took home more than $49.52 billion in estimated total wages.

These and other findings were highlighted in the latest Home Health Chartbook, released earlier this week by the Alliance for Home Health Quality & Innovation. Compiled annually by the Alliance with the help of Avalere Health, the Chartbook is a comprehensive analysis of the home health industry and the Medicare beneficiaries who utilize its services.

Data from the Chartbook comes from a range of government sources, including the U.S. Bureau of Labor Statistics (BLS), Home Health Compare, Medicare fee-for-service claims and several other Centers for Medicare & Medicaid Services (CMS) files.

The fact that the home health industry is becoming such a major economic force couldn’t come at a better time.

Millions of Americans have lost their jobs over the past nine months due to the COVID-19 public health emergency and its far-reaching impact. BLS reported Thursday that another 709,000 individuals filed first-time claims for unemployment benefits last week, on a seasonally adjusted basis.

That total is a slightly smaller number of initial claims than economists had expected, but still an astronomical spike compared to recent periods of economic stability.

To offset economic losses tied to the COVID-19 pandemic, multiple policymakers and politicians have suggested diverting further government support to the in-home care workforce. President-Elect Joe Biden, for example, pitched a $775 billion plan to boost the caregiver economy in July.

Home health agencies employed a similar number of workers in 2018, paying out a smaller wage total of $46.2 billion, however.

Employment of home health aides and personal care aides is projected to grow 34% from 2019 to 2029, much faster than the average for all occupations, according to BLS. As the baby-boom generation ages and the elderly population grows, the demand for the services of home health aides and personal care aides will continue to increase.

Broadly, the economic contribution of home health agencies has steadily risen since at least 2003, the Chartbook suggests. That’s true despite the shrinking size of the industry, at least in terms of Medicare-certified freestanding home health agencies.

From 1994 to 2015, the number of freestanding home health agencies climbed from 4,613 to 10,554. That total has fallen since then, dropping to 10,034 in 2018, according to the Chartbook.

Total home health expenditures reached $35.88 billion last year.

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Pennant ‘Encouraged’ by Vaccine News, But Not Assuming Near-Term Changes to Home Health Operating Environment

Home health providers across the board are slowly starting to bounce back from COVID-19-related disruption. One thing that now provides further hope is a potential vaccine, especially as the U.S. continues to break daily records around new infections.

The Pennant Group Inc. (Nasdaq: PNTG) is among the providers rallying around this week’s positive vaccine news, which is centered on Pfizer’s announcement that one of its experimental vaccines is more than 90% effective.

The company’s leadership team expressed cautious optimism during a Wednesday conference call to discuss its third-quarter financial results.

“While we haven’t assumed a change in the operating environment stemming from the widespread adoption of a vaccine, we are encouraged by the initial reports on the efficacy and availability of potential vaccines,” Pennant CEO Daniel Walker said.

The Eagle, Idaho-based Pennant is a holding company of independent operating subsidiaries that provide health care services through 75 home health and hospice agencies, in addition to 54 senior living communities.

Pfizer’s progress is certainly promising, but home health providers and other long-term care operators will likely still have to deliver care without a widely available COVID-19 vaccine for months. The drug company still needs to explore how the trial vaccine works in different populations, and many health care organizations lack the freezers needed to actually store an effective vaccine.

For now, Pennant is taking a wait-and-see approach, Walker noted. But the company believes it could reap the benefits of the vaccine during the second half of 2021.

“The key there is the actual execution, finalizing it, making sure that communities are comfortable with it,” Walker said. “I think once it’s fully baked and available, distribution won’t be that big of a difficulty.”

Aside from keeping an eye out for COVID-19 vaccine updates, Pennant reported a continued successful transition to the Patient-Driven Groupings Model (PDGM), the Medicare payment overhaul that has been somewhat overshadowed by the pandemic. Pennant has benefitted from PDGM’s relatively favorable reimbursement rates for higher-nursing-acuity patients, according to Walker.

“Our strong performance is driven by the ability of our local leaders to adapt to the changing reimbursement and operating environment, and appropriate reimbursement for care provided to higher-nursing-acuity patients,” he said. “Since our inception, we have been committed to caring for patients based on individual patient and community needs. Often, this has resulted in serving underserved, higher-nursing-acuity patients, … now more appropriately reimbursed under PDGM.”

The third quarter also saw ample dealmaking opportunities. Between August and September, for example, Pennant announced the acquisitions of four home health agencies and two hospice agencies. Most recently, the company announced the purchase of Grants Pass, Oregon-based Riverside Home Health Care.

These transactions bring the total number of operations acquired or started since 2019 to 227.

During Q3, the company also closed on its home health joint venture with Scripps Health, a San Diego, California-based nonprofit integrated health system. The deal was first announced in March.

“Each transaction represents a unique opportunity for local leaders to drive outside multi-year growth, as they respond to local market conditions and take advantage of additional acquisition opportunities,” Derek Bunker, Pennant’s chief investment officer, said during the call. “As evidenced by the different structures of these transactions, our disciplined growth strategy takes many forms.”

As an organization, Pennant’s focus is on the “opportunistic” acquisition of existing operations, but startups and joint ventures are additional tools available to drive similar long term-results, according to Bunker.

In Q3, Pennant’s total revenue checked in at $98.4 million, an increase of $10 million, or 11.3%, compared to the prior year’s quarter. The company’s home health and hospice services segment revenue was $64.4 million, an increase of $9.2 million, or 16.7%, compared to Q3 2019.

Total home health admissions for Pennant in Q3 were 6,771, an increase of 21.9% over the prior year’s quarter.

The company’s quarterly results don’t include any funds from the Provider Relief Fund.

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‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care

After one of the closest and most hotly contested campaigns in modern history, President-Elect Joe Biden addressed the nation on Saturday from an outdoor platform in Wilmington, Delaware.

While it’s far too early to say what the first 100 days of a Biden administration will look like from a detailed policy perspective, the president-elect has made one point abundantly clear. It’s time to get to work — and that work starts with the COVID-19 pandemic.

“Our work begins with getting COVID under control,” Biden said during his victory speech. “We cannot repair the economy, restore our vitality or relish life’s most precious moments — hugging a grandchild, birthdays, weddings, graduations, all the moments that matter most to us — until we get this virus under control.”

As the United States inches closer toward the macabre milestone of 10 million total coronavirus cases, the Biden administration’s response to the ongoing pandemic will need to be wide-ranging and thorough, touching on everything from vaccine development and distribution, to additional rounds of relief for health care providers. Long-term care and protecting America’s senior population will also need to be at the very center of its response.

“I will spare no effort — or commitment — to turn this pandemic around,” Biden continued.

In the weeks and months leading up to his victory this past weekend, Biden — a soon-to-be 78-year-old man himself — suggested a deep appreciation of home-based care.

In July, for example, the former vice president outlined a $775 billion plan to overhaul the nation’s caregiving infrastructure, which is mostly made up of women and people of color. As part of that plan, Biden said he hoped to create upwards of 3 million new caregiving and education jobs over the next decade, while likewise creating pathways for former caregivers to re-enter the workforce.

The plan additionally called for a $450 million boost for senior care, with some of those funds dedicated to improving wages and labor conditions for in-home care workers.

“Home health workers do God’s work, but aren’t paid much,” the then presidential candidate said on social media. “They have few benefits, and 40% are still on SNAP or Medicaid. It’s unacceptable. I’ll give caregivers and early childhood educators a much-needed raise.”

Biden hasn’t just highlighted his appreciation of home-based care in broad strokes and policy promises. In addition to his $775 billion plan, the president-elect has repeatedly brought attention to very specific, innovative programs that typically only industry insiders know about.

That includes making nuts-and-bolts references to CAPABLE, the increasingly popular program out of the Johns Hopkins School of Nursing designed to support aging in place by coordinating nursing, therapy and handyman services in the home.

“To hear him really describe [CAPABLE] was thrilling,” Sarah Szanton, the Johns Hopkins professor who helped create the program, recently told Home Health Care News.

Protecting America’s seniors

Moving forward, Biden and his staff will likely try to secure additional resources for home-based care providers and other long-term care operators. In its official policy plan for nursing home regulations, for instance, the Biden team stated it would invoke the Defense Production Act to increase the overall supply of PPE.

The campaign was highly critical of the Trump administration for failing to coordinate sufficient distribution of testing supplies and personal protective equipment (PPE) early on, so a lack of action on that front would only be viewed as hypocritical.

Currently, “protecting older Americans” is one of the main priorities featured on the Biden-Harris Transition website. That fact that hasn’t gone overlooked by those in the aging services space.

“We appreciate the Biden-Harris Transition team’s announcement regarding its COVID-19 response,” Argentum CEO James Balda said in a statement. “The specific emphasis on protecting at-risk populations, which includes older adults and those who serve them, as well as a focus on the efficacy of vaccine distribution, is critical to controlling the spread of this virus.”

Argentum is the country’s largest senior living association.

The Biden-Harris Transition team announced the formation of its 13-person Transition COVID-19 Advisory Board on Monday. The advisory board will be led by former FDA Commissioner Dr. David Kessler, former Surgeon General Dr. Vivek Murthy and Dr. Marcella Nunez-Smith, a Yale physician and researcher.

“Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” President-Elect Biden said Monday.

Notably, the advisory board also includes Dr. Atul Gawande, the surgeon and writer who founded Ariadne Labs, a joint center between Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health.

Gawande — former CEO of Haven, the health care venture founded by Amazon, Berkshire Hathaway and JPMorgan Chase — has been a staunch supporter of palliative medicine and end-of-life care. His participation on the board could signal a focus on those areas during the duration of the public health emergency.

The Coalition to Transform Advanced Care (C-TAC) said it has been encouraged by a number of Biden campaign proposals that have the potential to improve the lives of the seriously ill, particularly in home- and community-based settings.

“C-TAC looks forward to forging new relationships with those in the incoming Biden administration and Congress,” C-TAC Executive Director Jon Broyles said in a statement. “As we work toward building a health care system that works for everyone, it is essential that we come together to find innovative solutions that meet the needs of the sickest and most vulnerable among us, with particular attention to low-income, traditionally underserved individuals.”

Beyond home care

The advisory board may include others in days to come.

Given the pandemic’s outsized impact on people age 65 and older, additional expertise in aging — whether via gerontologists, industry leaders or researchers — would bring much value, according to Ruth Katz, LeadingAge’s senior vice president of policy. LeadingAge is a diverse association of nonprofit providers of aging services.

“We expect to see a focus on in-home and community-based services through programs in their platform on caregiving, education and workforce,” Katz said in a statement. “That’s a positive.”

Beyond directly supporting home-based care, a Democratic president in the White House and a split Congress may also mean a heightened willingness to reach across the aisle to get things done, at least compared to the past four years.

Initially, there’s bound to be friction between both governing parties, a concept reflected in the largely unsubstantiated voter-fraud concerns voiced by Republican leadership. Over time, though, lawmakers will hopefully find common ground on no-brainer, common-sense issues.

That could mean newfound momentum behind legislation with bipartisan support, such as the Home Health Emergency Access to Telehealth (HEAT) Act, a bill to provide Medicare reimbursement for audio and video telehealth services delivered by home health agencies during a public emergency. Among the bill’s backers is Sen. Susan Collins of Maine, one of the few Republicans to officially congratulate Biden on his victory.

It could also mean continued support for Medicare Advantage (MA), which, in turn, means continued support for home care. Often cited as the future of health care by Republicans, MA was actually first enacted under the Clinton administration as “Medicare Plus Choice.”

Better Medicare Alliance President and CEO Allyson Y. Schwartz reminded people of that on Monday.

“The story of Medicare Advantage is one this new administration can be proud to continue,” Schwartz, a former member of the U.S. House of Representatives, said in a statement. “We stand ready to work with President-elect Biden, Vice President-elect Harris and their team to build on this bipartisan success.”

Out of a total Medicare-eligible population of more than 62.4 million individuals as of October 2020, nearly 25.4 million had signed up for MA, federal statistics show.

Biden, of course, has also voiced support for “Medicare at 60,” a plan to allow Americans between the ages of 60 and 64 the option of buying into Medicare slightly earlier. If ever enacted, that plan would dramatically expand the population of Medicare beneficiaries able to receive Medicare-certified home health services.

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Why Complex Care Management Is Charter Healthcare’s ‘Crown Jewel’

In the midst of the in-home care M&A resurgence, Charter Healthcare Group has made a few moves of its own. Its recent acquisitions of Heartwood Home Health & Hospice and Vitality Home Healthcare reflect its two-pronged acquisition growth strategy.

Founded in 2006, Charter is a rapidly growing PE-backed post-acute care platform company.

Lately, when it comes to dealmaking, Charter has set its sights set on smaller organizations that need additional support, especially ones that share its focus on palliative care and complex care management services, Steve J. Larkin, the company’s CEO, told Home Health Care News.

“What we’re really doing is taking these small operations, talking with ownership, talking with local leaders, and then really creating a new future about how Charter can come in and handle these complex patients,” Larkin said. “Either in a palliative setting or a complex care setting with these at-risk providers, but then being able to work with them for those that may be appropriate or eligible for end-of-life care.”

Rancho Cucamonga, California-based Charter has locations across Arizona, California, Colorado, Nevada and Utah. The company’s service lines include personal care, skilled home health care, palliative care, complex care management and hospice.

Charter’s average daily census is about 4,000 patients.

In order to fill its acquisition pipeline, Charter has also sought out agencies in geographic locations where the company has existing relationships and partnerships.

In 2020 alone, Charter has made four acquisitions. In addition to Heartwood and Vitality, those deals include Las Vegas-based St. Luke’s Home Hospice LLC and Phoenix-based Arizona Select Hospice.

Over the past two years, the company’s home health business has experienced between 10% to 15% growth on a year-over-year basis. The company’s complex care management line has seen 38% year-over-year growth, while its palliative care division has seen 50% year-over-year growth.

While its growth has been a positive, it has also come with some growing pains. Finding a sufficient supply of in-home caregivers has been particularly difficult.

“The staffing component has been a real challenge,” Larkin said. “It’s just making sure that we can find, attract and train the right people. Staffing is constantly at the forefront of our conversations within the organization — to make sure that we can care for the patients that are coming in.”

Staffing challenges have been a consistent pain point for providers. Earlier this year, 44% of surveyed providers named staffing as their top operational challenge in 2020, according to HHCN’s 2020 Outlook Survey and Report.

To address this issue, Charter created a dedicated recruitment team last year. While this has helped, the COVID-19 pandemic has only made the situation even more difficult.

“I think COVID has made it that much more difficult,” Larkin said. Now we’ve got positions that have opened up because people have to step away. This has created stress, but I’ve been very pleased with the volume of candidates that have come in, as well as with the quality of candidates that have come in.”

Charter has also relied on its reputation in states where the company is well known to bolster its recruitment efforts. On the flipside, strategic acquisitions have been key in states that are new territory for the company.

“As we continue to recruit [in] states where people may not be as familiar with Charter, we’re relying on the local reputation of these businesses that we’re acquiring,” Larkin said.

Looking ahead, Charter wants to continue filling gaps between home health and hospice. Palliative care will remain a key focus, as will complex care management service — the company’s “crown jewel.”

“There is a significant amount of people in the population who are chronic and frail, even terminal, that may not wish to be in hospice or end-of-life care services,” Larkin said. “We also know the patients that we’re caring for today are more complex and wish to be at home. Our growth strategy at Charter is to really focus on palliative care and complex care management services, making sure that we’re keeping patients out of the hospital.”

To this end, working with at-risk providers, health plans and health systems has enabled Charter to evaluate the care the company provides.

“There’s a massive need in these markets for the services that we’re providing,” Larkin said. “For us, just making sure that we’re continuing to engage with our partners, with our communities, so that we know exactly what needs to be done.”

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SNF Struggles Opening Door for More Home Health Partnerships

Skilled nursing facility (SNF) operators continue to deal with operational and financial challenges related to the COVID-19 pandemic, with the biggest issues being declining occupancy rates, staffing shortages and the virus itself.

Home health agencies have been following the SNF market closely, with many looking for opportunities to divert patients away from those operators through newly launched SNF-at-home models. In addition to direct diversion, however, agencies should also be paying close attention to cross-continuum partnership opportunities.

That’s especially true if agencies can help SNFs maximize their efficiency while lowering their total cost of care.

In a recent survey of 170 representatives from Medicare-certified skilled nursing facilities, 12% of respondents said their facility would be able to stay in business for another three months or less based on current expenses and available financial relief. Another 25% said they’d be able to stay in business for another four to six months.

The survey was conducted by Home Health Care News sister publication Skilled Nursing News between Aug. 17 and Sept. 14.

Forging partnerships with SNFs isn’t a revolutionary concept, as many in-home care providers already have close connections with their skilled nursing peers.

The New Jersey-based Executive Care has worked to strengthen its internal data-tracking capabilities to work closer with SNFs and help them lower re-hospitalization rates, for example. Nexus Montogomery — a collaboration between six Maryland hospitals and post-acute care providers — launched an innovative pilot connecting the dots between SNFs and home care last year.

“One of the biggest ways this helps our business is that it keeps us engaged with the broader health care system,” Mitch Markowitz — vice president of business development for Family & Nursing Care, one of the participating home care providers in the Nexus Montgomery partnership — previously told HHCN. “We can support each other as we all collectively learn what the evolution of today’s health care industry really means. It’s changing constantly.”

Home health providers can also help SNF operators build density and have stronger overall regional footprints. The Atlanta-based SavaSeniorCare recently revealed that is a main goal for the organization moving forward.

On Nov. 3, SavaSeniorCare announced plans to transfer the operations of 48 skilled nursing facilities and assisted living properties in eight states by the end of the next year.

“The current state of the world brought on by the pandemic has caused us to closely examine our strategy, where we invest our resources and can achieve the greatest impact,” CEO Jerry Roles said in a statement. “We believe this decision will best prepare the company and our centers for the post-pandemic world, and allow us to continue our focus on our people, the residents who we are privileged to serve and our dedicated staff.”

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BayCare Leverages Health System Resources to Launch New Hospital-at-Home Program

BayCare — a large, Florida-based nonprofit health system — is the latest organization to join the ranks of those offering hospital-level care in the home setting.

The health system recently announced it will provide access to acute-level care in the home to help care for patients battling COVID-19, heart failure and COPD, among other possible conditions. BayCare is launching the hospital-at-home program through its home-based care arm, BayCare HomeCare.

The new program will operate as a hybrid model, combining the company’s home health service lines, remote patient monitoring, virtual visits and in-person visits, according to BayCare Vice President Dr. Jacquelyn B. Cawley, who also serves as CMO for ambulatory care and clinical integration.

“The nurse will actually go into the home and do a combination of face-to-face visits, as well as virtual visits,” Cawley told Home Health Care News. “With the remote patient monitoring, we’ll be able to monitor vital signs, … the nurse there in the home will also help host that virtual visit with a provider while being the eyes and ears.”

As one of the largest health care systems in Florida, BayCare operates 15 hospitals that serve four counties. BayCare HomeCare serves roughly 6,000 patients daily and covers 13 counties.

Through the hospital-at-home program, BayCare will also administer IV therapy, IV medications, IV hydration and other services.

As an organization, BayCare had its sights set on entering the hospital-at-home space for a while.

Still, the ball didn’t get rolling until the impact of the COVID-19 public health emergency hit, according to Cawley.

“We were very hard hit in Florida, and we wanted to help to decompress the hospital and our emergency departments,” she said. “In our home care, we were taking COVID-positive patients from the emergency departments, as a way to help mitigate the numbers of patients that they had. We were also taking early discharges from the hospital into either a hotel, an alternate care site or into their home setting.”

After tackling COVID-19 patients, providing hospital-level care at home on a permanent basis seemed like a natural progression for BayCare.

“We could bring pretty much everything that they would get in a hospital to the home setting for those appropriate patients safely,” Cawley said. “We were able to prove that with our COVID-positive patients, and we’ll be moving forward with that population, especially now that we’re starting to see the numbers increase again.”

There were another 126,742 new coronavirus cases on Saturday, according to Johns Hopkins University. That marked the third day in a row that new cases topped more than 120,000, according to CNN.

As the end of the year approaches paired with a normal flu cycle, many health care providers are gearing up for an influx of new coronavirus patients. 

While the model has gained a reputation for providing better outcomes at a lower cost, hospital-at-home has still mostly existed as a niche service line for providers in the U.S.

This was until 2019, when it seemed that the hospital-at-home model began to gain ground. A number of providers across the country implemented programs, including Highmark Health, CommonSpirit and Prisma Health.

For many providers, the prospect of launching a new hospital-at-home program can be daunting. Moving into this space requires an organization to have a strong clinical staff and operational support in place.

Being a large health system gave BayCare an advantage in this regard, according to Cawley.

“BayCare has a lot of resources and assets, as a large health system,” she said. “We had everything with home care already set up, as far as the remote patient monitoring. We have the nurse support. We already had that virtual platform, and we also had a specialty pharmacy IV therapy that was done through our nurses.”

Additionally, as a large health system, BayCare had urgent care providers and a robust on-demand virtual urgent care service.

With all of BayCare’s resources at its disposal, the key challenge was making sure everything came together coherently.

“Most of the resources we already had in place; it was just about how to coordinate them and bring them all together,” Cawley said. “We worked very closely with the hospital, with the emergency departments on what the workflow is. We have clinical criteria that we use, that we developed with our ED physicians, our hospitalist physicians and others in the community to really identify who are the best patients for this type of home-based service.”

When it comes to hospital-at-home models, reimbursement has always presented a challenge for providers looking to enter the space. Lately, that has become easier to navigate, according to Cawley.

“One of the reasons we chose to go with home care-based services is because we had a methodology to bill through home care appropriately, as long as we had a provider order and the patient was eligible for it,” she said. “We had a mechanism to bill for physician visits virtually once COVID came about. So there’s been more opportunity in 2020, between Medicare allowing for remote patient monitoring, and then more recently with COVID, for all of our payers to actually support virtual visits.”

Cawley believes the COVID-19 emergency has had a significant impact on the hospital-at-home model. Anecdotally, the interest in implementing similar programs continues to grow.

“When we talk to our counterparts across the country, everyone is either doing, planning or piloting something along the lines of this,” she said. “As long as we have the continued support of Medicare and other payers to support virtual care, I think we’ll be able to continue to move to this.”

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Bayada, Baptist Health Announce New Joint Venture

Bayada Home Health Care — one of the largest nonprofit providers of in-home care and post-acute care services in the country — is expanding its already massive footprint.

It’s doing so at a time when the need for home-based care is at an all-time high.

On Thursday, the Moorestown, New Jersey-based company announced it is forming a new joint venture with Baptist Health, a faith-based, mission-driven health system in Northeast Florida. The new JV will be known as “Baptist Home Health Care by Bayada” and begin operations in early 2021, pending licensing and regulatory approvals.

“This partnership enables Baptist Health to provide a wider array of in-home services to help people with multiple chronic conditions as well as patients recovering from an illness, injury or recent hospitalization,” Joe Mitrick, president of transitional care for Baptist Health and the hospital president of Baptist Beaches, said in a statement. “The demand for high-quality home health care services is rising, and there has never been a better time to build on our legacy of care for the community.”

As an overall system, Baptist Health comprises Baptist Medical Center Beaches, Baptist Medical Center Jacksonville, Baptist Medical Center Nassau, Baptist Medical Center South and Baptist Clay Medical Campus. The system also runs Wolfson Children’s Hospital, Northeast Florida’s only children’s hospital.

Bayada — which transitioned to nonprofit status in 2018 — provides a range of in-home care services to adults and children via its 345 total locations. Its U.S. footprint spans 22 states, with additional areas of operation in Canada, Germany, India and four other countries.

Among the strategic advantages, Baptist’s new joint venture with Bayada will allow the system to care for more of its patients in the home setting, something it had already been doing for 25 years.

An increasing number of health systems and hospitals are forging similar relationships with home-based care operators, which are generally better positioned to navigate the series of regulatory and payment changes currently taking place.

Teaming up with home health organizations also often gives systems an edge when it comes to avoiding costly readmissions.

“Health systems and hospitals have a vested interest in the success of their patients after they are discharged,” Bayada CEO David Baiada said in a statement. “With 45 years of home health care expertise grounded in our values of compassion, excellence and reliability, we are recognized as a valuable resource to help keep patients safe at home and out of the hospital.”

Nearly half the nation’s hospitals are getting lower payments for all Medicare patients this year because of their history of readmitting patients, Kaiser Health News recently reported. The penalties are part of the Hospital Readmissions Reduction Program, created under the Affordable Care Act.

Those penalties come at a time when systems and hospitals are already financially stressed, as many have had to postpone or cancel elective procedures due to the COVID-19 virus.

“We are committed to partnering with organizations like Baptist Health to meet the post-acute care needs of patients and other community residents, advancing Bayada’s mission to help millions of people experience a better quality of life in their own homes,” Baiada’s statement continued.

In addition to its core home health and post-acute care services, Bayada also offers non-skilled home care and private-duty nursing services to high-tech pediatric clients. It also delivers physician house calls.

Earl Evans — executive director of Baptist AgeWell, which provides enhanced primary care for adults 65 and older — said Bayada’s mission-driven mindset made it a perfect JV match.

“Baptist Health and Bayada’s culture and values are strongly aligned,” Evans said in a statement.

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‘These Funds Can Best Be Used Elsewhere’: LHC Group Returns $93.3M in Federal Relief

Rising demand for health care services delivered in the home and an increasingly favorable regulatory environment have set the stage for the nation’s top-tier home health operators. That idea has LHC Group Inc.’s (Nasdaq: LHCG) leadership team bullish about the company’s near- and long-term outlook.

LHC Group’s optimism is additionally supported by shifting referral patterns that suggest a new awareness of home-based care’s value. At the height of the COVID-19 public health emergency, for example, the Lafayette, Louisiana-based company saw a flood of primary care physician referrals.

“As we described in August, we continue to see a new normal in referral patterns,” LHC Group Chairman and CEO Keith Myers said during a Q3 earnings call on Thursday. “One where patients, families, physicians, discharge planners and other referral sources are increasingly choosing the safety, effectiveness and efficiency of in-home health care services over more costly — and potentially higher risk — congregant in-patient care settings.”

During Q1 2020, LHC Group saw 3,915 new sources of home health referrals. That improved to 3,996 in the second quarter, then to 4,582 in Q3.

The company has also increasingly turned its attention to the diversion of post-acute care patients into the home and away from skilled nursing facilities (SNFs).

“SNF diversion, which was an increasing trend, has become a best practice,” Myers said. “We believe that, at a minimum, the lower acuity third of patients referred to SNFs are clinically appropriate to be cared for in the home, achieving equal to or more favorable outcomes and patient satisfaction.”

LHC Group is already gaining a greater share of hospital discharges relative to SNFs, according to Bruce Greenstein, the company’s chief strategy and innovation officer.

When looking at discharges to post-acute care providers from Q2 2019 through Q1 2020, 21.3% of patients went to SNFs, while 21.1% of patients were sent to a home health provider, according to a recent report from Trella Health.

“That’s an area where, despite lower discharges from the hospital in an absolute number, we’re picking up a higher percentage of those that are coming out for any kind of post-acute care, as we continue to take market share from patients that otherwise would have ended up in a SNF,” Greenstein said on Thursday’s call.

COVID-19’s bottom-line impact

All in all, LHC Group incurred $10.5 million in COVID-19 costs during Q3. These costs are attributable to personal protective equipment (PPE) and employee-compensation initiatives, including bonuses and increased pay for front-line caregivers.

That amount is nearly half of the company’s Q2 COVID-19-related expenses, which came out to $27.3 million.

Throughout the home health industry, some operators have opted to cover those COVID-19 costs via the Provider Relief Fund, created under the CARES Act. LHC Group, however, decided to return the entire $93.3 million in funds it received from the fund.

“We believe returning these taxpayer dollars is the right thing for us to do, and that these funds can best be used elsewhere and with assisting with the ongoing response to the pandemic,” LHC Group President and former CFO Joshua Proffitt said on the call. “As a result, for the third quarter, we reversed $44.4 million … in government stimulus income that we had recognized in the second quarter.”

LHC Group’s service lines include home health, hospice and personal care services. Currently, the company operates in 35 states and Washington, D.C.

Overall, it posted net revenues of $530.7 million for the third quarter of 2020, a 0.41% increase compared to $528.5 million from the same period a year ago.

As for volume, LHC Group’s home health average daily census jumped from a “low point” of 74,817 for the month of April to a high of 84,091 for the month of October, a 12.4% increase.

“This monthly improvement has come even though there are a number of states that were slow to lift the ban on elective procedures and reinstated them in some cases,” Proffitt said.

As of Thursday morning, LHC Group is sitting at 85,259 patients on census, according to the company.

In April, the company’s home health admissions were at a low of 27,948. Q3 saw between 34,400 and 35,200 admissions per month, resulting in a 4.7% increase in organic home health admissions.

LHC Group had 36,786 admissions in October.

The company also noted it has experienced a severe decline in COVID-19-related missed visits, going from 22,913 in April to 722 in October.

LHC Group’s pipeline ‘as active as ever’

During the third quarter, LHC Group also further solidified its reputation for being a leader in joint venture partnerships with hospitals and health systems.

“Our partners have experienced firsthand throughout the pandemic just how well we have been able to deliver for them through close integration and collaboration, with the highest level of quality, in the most cost-effective setting,” Proffitt said. “That’s having a positive impact, not only on organic growth but also on our M&A pipeline.”

In August, the company finalized a JV with not-for-profit health care organization Orlando Health.

In October, LHC Group finalized a JV with University Health Care System.

The company also finalized a JV with Northeast Georgia Health System in October.

In November, the company finalized its plans to expand an existing JV partnership with Christus Health.

“We expect we’ll have a few more transactions to announce by the end of the year,” Proffitt said. “All told, we’ve completed joint ventures representing approximately $14 million in annual revenues since early August. With our value proposition on display, our pipeline is as active as ever.”

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Recovering Home Health Business Remains a ‘Significant Asset’ for Brookdale

Brookdale Senior Living Inc. (NYSE: BKD) was focused on rebuilding its home health census during Q2 of this year. In Q3, its home health census began increasing again, but it remains down overall on a year-over-year basis.

The Brentwood, Tennessee-based company’s home health average daily census took a hit earlier in the year due to lower occupancy in its senior living communities and fewer elective medical procedures being performed because of the COVID-19 virus. That contributed to a 14.4% year-over-year decline in its daily census for Q3.

The Patient-Driven Grouping Model (PDGM) has also continued to contribute to a decrease in home health revenue in 2020. Still, Brookdale executives are bullish on the segment moving forward.

“Our home health revenues stabilized mid-year and sequentially improved slightly in the third quarter,” Cindy Baier, Brookdale’s president and CEO, said on the company’s Q3 earnings call Thursday. “Our quality has improved to an industry-leading overall star average at 4.7 out of 5, which we expect will drive future growth.”

Brookdale is a leading operator of senior living communities in the U.S. The company operates and manages independent living, assisted living, memory care and continuing care retirement communities (CCRCs), totaling 726 communities spanning 44 states. It also offers a range of home health, hospice and outpatient therapy services to over 17,000 patients.

The biggest impact to Brookdale’s home health business was linked to operations outside of its own facilities.

“While lower occupancy in our communities affected the health care services census, home health inside our communities continues to perform at a strong rate,” Baier said. “Outside of the COVID-19 hotspot of Florida, our non-Brookdale community home health business referral growth and new case starts increased faster than prior to COVID-19 and improved relative to last year. This is an early indicator of the home health business recovery.”

Falling short on projections

Overall, Brookdale’s total revenue checked in at $706 million in Q3 2020, down 13.3% compared to $815 million in Q3 2019. The company estimates that $71 million was lost in revenue in Q3 due to COVID-19.

Its home health census went from an average daily census of 15,357 in Q3 2019 to 13,146 in Q3 2020.

Ultimately, the Q3 results fell short of projections.

“Brookdale posted Q3 results short of our estimates and consensus, primarily reflecting continued pandemic-driven occupancy pressure,” RBC Capital Markets wrote in a note Thursday following the earnings call. “That said, the company appears to be on incrementally better footing, as evidenced by increasing move-ins and less severe occupancy degradation over the course of the quarter.”

Brookdale has been receiving point-of-care COVID-19 tests from the U.S. Department of Health and Human Services (HHS). It saw about a 1% positivity rate among its residents as of Oct. 31.

“Year to date, Brookdale has incurred roughly $95 million of direct COVID costs but has recognized only $37 million of Provider Relief support, thanks in large part to Medicare exposure in the home health and hospices businesses,” RBC’s note read.

Brookdale was happy to learn that assisted living facilities will be benefactors of the third round of funding from the Provider Relief Fund as well.

On its end, investment banking company Jefferies believes that Brookdale’s home health segment could be of significant value to them.

“Brookdale has significant assets, [including] owned real estate, home health and hospice business,” Jefferies wrote in a note of its own. “Those are able to be monetized and could unlock shareholder value.”

Total home health revenue from Q3 2020 was just over $61 million, down 23.6% compared to Q3 2019.

Brookdale’s full-year revenue for home health last year was over $327 million. Since January of this year, its revenue totals have yet to reach $185 million.

Resident analysis

Brookdale’s internal surveys suggest that seniors still feel comfortable in senior living settings. Home health companies that have senior living segments have noticed the same.

“The good news is that we’re seeing the majority of residents, and prospects still think that senior living is a safe solution,” Baier said.

It would be an even safer solution, of course, with a widely distributed vaccine. And Brookdale is already looking forward to distributing it when it’s available as a way to ensure the health of its residents.

It’s likely that senior living operators will be some of the first to receive vaccines from distributors based on the populations they look after.

“With regard to a vaccine, I think that what everyone is trying to figure out, or at least the vast majority of people are trying to figure out is how to reduce risk,” Baier said. “And so while we haven’t conducted consumer research on the vaccine, it is something that we’re watching the research that’s available to us.”

For home health providers, it’s worth keeping an eye on how senior living deals with the prospects of a vaccine. After all, they could be up next.

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UnitedHealthcare Advances Home Strategy, Expects to Make 1.7M House Calls in 2020

A number of major Medicare Advantage (MA) carriers are expanding their supplemental benefit offerings shaped around in-home care next year. UnitedHealthcare, the insurance arm of UnitedHealth Group (NYSE: UNH), is among them.

Overall, UnitedHealthcare partners with more than 1.3 million physicians and care professionals across the U.S., plus another 6,500 or so hospitals and other care facilities. In 2020, UnitedHealthcare had more MA enrollees than any other group.

“We know the majority of older adults want to stay in their homes and communities as they age, and UnitedHealthcare continues to design plans that place the home at the center of health care support and delivery,” Steve Warner, senior vice president of Medicare Advantage in UnitedHealthcare’s Medicare & Retirement division, told Home Health Care News.

America’s largest health insurers — UnitedHealthcare, Humana Inc. (NYSE: HUM), Aetna, Blue Cross Blue Shield plans and others — have built out their home strategies in a variety of ways.

In some cases, that has meant the launch of internal in-home primary care and remote monitoring programs to better track members’ social determinants of health. In others, it has meant partnering with in-home care providers to offer the types of new supplemental benefits that the U.S. Centers for Medicare & Medicaid Services (CMS) has increasingly signed off on over the past few years.

“The interconnectedness of the health care system means that every touchpoint along a consumer’s health care journey is important,” Warner said. “Particularly for high-risk individuals and others who depend on a variety of needs being addressed from home, the people who provide these services are an integral piece of a shared community of support.”

On its end, UnitedHealthcare says it’s doing more than ever to support health and wellness from the comfort, safety and convenience of the home.

In 2021, most of its plans, for example, will include HouseCalls, a program that offers Medicare and Medicaid members a yearly in-home visit with a licensed clinician. The company expects to complete nearly 1.7 million HouseCalls visits for members in 2020.

HouseCalls has been particularly valuable during the COVID-19 pandemic, too, with the number of home visits in the third quarter growing by nearly 30% year over year, according to UnitedHealth Group CFO John Rex, who addressed the topic during an Oct. 14 earrings call.

“We continue to deepen our engagement with those seniors most in need, increasing the distribution of remote digital sensor kits to collect and monitor vital health data and address gaps in care generated by the pandemic,” Rex said at the time.

‘Health is more than medical care’

Apart from its HouseCalls program, at least six UnitedHealthcare plans are offering in-home support services under the “primarily health-related” supplemental benefit pathway in 2021, according to state-level data compiled by Washington, D.C.-based research and consulting firm ATI Advisory.

In comparison, only two UnitedHealthcare plans offered in-home support services supplemental benefits this year.

Geographically, the two UnitedHealthcare plans offering in-home support services in 2020 covered slightly more than two dozen counties. Next year, the six plans doing so will cover more than 250 counties, according to ATI Advisory’s data.

“They have made a very significant, clear increase in the coverage,” ATI Advisory CEO Anne Tumlinson told HHCN. “I think it speaks a lot to the power of these benefits.”

Overall, 429 MA plans will offer in-home support services across 36 states and Puerto Rico next year. Many more will also likely offer home-focused supplemental benefits through the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway in 2021.

These trends in supplemental-benefit design are, in part, linked to the realization that a large chunk of a person’s health is ultimately impacted by functional ability and social factors, including access to food, friends and transportation.

“We know that health is more than medical care, and that factors outside a doctor’s office play a significant role in influencing a person’s health and well-being,” Warner said. “This reality factors into how we design our plans and support older adults.”

UnitedHealthcare isn’t just coordinating and covering services that take place within its members’ homes.

At times, it’s even helping to provide the home in the first place.

“At an enterprise level, UnitedHealthcare continues to make significant investments in affordable housing as part of the company’s ongoing efforts to remove social barriers to better health for people in underserved communities,” Warner said.

Since its affordable housing initiative kicked off in 2011, the company has worked with a range of advocates to invest more than $500 million in developments that increase access to housing, health care and social services.

Telehealth is ‘here to stay’

The U.S. tallied 91,530 new COVID-19 infections on Election Day, adding to the skyrocketing cases numbers reported in the past week.

The COVID-19 pandemic is changing the health care landscape, Warner recognized, but it isn’t altering UnitedHealthcare’s commitment to helping members access the care they need. That’s true whether they reside in a clinical setting or at home, he added.

To maintain that commitment, UnitedHealthcare has turned to more telehealth solutions.

“In just one month earlier this year, for example, more than 12% of our UnitedHealthcare Medicare members had a telehealth visit with their doctor – up from just a fraction of a percent last year,” Warner told HHCN.

In 2021, all standard MA plans from UnitedHealthcare will offer telehealth visits with a $0 copay.

“As in-person visits resume, telehealth utilization is moderating, but remains significantly higher than the pre-COVID baseline,” Warner said. “We believe higher utilization and increased comfort level in embracing telehealth is here to stay.”

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How Excelin Home Health Used Telehealth to Automate Its COVID-19 Return-to-Work System

Between mid-March and mid-August, more than 12.1 million Medicare beneficiaries received some sort of telemedicine service for their health and wellness.

The numbers don’t lie: The COVID-19 emergency has officially ushered in a new age of telehealth in the U.S.

But while in-home care providers and other organizations have embraced telehealth to deliver virtual visits to patients, many have also leaned into it as a way of streamlining operational processes.

One such company is Excelin Home Health, which has been using telehealth to automate the return-to-work assessments the company conducts on a daily basis with its staff during the COVID-19 pandemic. Specifically, Excelin turned to Synzi, a St. Petersburg, Florida-based company that provides virtual visit and messaging tools via its telehealth platform.

“We populate a daily screening questionnaire, and it comes up on [our clinicians’] app every single day,” Alicia Marr, CEO of Excelin, told Home Health Care News. “The clinicians can open that app and answer that line of questions first thing in the morning.”

After completing the questions, their responses are sent back to the Excelin manager for that particular location. In turn, managers can automatically know which staff members are available to safely work with patients based on their symptoms.

Moulton, Texas-based Excelin is a Medicare-certified home-based care provider that has 12 locations across Texas and California. Its service lines include home health, hospice and private-duty home care services.

Currently, the company has roughly 500 employees and serves about 2,000 clients.

Prior to implementing its automated return-to-work assessments, Excelin relied on a manual process to help with COVID-19 staffing protocols.

In order to get an accurate headcount of which caregivers were available to work and which had COVID-19 symptoms, agency administrators had to individually text or call each one of their staff members, using spreadsheets to track responses. 

“Think about the time spent calling and asking every staff member those questions, keeping a manual log that risks information being inaccurate,” Marr said. “It was really burdensome for the staff.”

A number of other issues also resulted from Excelin’s previous manual process, she noted.

“Sometimes, the staff member wouldn’t answer all the questions. There would be interruptions, or it would just take such a long time for one or two callers to get through the list of all the employees,” Marr said. “It was a very tedious process. If there was a symptom that was identified, that meant you had to stop, call the manager and reconcile that. That means everybody still left on the list is delayed from receiving a call.”

Having caregivers independently submit questionnaires through the app has allowed for greater operational efficiency, according to Marr.

That’s particularly important at this point in time, when agency margins have been tightened due to rising personal protective equipment (PPE) costs and other expenses. 

Additionally, the company’s current return-to-work assessments system has been an asset when it comes to staying compliant with regulatory requirements.

In general, telehealth has been at the forefront of Excelin’s COVID-19 response. The company began offering telehealth services to all of its patients at the start of the public health emergency.

“We were very committed to wanting to support our communities and caring for the COVID-19 population,” Marr said. “When we developed our internal protocol for caring for patients, telehealth was very much a part of that protocol. We felt it was very important to protect our staff, to preserve our PPE and to protect our patients.”

Excelin’s is using telehealth services with roughly 15% to 20% of its patient population. This includes care coordination, medication reconciliation and touchpoints for high-risk patients.

“That was very much a part of the dialogue that we had with our referral sources from Day 1,” Marr said. “‘Let’s talk about telehealth and how we’re going to incorporate it into that plan of care.’”

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Humana Accelerates Value-Based Care Strategy with Home Health Providers, Others

Humana Inc. (NYSE: HUM) continues to shift its operations toward value-based care payment models, both with internal service lines and with external provider partnerships. The Louisville, Kentucky-based insurance giant is also doubling down on social determinants of health at the same time.

Those are just a couple key takeaways from a Tuesday conference call with investors and analysts to discuss Humana’s third quarter financial results.

With full-year expected individual Medicare Advantage (MA) growth of about 375,000 members, Humana is one of the largest MA entities in the nation. In addition to its MA business, Humana oversees a vast collection of in-house health care services, many of which are wrapped around the home.

“The Medicare Advantage program incentivizes a holistic focus on health,” Humana President and CEO Bruce Broussard said during the call. “And because of this, it offers an opportunity for private organizations like Humana to partner with providers on value-based care models customized to meet both the unique dynamics of the local market and the risk tolerance of a given provider.”

Currently, about two-thirds of Humana’s individual MA members are cared for by providers in value-based arrangements. Of those arrangements, nearly one-third are for full risk, meaning a provider is responsible for the entirety of the member’s care for a capitated payment.

Generally, value-based care payment models pay providers for the value of their services instead of volume. While some providers have been hesitant to move away from the predictability of fee for service, most of the ones working with Humana on a value-based care basis have ended up making money.

In fact, 86% of Humana’s value-based care partners were in a surplus in Q3 2020, receiving a higher level of payment than they would have in a fee-for-service arrangement.

Internally, Humana’s provider organizations that are part of this value-based care shift include its senior-focused and payer-agnostic primary care centers launched through a strategic partnership with PE powerhouse Welsh, Carson, Anderson & Stowe (WCAS). They also increasingly include its Kindred at Home operations and its Conviva care centers, which are separate from the WCAS partnership.

“We do continue to also want to grow the value base from us building our clinics and our home health side,” Broussard said. “You see the Partners in Primary Care product, the Conviva product, along with some of our home solutions moving more and more to value-based payment models.”

Home health admissions

Humana expects to grow its individual MA membership by 350,000 to 400,000 members in 2021, which represents growth of about 9% to 10%, according to the company.

It likewise anticipates further building out its primary care network.

Despite operational challenges related to the COVID-19 pandemic, Humana has opened up five new Partners in Primary Care centers with WCAS in the Las Vegas market over the last 45 days. It plans to open another three centers in Las Vegas later this year or in Q1 2021, while also deepening its Houston footprint.

Combined with its Conviva clinics, Humana will operate about 160 clinics by the first quarter of next year.

Regarding Kindred at Home, home health admissions were adversely impacted by the COVID-19 virus in early spring. As the year progressed, however, volumes began to stabilize, Humana CFO Brian Kane said during Tuesday’s call.

“Early signs of a rebound in demand are beginning to materialize,” Kane said. “Further, the company has been able to offset these initial challenges with strong clinical and overhead cost controls across the organization.”

Humana reported consolidated revenues of about $20.08 billion for Q3 2020, up 24% compared to $16.24 billion in the same period last year. Revenue for Humana’s health care services segment, which includes Kindred at Home, totaled $7.13 billion in Q3 2020, up 8% compared to $6.60 billion in the prior year’s quarter.

Although the health insurance giant is preparing for a possible loss in Q4, its strong first half of 2020 should set it up for potential M&A opportunities, Kane suggested.

“We do have ample capital and flexibility, which we believe is important,” he said. “I would say that over the next few years, we expect to have a balanced capital-deployment strategy. We’re always on the hunt for M&A opportunities in the strategic priority areas that we’ve identified, whether it’s around the home, primary care or pharmacy.”

‘The smallest actions’

Among Humana’s most visible initiatives around addressing social determinants of health has been its partnership with Papa, the startup that connects isolated older adults and others with a “Papa Pal.”

The Miami-based Papa announced a Series B round of $18 million in September, with investment led by Comcast Ventures, Comcast Corporation’s investment arm. On its end, Humana began working with Papa in 2018.

The COVID-19 pandemic has further highlighted the importance of social needs, such as social interaction, Broussard said on the Q3 earnings call. In response to those needs, Humana has extended its program with Papa.

Broussard specifically shared the story of a Humana member named Otis.

While registering Otis for the Papa program, a case manager noticed it was his birthday. The case manager, in turn, began singing happy birthday to him over the phone.

“Otis was overcome with emotion, noting it had been years since someone had even wished him a happy birthday,” Broussard said. “Sometimes the smallest action can make a big difference in someone’s life. Programs like Papa are an important element in addressing the holistic needs of our members.”

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LHC Group Names New CFO; The Pennant Group Picks New President

LHC Group Inc. (Nasdaq: LHCG) announced Monday that Dale Mackel has joined the company as its next chief financial officer.

Since 2016, the CFO position has been held by LHC Group’s current president, Joshua Proffitt.

“The LHC Group team of leaders is one of the deeper and more experienced in all of health care, with an established track record of care for the patients, families and communities we are privileged to serve throughout the country,” LHC Group CEO Keith Myers said in a press release. “Dale’s core values align with the mission and vision of LHC Group, which combined with his experience, made him the ideal fit to help us accelerate our work in payment innovation and models to thrive in the rapidly developing future of value-based care.”

Lafayette, Louisiana-based LHC Group is a provider of home health, hospice and personal care services. Its 32,000 employees deliver care in 35 states and Washington, D.C.

Mackel was formerly with BlueCross BlueShield of Nebraska, where he held the role of CFO while also serving as executive VP of finance and administration since 2016. Prior to BlueCross BlueShield of Nebraska, Mackel was Aetna’s market president for Nebraska, Iowa, North Dakota and South Dakota.

The hiring of Mackel — a managed care veteran — comes as LHC Group and other in-home care providers ramp up their participation in accountable care organizations (ACOs), bundled payments and other value-based payment mechanisms.

“LHC Group is on the forefront of value-based care with a long history of working closely with payers and joint venture partners,” Mackel said in the press release. “Its national reputation for the highest quality and patient satisfaction within the in-home health care industry, as well as their significant near-term and long-term growth potential, made this a very attractive opportunity for me and my family.”

Guerisoli takes over as Pennant’s president

The Pennant Group Inc. (Nasdaq: PNTG) has named Brent Guerisoli as the company’s new president. Pennant’s current president and CEO, Daniel Walker, will continue with the company as its CEO.

The company also also announced that Brian Wayment would take helm of Cornerstone Healthcare as its president.

The Eagle, Idaho-based Pennant Group is the parent company of a slew of affiliated home health, hospice and senior living organizations, which includes Cornerstone Healthcare. In 2019, Pennant was spun off from The Ensign Group (Nasdaq: ENSG).

Within its network, Pennant has 73 home health and hospice agencies, along with 54 senior living communities, in 14 states.

“I joined the organization because I was attracted to our operating model built around empowering and supporting local leaders that are seeking unique opportunities to build health care operations that provide life-changing service,” Guerisoli said in a press release. “I am honored to serve as president of Pennant and look forward to supporting our current and new local Pennant leaders as we seek to be the provider of choice in health care communities across the country.”

SCAN announces new CFO, board chair

SCAN Group, the holding company of SCAN Health Plan, has announced that Michael Plumb has been named chief financial officer. Dr. Linda Rosenstock has also been elected as SCAN’s new board chair.

Founded in 1977, SCAN Health Plan is one of the largest not-for-profit Medicare Advantage (MA) plans in the country, serving more than 220,000 members in the state of California.

Rosenstock joined the SCAN board of directors in 2017 and is the dean emeritus of the UCLA Fielding School of Public Health. She previously served as Director of the National Institute for Occupational Safety and Health in the U.S. Department of Health and Human Services (HHS).

“Rosenstock is committed both to public health and to addressing the social determinants of health that can play an outsize role in affecting outcomes,” Dr. Sachin H. Jain, the president and CEO of SCAN Group and SCAN Health Plan, said in a press release. “I’m confident she’ll provide SCAN with guidance and leadership as we seek out new and innovative partnerships not just to address illness, but to keep seniors healthy as they age.”

On his end, Plumb previously served as CFO of CareMore Health and Aspire Health.

“With his deep knowledge of health care finance and Medicare Advantage, Michael is perfectly poised to play a leadership role in maintaining SCAN’s sound financial footing as well as in new business development and diversification,” Jain said.

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Verma: Older Adults Must Have a ‘More Robust’ Set of Home Care Options

The U.S. Centers for Medicare & Medicaid Services (CMS) on Monday touted several tools designed to help states rebalance their long-term care ecosystem toward home- and community-based services. 

The development is the latest in a series of CMS efforts aimed at strengthening home- and community-based services amid the COVID-19 pandemic, with the ultimate goal of decreasing America’s reliance on nursing home care.

“The COVID-19 crisis has shone a harsh light on the human costs of a long-term care system that relies too heavily on institutional services like nursing homes,” CMS Administrator Seema Verma said in a statement included in Monday’s announcement. “Too often, they are seen as the default option, even for those who may not require round-the-clock care.”

Broadly, Monday’s “toolkit” offers examples of innovative state models and best practices to rebalance long-term services and supports programs toward in-home care. Examples largely focus on Medicaid, the primary funder of long-term services and supports nationally.

One specific example highlighted in the toolkit is Pennsylvania’s managed care policy that requires plans to implement a home care workforce innovation component within their programs, utilizing person-centered planning principles to improve the recruitment, retention and skills of direct care workers.

Another is Vermont’s Medicaid section 1115 demonstration to increase access to home- and community-based services for adults at risk for nursing home admission who may not be eligible for Medicaid and who do not meet level-of-care criteria for a nursing home.

“While nursing homes will always be an important part of a complete care continuum, many elderly individuals and their families should have access to a more robust set of home care and community-based care options,” Verma’s statement continued.

In FY 2018, 79% of total Medicaid long-term care spending for individuals with intellectual and developmental disabilities (I/DD) was tied to home- and community-based services. Nearly half of long-term care spending for individuals with mental health and substance use disorders was tied to home-base care.

Meanwhile, just 33% of long-term care spending for older adults and individuals with physical disabilities was tied to home- and community-based services in FY 2018.

Contextually, CMS issued its toolkit on the same day The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) released a report revealing that new COVID-19 cases are increasing in nursing homes in the U.S., mostly due to the community spread among the general population.

Weekly new COVID-19 cases in the general population rose by 61% to 391,527 new cases the week of Oct. 18, according to data from Johns Hopkins University.

A correlating uptick in new cases in nursing homes occurred when cases in the surrounding community started rising back in mid-September.

Source: AHCA/NCAL

“As we feared, the sheer volume of rising cases in communities across the U.S., combined with the asymptomatic and pre-symptomatic spread of this virus, has unfortunately led to an increase in new COVID cases in nursing homes.” Mark Parkinson, president and CEO of AHCA and NCAL, said in a press release. “It is incredibly frustrating as we had made tremendous progress to reduce COVID rates in nursing homes after the spike this summer in Sun Belt states. If everybody would wear a mask and social distance to reduce the level of COVID in the community, we know we would dramatically reduce these rates in long term care facilities.”

The full long-term services and supports rebalancing toolkit is available here.

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Centerbridge Partners, The Vistria Group Acquire Wellspring’s Help at Home

Help at Home — a Chicago-based home- and community-based services provider that operates across 13 states — has been acquired by a consortium of private equity buyers.

Specifically, Centerbridge Partners and The Vistria Group are teaming up to purchase Help at Home from Wellspring Capital Management, which will remain a minority investor in the company. The deal officially closed on Friday.

Founded in 1975, Help at Home provides a variety of medical and non-medical in-home care services across its footprint, caring for more than 60,000 clients across 155 locations. New York-based Wellspring — a PE firm that has raised more than $4 billion of initial capital commitments through six private equity funds — completed its acquisition of Help at Home in August 2015.

In the deal announcement, Help at Home CEO Paul Mastrapa thanked Wellspring for its five years of stewardship. The CEO likewise noted that the Help at Home team looks forward to working with both Vistria and Centerbridge in years to come, especially as the COVID-19 pandemic shines a brighter light on the value of home-based care.

“For more than four decades, Help at Home has enabled seniors and people with disabilities to continue to lead independent lives in the familiar settings of their homes and communities,” Mastrapa said. “Now, with the COVID-19 pandemic, the in-home care we provide is more critical than ever because it allows these often vulnerable populations to receive care and support in the safety of their own homes.”

Chicago-based PE firm Vistria is already a big player in the home care and hospice space. Its portfolio, for example, includes St. Croix Hospice, Hospice Care of South Carolina and Civitas Solutions.

Broadly, the firm’s purchase of Help at Home was an opportunity to further bolster the delivery of care in the home, according to David Schuppan, a senior partner at Vistria.

“Help at Home is a leader in what is an important trend in health care and one that’s consistent with a theme we’ve been exploring, which is the support of seniors and others with complex conditions in their preferred home- and community-based setting,” Schuppan told Home Health Care News in an email. “We think there’s tremendous societal and economic value creation here.”

With offices in New York and London, Centerbridge Partners is a private investment management firm that has $26 billion in capital under management. Centerbridge had previously worked with Vistria to acquire Civitas as part of a $1.4 billion deal that closed in March 2019.

“We are excited to have completed the acquisition of Help at Home, a trusted provider of care solutions that empowers individuals to live life on their own terms with support from highly trained, compassionate and dependable caregivers,” Jeremy Gelber, senior managing director at Centerbridge, said in a press release. “As we move forward, we will partner with Paul and the talented Help at Home team to expand access to the company’s services as the company continues to deploy its resources and expertise to deliver unsurpassed care.”

Help at Home and Centerbridge both declined to comment for this story.

While financial terms of the transaction were not publicly disclosed, PE Hub previously reported on a rumored deal between Help at Home, Vistria and Centerbridge in September. At the time, PE Hub reported the deal was for $1.4 billion.

Now officially in the books, Vistria and Centerbridge’s play for Help at Home adds to what has been an increasingly active M&A market.

The second quarter of 2020 saw the lowest number of home health, home care and hospice transactions since the end of 2017, according to data from M&A advisory firm Mertz Taggart. Q3, however, saw at least 25 total transactions.
“I’ve been selling home health agencies since 2006, and can’t recall a time when demand has been higher,” Mertz Taggart Managing Partner Cory Mertz told HHCN early in October. “Since July, we have received more calls from both strategic and financial buyers looking for home health than I can ever recall in a three- or four-month period.”

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Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021

The U.S. Centers for Medicare & Medicaid Services (CMS) released its final home health payment rule for CY 2021 on Thursday, with essentially no changes to the Patient-Driven Groupings Model (PDGM) or its controversial behavioral adjustment. 

In addition to doubling down on PDGM, boosting the home health base payment rate by 1.9% and making minor adjustments to the Home Health Value-Based Purchasing Model, CMS also clarified its new policy on Requests for Anticipated Payment (RAPs) for next year and beyond.

Home health agencies likely won’t be happy with the fine print.

In its 2020 rulemaking, CMS announced it was moving forward with a plan to fully eliminate RAPs — or home health-prepayments that provide a chunk of an episode’s anticipated payment at the beginning of care — by 2021. In place of RAPs, the agency explained it will instead require agencies to submit a one-time Notice of Admission (NOA) starting in 2022.

Although NOAs kick in for 2022, 2021 would be a transition year, with agencies still required to submit a watered-down RAP for billing purposes.

“With the removal of the upfront-RAP payment for CY 2021, we relaxed the required information for submitting the RAP for CY 2021 and stated that the information required for submitting an NOA for CYs 2022 and subsequent years would mirror that of the RAP in CY 2021,” CMS wrote in Thursday’s final rule. “Starting in CY 2022, [agencies] will submit a one-time NOA that establishes the home health period of care and covers all contiguous 30-day periods of care until the individual is discharged from Medicare home health services.”

While the elimination of pre-payments is already incredibly impactful, especially for smaller, cash-strapped home health agencies, CMS’s new policies also come with a built-in penalty for late submissions.

The RAP in 2021 and the one-time NOA starting in 2022 must both be submitted within five calendar days from the start of care. If agencies fail to do so, they’re subject to a one-thirtieth reduction to the wage and case-mix adjusted 30-day period payment amount for each day from the start of care date until the date agencies submit their RAP or NOA.

In other words, home health agencies will be hit with a 3% fine for each day they’re late filing their paperwork.

The fine print

A 3% fine for each late day to file a RAP or NOA doesn’t seem too bad at first glance. But that 3% fine turns into a 20% penalty very quickly.

After issuing its proposed rule in June, CMS received multiple comments from industry stakeholders asking when the non-timely payment reduction actually begins.

“A commenter requested clarification on the methodology used to calculate the non-timely submission payment reduction,” CMS stated in its 2021 final rule. “This commenter asked whether the reduction begins on Day 1 or Day 6.”

For purposes of determining if a “no-pay” RAP is timely-filed, the no-pay RAP must be submitted within five calendar days after the start of each 30-day period of care. For example, if the start of care for the first 30-day period is Jan. 1, then the no-pay RAP would be considered timely-filed if it is submitted on or before Jan. 6, the agency clarified.

What’s that mean? Well, in the event that the no-pay RAP is not timely-filed, CMS will calculate the one-thirtieth penalty from the first day of that 30-day period. So in the previous example, the penalty calculation would begin on Jan. 1 — and not on Jan. 7, the first day after an agency misses its deadline.

Translation: If an agency submits its no-pay RAP one day late, the result would be a 20% reduction to its 30-day payment amount.

Industry financial experts previously told Home Health Care News that the elimination of pre-payments alone could devastate mom-and-pop home health agencies.

“That will take these small agencies out,” McBee Associates President Mike Dordick told HHCN in July 2019.

A possible 20% penalty on top of that just adds insult to injury.

Cheating on your taxes

The RAPs penalty is an important detail from CMS’s final payment rule for next year, but the main takeaway is still the agency’s decision to stick to PDGM’s behavioral adjustment — effectively a 4.36% cut if left unmitigated. 

Industry stakeholders were hoping CMS would reconsider the adjustment after emerging data suggested it’s inherently flawed but exacerbated due to the COVID-19 pandemic. The adjustment has proven difficult for many agencies, particularly when paired with astronomical personal protective equipment (PPE) costs and other factors.

“Our members have been working hard throughout this health care crisis to serve older adults in need of  home health care, while at the same time shouldering significant pandemic-related expenses for PPE, staffing and other needs,” Katie Smith Sloan, president and CEO of LeadingAge, told HHCN in an email. “They’ve cared for older adults both in person and via telehealth, despite shortcomings in Medicare reimbursement policies that keep providers from being paid for delivering telehealth services.”

Those facts, coupled with CMS’s decision to not address faulty behavior assumption adjustments in its rule for CY 2021, put home health agencies in “an untenable position,” she added.

In addition to her role at the Washington, D.C.-based aging services industry association LeadingAge, Smith Sloan also serves as acting president and CEO of ElevatingHOME and the Visiting Nurse Associations of America.

In part, PDGM’s behavioral adjustment was based on CMS assuming home health agencies would do everything possible to lower Low Utilization Payment Adjustment (LUPA) rates while always “upcoding” to the highest-paying primary diagnoses.

Intrepid USA CEO John Kunysz told HHCN that line of thinking was wrong from the start.

“Maintaining the behavioral adjustment is akin to the government saying, ‘We believe you are going to cheat on your taxes, so we are disallowing a percentage of your deductions,’” Kunysz said in an email. “We operate in a highly regulated environment. The incentives to provide appropriate care far outweigh any temptation to try and game the system.”

Dallas-based Intrepid USA is a home health, hospice and home care provider with operations in more than a dozen states. In 2019, the company cared for more than 22,000 patients under its home health service line.

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Perspectives: Home Health Insiders Sound Off on the 2020 Election

The ongoing expansion of Medicare Advantage (MA), a federal minimum-wage hike and additional support for front-line health care workers during the COVID-19 public health emergency.

These are just a few of the industry-shaping topics that home health insiders are following going into Election Day this Tuesday. While each presidential election is important, 2020 will help set the trajectory of U.S. health care policy for years to come.

No matter who wins between President Donald Trump and former Vice President Joe Biden, one thing is clear: In-home care gained a larger role in the overall continuum of care this year — and that momentum isn’t going away.

To get a deeper understanding of the 2020 election and what it means for home-based care operators, Home Health Care News reached out to several stakeholders for their perspective. Their responses are provided below, edited for length and clarity.

* * *

Regardless of who wins, the fundamentals for home health care remain the same. There is a growing need for more care and higher levels of care in the home. The pandemic has only accelerated this trend as family members eschew institutional care settings. Meanwhile, telemedicine and virtual care will play the dual role of supporting quality care in the home — particularly for patients who need fewer services — and blurring the lines of what is considered traditional home care.

As state Medicaid budgets tighten, care for dually eligible individuals who have chronic and long-term care needs will need to be addressed. These individuals account for 20% of Medicare and 15% of Medicaid enrollment, yet account for about a third of spending for each. In-home care and care management can play a critical role in improving outcomes while reducing the overall cost of care. However, the U.S. Centers for Medicare & Medicaid Services (CMS), Congress and state Medicaid programs will need to figure out the right models to integrate this care while figuring out who pays for what and who gets the savings.

Ensuring that home health agencies can fully participate in virtual care initiatives — including reimbursement for such services — and ensuring that dual eligible integrated care efforts fully value the impact of care in the home are two of our top priorities.

Marki Flannery, president & CEO of the Visiting Nurse Service of New York (VNSNY)

* * *

The health care industry experienced unprecedented strains this year, but we also made strides in many areas. At the highest level, we saw bipartisan cooperation in the time of crisis that led to solutions for those acutely impacted by the pandemic, from telehealth coverage to Paycheck Protection Program (PPP) loans.

Regardless of the 2020 election outcome, in 2021, we’re turning our focus to a few key areas based on lessons learned from the public health emergency. Further elevating home health care as a viable care alternative is crucial. Whether it was helping to divert the surge on hospitals or sending patients home to recuperate from the effects of the virus in order to free up ICU beds, home care really rose to the occasion.

While there has been an increased appreciation and awareness of the power of home health care, there is still an opportunity to elevate understanding around the need for better home care reimbursement rates, fueled by an authentic understanding of the tireless value skilled and direct care workers provide. We are also working towards ways to secure and drive more competitive pay so that the home health care industry can more effectively fill the labor demand needed to support Americans who want to heal and thrive safely at home. We are continuing to see how cost-effective and truly preferred the home setting is for seniors who desire to age in place safely and securely. We want to do everything in our power to make this option more accessible.

— Jennifer Sheets, president & CEO, Interim HealthCare

* * *

Regardless of the outcome of the election, the prospects for positive legislation impacting the home health sector in 2021 are promising. The new Congress will be interested in making policy changes to strengthen the Medicare program, examining the needs of the Medicare population and building off of lessons learned because of COVID-19. One of these lessons is that access to home health care for vulnerable populations can and should be optimized, particularly at times when the Medicare patient population is uniquely vulnerable. The home health community has developed policy solutions that offer Medicare beneficiaries a wider array of post-acute care options, including those that expand the availability of care at home.

Being able to “choose home” for more Medicare patients who need care, as an alternative to other institutional care, can not only ensure that high-quality clinical care is available to a wider Medicare population, but can also ensure safety and increased patient choice.

We have also seen that care in the home should be optimized through increased use of technology. The availability of telehealth should be expanded upon for Medicare home health patients, particularly in times when infection risk is high, as was the case during COVID-19. The Partnership believes that telehealth opportunities should be optimized to ensure continuity of care for our nation’s most vulnerable patients.

— Joanne Cunningham, executive director, Partnership for Quality Home Healthcare (PQHH)

* * *

​I’m hopeful that the current election will have a very positive impact on the home health industry going forward. That is because our industry has done a wonderful job over the years of advocating for our interests with a paramount emphasis on bipartisanship that is clearly evidenced in the recently introduced federal legislation calling for home health telehealth reimbursement during national emergencies.

In both the House and the Senate, these bills are being sponsored and supported by both Democrats and Republicans. That is extraordinarily significant. And coupled with the magnificent work our industry has done treating those in need during the current pandemic, the message has been communicated far and wide that our industry’s support spans the partisan political divide and is here to simply treat patients, clients and families with the health care services they need, when they need them, in the comfort, safety, security and familiarity of their homes.

— Dean Chalios, president & CEO, California Association for Health Services at Home (CAHSAH)

* * *

Home care and hospice have the advantage of being supported by both parties. As such, whatever the outcome of the election, we expect any health care reforms to embrace health care at home as the awareness of its value has grown significantly during the pandemic. Once the dust settles after the election, we are prepared to work with the incoming Congress and administration to further advance home care and hospice.

— William A. Dombi, president of the National Association for Home Care & Hospice (NAHC)

* * *

The outcome of the 2020 presidential election could greatly impact legislation, support, attention and funding for home health care workers and agencies. Additionally, if the non-chronic illness Medicare-eligibility age is reduced to age 60 vs. 65, that will be a tremendous game-changer for payers, providers, patients and the entire health care ecosystem.

— Cleamon Moorer, Jr., president & CEO, American Advantage Home Care Inc.

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Griswold Continues Building Out Leadership Team; NAHC, HCAOA Announce Board Additions

Griswold adds to leadership team, board

Blue Bell, Pennsylvania-based Griswold Home Care has named Matt Ericksen director of sales and operations.

In his new role, Ericksen will bring expertise in business development, compliance and recruitment to the team, according to the company. He was most recently the director of operations at BrightStar Care Inc., one of the largest home care franchises in the country.

On its end, Griswold — also a franchise — has 200 locations spanning 30 states.

“Matt’s expertise will be invaluable in advancing the growth of our franchise system,” Griswold CEO Michael Slupecki said in a press release. The CEO, who joined Griswold in February, hinted at a leadership hire in a recent interview with Home Health Care News

The company also announced that Christobel Selecky has joined its board of directors. Griswold nabbed Selecky after searching for a potential board member with a background in population health and social determinants of health.

Selecky serves as the board chair of Satellite Healthcare — a provider of kidney dialysis services — and also serves as a board member for ImmunityBio and Teleperformance.

Axxess CEO elected to NAHC’s board

John Olajide, the founder and CEO of Axxess, has been elected to the National Association for Home Care & Hospice (NAHC) board of directors. His term begins in January and will last three years.

Axxess is a developer of cloud-based software solutions in home health, home care and hospice.

“Technology is so critical to the success of the industry,” Olajide told Home Health Care News. “Technology partners are integral to how things work. They can no longer be seen as just vendors. … Providers can’t deliver incredible service without good tech partnerships, so it was great [to be elected] to the board.”

Washington, D.C.-based NAHC is a nonprofit advocacy organization that represents over 33,000 home care and hospice providers across the U.S.

HouseWorks CEO named to HCAOA’s board

Andrea Cohen, the founder and CEO of at-home care company HouseWorks, has been elected to the board of directors for the Home Care Association of America (HCAOA). She will begin her term in January.

Washington, D.C.-based HCAOA represents thousands of home care agencies across the U.S.

On its end, Boston-based HouseWorks was founded in 2002 by Cohen herself. The agency — which offers both non-medical home care and home modification services — serves communities in Massachusetts, Pennsylvania, New Hampshire and Maine.

“I’m honored to have been elected by my peers in the home care industry to serve on the HCAOA board of directors,” Cohen said. “When I started my career and served on the National Private Duty Association board – the precursor to HCAOA — home care was in its infancy; today, the industry is recognized for its professionalism and for the valuable role it plays in allowing adults to age at home.”

A social entrepreneur, Cohen also serves on the board of The Commonwealth Institute, the Schwartz Center Leadership Council and the Caregiver Action Network. She is also an appointee to the Massachusetts Women Forum.

“HCAOA has been indispensable during COVID-19, connecting home care providers so we can share ideas for how to protect our caregivers and provide the safest and best care to our clients,” she said. “I look forward to working more closely with my colleagues to elevate our vital work.”

Montachusett Home Care names CMO

The Montachusett Home Care Corporation (MHCC) announced that David Ginisi has been named as the company’s chief marketing officer.

Leominster, Massachusetts-based MHCC offers personal care services to seniors, as well as homemaking, chore help and adult day health.

Ginisi will oversee the organization’s digital strategy and help increase messaging and outreach to the 21 communities in Massachusetts that the company works with.

“We are excited to welcome David to our leadership team,” MHCC CEO Lori Richardson said in a press release. “David will be a tremendous asset to our agency with his drive for community engagement and his extensive proven marketing and outreach experience.”

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[Updated] CMS Finalizes 1.9% Home Health Rate Increase for 2021, Keeps PDGM’s Behavioral Adjustment

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its final 2021 home health payment rule Thursday. In doing so, it changed very little from what it first proposed in June.

The final rule adds an estimated $390 million home health payment boost for agencies in 2021, or an aggregate increase of 1.9%. That estimate is less than the $540 million boost and 2.6% increase originally outlined in CMS’s proposed rule.

The increase reflects the effects of the 2% home health payment update percentage and a 0.1% decrease in payments due to reductions in the rural add-on percentages mandated by the Bipartisan Budget Act of 2018 for 2021, the agency noted. The rule also updates the home health wage index, limiting any decreases in a geographic area’s wage index value to no more than 5% next year.

On one hand, the rule brings a semblance of stability to the home health industry by not making any major changes to the Patient-Driven Groupings Model (PDGM). At the same time, by keeping the status quo, CMS also keeps in place the widely controversial behavioral adjustment built into PDGM.

Home health advocates had been pushing for CMS to reconsider PDGM’s behavioral adjustment for months, especially after an independent analysis found the overhaul lowered home health spending by a projected 21.6% in 2020. William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), expressed disappointment on that point in an email to the organization’s members.

“We are disappointed that CMS put off consideration of dropping the behavioral adjustment to payment rates based on its view that it needs a full year of data before it can act,” Dombi wrote. “We believe sufficient information is available to recognize that the behavioral changes assumed have not occurred. We will continue to work to get a mid-year rate change to reflect the absence of the rate behavior that CMS assumed.”

This is a developing story. Please check back shortly for additional updates.

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Encompass Health Gaining Ground with ACOs, But Still Facing Assisted Living ‘Lockdowns’

Hundreds of thousands of dollars’ worth of monthly personal protective equipment (PPE) costs. Nationwide lockdowns of assisted living communities. Continued restrictions on elective surgeries in most markets.

These remain just a few of the major pain points that Encompass Health Corp. (NYSE: EHC) and its home health business face amid the COVID-19 pandemic. With 40 states reporting an increase in new COVID-19 cases as of Thursday, they’re pain points that will likely stick around for the foreseeable future, too.

But while the general operating environment remains difficult, “a proven track record of working through difficult situations” and progress on value-based care arrangements has Encompass Health’s leadership team feeling bullish on the Birmingham, Alabama-based company’s outlook heading into 2020’s final chapter.

“Since 2009, we have successfully managed through an economic recession, regulatory changes, sequestration and Medicare payment freezes and cuts,” Encompass Health President and CEO Mark Tarr said Thursday during a third quarter earnings call. “Now we can add a global pandemic to that list.”

Encompass Health offers both facility-based and home-based care to patients across 136 hospitals, plus a combined 325 home health and hospice locations. 

“We remain confident in the prospects of both our business segments and our ability to overcome these challenges,” Tarr said. “It’s what we do. We adapt. We persevere. We continue to grow.”

Nationwide lockdowns

Despite this year’s headwinds, Encompass Health reported total net operating revenues of about $1.17 billion in Q3 2020, a 1.1% increase compared to the $1.16 billion the company brought in during the same period a year prior.

Its home health and hospice segment posted net operating revenues of about $274.5 million for the quarter, a 5.1% dip compared to the $289.3 million it brought in during Q3 2019. Hospice was on par with 2019 numbers, but a decline in admissions and a drop in revenue per episode contributed to Encompass Health’s home health business being down 6.5% on a year-over-year basis.

“Our most significant decline in volume has been in the physical therapy discipline, due to the decline in elective procedures and being shut out from assisted living facilities,” Tarr noted.

Encompass Health posted overall home health admissions of 40,765 in Q3 2020, down 3.3% compared to 42,174 in Q3 2019. Elective procedure admissions, in particular, were down 20%, with an even bigger decline in admissions from assisted living (AL) and independent living (IL) communities.

“Continued facility-access restrictions have negatively impacted the volume of patients admitted onto our service who reside in assisted or independent living facilities,” Tarr said. “These admissions are down approximately 40%, year over year.”

Historically, AL and IL admissions account for 15% to 20% of total home health and hospice volumes, according to April Anthony, who serves as CEO of the segment for Encompass Health.

“As things began to kind of ease up in the August, late July timeframe, we started to get a little bit greater access,” Anthony said during Thursday’s call. “But now as we move a little bit into a period of [COVID-19] spike, it definitely feels like we’re seeing certain markets, particularly in the Northeast, again go to lockdown. They’re saying, ‘We’ll let your nurse in, but not your therapist. We’ll let your nurse in for hospice, but won’t let your chaplains or social workers in.’”

To overcome those two hurdles, Encompass Health has restructured its compensation policies for therapists and identified new referral sources, including alternate surgery centers.

Gaining ground with ACOs, MA payers

While Encompass Health leadership spent a good portion of Thursday’s call talking about hardships and operational realities, they also touched on multiple positives for the company.

Work with accountable care organizations (ACOs) is among the bright spots, for example. Currently, Encompass Health partners with more than 100 Medicare Shared Savings Program ACOs around the country, with nine new ACO relationships emerging during the third quarter.

“A recent analysis of 2019 claims data revealed that we grew our share of ACO beneficiaries by 16% in 2019 versus 2018, whereas the rest of the home health industry remained flat year over year,” Tarr said.

Similar to its ACO progress, Encompass Health has been able to land more value-based payment arrangements with Medicare Advantage payers. The company added two new contracts in Q3, with ongoing discussions anticipated to yield additional contracts over the coming quarters.

“Although the pandemic has made some collaboration efforts more difficult and necessarily virtual in nature, we believe there is a strong interest in partnering with Encompass Health’s home health and hospice segment among ACOs and Medicare Advantage payers seeking value-based payment arrangements,” Tarr said.

Still, it’s tough to escape the shadow of COVID-19.

As Encompass Health wins new ACO and MA business, it also has to factor new costs like PPE into its decision-making. Average monthly PPE costs for its home health and hospice segment range from $96,000 for gloves to $147,000 for respirators.

Fixing PDGM

Looking ahead, Encompass Health has its near-term attention turned to the home health final payment rule for 2021, which also dropped on Thursday.

An analysis conducted by health economics and policy consulting firm Dobson DaVanzo & Associates previously found that the Patient-Driven Groupings Model (PDGM) contributed to a 21.6% drop in home health spending this year, mainly due to the model’s built-in behavioral adjustment.

Anthony said the final rule is unlikely to remedy that, a statement that quickly turned out to be true.

“I do think that we’re having some good conversations, … very data-driven conversations in Washington,” she said. “I don’t think we’re going to see recognition of the behavior change assumptions being flawed for this coming year’s rate.”

On a more long-term basis, Encompass Health is also watching the home health and hospice M&A market closely.

“After several months of unusually slow M&A activity in the home care sector, we are encouraged that the pipeline of acquisition opportunities is rebuilding, particularly for hospice,” Tarr said.

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Amedisys Makes Progress on SNF-at-Home Model, Anticipates Positive 2021 Operating Environment

When there are challenges in any industry, the organizations that hurdle them quickly and efficiently end up gaining an advantage. Amedisys Inc. (Nasdaq:AMED) feels like it has done that.

After a census bounce-back from COVID-19, a successful transition to the Patient-Driven Groupings Model (PDGM) and an identification of new ways to accelerate its home health business in the coming years, the Baton Rouge, Louisiana-based company is optimistic about its position.

“Our performance in Q3 bested our internal modeling and [Wall Street] expectations, and highlights how important essential and resilient home health, hospice and personal care are to the health care delivery system,” Amedisys CEO Paul Kusserow said on the company’s Q3 earnings call Thursday.

Amedisys is a provider of home health, hospice and personal care services. It has well over 500 care centers in 39 states and Washington, D.C. Its net service revenue for Q3 2020 was $544 million, topping the $494 million it posted in Q3 2019.

While COVID-19 still presents operational difficulties, it has become “business as usual” for Amedisys, according to Kusserow. The company also feels like its value proposition has been bolstered over the last year, with its service lines set up to benefit from considerable tailwinds moving forward.

In home health care, Amedisys’s total admissions grew by 5% in Q3 2020 compared to the same period a year ago, with its overall volume growing by 6%. Operating income increased from $211 million in Q3 2019 to over $222 million for this year’s third quarter.

“It just showed how strong and quickly the business has recovered from the initial impact of COVID-19,” Kusserow said. “We expect these trends to strengthen throughout Q4, setting us up for strong growth in 2021.”

Trick or treat

The 2021 home health final payment rule is expected to come out within the next couple of days. When it does, Amedisys expects it will bring welcomed news.

“The rule traditionally comes out around or on Halloween,” Kusserow said. “We don’t expect to be scared this year — a treat, not a trick.”

Between the final rule and a proposed telehealth payment bill for home health care, Amedisys believes potential reimbursement changes will give it an approximate bump of $40 million next year.

The country’s demographics are on the entire home health industry’s side, including Amedisys. But so are the psychographics, Kusserow said. Nine out of 10 of baby boomers want to age in their homes.

“Add economics to that, as home care is what people want,” Kusserow said. “It’s the cheapest type of care, and it’s the most suitable for the types of long-length, chronic illnesses that we will be treating in the future.”

Even COVID-19 — at least for Amedisys — has flipped direction and become more of a tailwind for the company. That’s especially true when it comes to the diversion of patients and residents from congregate care settings into home-based care.

On its end, Amedisys is already looking to conquer the ground that other providers have lost during the public health emergency.

“We are innovating to meet this demand,” Kusserow said. “We’re working to be able to increase our capacity to care for more traditional patients, as well as moving up the acuity scale and focusing on new, sicker patients that had no other options but institutions [in the past].”

The agency already received 1,700 new home health referrals from sources in Q3 that they had not received referrals from last year.

Additionally, Amedisys is working to show patients and referral sources that it can create a SNF-like environment in the home. The company says it has made progress on its SNF-at-home development, with its focus being a package of services combined with traditional home health to treat higher acuity patients in their homes.

The National Association for Home Care & Hospice (NAHC) has been among the organizations vying for a formal SNF-at-home benefit under Medicare.

“SNF-at-home represents an interesting new growth avenue for the company and will be an opportunity for growth even beyond the pandemic,” Kusserow said. “The time to work with referral sources on taking their higher acuity patients is now — and we’re capitalizing on it.”

PDGM success

Amedisys credits its PDGM success to preparation. It internally set up trials and pilots as if the new payment system was underway in fall of 2019.

The company’s success tackling the shift in the home health landscape is another reason that it’s bullish on expanding its brand in the future. While it has dealt with PDGM well, it’s not so sure others have — even if they haven’t shown it yet.

“When the current, temporary COVID subsidies holding the home health market together are lifted, the true impact of PDGM will finally be felt within our industry,” Kusserow said. “We will be ready to continue our organic and inorganic expansion in home health … to capture more and more market share of a still highly fragmented market.”

While PDGM is supposed to be budget neutral per the Bipartisan Budget Act of 2018, spending on home health care has been 21.6% lower than projected, according to an analysis from the health economics and policy consulting firm Dobson DaVanzo & Associates.

If that data holds throughout the year, Amedisys believes that would mean a rate give-back or an increase in the payment rate update for 2022, which is also good news for providers, particularly the ones who have weathered PDGM’s storm in 2020.

“We are thriving in PDGM and have worked incredibly hard at proactively turning headwinds into tailwinds,” Kusserow said. “The growth algorithms we’ve developed for Amedisys in 2021 and beyond are truly exciting. And I believe we have positioned ourselves optimally to fully capture any opportunities that come our way.”

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HHS Loosens Provider Relief Fund Restrictions, Allows Agencies to Cover Lost Revenue

In response to ongoing opposition from both lawmakers and providers, the Department of Health and Human Services (HHS) recently announced it has made changes to its rules surrounding COVID-19 relief funding.

The department’s amended rules now allow providers to use Provider Relief Fund (PRF) money toward lost revenue that’s potentially unrelated to COVID-19.

“After reimbursing health care-related expenses attributable to coronavirus that were unreimbursed by other sources, providers may use remaining PRF funds to cover any lost revenue, measured as a negative change in year-over-year actual revenue from patient care related sources,” HHS said in a recent statement.

Before the recent update, HHS placed a stricter stipulation on what would eventually amount to $175 billion of funds provided through the CARES Act stimulus package. This was to prevent providers from becoming more profitable in 2020 than 2019 by improperly using federal funds for financial gain instead of an operational lifeline.

While the PRF program was “well-intentioned,” it has been mired with challenges associated with conflicting and unclear guidance along the way, Matt Wolfe, a partner at law firm Parker Poe, told Home Health Care News.

“In September, when HHS put out guidance that seemed to limit or restrict these provider relief funds, there was understandably a significant amount of pushback by providers and members of Congress,” Wolfe said. “When [HHS] created this program under the CARES Act, they were really trying to make sure that health care providers of all stripes were able to respond to the public health emergency and keep their doors open.”

Since its formation, the PRF has accomplished its goal of keeping home health agencies and other afloat, Wolfe believes. Still, over the past couple of months, there had been growing concern that HHS was becoming more restrictive than what Congress originally intended.

“You’re putting providers in this difficult situation of saying, ‘Well, I needed this money because it’s what allowed me to make it through this unprecedented challenge,’” he said. “At the same time, they’re wondering, ‘If I retain the funds and don’t pay them back, am I going to have some potentially large obligation down the road?’”

HHS’s amendment to the reporting requirements is key because it clarifies whether providers should hang on to the funds.

While certainly an improvement for home health agencies, and “a step in the right direction,” there’s still work that needs to be done to accomplish the Congressional intent of the program, according to Wolfe.

“For example, it allows a provider to be able to show lost revenue attributable to the coronavirus, essentially by looking at 2019 patient-related revenue compared to 2020 patient-related revenue,” he said. “Depending on your operations in 2019, you may have had an acquisition or some other type of growth at the beginning part of 2020. You may have actually still lost revenue that isn’t dissipated revenue in 2020, but that simplistic comparison of 2019 to 2020 may not actually show that.”

As more providers retain funds, the industry will likely also see an increase in federal oversight.

Since providers are dealing with federal dollars, there’s the possibility of False Claims Act liability, according to Wolfe.

Moving forward, it will be critical for providers to receive clarity in order to continue to make informed business decisions.

“There’s a lot still to be determined in terms of how you’re going to comply with these reporting requirements,” Wolfe said. “Some of the decisions about how to report are going to influence how you spend the money. It’s really critical that HHS provides that clarity so that providers can make decisions about how to utilize these funds if they haven’t already.”

The HHS to loosen the Provider Relief Fund rules marks the second significant relaxation of rules around federal support for health care providers in recent weeks.

The Centers for Medicare & Medicaid Services (CMS) also extended repayment terms for its Medicare Accelerated and Advance Payment Program earlier this month.

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Home Health Providers Prepare for ‘Very Tough Winter’ Ahead

The seven-day average for new COVID-19 cases hit 68,767 on Sunday, shattering the previous high set in July. Meanwhile, Friday and Saturday took over as the two highest days for new cases since the pandemic began.

Despite mitigation efforts and progress on rapid testing, the U.S. is firmly in the middle of a third surge, one that even rivals spring’s initial outbreak in terms of raw numbers. Home health providers have yet to feel the full effects of this latest swell, but many believe another round of patient-volume disruption could be on its way if the situation isn’t contained.

“We are certainly seeing an uptick in COVID-19 cases in the geographic areas VNA Health Group serves,” Dr. Steven Landers, the organization’s president and CEO, told Home Health Care News. “The number of COVID-19 related hospitalizations and home health referrals have increased in October, but are not yet anywhere near the crisis levels we experienced in April and May.”

VNA Health Group is among the largest independent, nonprofit home-based care providers in the nation, operating across New Jersey, plus parts of Ohio and Florida. Its front-line workers have cared for several hundred COVID-19-positive seniors over the past eight months.

In the Pacific Northwest, Washington-based EvergreenHealth Home Care is similarly not experiencing a major influx of COVID-19 patients at this time, Chief Home Care Officer Brent Korte told HHCN. Nonetheless, the hospital-affiliated home health provider and COVID-19 pioneer remains nimble in its planning, should volumes and circumstances suddenly change.

“Since the onset of the pandemic, EvergreenHealth Home Care has operated under the assumption that a surge could come at any time, and we are prepared to handle an increase in [COVID-positive] patients,” Korte said. “We have been preparing nonstop for the past eight months, since we cared for the first COVID patients in the U.S. in early March.”

A spokesperson for a large, multi-state post-acute care provider with a home health services line likewise told HHCN his organization isn’t experiencing a current surge in COVID-19 patients nor a decrease in volumes.

The ‘steep slope of the curve’

Health experts had long been anticipating a winter surge, materializing right around the Nov. 3 presidential election. But unlike past spikes isolated to one state or one region, the current surge is geographically diverse, with outbreaks across the Midwest, Great Plains and the South, in addition to certain metropolitan markets.

In El Paso, Texas, for example, intensive care units hit full capacity on Saturday, according to The Washington Post. In Utah, the state hospital association warned that the state may soon have to implement a “crisis standards of care,” prioritizing care toward younger patients more likely to recover.

All signs suggest the nation is once again at a “dangerous tipping point,” former U.S. Food and Drug Administration Commissioner Scott Gottlieb told CBS News.

“We’re entering what’s going to be the steep slope of the curve,” Gottlieb cautioned.

When home health providers did see a sudden COVID-driven dip in patient volumes, it came toward the end of March and early April, when hospital systems halted elective surgeries and individuals declined visits due to exposure concerns. After that drop is when providers began to then see the continuous flow of COVID-19 patients onto home health services.

Data gathered by home health and hospice technology company Homecare Homebase (HCHB) confirms that in-home care providers are not seeing the same kind of volume swings — yet.

After the spring decrease, home health admissions rapidly climbed to pre-pandemic levels by the end of May and early June, the HCHB data shows. Admission numbers then gradually increased to a near-term, relative high until late-September, apart from a minor blip between mid-July and mid-August.

New data suggests admissions are trending slightly downward again in October.

Source: Homecare Homebase

On its end, the Visiting Nurse Service of New York (VNSNY) — the biggest nonprofit home-based care provider in the country — is not seeing a significant upswing in COVID-19 cases at this time. Additionally, its volumes remain steady.

“We’ve been able to recover fairly smoothly from the drops in service that we saw earlier in the year,” Andria Castellanos, VNSNY executive vice president and chief of provider services told HHCN. “Our volume continues to improve each month as our referral sources normalize. Of course, we are monitoring the numbers very closely every day, throughout the day, and we are in constant communication with our clinicians and the physicians, hospitals, nursing homes, assisted living facilities and other partners that VNSNY serves.”

While there is a clear surge in new cases, Dr. Anthony Fauci, the nation’s top infectious disease expert, pointed out the U.S. is still in the first broader “wave.”

“We’ve never really had waves in the sense of up and then down to a good baseline,” Fauci said Monday at the All Markets Summit. “It’s been wavering up and down. So now we’re at the highest baseline. … [It’s] kind of semantics. You want to call it the third wave or extended first wave. No matter how you look at it, it’s not good news.”

Staying vigilant

If home health providers do ultimately experience an uptick in COVID-postive patients, they’ll be prepared. Most have never stopped stocking up on personal protective equipment (PPE) or refining their operational protocols.

That includes VNSNY, said Castellanos, who heads up the organization’s COVID-19 Emergency Response Team.

“VNSNY has developed a new PPE procurement supply chain,” she said. “We now have an adequate supply of PPE available for all of our staff, who are well trained and updated on all protocols. We understand that changes can happen very quickly, and our staff and Emergency Response Team are on alert 24/7 and in sync — ready to respond immediately [if needed].”

In addition to PPE and protocols, providers are also in better shape when it comes to staying connected and supporting their clinicians in the field.

As in-home care providers head into “a very tough winter ahead,” EvergreenHealth Home Care is focused on keeping staff safe, delivering high-quality care and making sure its workers all have jobs that aren’t going away, Korte noted.

“I recently had the opportunity to round with our clinician care teams, and while everyone is experiencing and embracing the challenges of the COVID-19 pandemic in their own way, especially when it comes to missing our personal connections with one another, we’re working together to find creative ways to stay connected and empower each,” he said. “We are in a hiring mode currently — so our staff are thankful to have security in their jobs as so many people in our community have been hit by the economic downturn.”

VNA Health Group, too, is focused on protecting its patients and staff. Part of that has meant implementing an aggressive employee influenza-vaccination campaign to protect workers from the flu, which could potentially be devastating when paired with the COVID-19 virus.

Even with all the planning, preparation and caution, home health providers will still have to keep their fingers crossed that the public at large takes the current surge seriously, Landers added.

“We are hoping that the people in the communities we serve will be vigilant about the public health measures that can bring this back down so that we don’t revisit those earlier high levels of infections and deaths,” he said.

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HHS Prioritizing ‘Largest’ Home Health Agencies for Federally Distributed COVID-19 Tests

The U.S. Department of Health and Human Services (HHS) has offered further clarification on its COVID-19 testing strategy for home health agencies.

According to an online “index” of its distribution efforts, HHS is sending tests to the “largest 100+” home health and hospice agencies, with those providers then tasked with distributing COVID-19 tests to locations within their networks.

In total, that allocation of tests will cover 1.8 million patients and allow staff at the selected agencies to be tested once per week, according to the department.

Thus far, 632,480 COVID-19 Abbott BinaxNOW diagnostic tests have been sent to home health and hospice agencies, an HHS spokesperson told Home Health Care News in an email.

For context, HHS is planning to distribute 150 million tests it procured from Abbott to U.S. senior care providers and others “as quickly as possible.” Nearly 37 million of those tests will have been distributed by the end of this week, with over 7 million going to nursing homes and 26.5 million going to state governments across the country.

“As I have stated before, the way to flatten the curve, slow the spread and save lives until we have a safe and effective vaccine is smart policies, plus smart testing,” HHS Assistant Health Secretary Adm. Brett Giroir said on a call with reporters Monday. “This is the proven formula that worked in the Sunbelt in the deep South, and [it] can work across the country.”

The home health care industry is historically a very fragmented field, with anywhere from 10,000 to 12,000 different agencies in operation over the past few years.

In 2019, Kindred at Home was the largest home health organization in terms of patient volume, yet it only controlled 5.9% of the overall market, according to Atlanta-based data and technology firm LexisNexis Risk Solutions, which is a part of the global analytics company RELX (NYSE: RELX).

Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (Nasdaq: LHCG), Encompass Health (NYSE: EHC) and AccentCare are also among the top-five largest providers. Even so, not a single one accounted for over 5% of the U.S. home health market in 2019.

Of the 150 million tests that are set to be distributed, 10 million are expected to be sent to home health and hospice providers.

HHS is encouraged by how the tests have been deployed and utilized thus far.

“The response to the additional tests [distributed] to the ecosystem has been tremendous,” Giroir said.

Giroir also reiterated on the call that asymptomatic testing is encouraged, especially for workers coming into contact with vulnerable populations.

Previously, the U.S. Centers for Disease Control and Prevention switched its guidelines to not recommend testing for individuals that were asymptomatic. Since then, they have reversed that decision.

“We do support asymptomatic testing,” Giroir said. “The only way that you’re going to screen millions of people per month is to use these antigen tests, which have been in our armamentarium.”

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Lack of Stimulus Bill Could Lead to Rise in COVID-Related Lawsuits

Throughout 2020, there have been a number of new laws and legal trends that could have major impacts on the in-home care industry. In order for providers to be successful in the long run, it’s important to remain abreast of the latest developments.

That was the message delivered by Angelo Spinola, an attorney and shareholder at Littler Mendelson, during this year’s National Association for Home Care & Hospice (NAHC) annual conference.

Among key legal developments, Spinola touched on the Families First Coronavirus Response Act (FFCRA), which creates paid leave — both sick leave and family medical leave — for employees who satisfy certain conditions.

When it comes to the FFCRA, the status of the health care provider exemption should be an area of interest to providers, according to Spinola.

When the law originally went into effect in April, the U.S. Department of Labor (DOL) created a broad exemption for health care providers.

“It certainly covered home health providers … and arguably covered most of the non-medical home care providers as well,” Spinola said. “What the [DOL] allowed companies to do, if you did meet the exemption, is exempt everybody within the entity, meaning it wasn’t specific to the employee. It’s whether the employer would qualify as a health care provider.”

Under the law, providers who qualified for the exemption could elect to not offer coverage to any of their employees, or they could offer partial coverage, such as paid sick leave, but not paid family medical leave.

“There were many home care agencies that were doing just that; they were offering the paid sick leave, but not the paid family medical leave,” Spinola said. “The reason for that decision is that companies were really concerned about losing caregivers for an extended period, for 12 weeks of time, because their children were out of school. [They were concerned about] not having anyone available to care for their clients.”

Recent rumblings in New York have caused confusion around what companies qualify for the exemption, however.

The state of New York issued a legal challenge to DOL regulations, effectively saying that the department exceeded its authority in making the health care provider exemption so broad.

Generally, the state of New York challenged four elements of the FFCRA regulations including the work availability requirement, the definition of health care provider, intermittent leave and the documentation requirement.

The state won on all grounds.

“What does this mean for you?” he said. “It means that if you were relying on a health care provider exemption to exclude coverage under the FFCRA, … there’s some risk to you for having relied on that exemption. You were relying on a broader exemption that has now been struck down.”

The DOL has since revised regulations, and providers need to determine whether their agency is subject to the FFCRA.

As far as other steps providers should take, it’s crucial to determine whether it’s in the company’s best interest to provide full or partial FFCRA benefits to all employees. Providers should also communicate with employees, as well as implement an arbitration program, according to Spinola.

Stimulus package, qualified immunity

The next coronavirus-related stimulus package remains top of mind for providers.

When it comes to advocacy initiatives, most providers had five key areas of focus.

These areas include increased pay for front-line workers to discourage many from going on unemployment, child care support for caregivers, priority access to personal protective equipment (PPE), qualified immunity and the creation of an “HCBS Direct Care Worker Fund.”

In May, House Democrats unveiled the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, a COVID-19 stimulus bill. The bill included most of the five industry initiatives except for qualified immunity.

Ultimately, the bill passed out of the house, but couldn’t pass in the Senate.

Another stimulus package, the Health, Economic Assistance, Liability Protection and Schools (HEALS) Act, was introduced in July. Out of five industry initiatives, the bill only included paid child care and qualified immunity. The legislation failed to pass out of the Senate.

“The problem that we are seeing is there’s no movement right now,” Spinola said. “They’re $2.5 trillion apart. There are significant differences between the two acts.”

While it’s impossible to say what will happen, Spinola pointed to the state of the economy as an indicator of the future.

“I think that what might happen is directly tied to the state of the economy,” he said. “We saw the economy really tank. We saw record unemployment claims. …I think we are seeing now because the economy is starting to rebound, there’s less pressure on Congress to create this stimulus package.”

As the election draws closer, there will be less focus on the stimulus bill.

“That’s concerning because that means a lot of the things that we were hoping to accomplish, … we might not get,” Spinola added.

In particular, if qualified immunity doesn’t pass, it puts the industry in a very vulnerable spot for litigation.

Overall, there have been at least 792 COVID‐related labor and employment lawsuits filed against employers, and more than 2,000 general COVID‐related lawsuits. More than 10% of these cases include class-action claims.

“Not surprising that since COVID hit, we’ve seen an increase in related cases,” Spinola said. “Each month, the number gets higher and higher, and we’re going to continue to see this. Unfortunately, we are seeing it specifically in the health care space.”

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COVID-19’s Impact on the Home Health Industry Is Still Unclear

Despite the ongoing public health emergency, hard data on how COVID-19 is affecting the U.S. home health industry is still lacking.

That’s according to a new analysis from The Commonwealth Fund

As opposed to other industries, the Medicare-certified home health subsector’s struggle with COVID-19 has not received much attention. The worry is that a lack of understanding could affect beneficiaries, providers and policies for years to come.

In order to conduct its analysis, The Commonwealth Fund examined the current home health landscape, interviewed agencies and reviewed the recent policy changes within the industry. The Commonwealth Fund is a foundation that does research on health care issues.

“The impact of COVID-19 on Medicare home health services is not fully understood,” its analysis states. “More research is needed on how COVID-19 affects home health use, particularly for populations experiencing disparities in accessing care.”

One of the other main, overarching themes from the Commonwealth Fund analysis is that the definition of “home health,” at least under Medicare, needs to be expanded.

Without that expansion, multiple providers need to come into the equation to help the patient, which often complicates things.

“Medicare beneficiaries who require skilled care and help with activities of daily living need to secure and coordinate two providers under two payment systems: Medicare and either Medicaid or private pay,” the analysis reads. “These beneficiaries may be at risk for poor outcomes because of lack of coordination between providers. Home health aide shift changes alone, for example, are associated with increased likelihood of hospital readmission within 30 days of initial discharge.”

At the very least, provider care coordination — both internally and externally — needs to be improved in order to see more positive outcomes.

In regard to COVID-19, home health beneficiaries are among the most vulnerable due to older age and the prevalence of chronic conditions.

Now, patients are generally seeking care less due to fear of COVID-19 exposure, which could lead to worse outcomes in the end. A June survey from Home Health Care News found that 90% of home health agencies had lower revenue since the beginning of the pandemic, with nearly two-thirds experiencing at least a 20% decline. 

Agencies are also spending considerably more than usual on purchases like personal protective equipment (PPE) and other COVID-19 related resources. 

Until the true impact of COVID-19 is known, providers need sufficient aid and assistance from the federal government in order to take care of their patients.

“Home health is well positioned to offer services to individuals in their own homes, which is an increasingly important care option during the pandemic,” the analysis notes. “However, the current design of the Medicare home health benefit is not sufficient to meet the needs of post-acute beneficiaries.”

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[Updated] Lawmakers Introduce New Bill Paving the Way for Home Health Telehealth Reimbursement

Home health providers are one step closer to getting the No. 1 thing they’ve been asking for since the COVID-19 pandemic began: reimbursement for telehealth-driven visits.

On Friday, U.S. Senators Susan Collins (R-Maine) and Ben Cardin (D-Md.) introduced the Home Health Emergency Access to Telehealth (HEAT) Act, a bipartisan bill to provide Medicare reimbursement for audio and video telehealth services furnished by home health agencies during the COVID-19 emergency.

U.S. Representatives Roger Marshall (R-Kan.), Terri Sewell (D-Ala.), Jodey Arrington (R-Texas) and Mike Thompson (D-Calif.) introduced similar legislation in the House.

“Home health serves a vital role in helping our nation’s seniors avoid more costly hospital visits and nursing home stays,” Sen. Collins, chairman of the Senate Aging Committee, said in a statement. “The COVID-19 emergency has further underscored the critical importance of home health services and highlighted how these agencies are able to use telehealth to provide skilled care to their patients.”

If finalized, the HEAT Act would pave the wave for home health telehealth reimbursement during the current pandemic as well as future public health emergencies, when appropriate. The newly introduced legislation outlines that services would not be reimbursed unless the beneficiary consents to receiving services via telehealth, however.

To ensure that the Medicare home health benefit does not become a telehealth-only benefit, Medicare reimbursement would only be provided if the telehealth services account for no more than half of the billable visits made during a 30-day payment period.

“I know firsthand the benefits of home health care,” Rep. Sewell said in a statement. “When my dad was left wheelchair-bound after a series of strokes, we were fortunate enough to find home health care from highly skilled and caring health care professionals right where he wanted to be — at home in Selma. As a passionate supporter of protecting home health services, I’m proud to introduce the bicameral and bipartisan [HEAT Act], which will ensure that home health providers have the resources necessary to protect patients in their homes and health care professionals during the duration of the COVID-19 pandemic.”

Overall, the utilization of telehealth services has exploded since the middle of March.

In fact, more than 34.5 million telehealth services were delivered in Medicare and other government programs from March through June, according to recently released data from the U.S. Centers for Medicare & Medicaid Services (CMS). That’s a more than 2,500% increased compared to the same period in 2019.

While home health providers have certainly been a part of that boom in Medicare, they’ve typically had to provide telehealth services out of their own pocket. As currently structured, the home health benefit does not include a pathway for paying for any types of visits not furnished directly in person.

Industry advocacy organizations LeadingAge, the National Association for Home Care & Hospice (NAHC), the Partnership for Quality Home Healthcare (PQHH) and others have been working toward the HEAT Act for months, often pushing for telehealth payment during the discussions before each of the COVID-19 relief measures that have been passed.

“Many of our home health members have been providing critical services without reimbursement during the pandemic,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “The HEAT Act would resolve this inequity and put our home health members on par with all other providers with regards to flexibility during this and future public health emergencies.”

In addition to her role at LeadingAge, Smith Sloan also serves as acting president and CEO of the Visiting Nurse Associations of America and ElevatingHOME.

William A. Dombi, president of NAHC, also applauded the newly introduced bill.

“From the early onset of the COVID-19 pandemic, it has been well known that limiting person-to-person contact is key in reducing transmission and infection rates,” Dombi said in a statement. “Enabling home health agencies to incorporate telehealth visits into the plan of care, with reimbursement, will unlock new means of safe care delivery bringing peace of mind to Medicare beneficiaries.”

This is a developing story. Please check back later for additional updates.

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Varsity-Backed Angels of Care Announces Strategic Partnerships, Expands into Three New States

Angels of Care, a home health provider that specializes in caring for pediatric patients with complex medical conditions, announced Thursday that it has entered into a strategic partnership with Nursing Solutions and Mission Medstaff.

Under terms of the strategic partnership, Nursing Solutions and Mission Medstaff will join Angels of Care’s platform going forward. The financial terms of the deal were not disclosed.

Founded in 1992, Phoenix, Arizona-based Nursing Solutions is a home health provider that cares for both adult and pediatric patients. Its service lines include long-term skilled nursing care, personal care and respite service.

Mission Medstaff — founded in 2009 — also provides home health services to both pediatric and adult patients, doing so in North Carolina and South Carolina.

Moving forward, Nursing Solutions and Mission Medstaff patients will continue to receive services from the caregivers and office staff they are familiar with, Jessica Riggs, CEO of Angels of Care, told Home Health Care News in an email.

“The partnership will enable each company to benefit from Angels of Care’s scale and expertise in recruiting and training excellent nurses, and supporting the families of patients with complex medical needs,” Riggs said.

Founded in 2000 by Bonnie West, Sherman, Texas-based Angels of Care provides private-duty nursing care, skilled therapy and other home health services across five states. According to the provider’s website, it employs more than 4,000 passionate pediatric nurses, skilled nurses, physical therapists, occupational therapists, speech therapists, attendants and specialists.

Angels of Care is backed by Varsity Healthcare Partners, a lower middle-market private equity firm focused on health care services.

For Angels of Care, Nursing Solutions and Mission Medstaff were attractive targets because of how well the companies aligned as far as mission, services and values.

“Like us, Angels of Care is passionate about providing the highest quality care possible to its patients,” Matt Hampton, founder of Mission Medstaff, said in a statement. “We are excited to join their platform, which will enable us to continue providing exceptional, cost-effective, family-focused care for our patients with complex medical needs.”

Another draw for Angels of Care: The deal allows the company to further expand into additional geographies.

On Nursing Solutions’ end, the opportunity to join an established home health platform that has a strong industry foothold was appealing.

“We evaluated a number of alternatives and felt this partnership with Angels of Care was in the best interest of our clients and caregivers,” Bill Johnsen, founder of Nursing Solutions, said in a statement. “We look forward to joining this winning team and continuing to serve the needs of our patients 24/7.”

The global pediatric home health care market is valued at $30.9 billion and is expected to grow to roughly $56 billion by 2026, according to a 2020 study conducted by Acumen Research.

While there is high demand for pediatric home health services, operators are often challenged by staffing and reimbursement constraints. One innovative solution focused on both problems has been the “Family CNA Model,” pioneered in Colorado by companies like Team Select Home Care.

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Nearing 2021 Consolidation Strategy, Trinity Health At Home Keeps Focus on Patient Care

A member of Catholic health system Trinity Health, Trinity Health At Home currently ranks as the eighth-largest home health provider in the country. It will gain even more market share next year, thanks to an ambitious plan to formally consolidate Trinity’s national network of home health agencies with regionally owned affiliates.

Despite the advantages of scale, Trinity Health At Home and its sister agencies continue to operate through various hardships caused by the COVID-19 virus, Mark McPherson, the organization’s interim president and CEO, told Home Health Care News in September.

Those challenges include a shortage of experienced nurses, restricted access to long-term care facilities and more.

“We want to be able to take on new business, but we’re limited by what we can produce, what we can accommodate within our nursing staff,” said McPherson, who also serves as interim CEO of Mercy Home Health and as CFO for the Trinity Health system. “Nursing, in particular, is the area where we are struggling the most to find adequate staff.”

The demand for nursing positions has grown across all health care subsectors, but there has long been an especially high demand in the home-based care arena. That demand has only accelerated due to the COVID-19 pandemic, with most hospitals and health systems looking to shift care into the home.

Overall, the U.S. Bureau of Labor Statistics projects a 14.8% growth in registered nurse (RN) positions through 2026.

While Trinity Health At Home is looking to hire more nurses broadly, the bulk of its focus is on finding and keeping veteran home health clinicians, McPherson said.

“In home health care, it’s difficult to take somebody who’s a new grad, right out of school, then put them in the field,” he said. “There’s just simply too much of a learning curve. There’s just not enough people to bounce issues off of when you’re out there working by yourself.”

Avoiding a ‘bidding war’

With a dearth of home health nurses nationally, McPherson has Trinity Health At Home and other Trinity home health agencies focused on retention. Part of that has meant supporting staff during the public health emergency and rewarding them with financial bonuses whenever possible.

“We’re going to have to be willing to invest in some additional bonuses or forms of compensation to capture those experienced nurses and make sure we keep them,” he said. “Unfortunately, it’s going to be a bit of a bidding war until there’s more of a supply of experienced home health nurses out there.”

In terms of other coronavirus-related challenges, Trinity Health At Home and its peers also faced decreases in patient volumes in spring.

Securing personal protective equipment (PPE) was likewise difficult in the early going, according to Ruth Martynowicz, who serves as interim COO of both Trinity Health At Home and Trinity Health Mid-Atlantic’s Mercy Home Health.

“The biggest problem back then, which I’m sure you’ve heard over and over again, was the lack of readily available PPE,” Martynowicz told HHCN. “With volume, there was a huge impact in March and April, in that patients did not really want to go into the hospitals or have people coming into their homes.”

For the most part, volumes have returned to “business as usual” for Trinity Health At Home and Mercy Home Health. In some regards, patient flow has actually improved compared to pre-pandemic levels, as some referral sources are turning to home health care more frequently.

But a persistent pain point from spring to fall has been access to patients in skilled nursing facilities (SNFs), continuing care retirement communities (CCRCs) and other congregate settings.

“The hospitals are bouncing back, and physician offices are actually thinking of us more frequently,” Martynowicz noted. “The biggest barrier — though this is getting better, too — is in the area of [facilities]. Skilled nursing facilities, CCRCS … have taken longer to come back. They want to make sure that anyone that goes into their building doesn’t have COVID, that they’re using the appropriate PPE.”

Coming together

Aside from the COVID-19 virus, McPherson and Martynowicz are gearing up for the consolidation of all national and regional Trinity home health locations into one entity. In addition to Mercy Home Health, for example, those regionally owned home health organizations include Trinity Health Mid-Atlantic’s St. Francis At Home and St. Mary Home Care.

Overall, there are 15 different entities that will collectively be known as Trinity Health At Home when the consolidation takes place in July 2021.

“Right now, Trinity Health At Home, I think, is around the eighth-largest home care provider in the country,” McPherson said. “When we consolidate all those entities, we should move up to around No. 5, in terms of size.”

Once that consolidation is complete, Trinity Health At Home will have locations in 13 different states, stretching from California in the West, to Florida in South and New York in the Northeast.

Although next year will be the official “year of integration,” McPherson said all of Trinity’s nationally owned and regionally owned home health operations have started coming together to communicate and share best practices. 

“There are some things that Mercy Home Health does better than Trinity Health At Home,” he added. “There are some things that Trinity Health At Home does better than Mercy Home Health. We’re taking the best practices of both putting them together.”

Based in Livonia, Michigan, the overarching Trinity Health includes 92 hospitals and 100 continuing care locations, including PACE programs and senior living facilities, plus home health and hospice services. In total, its continuing care programs provide nearly 2 million visits, annually.

Trinity Health has annual operating revenues of about $18.8 billion and assets of $30.5 billion, with the organization returning about $1.3 billion to its communities in the form of charity care and other benefit programs.

‘We’re doing our best to prepare’

During the spring surge, Trinity Health At Home and Mercy Home Health collectively recorded about 400 COVID-19 cases among patients. For context, the two organizations jointly have a combined census of about 7,000.

When HHCN connected with McPherson and Martynowicz in September, Trinity Health At Home and Mercy Home Health collectively had about 130 cases. Even with cases spiking across the country, that figure has held steady throughout October, the executives confirmed on Wednesday.

Over the last week, the U.S. has averaged about 59,000 new cases a day, with hospitals in some states once again approaching full capacity, reports The New York Times. The daily total could soon surpass 75,687.

“We’re doing our best to prepare for [a fall surge],” McPherson said. “We have an ample supply of PPE, and we’ve never really gotten away from conserving PPE, impressing upon everybody that we need to use the right mask for the right situation.”

To mitigate some of the pandemic’s challenges and the nursing shortage, McPherson said he hopes that lawmakers and the U.S. Centers for Medicare & Medicaid Services (CMS) will come together to create a pathway for telehealth reimbursement in home health care.

“Telehealth also allows us to use the same amount of nursing resources to treat more patients,” he said. “And that’s what we need to be able to do.”

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Home Health Providers Find Telehealth Reimbursement in Palliative Care

Telehealth adoption has dramatically increased across health care during the COVID-19 crisis, including in the home-based care space.

On their end, home health providers have built out their telehealth programs to make more comprehensive and safer care plans for their patients. Unlike other health care practitioners, however, it is much more difficult for a home health provider to get paid for virtual visits.

That has forced them to get creative.

For instance, Ohio Living Home Health, a large home- and community-based services provider that conducts over 170,000 home health visits per year, has been able to bill for palliative care remote patient monitoring under Medicare Part B.

It has been unable to bill for those remote services in home health, but still conducts those virtual visits anyway.

“The [reimbursement] is provided under the palliative care program, not home health,” Yvette Valentine, director of office operations at Ohio Living Home Health, said last week at the Vision to Virtual conference hosted by Health Recovery Solutions. “So the patient is on home health, and we’re still billing our home health services under Part A. And then if the patient is on palliative, that billing is done under Part B, along with remote patient monitoring.”

In order to recoup some reimbursement for telehealth labor, it has also worked with commercial groups, such as UnitedHealthcare and other Medicare Advantage payers.

Fairhaven, Massachusetts-based Southcoast Visiting Nurse Association has had similar experiences to Ohio Living Home Health. It is unable to receive reimbursement for home health remote visits, but still receives some payments from the U.S. Centers for Medicare & Medicaid Services (CMS) on its palliative care side of the business.

The agency — which serves over 9,000 patients per year in Massachusetts — is also expanding its home health telehealth services, despite the lack of reimbursement.

“We are not currently receiving reimbursement through CMS for home health remote patient monitoring,” Jessica Magalhaes, the agency’s telehealth program leader, also said at the conference. “But we’re working to expand the program by partnering with Southcoast’s ACO group.”

Broadly, palliative care has become increasingly prevalent among home- and community-based organizations’ service lines.

A 2019 report published in the Journal of Pain and Symptom Management highlighted that serious health-related suffering will almost double by 2060 in the U.S. Those projections suggest that an emphasis is needed on palliative care.

That’s also reflected in recent changes to Medicare Advantage supplemental benefits over the last few years. More and more MA plans are paying agencies to provide palliative care to their beneficiaries, which could provide tailwinds for both home health and home care agencies in the future.

CMS last expanded the list of telehealth services that Medicare fee-for-service will pay for during the coronavirus public health emergency on Oct. 14. As a result of the expansion, Medicare now pays for 144 services performed via telehealth.

Between mid-March and mid-August 2020, over 12.1 million Medicare beneficiaries – or over 36% of people with Medicare fee-for-service — have received a telemedicine service.

Finding partners

Not all home health providers are new to telehealth. As a provider that deals with patients on a slew of islands in the Northeastern part of the U.S., telehealth has been a part of MaineHealth Care at Home’s business since the turn of the century.

Its experience is an advantage in the space. So is the state it operates in, as Medicaid does currently reimburse for telehealth services in Maine.

Still, while telehealth is a must for the organization, its reimbursement still lags, especially in home health care.

“We’re doing quite a bit [of telehealth] in rural Maine,” MaineHealth Care at Home Donna DeBlois said at the conference. “We’re not getting paid very well, but we are trying to pursue partnerships with our Maine medical partners to be able to do Part B billing for telehealth.”

But COVID-19 has helped its patients and their families become more comfortable with telehealth overall, and the strides made over the last year, DeBlois hopes, will pay dividends moving forward.

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Home Health Agencies Need to be ‘Best of the Best’ to Land MA Business

As Medicare Advantage (MA) enrollment explodes and plans begin to offer more benefits to members, home health and home care agencies alike need to prove their value in order to gain new business.

Specifically, home health providers need to demonstrate how they can lower costs and potentially add members for MA plans.

“The important thing is to make sure that we understand the Medicare Advantage plan’s goals, and what the value proposition that home health agencies can provide to them is,” Jeff Aaronson, the consulting director at McBee Associates, said Monday at the National Association for Home Care & Hospice’s (NAHC) 2020 conference.

Wayne, Pennsylvania-based McBee Associates is a health care services and consulting firm that offers financial, operational and clinical help to health care providers across the health care continuum.

Overall, MA enrollment increased by 60% from 2013 to 2019, according to recent statistics compiled by actuarial consulting firm Milliman. During that same period, enrollment in traditional Medicare increased by only 5%.

On their end, that’s what MA payers want more than anything — more individuals signing up under their plans. But they also want to see cost containment and to find better models for care, Aaronson said.

“[These payers] are looking at how to develop new effective models of care and how can they take better care of their patients,” Aaronson said. “So they’re very much a disruptive force in the industry — but in a very positive way — looking for creative ways to reduce hospital stays, reduce trips to the emergency rooms [and much more].”

To forge successful MA relationships, home health agencies need to use data to prove their worth across multiple areas.

That shouldn’t be too difficult for agencies. Most have spent years working with complex patients, individuals that MA payers need help keeping healthy if they are going to continue to add beneficiaries while keeping costs manageable.

“They want to align with the best of the best,” Aaronson said.

Being “the best of the best” means having good star rating patient-satisfaction scores. It also means constantly lowering rehospitalization and ER rates while filling care gaps across settings.

Increasingly, Medicare Advantage entities are additionally looking to contract with providers that have a larger array of services. That has been a persistent trend in the home health space, as more agencies enter into palliative care and other service lines.

“A way to better enhance your value and to better enhance your negotiating standpoint is having a bundle of service lines to provide, such as home health, hospice, personal care [and others],” Aaronson said.

Agencies that can operate across the continuum of care are immediately more valuable to MA plans because of their flexibility.

Additionally, having non-traditional capabilities in line with the new Supplemental Benefits for the Chronically Ill (SSBCI) program is also an advantage.

Broadly, SSBCI is all about keeping patients healthy before their condition becomes acute. Pre-acute care — the category of non-medical home care that agencies have increasingly been paid by MA plans to provide — is very valuable from a cost perspective.

That pre-acute care includes having the capability to keep members from falling, for example. It likewise includes helping them with transportation and nutrition, among other activities of daily living.

“Can you provide some of those services within your organization that will appeal to the MA plans to help keep those patients healthy and avoid expensive hospital stays?” Aaronson said.

Keeping track of fall rate statistics is a good place to start for home health agencies looking to market themselves to MA organizations. Tracking data, in general, is vital, including an agency’s cost-per-visit, supply cost and cost-per-beneficiary.

Geography can similarly be beneficial, depending on where an agency is located, especially if it operates in a certificate of need state.

“Specific counties that you operate in may have very little competition,” Aaronson said. “There might not be that many different agencies in certain counties. If you can find where [the] map of MA plans matches your map, there’s a great opportunity there.”

Home health is a relationship-based business. But in the MA world, contracts depend on what an agency can do for plans and their ability to prove that value.

“If you can’t provide value to those MA plans, then it just becomes a transactional relationship, … and that’s what we don’t want in this industry,” Aaronson said. “We want to be partners with the MA plans.”

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Wildfires, COVID-19 and PDGM: Growing a Home Health Business During Moments of Crisis

Home health agencies are used to operating during moments of crisis. That’s especially true for California-based Medical Home Care Professionals, which has had to overcome several over the past few years.

In 2018, for example, Medical Home Care Professionals operated during the historic Carr Fire that devastated nearly 230,000 acres across California’s Shasta and Trinity counties. This year, the agency has experienced the indirect consequences of more wildfires and the direct impact of the COVID-19 virus — all while transitioning to the Patient-Driven Groupings Model (PDGM).

To find out what it takes to stay afloat during such turmoil, Home Health Care News recently caught up with Elaine Flores, the COO of Medical Home Care Professionals, for its latest episode of Disrupt. Highlights from the conversation are below, edited for length and clarity.

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HHCN: Before talking about the 2020 wildfires and operating during moments of crisis, can you provide some background on your agency?

Flores: Medical Home Care Professionals is a locally owned and operated home health agency in Redding, California. We also do custodial-type care. Our owner, Kathy McKillop, founded the company in 1985. We’re celebrating our 36th anniversary this October. Kathy was — and still is — a licensed vocational nurse. She had a patient at one of the local hospitals who wanted to go home. She felt that she could make that happen, so she took him home and started caring for him, providing 24-hour services. That was just what our community needed.

We’re now serving over 300 patients, with about 120 employees. We’re a Medicare-certified home health agency as well as a state-licensed home health agency for California. We work heavily with the MediCal program. We service all age demographics, from infants to geriatrics. We even do end-of-life work.

Your agency has had to walk a rocky road over the past few years, jumping from crisis to crisis. You operated through forest fires in 2018, then a historic blizzard after that. Now, you’re facing more forest fires and the COVID-19 virus. What has that been like?

In July 2018, our community had a fire called the Carr Fire. It started at our beloved Whiskeytown Lake, which is about 15 or 20 miles from the center of town. It started by accident. A vehicle was towing a trailer. A spark started a fire or something along those lines. The fire was burning in the wooded areas by the lake, but then the wind shifted and everything got really scary. We started losing structures as the fire moved.

As an agency, we had to put our emergency preparedness plan into action. For some context, the U.S. Centers for Medicare & Medicaid Services (CMS) in 2015 announced it was coming up with new Conditions of Participation (CoPs) for home health agencies. We started evaluating ourselves and preparing for these different CoPs, which included stricter requirements around agencies’ emergency-preparedness plans.

That benefited us. Overall, we felt that we were pretty prepared. When that fire started encroaching upon residential areas within our community, we were able to implement our plan, quickly alerting patients and coordinating evacuations. We evacuated patients into the Chico, California, area. In some instances, we evacuated them into skilled nursing facilities (SNFs). Our rock-star staff worked tirelessly to coordinate care for, at that point, 275 patients.

We had our command post at our office. Our first priorities were identifying high-risk patients and alerting the caregivers. We had employees losing homes. We had patients losing homes. We had to reassign staff, reassign patients. It was quite challenging.

How does that situation compare to the wildfires now?

Right now, we’re pretty safe. Our fire season doesn’t end until December, though. Who knows what can happen between now and then. Right now, we’re dealing with bad air quality. I’ve had to send staff members home because they may have an underlying condition like asthma, which could lead to difficulty breathing.

There was one day last week where it was 9:30 a.m., but it was pitch black because of the smoke.

What have been the keys to staying afloat and delivering care during these disasters? Again, you also operated through a historic blizzard right after that 2018 fire.

Having the right team is the key to it. Everybody on our team has that “I will do whatever we need to do to ensure that our patients and our employees have what they need” menality.

In regard to the blizzard, we had tons of snowfall for our little town, this torrential downpour of just snow. My phone immediately started going off the morning we woke up to it. It was my staff. We had people who couldn’t get to work. We had patients who had caregivers that were on shift that needed to be relieved.

We started another “command central.” We found people with big, big vehicles to get us into the office. When we got to the office, though, we were locked out because the roof had collapsed onto our main door. We had to get real creative, real quick.

How are you doing in regard to COVID-19? That can’t be a good mix with the smoke and breathing issues.

Everybody’s just trying to remain calm, remain vigilant. In the office, we have specific procedures that everybody follows. We wear masks within the office. We’re protecting each other in that respect. We’ve all tried to make sure we’re wearing the appropriate personal protective equipment (PPE) when delivering one-on-one patient care. All of our clinicians are screened over the phone on a daily basis, asked very specific questions. That’s all documented. Do you have a fever? Do you have shortness of breath? In terms of the intersection of COVID-19 and the fires, we want staff to change out their masks more frequently because of the smoke.

I know a lot of home health agencies are at a new normal when dealing with the coronavirus. At what point did Medical Home Care Professionals start to feel the impact?

We felt it when Governor Gavin Newsom issued the emergency order to stay at home — the shelter-in-place order. I remember it vividly. It was on March 18. We felt the shift right then and there. The next day, we came into the office and called our CEO. She was so supportive and said, “You guys, let’s think of the best way to do this. Let’s figure out what the shelter-in-place order means for our team.” We started looking at working from home. So, early March is when we felt the shift from COVID.

Shasta County has not had a very elevated conversion rate for COVID-19. I think we’re sitting at maybe 650 to 675 positive COVID cases since March. We really haven’t had big time exposure like most bigger cities. But we took every precaution that we needed to take, knowing what we knew. About 75% of our workforce is at home. We started doing multidisciplinary Zoom meetings.

How is Medical Home Care Professionals preparing for the fall COVID-19 surge?

We’ve taken a look at all of the protocols that we’ve put in place for COVID-19. We are also really promoting flu shots. We’ll start calling patients maybe more frequently than once a day — maybe a couple times a day. The other thing that we are going to do is continue ordering our PPE as we can get it. When this first occurred, who would have ever thought I would need to send one of my clinicians into the home in full PPE? We didn’t have an abundance of gowns. We didn’t have an abundance of N95s or surgical masks. We had to create our stockpile from nothing. We went from purchasing a box of surgical masks for $5 to now $50.

Did you come across any fraud schemes or shady PPE experiences?

We did. We were following a lot of our colleagues that were in the southern and central parts of the state. They were giving us leads on different entities. We went ahead and purchased 2,000 surgical masks from a vendor at one point. Our friends at Kaiser had purchased 1 million, so we thought it must be a good, reputable company. Well, they never got their supplies. Actually, they got them, but three months later. So did we, which is frustrating. There was another shipment, I recall, that came in — and the masks were soiled. They had molded, so we had to fight to get a refund for those.

We’ve talked about wildfires, a winter storm, the ongoing public health emergency and PPE scams. On top of all that, you’re also facing the transition to PDGM. How has that gone?

It’s gone. We were prepared for it. A couple years prior to launch, we had been to numerous conferences through our state association. We felt that we had a good ramp up for it. PDGM really has the philosophy of how we run our business anyway. We are in communication with our clinicians and with our patients on a daily basis. Care coordination is amazing at our agency. Our nurse leaders really coordinate patient care from the beginning of care to discharge. We had just a few areas where we needed to pivot.

That was with, for example, billing processes and Low Utilization Claims Adjustments (LUPAs). We had to understand all of the new ways that we were going to get reimbursed, then share that with our clinical team so they were more aware of the financial impact. But we’re doing okay with PDGM. Yes, we have had some challenges, some curveballs in there. But we’ve been able to adapt and pivot while working together as a team.

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M&A Experts ‘Can’t Recall a Time When Demand Has Been Higher’ in Sizzling In-Home Care Market

M&A activity across home health, hospice and in-home care appeared to be “business as usual” at the start of 2020. COVID-19 froze the market in March, however, causing both buyers and sellers to bide their time.

But dealmaking action is finally starting to heat up again, multiple M&A experts confirmed to Home Health Care News.

In the past few weeks alone, for example, Charter Health Care Group announced its purchases of Vitality Home Healthcare and Heartwood Home Health & Hospice. Meanwhile, Bridges Health Services announced a series of mergers with various home health and hospice providers. Most recently, Chicago-based private equity firm the Vistria Group agreed to sell St. Croix Hospice to an affiliate of investment company HIG Capital.

To get a better understanding of the developing M&A market, HHCN asked several experts to provide insight into what they are currently seeing in the final months of 2020. They also touched on 2021 expectations.

* * *

I’ve been selling home health agencies since 2006, and can’t recall a time when demand has been higher. Since July, we have received more calls from both strategic and financial buyers looking for home health than I can ever recall in a three- or four-month period.

While hospice M&A has dominated the spotlight these past couple years, home health M&A has cooled off. The uncertainty of the Patient-Driven Groupings Model (PDGM) caused both the strategic and financial buyers to hold off on any significant home health investments until after dust settled on the overhaul. We expected buyers would be ready to engage in the second quarter of 2020, but COVID-19 delayed that by a couple months in April and May.

With the public companies, which are the ultimate consolidators, the long-term strategy remains the same. They want to have all three legs of the stool: home health, hospice and personal care. And they want that in each of the markets they serve. As a practical matter, most of these companies are really focused on filling out the skilled side first. As recently as three years ago, most of these strategic buyers had a significantly larger home health presence than hospice. That has changed.

As a result of the aforementioned hospice M&A activity and a lot of denovos, many of these strategic buyers are now shifting their attention back to penetrating new markets via home health acquisition, which they will then complement with hospice and at some point, plus personal care.

My crystal ball is clouded somewhat with an election less than a month away and a threat of another significant COVID outbreak, but I’m going to go out on a limb and speculate we will see near-record — if not record — home health M&A activity between Q4 2020 and Q1 2021.

— Cory Mertz, managing partner at Mertz Taggart

* * *

In order to provide an appropriate context to understand how 2021 is setting up, we must first look back to this time last year. There was a mixed level of excitement regarding the forecasted 2020 home health merger and hospice acquisition marketplace.

Home health owners were facing PDGM implementation with certain uncertainty. Hospice owners were enjoying uncounted unsolicited calls and emails from buyers asking for “just a few minutes of their time.” A tale of two cities!

Since mid-March, the COVID pandemic “tripped the breaker” on scheduled and intended home health and hospice deals — or did it? Data researched and compiled exclusively by The Braff Group may come as a surprise to some.

Home Health’s expectation for a “down” year appears to be on track as expected; 42 projected deals vs. 60 transactions in 2019. Similarly, during the past five years, we’ve documented 296 completed deals; averaging just under 60 per year.

Looking ahead to 2021, home health will start off slow but pick up greater deal activity as the year unfolds, especially for mid- and larger-size agencies.

There are several reasons for this. Sellers, as well as buyers, will be well past the initial shock of dealing with COVID-19 and have settled into new daily norms and routines. While we have not completely recovered, many agencies have returned to pre-COVID levels of activity. Once preoccupied within their own portfolio companies, private equity firms now are back aggressively looking to build up their pipelines and line-up deals to get done. By many indicators, home health, and especially hospice valuations remain at all-time highs.

— Mark Kulik, managing director at The Braff Group

* * *

I do believe we will continue to see in-home care M&A acquisitions pick up. I believe that dual-service-line providers will continue to get more traction in the market. Hospice continues to be a valuable target for both strategic and sponsor buyers. We believe that home health-only agencies will continue to be challenged with admissions and the PDGM RAP reductions in cash flow.

According to a survey by the National Association for Home Care & Hospice (NAHC), almost 80% of home health agencies have experienced a decline in admissions due to the pandemic, with a majority of agencies reporting a decline of greater than 15%. Although elective procedures and routine visits are beginning to open up across the U.S., we are still seeing agencies struggle with therapy-heavy episodes and facility-based patient admissions. With the decrease in admissions, timing for presenting the company to buyers may cause them some reservations until the agency has proven stabilization related to admissions and Low Utilization Payment Adjustments (LUPAs).

In regard to the future of dealmaking in this space, agencies with both home health care, private duty and hospice service lines will be more eye-catching to potential buyers. Diversification of service lines will remain attractive.

— Tom Maxwell, co-CEO at Maxwell Healthcare Associates

* * *

With the onslaught of the COVID-19 pandemic in early March, it quickly became pretty clear that M&A activity generally, as well as with in-home care, was going to slow down significantly through the balance of Q1 and likely until the middle part of Q2. We thought we would begin to see an uptick in deal activity around mid-June and after, and that assessment has more or less turned out to be accurate.

While business travel and group meetings have continued to be on-hold for many, sourcing deals, discussions among transactional parties, diligence and other deal-related activity has adapted to the new “normal” through virtual meetings, conference calls and increased use of outside support such as law firms like ourselves and other industry transactional advisors and consultants.

Since mid-June, we have seen a marked increase in “deal talk” among sellers, buyers, bankers, investors and lenders both in home care and hospice, and we are currently working on a number of home care and hospice transactions across the country.

As transaction parties have begun to understand better some of the COVID-19 related factors and issues and their impact on deals, valuations have stabilized and in some cases increased. We expect to see a continuing surge of deals as both PE and strategic players seek to add bolt-on transactions in their markets and additional platforms where available.

Capital remains generally available to acquirors, and both home care and hospice are being seen as more stable health care verticals with the ability to give patients an alternative environment to group settings like hospitals and nursing homes. That is an additional important consideration to patients and payers in this COVID-19 era.

In sum, all indications are that absent a systemic disruption, home care and hospice deal activity should continue to be active through 2020 and well into 2021.

— Les Levinson, co-chair of the national health care transactions practice at Robinson & Cole LLP

* * *

At the onset of the coronavirus pandemic, there was uncertainty of the impact of the virus across all sectors of the health care industry. The practicalities of country-wide lockdowns, coupled with high-risk patients who were reluctant to allow providers into their homes, led to weaker performance for in-home health care companies. For companies that qualified, government stimulus in the form of Paycheck Protection Program (PPP) loans alleviated cash flow concerns and allowed many providers to weather the storm. As a result, M&A activity slowed and deal activity was put on hold.

We are eight months into the pandemic, and M&A activity has accelerated. Transactions that were on hold are ramping up. Valuations are strong. Buyers are becoming more active as additional investment opportunities arise, and the upcoming U.S. presidential election seems to be motivating dealmakers to close deals before the end of the year.

In-home health as a “buy-and-build” strategy is attractive to investors as the sub-segment is highly fragmented. Buyers executing a consolidation strategy backed by a scalable platform for growth and supported by strong processes and systems, along with a well thought-out integration plan for acquisitions to achieve synergies, should experience robust investment returns.

— Claudine Cohen, managing principal, transactions and turnaround advisory at CohnReznick

* * *

It is a sobering truth that if you follow the money, you usually find the answer, or at least the motivation. Currently, investors are deploying massive amounts of capital to acquire home care agencies. The interest is at record levels. The money is telling us that we’re on the threshold of a golden age for home-based care. The growth of home care will be of great benefit to the patients. Let’s hope this growth trend continues.

— Andre Ulloa, principal at American Healthcare Capital

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NAHC Pushing for Palliative Care, SNF-at-Home Medicare Benefits

As home health and home care operators move toward the ninth month of the COVID-19 pandemic, it’s important to take stock of what has been accomplished from a policy perspective. Many of 2020’s regulatory changes will be fleeting, but others will shape the future of post-acute care for years to come.

That was the message delivered Monday by National Association for Home Care & Hospice (NAHC) President William A. Dombi during the nonprofit advocacy organization’s annual conference. In addition to providing a regulatory recap, Dombi hinted at new Medicare benefits on the horizon and explained how the value of home-based care is at an all-time high.

“There has been an increased awareness of the breadth and depth of care at home, and this will have a long-standing impact on policy and politics as well,” he said. “There has been an absolute, exponential increase in respect for what you do in the home care setting. We took the stresses of the pandemic head-on and proved that care in the home is not only essential but [the best option].”

During Monday’s Washington update, Dombi revealed that 67% of in-home care providers are serving COVID-19-positive patients.

To support them in delivering that care, providers have been able to lean on a variety of lifelines, including funds from the CARES Act Provider Relief Fund and the Paycheck Protection Program (PPP). Providers have also received essential-worker classification and greater telehealth flexibilities.

Additionally, the U.S. Centers for Medicare & Medicaid Services (CMS) has recognized that virtually the entire Medicare population meets homebound status requirements.

“When you’re Medicare eligible, over the age of 65 or on disability, and you need health care services, you have a compromised condition to put you at even greater risk of fatality,” Dombi said. “CMS agreed with our position on this and issued interpretive guidance indicating that individuals who need to leave the home for services, it is medically contraindicated, thereby meeting the homebound standard.”

During the public health emergency, CMS also paused claims audits and the Review Choice Demonstration (RCD), a regulatory initiative designed to reduce improper billing in home health care. That has since been restarted, with temporary administrative flexibilities.

COVID-19 testing, non-physician certification

At the end of September, the U.S. Department of Health & Human Services (HHS) announced that home health and hospice agencies would receive 10 million rapid COVID-19 tests from a federal inventory of about 150 million. Dombi likewise touted that as a win.

In the first week of distribution alone, he noted, about 160,000 tests were distributed to home health and hospice agencies.

“The fact that HHS recognized that home care was an essential part of health care services and made us part of that allocation in itself is a notable success,” Dombi said. “Just being recognized, not being considered some stepchild in health care.”

Among the other topics he touched on during his Washington update, NAHC’s president highlighted excitement around non-physician certification, something the home health industry had been working toward for years.

Senator Susan Collins (R-Maine) first introduced legislation that pushed for this change in 2007.

“We found ourselves in the middle of discussions, negotiations and advocacy with the CARES Act, and Senator Collins said, ‘I think this is our chance to get it done.’ [She] was able to convince the Senate that now is the time to allow non-physician practitioners to have equal status with physicians, to the extent that the state law allows it within the Medicare home health benefit,” Dombi said.

New Medicare benefits

Despite making major inroads across various fronts, there are still a number of measures that need to be taken.

For one, providers are still on the lookout for the next coronavirus-related stimulus package, which was originally expected before the July 4th Congressional recess, then again before the August recess.

“This is a back and forth that’s happening between the House and the Senate, between Republicans and Democrats,” Dombi said. “We’re still looking to see if we can have something before they go on recess in October, but we’re planning also for a lame-duck session on it.”

As far as what providers hoped to see in the next package, the list includes continued funding for the Provider Relief Fund, plus expanded funding for Medicaid home- and community-based services. The list also includes premium pay for front-line workers and litigation immunity.

Another area of focus for NAHC is palliative care. The organization is moving to get revisions in the Medicare coverage manual under home health care to fully recognize palliative care as one of the services provided as part of the existing benefit.

“We don’t think we need Congressional action to get there,” Dombi said. “Some of you — maybe many of you — are already doing things that would qualify as skilled palliative care under the benefit and getting Medicare to pay for it.”

Home health providers can also expect to see the 2021 payment rule finalized before the end of October or during the first few days of November. NAHC is calling on CMS to roll back the 4.36% behavioral adjustment in the Patient Driven Groupings Model (PDGM) ahead of the announcement of the final rule.

“It’s not just because we are in this unprecedented year of COVID-19,” Dombi said. “CMS projected a decrease in [Low Utilization Payment Adjustments], as they thought home health agencies would try to maximize 30-day episodic reimbursement. We have seen just the opposite of that, partially influenced, of course, by COVID-19.”

Additionally, NAHC is pushing for the creation of a new benefit that will allow for a skilled nursing facility (SNF) level of care at home.

“We have designed a [SNF-at-home] benefit to give individuals on the Medicare program the option of going home with expanded services,” Dombi said. “We think the design will work to be a win for the Medicare program as well. It’s been proven that you can provide less costly and high-quality care at home.”

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As Malpractice Claims Against Home-Based Care Nurses Rise, Providers Must Focus on Risk Management

When it comes to malpractice claims, home-based care nurses are often more susceptible compared to their counterparts in other nursing specialties.

That’s a fact that has held true for a while, too. Home-based care nurses — including home health, hospice and palliative care professionals — have seen a steady rise in professional liability claims since 2011.

Overall, home-based care accounted for more than 20% of total closed claims against nurses in 2020. This is a sharp increase from 12.4% in 2015 and from 8.9% nine years ago, according to a recent nurse professional liability exposure claim report from CNA Healthcare Underwriting and the Nurses Service Organization (NSO).

In comparison, professional liability for nurses in other areas of aging services — independent living, assisted living, memory care and skilled nursing — only accounted for 11.2% of claims in 2020, according to the report.

There are several factors that contribute to why there are more malpractice claims in home-based care than any other nursing specialty, Georgia Reiner, a risk specialist for NSO, told Home Health Care News.

For one, there’s an increasing acuity in patients who receive care in the home. That’s a trend that has only accelerated in 2020 due to the COVID-19 virus and a general rise in hospital-at-home models.

“There are more older adults in this country — as the boomer generation ages and more of those patients wish to age in place — in their homes,” Reiner said. “You also have health care organizations being incentivized to discharge their patients from hospitals and nursing homes as soon as possible.”

Matt Wolfe, a partner at law firm Parker Poe, echoed those sentiments, noting that the increase in liability claims is likely linked to the health care system’s ongoing shift toward home. In addition to hospital-at-home programs, that shift includes SNF-at-home models, in-home cancer care initiatives and more.

“I think it’s a reflection of the fact that more and more services are being provided in home- and community-based settings, which, I think, is a good thing for patients and for our health care system, writ large,” Wolfe told HHCN.

Another factor contributing to the spike in liability claims: nurses working in the home often lack the institutional support of their counterparts in hospitals, skilled nursing facilities (SNFs) and other health care organizations.

“This may mean that there are fewer providers who are also available, who can help catch key opportunities to prevent adverse patient events,” Reiner said. “And then there’s also less technology available in the home to help catch key opportunities to prevent adverse events for patients. There are also fewer providers who can share liability when things do go wrong for patients.”

Reiner also pointed out that the majority of care that takes place in the home setting is delivered by unlicensed assistive personnel and CNAs. This, in turn, places more responsibility on home-based nurses, such as RNs, LPNs and LVNs, for patient’s overall care.

Risk management

The findings from the CNA Healthcare Underwriting and NSO report are an indication that home care agencies should focus even more on what they can do to manage risk.

“Risk management is as important to an agency’s mission as anything else it does,” Wolfe said. “That includes human resources, customer service and clinical practices. You really need to make sure that you are addressing issues or preventing bad events from happening in the first place.”

There are a number of things that providers can do to manage risk, according to Wolfe.

For example, sound hiring practices can ensure agencies are hiring the most qualified job applicants. Robust training programs can additionally make sure in-home nurses have all the education and tools they need to succeed.

Similarly, maintaining regular oversight practices can also help uncover bad habits or minor hiccups among in-home care staff — which can then be promptly corrected.

Additionally, providers should work closely with their malpractice carriers, Wolfe stressed.

“There’s a lot that can be done between an adverse event happening and a claim being filed,” he said. “I think redoubling efforts on that accord is really important. I would strongly encourage agencies to work with their malpractice carriers to figure out the best ways to address those issues and, really, to try to resolve disputes before they even rise to the level of filing a claim.”

On their end, nurses can take a number of steps to help lower the chances of malpractice claims.

“I think that nurses individually can make sure that they’re practicing within their scope,” Wolfe said. “They can make sure they’re staying in communication with the supervising physician or the physician that is signing the plan of care.”

Nurses can also make a concerted effort to routinely communicate with their office and administrative staff. If they do have concerns on the job, nurses should “speak up immediately,” documenting concerns while double checking that any interventions are appropriate.

Reiner also emphasized the importance of patient assessments and documentation for nurses.

“Beyond screening at the commencement of services, reassessments should also occur at least every six months, or any time that a patient’s condition or needs change,” she said. “All of these assessments and reassessments need to be documented, including any other individuals who may have participated in the process beyond the nurse themselves. Any changes in the patient’s condition should also elicit a revision to the patient’s service plan.”

Nurses should also keep a close eye on the duties they delegate to unlicensed assistive personnel or caregivers. This ensures they don’t provide any clinical care that goes beyond their training or the regulatory limits, according to Reiner.

Ultimately, it’s important to recognize that malpractice claims are a part of being in the health care sector.

“You can’t do anything to eliminate the risk, but there’s a lot of things that you can do to reduce these risks so that, whether you’re a nurse, agency director, or an owner, you can sleep well at night,” Wolfe said.

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Most Home Health Aides ‘Can’t Afford Not to Work’ — Even When Lacking PPE

In March, Sue Williams-Ward took a new job, with a $1-an-hour raise.

The employer, a home health care agency called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.

Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving turkeys and Christmas hams.

Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.

Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women. One was blind, one was wheelchair-bound, and the third had a severe mental illness. None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.

Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not respond to multiple phone and email requests for comment about the PPE available to its workers.

Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity and freedom.”

He said that within three days Williams-Ward was coughing, too. After six weeks in a hospital and weeks on a ventilator, she died of COVID-19. Hers is one of more than 1,200 health worker COVID deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.

During the pandemic, home health aides have buttressed the U.S. health care system by keeping the most vulnerable patients — seniors, the disabled, the infirm — out of hospitals. Yet even as they’ve put themselves at risk, this workforce of 2.3 million — of whom 9 in 10 are women, nearly two-thirds are minorities and almost one-third are foreign-born — has largely been overlooked.

Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve often done it all on poverty wages, without overtime pay, hazard pay, sick leave and health insurance. And they’ve gotten sick and died — leaving little to their survivors.

Speaking out about their work conditions during the pandemic has triggered retaliation by employers, according to representatives of the Service Employees International Union in Massachusetts, California and Virginia. “It’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.

The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it: “This is exactly what structural racism looks like today in our health care system.”

Every worker who spoke with KHN for this article said they felt intimidated by the prospect of voicing their concerns. All have seen colleagues fired for doing so. They agreed to talk candidly about their work environments on the condition their full names not be used.

***

Tina, a home health provider, said she has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.

Like many of her colleagues — 82%, according to a survey by the National Domestic Workers Alliance — Tina has lacked protective equipment throughout the pandemic. Her employer is a family-owned company that gave her one surgical mask and two pairs of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.

When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked. “It felt like I was in a Third World country,” she said.

The home health agencies that Tina and others in this article work for declined to comment on work conditions during the pandemic.

In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of home health providers begins with American labor law.

The Fair Labor Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era. The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance. Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”

“A deliberate decision was made to discriminate against colored people — mostly women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah Yearby, a law professor at St. Louis University.

In 2015, several of these exceptions were eliminated, and protections for home health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University. “But the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”

Burkett McInturff, a civil rights lawyer working on behalf of home health workers, said, “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”

The Occupational Safety and Health Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment Law Project. Berkowitz is also a former OSHA chief. In her view, political and financial decisions in recent years have hollowed out the agency: It now has the fewest inspectors and conducts the fewest inspections per year in its history.

Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers. This loophole protects them from the responsibilities of employers, said Seema Mohapatra, an Indiana University associate professor of law. Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”

Should workers contract COVID-19, they are unlikely to receive remuneration or damages.

Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said. As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.

Many home health providers care for multiple patients, who also bear the consequences of their work conditions. “If you think about perfect vectors for transmission, unprotected individuals going from house to house have to rank at the top of list,” Kohn said. “Even if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”

Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work. Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from previous work injuries — has no other option but to risk getting sick.

“I can’t afford not to work. And my clients, they don’t have anybody but me,” she said. “So I just pray every day I don’t get it.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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ProMedica Home Health Care, Banner Health Home Care Share Best Practices for Virtual Visits

The COVID-19 emergency has triggered a rise in the use of telehealth strategies to deliver care, especially virtual visits.

In fee-for-service Medicare alone, the number of virtual visits delivered each week in the U.S. skyrocketed from 14,000 pre-coronavirus to more than 1.7 million during the pandemic’s peak, according to Department of Health and Human Services (HHS) Secretary Alex Azar.

Although in-person visits still dominate in the space, many home health providers have added virtual visits to their operating mix, with many planning to continue them even after the pandemic subsides.

Despite their benefits, virtual visits pose unique challenges for providers carrying them out for the first time. To avoid unexpected speed bumps, there are several best practices home health agencies and other providers should consider.

In some ways, the public health emergency has exposed the shortcomings and limitations of current health care delivery systems, Kim Putnam, telehealth supervisor at ProMedica Home Health Care, said Thursday at the Vision to Virtual event, hosted by Health Recovery Solutions (HRS).

“I’m not going to say there’s anything good about this pandemic,” Putnam said. “However, it has certainly catapulted the term ‘telehealth’ out into the public.”

ProMedica Health System includes 13 hospitals across Michigan and Ohio. ProMedica Senior Care, the company’s post-acute care arm, includes skilled nursing facilities (SNFs), outpatient rehab, hospice and home health care.

For providers that are implementing telehealth programs, technical and functionality preparation is crucial.

That includes keeping IT teams connected and updating them about any technical issues that pop up during telehealth implementation. Doing so will go a long way in establishing a provider’s credibility when setting up their telehealth program, according to Putnam.

“When you begin your endeavor to do telehealth, … your IT departments have got to meet, and they’ve got to have support from each other and from your vendor,” she said. “There’s got to be interoperability so that when you get out to the home, you’re not having the frustration of the technology not working. There’s nothing more frustrating for the installer, the nurse and the patient when you get out there and something doesn’t work.”

It’s also important for providers to set up a “telehealth hub,” or central location in the office specifically for virtual visits.

At one of ProMedica’s locations, the telehealth hub is a back area that is walled off from the main office. The necessary equipment is also set up in this space, according to Putnam.

“You want to ensure that you’ve got a quiet zone,” she said. “You want to make sure that others are aware that the virtual visit is occurring. We have a little sign that we put up outside that says ‘virtual visit in progress,’ because there are folks that walk through this area. This ensures they’re not carrying out a conversation that could be overheard by the patient that’s in the home.”

Putnam also emphasized the importance of setting aside time for new nurses to practice using the equipment. This can be achieved by facilitating “mock” virtual visits.

“They may be a little intimidated at first,” Putnam said. “They’re kind of fumbling with the equipment, but once they get a comfort level … that kind of anxiety seems to step away.”

To this end, creating scripted scenarios can also be helpful in getting new nurses acclimated.

When working with patients, Putnam stressed the importance of calling them by their name, making sure they have the provider’s undivided attention and conducting a follow-up call with them the next day.

“Our overall goal should be patient engagement,” Putnam said.

One company, Banner Health Home Care, has been able to leverage virtual visits to better serve their clients that receive social work services.

“We have more patients than social workers,” Mandy Johnson, care coordination and post-acute senior manager at Banner Health Home Care, said during the event. “By using video visits, we’re able to connect with more patients than if we had to drive to each of their homes. We still do in person visits, but this allows us … to meet them where they’re at or to do those check-ins.”

Banner Health Home Care has six branches in Arizona and Colorado. The company’s average daily census is roughly 2,500 to 3,000 individuals served.

The opportunity for increased patient engagement is a key benefit of virtual visits, according to Johnson.

“When you talk to a patient over the phone, you’re not always able to tell if they’re engaging in the conversation,” she said. “You can’t always tell if they’re interested in what you have to say, or if they’re at a place in time where they’re ready to hear that information. By being able to see them, you can truly check and understand that they’re hearing you and they understood what you said.” 

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[Updated] Home Health Adherence Rates Above 70% in Early 2020

It’s not uncommon for patients referred to home health care following a hospital discharge to never start services. In fact, a recent study based on 2016 claims data found that just 54% of patients referred to home health actually utilized it.

But a new report from analytics and metrics firm Trella Health suggests that figure is improving.

To identify the latest post-acute care (PAC) discharge, admissions and utilization trends, Trella researchers analyzed Medicare fee-for-service claims data from Q2 2019 through Q1 of this year. During that time frame, more than 70% of patients with home health instructions adhered to those orders — a significant leap compared to four years ago.

Specifically, 71.7% of patients adhered to home health instructions in Q1 2020, while 70.3% did so in Q3 2019, according to the Trella report. Trella defines home health adherence as the percentage of home health episodes started or resumed within 30 days of discharge as instructed, divided by the total number of discharges with home health instructions.

That definition is slightly different than what the recent study used, but it still reflects improvement, Trella’s Kirsten Reed, author of the report, told Home Health Care News.

There are numerous factors that play into the improved home health adherence rate, but likely none more important than patient education. Many home health providers have worked to establish stronger relationships with their patients over the past few years, educating them on the value of skilled home health care often while they’re still in the hospital.

“Within the first week of receiving a referral, we try to make at least four points of contact with a patient and/or an emergency contact within their profile,” Cleamon Moorer, Jr., president of American Advantage Home Care Inc., previously told HHCN. “Some of that conversation is about educating on what to expect from a skilled care provider.”

A shift in referring patients undergoing certain procedures — such as joint replacements — to home health may also play a role, Reed added.

The same holds true for programs like the Hospital Readmission Reduction Program (HRRP). Under HRRP, hospitals could get penalized financially for certain negative health outcomes.

“Providers and discharge planners might therefore be more likely to highlight the importance of home health instructions than they were previously, as these programs have been a greater focus over the past few years,” Reed said. “For non-emergent procedures that typically result in home health referrals, the care team may proactively work with a patient before admission to create a discharge plan and discuss home health options.”

Looking ahead

Home health adherence rates may have been up from Q3 2019 through the first quarter of this year, but it’s difficult to predict whether that trend will continue throughout the rest of 2020.

With the onset of the COVID-19 pandemic, many prospective home health patients ultimately declined services due to exposure fears, especially in March and April. Anxieties lessened over the summer, but some believe patients will once again become concerned about having individuals enter their homes during a fall or winter resurgence.

“The biggest concern — and opportunity — we have as an organization is the continued uncertainty, unrest and anxiety facing our communities, our patients, their families and our front-line ‘heroes’ in the field,” Dan Dietz, president and CEO of CommonSpirit Health at Home, told HHCN earlier this month. “Adding fuel to ‘COVID-fatigue’ is the unknown impact of the flu season aligning with a possible resurgence of the coronavirus.”

Trella similarly highlighted that uncertainty in its report.

“We are curious to see how COVID-19 affects adherence rates, as patients had to balance a desire to receive care at home, if possible, with the fear of caretakers potentially spreading the virus,” the report stated “Especially early in the pandemic, when personal protective equipment was scarce and testing was limited, patients were forced to make difficult decisions and tradeoffs.”

Adherence may remain high, however, if hospitals, discharge planners and patients continue to understand the value of home health care.

“COVID-19 has underscored the importance of post-acute care and why underinvesting in the space is simply not an option,” Reed told HHCN. “As acute care hospitals faced capacity concerns, home health agencies quickly pivoted to alleviate the strain on their inpatient partners. Whether that meant picking up the phone daily to keep referring facilities up to date on their ability to accept patients, offering no-contact telehealth options when possible, or assuaging concerns around sanitation and PPE, the home health sector has proven to be an invaluable part of the health care continuum.”

Discharge destinations

Apart from home health adherence, Trella’s new report also flagged patterns in overall PAC discharges from Q2 2019 through Q1 2020. Over that time, 50.6% of in-patient discharges were coded for a PAC stay, a slight decrease from 52.2% over the previous four quarters.

For patients who received PAC orders upon discharge, 21.3% went to skilled nursing facilities (SNFs). That was slightly higher than the 21.1% coded for home health services, according to Trella.

Those figures are a reverse of what Trella found in its Q1 2019 trends report, which had home health as the most common post-acute care referral destination.

Due to the COVID-19 virus and the devastating impact it has had on the SNF space, it’s likely that home health will again become the No. 1 PAC destination moving forward.

“SNF admissions and utilization will decline at an even greater rate than before the pandemic due to the devastating toll COVID-19 has taken on them financially and how quickly the virus can spread within the care setting amongst patients who are high risk for serious illness or death if infected,” Reed said. “Concerns persist about how well SNFs can successfully cohort patients with known or probable exposure from the rest of their patient population, especially as they seek to implement cost-effective testing regimens.”

There is also a potential for the share of home health referrals to increase in the future due to more dedicated SNF-diversion efforts.

“Our analysis of Medicare claims for the Q1 2020 reporting period uncovered some noteworthy data points, though post-acute care trends remained fairly stable,” the Trella report continued. “As the first quarter of COVID-19 impacted data becomes available, we anticipate greater shifts and disruptions to established patterns will emerge.”

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WellSky to Acquire CarePort from Allscripts in $1.35B Deal

WellSky announced Tuesday it has entered into an agreement to acquire CarePort Health from Allscripts Healthcare Solutions (Nasdaq: MDRX), a health care information technology provider. The deal is for $1.35 billion, according to Allscripts.

WellSky is an international software and professional services company with clients that include home health providers, hospital systems, blood banks, labs, hospices, government agencies and human services organizations. The company is jointly owned by private equity firms TPG Capital and Leonard Green & Partners, which teamed up with WellSky this July.

Boston-based CarePort is a care coordination software company that connects health care providers and payers, an increasingly important function as Medicare Advantage enrollment continues to soar and as the U.S. health care system steadily shifts away from fee-for-service models.

Currently, CarePort serves 1,000 hospitals and health systems, plus 110,000 post-acute provider locations.

CarePort was an attractive acquisition target for WellSky because of the natural alignment between both organizations, Bill Miller, CEO of WellSky, told Home Health Care News in an email.

“WellSky is committed to investing in care coordination and interoperability solutions, and CarePort was the obvious choice — based on its superior technology, market leadership and national presence,” Miller said. “We’ve been impressed with CarePort’s proven track record as the leading post-acute care coordination platform in the U.S.”

CarePort’s $1.35 billion price tag represents more than 13 times the company’s revenue over the past 12 months. It’s also roughly 21 times CarePort’s non-GAAP adjusted EBITDA over the trailing 12 months

As part of the deal, CarePort’s customers and more than 200 employees will join WellSky.

“This agreement is another all-around win for Allscripts, as it unlocks significant value for our shareholders, enables us to increase our focus on our core business and brings our CarePort customers the benefit of continued investment under new and very strong ownership,” Rick Poulton, Allscripts president and CFO, said in the press release announcing the news.

For WellSky, the planned purchase of CarePort allows the company to better manage the acute care discharge process, as well as keep track of patients across post-acute care settings, including home health care.

Additionally, the deal will allow home health providers to streamline their referral management and intake processes, according to Miller.

“CarePort’s EHR-agnostic platform allows home health providers to effectively coordinate patient care through real-time collaboration with hospitals, health systems, ACOs, and other post-acute providers to close gaps in care and improve patient outcomes,” he said. “This collaboration has the potential to create a meaningful, measurable difference for patients, providers and payers across even more care settings.”

Overall, CarePort represents about 6% of Allscripts consolidated revenues. Allscripts reported Q2 2020 revenues of $406 million in July.

The sale is slated to close before the end of the year, subject to clearing customary regulatory hurdles. WellSky and CarePort will continue to operate independently prior to that time.

“Joining WellSky means that we can increase vital connections between acute, post-acute and community care providers to make a meaningful difference in the lives of more patients in more places,” Dr. Lissy Hu, CEO of CarePort, said in the press release.

WellSky’s plan to acquire CarePort is closely in line with leadership remarks following the news about Leonard Green & Partners. At the time, WellSky noted the new investment would help it expand current capabilities and service offerings, particularly when it comes to analytics, telehealth and payer relationships.

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Home Health Buyers, Sellers Headed Toward Frenzied Finish to M&A in 2020

Charter Health Care Group — a PE-backed post-acute care platform company with multiple locations across five states — announced Tuesday the acquisitions of both Vitality Home Healthcare and Heartwood Home Health & Hospice.

The news comes less than two weeks after Bridges Health Services similarly announced a series of transactions at the start of October. It likewise comes after The Pennant Group Inc. (Nasdaq: PNTG) closing on a new joint venture and making its own hospice acquisition.

While none of these deals are directly related, they signal a recent rekindling of the M&A fire across the home health and hospice spaces. Dealmaking experts are starting to notice, too, with some expecting a frenzied final few months of 2020.

“I was discussing this with my partner,” Rich Tinsley, president of M&A advisory firm Stoneridge Partners, said during last month’s Home Health Care News FUTURE event. “I’m expecting the end of this quarter and Q4 maybe being one of our strongest second halves of the year in the last decade. Volume is definitely picking back up and, speed is picking back up in transactions on deal flow.”

Originally, many home health and hospice insiders believed 2020 would be a record-setting year for dealmaking, partly due to the transition of the Patient-Driven Groupings Model (PDGM) and a handful of other major regulatory changes. But that historic M&A action hasn’t played out for a variety of reasons.

On one hand, many of the small- to mid-sized home health and hospice agencies that were likely going to come on the market this year haven’t due to the ongoing COVID-19 pandemic. Operators once interested in selling are now too focused on delivering care during a crisis, while formerly distressed businesses have been able to stay afloat through Paycheck Protection Program (PPP) money, Medicare loans and Provider Relief Fund grants.

At the same time, buyers looking to conduct traditional due diligence or “kick the tires” on acquisition targets haven’t always been able to because of travel restrictions, Tinsley noted.

“Everybody was expecting to have a lot of volume to the home health side, with lots of those smaller to medium-sized [deals],” he said at FUTURE. “Then as we kept going into the transition to the new payment system, COVID hit. Everything kind of went into quicksand from a deal perspective.”

Buyers and sellers of all shapes and sizes have clearly started to rise out of the muck in recent weeks, however.

In addition to the previously mentioned deals, for example, Cypress at Home announced its acquisition of All About Home Care Inc. on Oct. 5., while Nova Leap Health Corp. made home care acquisitions in the New England and South Central U.S. markets. Kindred Healthcare also announced the pending sale of its RehabCare business line to Select Rehabilitation this month.

Perhaps the largest of all the home health and hospice deals to take place this fall: The Providence Service Corporation’s (Nasdaq: PRSC) $575 million play for Simplura Health Group, a company that oversees a home health and personal care network spanning seven states.

“There was a four- to six-, maybe seven-week period of time when everything got frozen,” Tinsley said. “We’re just now getting out of that and things are moving.”

‘Not exactly the same deal’

It’s not just the confirmed deals that suggest the M&A landscape has started to heat up again. There have been rumors swirling around at least two noteworthy deals in the home-based care space.

Toward the end of September, reports surfaced that Centerbridge Partners and Vistria Group were joining forces on a $1.4 billion deal for Wellspring Capital Management’s Help at Home. Days later, sources familiar with talks said Anthem Inc. (NYSE: ANTM) was in “late stage” talks to acquire PE-backed CareCentrix.

“The COVID crisis has underscored how important home health is to the future of health care,” Kenneth Baer, a CareCentrix spokesperson, told HHCN at the time. “Based on that and the strength of our business, we have received many interesting inquiries, but we are focused on delivering better health for the thousands of patients who rely on us for care.”

Apart from direct acquisitions, general investment in proven home-based care businesses is picking up as well. Also in September, Liberty Lake, Washington-based Family Resource Home Care announced a new investment partnership with Great Point Partners, a health care-focused private equity group out of Connecticut.

Tinsley isn’t the only one to notice all of the action. Philip Feigan, managing partner of Polsinelli’s Washington, D.C., office, has also seen a clear uptick in transactions — with an important caveat.

“Over the last four weeks, they’re really picking up,” Feigan said at FUTURE. “They’re as strong as they’ve ever been. A lot of the deals that have stopped are looking a little different. When they come back, they’re not exactly the same deal.”

M&A legal hurdles

Although deals are starting to pick back up, negotiations and agreements likely look very different compared to years past, according to Feigan. In fact, some yet-to-be-finalized deals that took shape in late 2019 for 2020 may even see substantial changes.

“Prior to COVID, I think the legal, regulatory and even the tax [factors], were not necessarily driving the deals,” Feigan said. “They were just following the deals, making sure there is nothing that stopped the deal from happening. Now, there’s a lot more involved on the legal side because of the things that have happened over the last few months.”

PPP money, in particular, becomes a significant legal consideration in any deal.

Since the Small Business Administration (SBA) initiated the program, thousands of home-based care organizations have received PPP loans, which could range from less than $150,000 to millions of dollars.

Unlike other loan programs, PPP money is open to full forgiveness. Yet that forgiveness process hasn’t begun, so prospective buyers need to be aware of any PPP risk their acquisition target currently bears.

“The key that made it different from any other type of loan is if you used the money properly and followed the rules, you could get up to the entire amount of the loan forgiven,” Feigan said. “When you’re talking about doing an acquisition or selling your business, if either party has received a PPP loan, that can be a lot of money you’re talking about that’s at risk of forgiveness from the government.”

When PPP money is involved, Feigan recommends that sellers first seek SBA consent for a change of ownership. Along those lines, sellers should additionally secure the consent of the bank that handled the PPP loan and related paperwork.

From a buyer’s perspective, it may even be worth revisiting the timing of a deal so it can take place after loan forgiveness has been reached. Alternatively, a buyer should consider adding language to any deal clarifying who bears risk if a loan isn’t forgiven.

“There’s a whole new playbook for the PPP part of doing a deal that didn’t exist before,” Feigan said. “You don’t want to rely on what you’ve normally done in a transaction.”

Tax considerations

How common are PPP considerations in today’s home health and hospice deals? Stoneridge had just closed on eight transactions in the 60 days prior to Tinsley’s appearance at FUTURE — and all eight of those deals had some sort of PPP component.

Besides the immediate consideration, buyers and sellers in PPP-related deals also need to think about future tax implications, according to William Sanders, who chairs Polsinelli’s tax practice group.

Under U.S. tax law, loans that are forgiven typically fall into taxable-income territory. With PPP specifically, if a loan is forgiven, expenses that are usually deductible won’t be deductible, which has the same basic impact as making the receipt of the forgiveness taxable.

“What this means from an M&A-transaction perspective is that a seller needs to be aware of the fact that those expenses won’t be deductible by them in the pre-M&A closing period,” Sanders said at FUTURE. “And a buyer, on the other end, has to make sure that the documents will require the seller to exclude those expenses as deductions in the period prior to the transaction.”

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Home Health Value-Based Purchasing Model Set for Nationwide Expansion in ‘Next Year or So’

The Center for Medicare & Medicaid Innovation (CMMI) is in need of a “course correction,” top U.S. health care officials believe.

And part of that may include a national expansion of the Home Health Value-Based Purchasing Model.

Created under the Affordable Care Act, CMMI — also known as the CMS Innovation Center — supports the development and testing of innovative health care payment models. Since its formation, CMMI has developed at least 54 payment models, including the Home Health Value-Based Purchasing Model.

As U.S. health care costs continue to rise, CMMI’s work has grown increasingly important, especially around value-based care, according to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. National health care spending is expected to grow at an average annual rate of 5.4% from 2019 to 2028, outpacing the gross domestic product’s average annual growth rate of 4.3%.

But of those 54 payment models, only a handful appear to be working.

In fact, just five have shown statistically significant savings.

“In 2019 alone, over 450,000 providers participated [in those models], serving over 26 million patients,” Verma noted. “But more recently, the evaluation data for the early models have been completed. And unfortunately, the results are deeply concerning.”

Verma addressed CMMI’s progress and the future of value-based care on Tuesday during a virtual event hosted by CMS’s Health Care Payment Learning & Action Network (LAN). Verma was joined by Brad Smith, who co-founded and served as CEO of home-based palliative care provider Aspire Health before being named CMMI’s director in January.

“The Center stands in need of a course correction in model design and portfolio selection, if value-based care is to advance,” Verma said.

Providers ‘must have skin in the game’

Shifting the U.S. health care system toward value-based care is one of CMS’s many priorities, Verma remarked during the virtual event. In addition to payment, value-based care also means providing pricing transparency, strengthening interoperability and minimizing paperwork burden for providers.

When it comes to establishing more successful value-based payment models, CMMI needs to prioritize two pillars, Verma said.

First, it must step back from voluntary models “designed with an abundance of financial carrots to attract participation.”

“Models must incorporate design elements that require participants to have skin in the game,” Verma said. “Models where providers have downside risks have actually performed better.”

Secondly, CMMI needs to do a better job of developing effective, meaningful benchmarks to measure the success of value-based payment models.

Smith echoed that idea, pointing out that CMS and CMMI have been too generous or lenient in judging how new payment mechanisms are performing.

“CMMI has learned a tremendous amount over the past 10 years about value-based care arrangements, and we are grateful for the tremendous participation we have had to date in our models,” Smith said at the LAN event. “As we move into the next phase of the Innovation Center, we believe we must push even harder to move more providers into value-based care payment arrangements.”

Expanding the Value-Based Purchasing Model

While most of Tuesday’s remarks took a hard look at what CMMI has accomplished thus far, both Verma and Smith did point out several positives.

Smith, for instance, called out the Home Health Value-Based Purchasing Model as one of the Innovation Center’s most successful efforts.

Implemented in 2016, the Value-Based Purchasing Model was designed to pay home health providers in nine states based on outcomes and the value of services delivered. This year was the sixth year of CMMI testing out the model, exposing home health providers to 6% upside or downside risk based on their performance.

Home health providers in participating states have mostly supported the value-base model, with many calling for a national expansion beyond the current states of Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington.

CMMI hasn’t hinted it has any plans to do so — until now.

“As we look at our portfolio, we have other models that we believe may be able to expand in the coming years,” Smith said. “For example, our Home Health Value-Based Purchasing Model has shown significant cost savings and improvement on key quality metrics. It’s one of the examples of the models that we’re looking at to think about if we could expand it nationally in the next year or so.”

Besides the Value-Based Purchasing Model, Verma and Smith likewise pointed to the relatively new Primary Cares Initiative and the related direct-contracting model as impactful value-based care efforts.

“Last year, we announced the CMS Primary Cares Initiative, featuring the direct contracting model, which has the potential to drive quality and value across the entire system in a way that we’ve never seen before,” Verma said. “Going forward, we believe direct contracting can take an exciting new step with a geographic option, in which a set of entities would take on full risk for all eligible Medicare beneficiaries in a certain region.”

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Hospital Admissions Remain Down, But That Isn’t Bad News for Home Health Providers

Hospital admissions across the U.S. fell dramatically in spring with the onset of the COVID-19 virus. That sudden drop, in turn, caused patient volumes to plummet for home health providers that work primarily with acute referral sources.

While hospital admissions rebounded in summer, they remain far below pre-pandemic levels, according to a recently published study in the journal Health Affairs. But that may actually be positive news for the home health industry.

To study hospitals’ admission patterns during the public health emergency, a team of researchers analyzed more than 1 million medical admissions from Sound Physicians, a large, nationally represented hospitalist group. Sound Physicians contracts with almost 4,000 physicians across a wide range of hospital settings, though most commonly with community hospitals containing between 100 and 500 beds.

The researchers specifically narrowed in on admissions across 201 Sound Physicians hospitals in 36 states, comparing 2020 coronavirus-skewed numbers with baseline figures from 2019.

During the initial coronavirus surge in spring, non-COVID-19 hospital admissions fell by about 43%. All medical admissions — counting those triggered by COVID-19 — declined by about 34%.

“Volumes fell in part because hospitals purposefully curtailed elective surgery and other non-critical medical services,” the researchers wrote. “But hospitals have also reported puzzling declines in admissions for acute medical illness, including stroke and acute myocardial infarction.”

Even among hospitals experiencing a minimal impact from COVID-19 admissions, non-COVID-19 medical admissions fell by 39.5%, the study found. For hospitals with the greatest COVID-19 impact, non-COVID-19 admissions fell by 50%.

Generally, admission declines were similar across different demographic subgroups of patients. Additionally, admission declines happened across medical conditions, though some conditions experienced sharper declines compared to others.

“In our analysis, the three medical conditions for which non-COVID-19 admissions declined the least were stroke, altered mental status, and pancreatitis — conditions generally associated with new or severe symptoms not easily ignored or effectively managed at home,” the researchers observed.

By this year’s summer rebound, non-COVID-19 medical admission volumes had returned to within 16% of baseline figures, though admissions for certain non-COVID-19 conditions — pneumonia, COPD and sepsis, for example — remained well below pre-pandemic norms.

And here’s where the potentially positive news for home health providers kicks in.

In their Health Affairs piece, the researchers speculated that hospitalization rates may not return to pre-pandemic levels for quite some time — not due to patients’ COVID-19 concerns, but rather due to the growing confidence physicians and hospitalists have in home-based care.

“It is too early to determine the extent to which hospitalizations will return to baseline levels,” researchers noted. “A new, lower norm is conceivable if clinicians become more comfortable with alternatives to inpatient admission, including home-based care with remote monitoring.”

The fact that hospital admissions haven’t quite rebounded could also signal good things to come for home health providers because their volumes have recovered compared to pre-pandemic levels. Take Encompass Health (NYSE: EHC), for instance.

With more than 320 combined locations, Encompass Health is the fourth-largest provider of Medicare-certified home health services and a top-11 provider of hospice services.

For the week of April 12, Encompass Health’s home health operations saw less than 4,100 total episode starts — a substantial dip for the home health giant.

“If you look at what happened to just hospitals’ census during those first few weeks of the pandemic, … we weren’t just having the decline in elective procedures,” April Anthony, who leads Encompass Health’s home health and hospice segment as its CEO, previously told Home Health Care News. “As we well know now, people were seeing fewer heart attacks. We were seeing fewer strokes — just everything across the board was suppressed there for a time. People were scared to seek care, even when it was a very legitimately needed situation.”

By August, though, its volumes were actually higher than pre-coronavirus levels, with more than 5,300 total episode starts for the week of Aug. 16. That came despite hospital admissions still being down overall, as highlighted by the Health Affairs study.

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Payment Reform, COVID-19 May Derail a Unified Post-Acute Care Payment System

Now that the dust has settled on the Patient-Driven Groupings Model (PDGM), some have returned their attention toward the idea of another major reimbursement overhaul: a unified post-acute payment system.

There had been mounting momentum behind a unified payment model for post-acute care providers headed into 2020. The ongoing COVID-19 emergency has derailed a lot of that momentum, but conversations are starting to pick up again.

Generally, the post-acute care landscape includes skilled nursing facilities (SNFs), in-patient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs) and, of course, home health providers.

Currently, these providers operate under setting-specific Medicare reimbursement mechanisms, such as PDGM in the home health care and the Patient-Driven Payment Model (PDPM) in the SNF space. A unified model would eliminate this separation, creating one payment system for all post-acute providers.

It’s an idea that was originally born out of the IMPACT Act, which was passed in 2014.

“The idea was to flatten payment across the four post-acute care settings,” David Grabowski, a health care policy professor at Harvard Medical School, told Home Health Care News. “Rather than paying different payment rates for four different sets of services, it was an idea that the Medicare program could level the playing field and pay a common rate for patients who might be discharged to any of those four settings.”

In addition to his role at Harvard, Grabowski was appointed to the independent Coronavirus Commission on Safety and Quality in Nursing Homes.

A key benefit of having one post-acute reimbursement system would be having payment tied to a patient’s condition rather than setting, according to Grabowski.

“Currently, we have these distortions where we have individuals that probably could be cared for in lower-intensity settings, [but they’re] unfortunately being discharged to institutional settings or going to an LTCH when they could be at a SNF, or getting discharged to a SNF when they could be at a home health agency,” he said.

As envisioned by the IMPACT Act, there is also a greater emphasis on outcomes as a driver of reimbursement under a unified post-acute payment system, Lisa Grabert, a research professor at Marquette and Georgetown universities, told HHCN.

“It required that all of the data that’s reported to CMS across the four different settings be done in a consistent manner,” Grabert said. “You could potentially make comparisons across the settings.”

Making sense of an ‘anomaly of a year’

Despite perceived benefits, there are a number of potential difficulties in creating a unified post-acute payment model.

“Unifying payment also means unifying regulation,” Grabowski said. “It also means unifying quality measurement across the four settings, and it’s not clear to me that some of the rules that we’ve had in place work very well.”

For example, in the SNF world, the three-day rule requires an individual to have been admitted to the hospital on an in-patient basis no fewer than three consecutive days in order to qualify for fee-for-service reimbursement in a SNF.

Grabowski questioned how a rule such as this one would persist under a new model, especially in relation to home health care, where a number of individuals are receiving services without prior hospitalization. He pointed out that exceptions will have to be made in order to proceed.

There is also the COVID-19 emergency to consider.

In some ways, the public health emergency shifts post-acute care toward a universal payment model, according to Grabowski and Grabert. In other ways, it pushes the segment further away from it.

It’s important to remember that 2020 is an anomaly of a year in terms of the services that the Medicare program has delivered in the four settings of post-acute care. It would be difficult to use information gleaned from this year as the baseline to form the new model, according to Grabert.

Additionally, the comprehensive payment reforms in both the home health and SNF settings may further contribute to these difficulties.

“Those two factors coupled on top of each other mean that it’s really difficult to figure out what were new changes and phenomenons of the new payment system, versus just changes and phenomena associated with the pandemic,” Grabert said. “Those two stacked on top of each other may mean that it will be several years before CMS can figure out if they have accurate enough data to move to that unified payment system.”

Support for a unified model

On the other hand, the spotlight that has been placed on nursing homes throughout the public health emergency may play a role in pushing a unified post-acute payment model.

At the beginning of the month, the Medicare Payment Advisory Commission (MedPAC) had its first meeting of the year and released new data that revealed 80% of COVID-19 deaths are in the Medicare population, and over 40% of deaths are among residents of nursing homes and assisted living facilities.

Many policymakers, in addition to the media, have zeroed in the nursing home space because of this. The public perception of the nursing home industry, as a result of the public health emergency, may be strong enough to give CMS the political cover it needs to use its unified payment authority to implement a big policy change for nursing homes without any legislative barriers, according to Grabert.

“Given that skilled nursing facilities make up nearly half of the overall annual spend in the Medicare post-acute baseline, policymakers may be tempted to take advantage of the unified [post-acute care] model as a policy tool to address SNF, and possibly broader, reform,” she said. “Though actually implementing unified payment may need additional Congressional action, the mechanics to actually develop payment reform and release a detailed plan need no further Congressional action — a tremendous amount of authority already exists within the executive branch.”

If the Trump administration is reelected, it’s likely officials will be looking at looming fiscal pressures. The concept of a unified payment system has been on its radar in the past as a cost-savings tool

In February, the Trump administration released its proposed budget for the fiscal year 2021, which projected that a unified post-acute care payment model would save $101.5 billion from 2021 to 2030.

Even if a new administration is elected, this could still remain a factor.

“If the Biden administration comes into power, they may be looking again at this post-acute care space and the idea of unified payments as a [way] to get some savings out of the Medicare program,” Grabert said.

As of now, CMS has only affirmed its intentions of following the Congressional mandate, according to Grabert.

“There’s nothing really significant, I would say, coming out of CMS on this topic, aside from the fact that they take the current Congressional mandate of coming up with this unified prototype seriously, and they plan on issuing a report to Congress on time, as is required under current law of the IMPACT Act,” she said.

Congress has also begun to posture that it would like the agency to do some oversight and report to them on how the implementation has been going and possibly slow things down on the timeline.

“The evidence of that is a recent letter that came out from [Senators Pat Toomey (R-Pa.) and Michael Bennet (D-Colo.)] to CMS on the IMPACT Act timeline,” Grabert said. “There’s this Senate letter requesting some oversight of how CMS has implemented the underlying law, and certainly suggest that a delay should be considered at this time due to the pandemic and comprehensive home health and SNF payment reform.”

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PDGM ‘Not as Difficult as It Was Cracked Up to Be’: Longtime Hospice Provider Enters Home Health Market

To borrow from “A Tale of Two Cities,” it’s the best of times and the worst of times for a provider to be entering into the home health space.

On one hand, COVID-19 — and the business and clinical complications that come with it — pose unprecedented day-to-day challenges. As the biggest payment overhaul in two decades, the Patient-Driven Groupings Model (PDGM) presents its own nuanced hurdles as well. 

Yet on the other hand, more patients and families are looking to be treated in the safety of their own homes than ever. And even before COVID-19, the U.S.’s aging population and the cost-saving ability of home-based care were providing tailwinds for providers of all shapes and sizes.

Hospice by the Bay — a longtime provider of hospice care in San Francisco — is currently learning about that duality firsthand. Three years ago, it tentatively began exploring home health in an effort to eventually establish a continuum of care within its network, effectively meeting patients earlier on in their care journey.

“We decided many years ago that we wanted to expand the way that we were thinking about delivering care at home, and we wanted that to include home health care,” Hospice by the Bay CEO Kitty Whitaker told Home Health Care News. “We felt that we were in a position to be able to do this, because we’ve been delivering care in the home for about 45 years.”

Founded in 1975, Hospice by the Bay was the first hospice provider in California and the second in the entire country. It has a total census of around 1,000, with its home health arm accounting for just about 300 patients. Along with home health and hospice, the agency also provides palliative care and bereavement services.

Hospice by the Bay’s entrance to home health was deliberate, but it was meant to be taken slowly. Once two agencies within its footprint were in the market to be acquired, however, things began moving faster. First came InCare Home Health in October 2017, then Healing at Home a year later.

With those acquisitions, Hospice by the Bay brought on advising home health management and more staff. All of a sudden, Hospice by the Bay was as much a home health operator as it was a hospice provider.

Building a one-stop shop

The swift movement on home health — and the overall vision — has ended up paying dividends. Since May, Hospice by the Bay’s home health census has increased by 25%.

In addition to its entrance into home health, Hospice by the Bay is also anticipating tailwinds from other post-acute care trends: explosive growth in Medicare Advantage (MA) and rising demand for palliative care among them.

“We’ve been pretty deliberate in our strategic initiatives,” Whitaker said. “We’ve made intentional, strategic decisions that we think [align us] with the future of health care. … We’re having to work more with the Medicare Advantage programs. And they will be looking to work with organizations like ours that have different service lines that are a one-stop shop for them. And we have deliberately really tried to set ourselves up to be ready for that.”

Aiming at being on the frontier of the future of health care started with home health, but it didn’t end there. 

Pairing palliative care with its home health and hospice service lines makes sense from a clinical standpoint, Whitaker said. At this point, it’s more about waiting for the right payment models that reward good palliative care to take shape.

“The Medicare Advantage programs — and private insurance in general — have shown a real interest in palliative care, whereas Medicare to some degree has kind of sat on its hands,” Hospice by the Bay CFO Denis Viscek told HHCN. “But I think the private insurance and Medicare Advantage programs see it as a real valuable benefit to their patients and beneficiaries.”

Eventually, Viscek believes that palliative care could greatly outpace the hospice market in the U.S., which he told HHCN sister site Hospice News in December.

Palliative care in the United States has been steadily increasing this century, growing by 178% in hospitals from 2000 to 2016, according to the 2018 Palliative Care Growth Snapshot issued by the Center to Advance Palliative Care (CAPC).

Community-based palliative care is becoming more prevalent as well, especially since these types of services became reimbursable through MA plans. That provides an opportunity for agencies like Hospice by the Bay to step in.

More than 60 MA plans across the country are offering in-home palliative care as a supplemental benefit in 2020.

The challenges of home health

While COVID-19 has been a challenge, it has also clearly added interest in Hospice by the Bay’s home health business.

But the company didn’t skate by without any help. In order to keep all of its staff on board, which it did, Hospice by the Bay applied — and received — upwards of $5 million in Paycheck Protection Program (PPP) money, according to publicly available data from the Small Business Administration (SBA). 

And home health’s boogeyman — PDGM — was daunting in theory, but not in practice.

“PDGM was not as difficult as it was cracked up to be,” Viscek said. “It was certainly a change. But we weathered that pretty well. And one reason we weathered it pretty well is that we were not driven by therapy before.”

Instead, for a longtime hospice provider, the main challenge was more of a mindset-related one. It wasn’t about just learning PDGM, but also embracing the thin margins that come with home health, generally.

“We had to learn right away with PDGM,” Whitaker said. “I also think that you need to really look at this service line as one where you’re not going to have huge margins, and you need to be okay with that. You really need to look at it as being part of your system of care.”

Because home health margins are thin, the company is investing in areas it never has before, like intensive, technology-driven data tracking.

It’s currently building out its data plans through software company Epic’s technology.

“There’s really two parts to the data,” Viscek said. “One is the metrics necessary to manage the business efficiently. We’re ahead of that game — we started that process six or eight months ago. … The second is the data that we need to give to payer sources on why to choose us and why contract with us. And we’ve managed to get that kicked off recently.”

The only thing holding Hospice by the Bay back from it’s home health destiny now is Hospice by the Bay — its name, that is. 

“Taking hospice out of our name will allow us to better attract referral sources that really understand that we’re an organization that has these different systems of care that we can deliver at home,” Whitaker said.

A name change is underway, but for now, it’s secret.

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Half of Patients Referred to Home Health Don’t Receive Services — But Providers Can Change That

Home health is often utilized as a recovery tool when patients transition out of the hospital because of its ability to improve outcomes. But many of the Medicare beneficiaries who receive referrals after being discharged aren’t actually receiving these services.

Overall, the past several decades have seen an increase in the use of post-acute services, with more than 40% of Medicare beneficiaries receiving such care after being released from a hospital, according to a recently published study in JAMA Network Open.

When it comes to home health care, in particular, roughly 2.3 million Medicare patients were discharged from hospitals with home health referrals in 2016. Despite that large amount of referrals, only 54% of those individuals utilized home health services after their hospitalization within two weeks.

Additionally, 37.7% never received care; 8.3% were either institutionalized or died within 14 days, without receiving a home health visit. This data underscores the role these services can often play in helping patients return to prior levels of functioning.

“After 14 days, patients get home, think they’re fine, then they have a decrease in their mobility or whatever their status is from the hospital,” Mike Gregory, chief patient advocacy officer at Intrepid USA Healthcare, told Home Health Care News.

Dallas, Texas-based Intrepid USA Healthcare Services is one of the largest home health, hospice and home care companies in the country.

Although the study’s findings were gleaned from 2016 Medicare data, it’s likely that the results haven’t seen much improvement, Jun Li, one of the study’s authors and an assistant professor at Syracuse University, told HHCN.

“Certainly from speaking with discharge planners, for example, it seems like not much has changed in terms of their ability to track which patients are actually getting home health care,” Li said.

Falling through the cracks

From a home health perspective, there are a number of factors that contribute to this breakdown of whether hospital-referred patients receive care.

One factor: Providers aren’t always getting useful and accurate patient information from hospitals, Cleamon Moorer, Jr., president of American Advantage Home Care Inc., told HHCN.

“[That includes] contact information of patients, as well as emergency contacts and family members,” Moorer said. “There’s an opportunity to close the gap on clarifying correct contact information. I think from time to time, if a patient is highly sedated, or if there’s been a change to their contact information prior to leaving the hospital, discharge planners, case managers, social workers and the like may not be made aware of the latest contact information.”

Dearborn, Michigan-based American Advantage Home Care provides skilled nursing, rehab and specialty care services across nearly a dozen counties.

In order to avoid inaccurate information, it’s important to validate it on the front-end. For American Advantage Home Care, this means reaching out to emergency contacts in a timely manner.

“We take the patient referral, and we begin to validate as soon as we possibly can,” Moorer said. “To some, it may seem intrusive, if you call the emergency contact number while the patient is still in the hospital. We start by saying who we are and that it’s not an emergency, but we’re calling on behalf of the patient, because we received a referral from either a hospital or a clinic or a primary care physician.”

Providers that aren’t creating multiple points of contact with patients may find themselves having a difficult time keeping track of patients, he added.

“You almost need to be a patient navigator or tracker as a home health care provider,” Moorer said. “If you simply pass along the patient’s information to your start-of-care nurse or clinician … it may not be of the utmost urgency to start a new patient if they already have a full caseload.”

Once a patient has been discharged and an initial visit has been set, American Advantage Home Care’s call center team reaches out to patients to inform them about their assigned clinician and to nail down specifics as well as personal preferences.

“Within the first week of receiving a referral, we try to make at least four points of contact with a patient and/or an emergency contact within their profile,” Moorer said. “Some of that conversation is about educating on what to expect from a skilled care provider.”

Improving patient education

Another factor that pops up is patients leaving the hospital aren’t always educated on the difference between non-medical personal care and home health care. This results in patients turning down services because they believe a family member or friend can fill in as their caregiver.

“In the event that a patient is being discharged and they don’t know the difference between the two, they may lean on a loved one,” Moorer said. “They may say, ‘My son or daughter lives with me. I’ve got a niece or nephew that helps me get in and out of the bed. They bathe me. I don’t need anyone coming in and out.’”

Additionally, some patients may turn down services due to reservations about having someone they are unfamiliar with in their home.

“They’re quite often embarrassed about having strangers in their home,” Intrepid’s Gregory said. “For whatever reason, they’re just not comfortable having someone they don’t know. When you’re able to build that relationship up front, … they’re much more likely to allow a stranger in.”

For home health providers, working closely with referrals partners can go a long way in making sure patients don’t fall through the cracks. This means following up with discharge planners after a patient has been released.

This can also mean working with referral sources in cases where a provider is unable to accommodate a patient, Scott MacInnis, chief revenue officer at Elara Caring, told HHCN.

“If for some reason, if we are unable to see the patient, we would contact the referral source and help to coordinate the sourcing of another provider, making sure that there are alternative resources for the patient, especially in instances where the needs of the patient are beyond the scope of home health,” MacInnis said.

Addison, Texas-based Elara Caring is a home health, hospice and personal care provider that operates across several states, caring for thousands of patients each year.

Looking forward, making sure that patients actually receive quality home health care will be especially important as the U.S. prepares for a possible second wave of the COVID-19 emergency.

“Home health is still underutilized,” Gregory said. “It is one of the most cost-effective forms of taking care of the patients, especially now with COVID-19. Patients do not want to go to the nursing home, they don’t want to be in the hospital.”

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‘Talent Acquisition Is Critical’: Inside PopHealthCare’s Home-Based Primary Care Model

After steadily gaining steam over the last decade, in-home primary care models have reached a critical turning point in 2020.

A handful of in-home primary care businesses have received multimillion-dollar investments to expand across the U.S., for example. At the same time, the U.S. Centers for Medicare & Medicaid Services (CMS) is testing out new ways for primary care providers to treat their patients in the home setting.

Part of the Franklin, Tennessee-based GuideWell, PopHealthCare is positioning itself to capitalize on that momentum. To help scale its national network, the in-home primary care and risk-adjustment organization announced the hiring of Dr. Christopher Dodd as its new chief medical officer at the end of September.

PopHealthCare has completed over 100,000 in-home visits since launching. It currently manages the health needs of over 11,000 members with complex conditions.

In addition to PopHealthCare, the nonprofit GuideWell’s portfolio includes Florida Blue, GuideWell Connect, GuideWell Health and Diversified Service Options.

Home Health Care News recently connected with Dodd to learn more about PopHealthCare and its growth plans. Prior to his new role as CMO, Dodd served as chief clinical officer for ConcertoHealth.

Highlights from HHCN’s conversation with Dodd are below, edited for length and clarity.

HHCN: This is my first time connecting with PopHealthCare. Before we jump into things, can you please provide some brief background on your organization?

Dodd: I’ll start with GuideWell.

GuideWell is a mutual holding company that’s focused on building the future of health through innovation and collaboration. It consists of multiple companies focused on improving individual and community health. We have a laser-sharp focus on transforming the U.S. health care system, which has significant opportunities for improvement, we believe.

One of the ways that GuideWell firmly believes the system needs to be transformed has to do with the delivery of high-quality, in-home care for geriatric and vulnerable populations. With that in mind, GuideWell saw the opportunity in 2017 to acquire PopHealthCare, a private company that was leading in the delivery of in-home care for frail and vulnerable populations. On top of that, PopHealthCare also provided prospective- and retrospective-risk adjustment services for health plan partners.

GuideWell felt that PopHealthCare would be a wonderful way to transform the system by delivering better care and outcomes for populations with the most need.

PopHealthCare is under the GuideWell umbrella. But PopHealthCare also has different divisions. CareSight is the in-home primary care business, correct?

You’ve got it. There are three specific products that PopHealthCare offers to its health plan partners. CareSight is the in-home primary care line. There’s also InSight, which is how the company was initially founded. In 2005, the original physician founder saw an opportunity to develop a service that helped better understand the barriers that people were facing in living their healthiest lives possible. InSight is a sort of an in-home assessment program, which continues to this day. The goal is to provide a better lens to see the needs of individual patients.

As we identify patients who have significant care needs, that CareSight program is able to intervene and be the effector arm to help move patients from crisis to stability, in turn improving their health.

Then there’s RiskSight, which brings retrospective risk into full focus to maximize risk-score accuracy.

You were named CMO of PopHealthCare at the end of September. What were you doing before that? And congratulations, by the way!

I appreciate it. So, I’m a trained internist. I also have a background in public health. Overall, my training is really in figuring out, “How do you deliver care to vulnerable populations?” We can be talking about the geriatric population, particularly seniors who have multiple chronic conditions. But we could also be talking about frail and vulnerable non-senior populations. For example, a single mother who is living with diabetes and bipolar disorder, somebody who is at risk of losing her job from repeated hospitalizations.

My training in global health and social medicine has allowed me to closely study health care models for vulnerable populations, both in the United States and around the world. I’ve worked in Mozambique and Nicaragua, for instance, in addition to our underserved communities across the U.S. But regardless of the geographic location, I’ve come to realize the home is really the best place to deliver care.

Why is that the case? At what point did that light bulb go off?

I guess it was in the early 2000s, as I was training in what I refer to as social medicine. I had the opportunity not just to study chronic medical conditions like diabetes, heart failure and emphysema. I had unique training in the sense that I had to understand why people got sick. That was illuminating. Now, everyone’s starting to realize in greater frequency that we need to hone in on social determinants of health. It’s the social barriers and behavioral health conditions that really stand in people’s way of living their healthiest lives possible. If you don’t have the ability to understand a person’s environment, their social selves, then you’ll likely have a very difficult time collaborating with them to develop a treatment plan that addresses, in a comprehensive way, all of the barriers that they’re facing to be healthy.

When PopHealthCare named you as its new CMO, it noted that you’ll be in charge of scaling its existing network. What’s that network look like today?

That’s definitely one of the opportunities that I’m excited about. At present, PopHealthCare operates in 17 states and has relationships with 26 health plans. Those health plan partners range from local, to regional, to national health plans. One of our primary, short-term objectives is to reinforce those relationships and grow them. Why? So we’re able to care for more seniors and more vulnerable populations in our markets. But then we also want to grow that footprint and care for even more individuals moving forward.

HHCN just hosted FUTURE. During that event, Humana’s home segment president explained how she sees in-home primary care as a key part of a “home-centric ecosystem of care delivery assets.” Do other health plans share that view?

I do think there’s a growing appreciation for in-home primary care. But is home-based primary care right for everyone? Is it the best option for you or me, relatively healthy and young individuals? Not really. Maybe we’d like home-based primary care for convenience, sure. I think we need to get more focused about what the problem statement is in the U.S. health care delivery system. Obviously, it’s complex. But what we know is that 15% to 20% of patients consume 80% of the costs.

What we want to shout out loud here is that for this portion of the population, individuals who are seniors, frail or otherwise vulnerable, they need a different approach to health care delivery. The current approach of clinic-based, facility-based care just doesn’t work. By shifting to a home-based delivery model for primary care — and for what I’d refer to as complex care for frail and vulnerable populations — you’re going to deliver better care and get better outcomes. By doing so, the system wins in terms of lower total costs of care.

A couple of other points that I would add: When you look at all of health care spending, it’s something like 4% or 5% of all dollars go to primary care. For me — and I’m biased, of course, because I’m a primary care doctor — that is fundamentally wrong. There’s not enough resources and focus going into primary care. But with the increasing emphasis and acceleration of value-based care, of getting paid up front and determining how you want to spend the money to get the best health outcomes, primary care has this renewed sense of power that it has lost over the last several decades. That’s the opportunity that PopHealthCare and our health plan partners are seizing. They’re saying, “If we can get the right economic model to support this care delivery model, everybody’s going to win.”

We’ve been talking about in-home primary care generally, but what about at this particular point in time?

First and foremost, in-home primary care is important to keep the senior and at-risk population healthy. We know that the coronavirus is much more likely to create bad outcomes for people over the age of 55, and for people who have complex health and social needs. It’s a terrible thing that’s happening, but it’s been a wonderful opportunity for people like myself and for companies like PopHealthCare. By wonderful, I mean we finally get a chance to have our care model validated. It’s a chance to generate more awareness of how important it is when it comes to keeping people safe and promoting better health outcomes.

Does PopHealthCare currently work with any home health or home care agencies out there?

Everybody clearly understands the immense value that home health agencies bring to the table. At this time, we’ve decided to very much stay in our swim lane of home-based primary and complex care for geriatric and vulnerable populations. But as we’re doing that, we’re spending a lot of time developing relationships and partnerships with home health agencies, durable medical equipment (DME) suppliers, home infusion companies and others. We’re identifying those who do their work the best, making sure we have a “bat phone” to the right people.

Does PopHealthCare plan on working in any of the newer primary care models coming out of the CMS Innovation Center?

There’s a lot of excitement around what I think you’re referring to — CMS’s direct contracting models, with Primary Cares First being one of them. They’re super exciting. There’s a lot of potential there. PopHealthCare is taking a close look at those types of models. At some point soon, I think we’ll make a decision whether we want to to jump right in. But at present, we’re still evaluating.

What’s the most challenging aspect of the in-home primary care model? Is it the payment methodology? Is it the actual delivery of care and getting enough physicians who want to work in the home?

It all starts with who’s on your team. Talent acquisition is critical. While there’s a ton of great health care professionals out there, it’s not easy to find health care professionals who both have the expertise to treat heart failure and keep an eye on the social factors that play into it. You need a social-medicine orientation that allows you to look at the whole person and understand the medical needs along with the behavioral health needs, the mental health needs. You have to understand substance-use disorders and all of those social barriers to health. You have to be able to understand how to put together a treatment plan that takes into account all of these things so you can deliver the right care, at the right place, at the right time, with the right care team. So, talent acquisition is a big challenge.

The economics are critical, too. It’s expensive to deliver this type of care. Operating in a traditional fee-for-service model doesn’t work. You’ve got to get a fee structure up front to be able to fund the business. Then if you do a great job, you can have some sort of gain-share opportunity where — if you keep people healthy, home and out of the hospital, and you reduce the total cost of care — you are able to share in any savings with the health plan.

I think the other thing that’s important in terms of economics is volume. The more volume and the more patients you have in a given geography, the easier it is to deliver care.

What plans does PopHealthCare have for the year ahead? What are your goals as CMO?

Well, let me let me say a couple of things about why I’m so excited to join the team. One of the differentiators for PopHealthCare compared to some of the other companies out there in the market is we have a philosophy that says, “No matter what your age is, you can have complex health and social needs.” So, we’ve developed a care model that is able to provide care for frail elderly patients just as well as it’s able to for people who are in their 30s or 40s, who are living with a mental health condition and a chronic medical condition like kidney disease. I think what’s even more exciting is that we’ve been able to implement our care model across different geographies with different populations and demonstrate really great ROI for our health plan partners — reduced hospitalizations and emergency department visits.

In terms of moving forward, I think that the company is going to keep making the investments that are necessary to continue to be a leader in the delivery of care for complex populations. That means having the right tech and systems in place. That means increasing our telehealth and remote patient monitoring capabilities, so that we’re able to have access to important data points in a more timely fashion.

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Recently Launched Alivia Care Plans to Enter ‘Saturated’ Home Health Market

Alivia Care Inc., a new operator in the senior care space, has plans to enter the home health market.

Launched at the end of September, Alivia currently provides hospice and palliative care throughout the Jacksonville, Florida, area. The company’s history is tied to Community Hospice & Palliative Care, which now provides care as Alivia’s subsidiary, serving 8,000 hospice patients and 9,000 palliative care patients annually.

Community Hospice & Palliative Care’s CEO, Susan Ponder Stansel, has joined Alivia as its president and CEO.

Aside from Alivia’s hospice and palliative care service lines, the company will provide home health care, private-duty nursing and personal care services moving forward. Alivia will additionally offer PACE programs and advanced care management in the future.

PACE — or Programs of All-Inclusive Care for the Elderly — is a comprehensive care model that often uses a combination of in-home care and center-based care to keep older individuals out of institutional settings.

“The goal was to create a care continuum as a whole, while paying attention to the individual products and give them the attention that they need to make sure that our quality and network keeps up with our goal to be innovative,” Ponder Stansel recently told Home Health Care New.

In creating a sort of one-stop-shop for aging services, Alivia has its eye on the future of how care will be delivered, according to Ponder Stansel. Increasingly, health system partners and payers are looking to team up with providers capable of caring for patients on a longitudinal basis.

“Part of it was to make sure that we are not just at the end of the waterfall, waiting for the fish to come over,” Ponder Stansel said, referring to Alivia’s roots in end-of-life care.

As far as home health care, Alivia’s interest was piqued when the company saw how more hospitals were beginning to move toward risk-based payments.

“We really want to be in the home health business, as well as have the home health capacities to allow us to do more of that advanced illness care, because we do see … a lot more interest in them moving to that risk-based payment,” Ponder Stansel said.

One of the biggest challenges Alivia has experienced in the home health space is figuring where its market opportunities are in an already saturated landscape.

From 2018 to 2019, the number of home health agencies dropped by about 3.6%, a decrease of 427 individual providers, according to the Medicare Payment Advisory Commission (MedPAC) 2020 data book. Since 2015, the home health subsector has contracted by more than 8%, with nearly 1,000 agencies exiting the market.

In light of this, Alivia has opted for acquisitions of existing entities over starting de novo locations, Ponder Stansel said.

“We figured that for us, the better way would be to go ahead and buy an existing book of business,” she said. “We weren’t starting cold.”

Looking ahead, Alivia is also paying close attention to how the Patient-Driven Groupings Model (PDGM) and other payment changes will shake out for the company’s home health business.

“It’s not just PDGM. There’s the pre-claim authorization,” Ponder Stansel said. “There’s a lot of pressure on home health care agencies. They have sort of a ‘death by 1000 cuts.’ For what we want to do with home health, PDGM is actually a good change because it incentivizes you to take those higher-acuity patients and not be so therapy-heavy, and that really that aligns with our serious-illness strategy very well.”

Additional reporting by Jim Parker, editor of Hospice News.

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Trump Signs Funding Bill Restructuring Medicare Loan Repayment Terms

In passing a bipartisan funding bill last week to avoid a possible government shutdown, the U.S. Senate officially restructured and relaxed repayment terms for the Medicare loans taken out by home health providers in spring.

President Donald Trump signed the funding bill into law on Wednesday, just two days before being flown to Walter Reed Hospital due to COVID-19-related health concerns.

The continuing resolution funds the government through Dec. 11. As it pertains to Medicare loans, it creates new deadlines for home health providers, skilled nursing facilities (SNFs) and others to repay any advance and accelerated payments received in 2020.

“This makes real accommodations for providers,” Judy Waltz, a partner at Milwaukee, Wisconsin-based law firm Foley & Lardner LLP, previously told Home Health Care News.

Overseen by the U.S. Centers for Medicare & Medicaid Services (CMS), advance and accelerated payments are meant to keep Medicare-reimbursed health care organizations afloat during turbulent times. Since the start of the COVID-19 emergency, CMS has disbursed more than $100 billion in such loans.

Overall, home health providers received $1.7 billion in loans before CMS suspended the advance and accelerated payment programs in late April. Short-stay hospitals, comparatively, received more than $78 billion.

“Medicare accelerated and advanced payments have been a lifeline to many hospitals and health systems in the fight against this historic pandemic, allowing them to continue to deliver the care that their patients and communities depend on,” American Hospital Association President and CEO Rick Pollack said in a statement.

Under normal conditions, Medicare providers were supposed to begin paying back their loans on Aug. 1 — or risk CMS withholding reimbursement for any unpaid debts. August came and went, however, without CMS garnishing any payments.

At the time, CMS Seema Verma suggested the agency expected Congress to address the issue directly.

The recently finalized funding bill now gives hospitals one year before Medicare can claim their payments to repay the loans. Other Medicare providers will have up to 210 days.

Providers will have 29 months since their first payment to fully repay the loan; they previously only had one year under the original deadline. Additionally, the measure lowers the interest rate on outstanding payments from 10.25% to 4% .

Industry advocates and trade associations have tried to get accelerated payments forgiven entirely, but that was never really an option, Waltz previously noted.

“Medicare can’t just access more money or do whatever Congress does to pay for the federal debt,” she said. “It’s very specific to the trust funds, so the idea of a forgiveness wasn’t realistic.”

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‘The Pandemic Is Far from Over’: Top Concerns for the Home Health Industry This Fall

The home health industry entered the eighth month of the COVID-19 pandemic this October. While most have adapted to a “new normal,” the public health emergency — and a possible second wave — understandably remains the biggest concern for many operators across the country.

As of Oct. 1, there had been more than 7 million COVID-19 cases in the U.S. with more than 200,000 deaths, according to federal statistics. A forecasting model created by the Institute for Health Metrics and Evaluation at the University of Washington estimates that there will be 371,509 COVID-19 deaths by January 2021.

To get a better understanding of what home health operators are up against this fall, Home Health Care News asked several CEOs and C-suite executives about their biggest concerns — and their plans for addressing them. In addition to the COVID-19 virus, respondents also touched on staffing challenges, consolidation and more.

Here are the top concerns of seven home health leaders as the industry heads into 2020’s final months.

* * *

The biggest concern that we have is what will happen with COVID-19. We have seen a surge happen as young adults return to college and then spread this into the community. Will that negatively impact our senior populations or reduce the referrals we are seeing from some doctors who have resumed elective surgeries? We are working with doctors’ offices that we regularly get referrals from to discover their plans and plan how we can work together to mitigate the impact for both the agency and for the doctor.

Other referral sources like assisted living facilities have stayed on stringent lockdowns, and we see that continuing throughout the duration of the crisis. The concern here is for access to caregivers and the ability of staff to be able to go in and do their job appropriately to make sure that these seniors are not left behind as a result of the ongoing surge that we expect to continue for several months.

We are mitigating this by working with facilities to reduce exposure potential by assigning specific staff just to that facility, running daily ongoing COVID checks and possibly utilizing some of the testing capacity that we expect to see from the federal government for rapid tests. We also have a standing relationship with local testing facilities to get staff in and tested immediately if needed, so that we can do immediate checks and short-term quarantines. We then utilize backup staff who have office positions as a stopgap until the all clear notice is given.

— Beau Sorensen, chief operating officer at First Choice Home Health & Hospice

* * *

The remainder of the year will be focused on a series of concerns including the need to increase provider support through the Provider Relief Fund, addressing Medicaid support shortfalls, securing support for telehealth reimbursement, and bolstering anticipated needs for PPE and staff testing.

Each of these items can be addressed through the ongoing stimulus legislation efforts or through Congressional action post-election. We have taken steps to cover both opportunities with targeted legislation on telehealth and Medicaid, along with broad supports in health care overall for the Provider Relief Fund, Medicaid, PPE and testing as part of the stimulus packages.

Given the extent of needs in the home care and hospice community, no one single focus is sufficient.

— William A. Dombi, president of the National Association for Home Care & Hospice (NAHC)

* * *

My biggest concern going into the fall is a COVID-19 resurgence coupled with what could be a tough flu season. This puts our staff at greater risk and could have a terrible impact on the elderly and at risk populations.

How do we address this? By working to get 100% of our clinicians vaccinated against influenza, ensuring we have adequate PPE and keeping our staff up-to-date on how to avoid community-based infection while both on or off the job. The health of our staff is our highest priority, and we have to double down on what kept them safe in the early days of COVID.

The pandemic is far from over, and I fear that the fall could be far worse than the spring if we don’t continue to take real action to keep health care workers safe.

— Brent Korte, chief home care officer at EvergreenHealth Home Care

* * *

As we move into fall, amidst this next phase of the pandemic or otherwise, our biggest concern remains caring for all patients with a range of health care needs: from high-acuity medical care to personalized non-medical support.

This means caring for the widest range of those who need our help, including pediatric patients with complex medical needs at home or in school while parents sort out virtual/hybrid learning models. It means setting up seniors with home aides to assist with meals and other chores. We’re also providing clinically based COVID-19 testing and screening services to ensure healthy work, learning and retail environments.

Our aim is that patients with milder COVID symptoms can transition home with the same high-quality care, while freeing up hospitals to support more intensive cases of COVID-19. To do this, we continue to fight the other battle, the caregiver shortage. To care for our patients, we search for and welcome the caregivers who want to give back, support their communities and make a difference in a job that is recession-proof and can change lives. Currently, those candidates could be from the many left jobless by the pandemic, including those from the hospitality, travel and restaurant industries.

Our challenge to meet patients where they are means being there to combat feelings of social isolation, especially as we approach the fall and winter seasons. By caring for our patients’ minds, bodies and spirit through our “Home Life Enrichment” standard-of-care, we can keep them healthy and safe but also connected to their loved ones and the world around them via in-person or telehealth interactions. For those facing end-of-life, meeting patients and their families with the support and comfort care of hospice in their final days and moments is what makes our team different.

— Jennifer Sheets, president and CEO of Interim HealthCare

* * *

What are the top concerns for our home health agency this fall? Is it our star rating? Our patient satisfaction? Maintaining a low re-hospitalization rate? Is it delivering on value or ensuring compliance? Surveys? Staffing? The Patient-Driven Groupings Model (PDGM)? The Review Choice Demonstration (RCD)? Audits, payers, costs, technology or hospital narrow networks? COVID-19?

These are all yesterday’s concerns. Today’s top concern is how hospital systems and the U.S. Centers for Medicare & Medicaid Services (CMS) want the small home health agencies to close. This is good for the large providers that have exclusivity and control a majority of the Medicare revenue, but bad for small providers, which are the great majority of agencies in America. We don’t have a seat at the table regardless of cost, quality or patient’s choice.

The second concern is the volume increase of “low pay,” “slow pay” and “no pay” high case-mix patients who are having issues accessing care. Agencies are going to have to be providing their referral sources with 5-star care. If an agency has a bad referral source, it’s safe to assume they are another agency’s good one. If agencies keep taking bad referral sources hoping that they will turn into good ones, it will most likely accelerate an agency’s closure. Agencies must be continuously looking for partnership opportunities with referral sources that want value — or get an exit strategy.

— Peter Miska, president of Phoenix Home Care LLC

* * *

The biggest concern — and opportunity — we have as an organization is the continued uncertainty, unrest and anxiety facing our communities, our patients, their families and our front-line “heroes” in the field. Adding fuel to “COVID-fatigue” is the unknown impact of the flu season aligning with a possible resurgence of the coronavirus. That requires us to remain vigilant in our support and messaging. We’ll continue to build upon what we have learned so far.

Over the last seven months, we have successfully navigated through the varying challenges of the pandemic to keep our patients, employees and communities safe. The result of this focus led to the implementation of new tools, technology and strong processes that have elevated home health in the continuum of care. We are reaching more patients, more families and serving our communities in different ways than we have in the past, putting us in a strong position to weather additional challenges as they come.

In response to the pandemic, we implemented innovative technology strategies and solutions to assist in keeping everyone as safe and connected as possible. As the flu and COVID-19 collide, we will continue leveraging our technology-based solutions such as remote patient monitoring, virtual visits and medication management delivery to enhance our care plans while supporting infection control measures and social distancing to minimize risk for our caregivers.

Regular COVID-19 training and flu education ensures a consistent approach to proven methodologies that have been implemented to protect our greatest resource – our staff – so they can do their best work for our patients.

We have used and will continue to use analytics to help make data-driven decisions during the pandemic. We have refined processes and implemented changes based on our learnings to ensure the safety of all. We have focused equal effort into providing tools and resources to our front-line caregivers to ensure they are safe, engaged, supported and have what it takes to be resilient in hard times.

— Dan Dietz, president and CEO of CommonSpirit Health at Home

* * *

Trinity Health At Home has seen an increase in home care visits at faster rates than expected this quarter. As patients across our nation continue to seek equal access to health care, the need for home care services continues to climb. As home care providers, we must continue monitoring and improving our processes to ensure current and future patients have access to care. At the start of the pandemic, we adapted quickly across our home health agencies to meet patient needs under new circumstances. Our innovation will continue in the brighter days ahead.

Though we have all adapted to COVID-19, we must continue to take our COVID-19 response and processes very seriously. At Trinity Health At Home, the safety and well-being of our patients and colleagues remain our priority moving forward. Right now, support for our devoted nurses and clinicians is of utmost importance. We are securing additional supplies of PPE, ensuring the safety of staff on home visits and encouraging self-care to limit the stress and uncertainty of our new normal. By keeping our colleagues healthy and engaged, we can ensure proper staffing levels to guarantee high-quality home care and expand access to care within our communities.

— Mark McPherson, president and CEO of Trinity Health At Home

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LHC Group Locks Down Two New JVs, Acquires Hospice Provider

LHC Group Inc. (Nasdaq: LHCG) on Thursday announced the finalization of two joint venture agreements.

A home health, hospice and personal care services provider, Lafayette, Louisiana-based LHC Group currently operates in 35 states and Washington, D.C.

In one of the two new JV agreements, LHC Group will share ownership of SunCrest Home Health, a Gainesville, Georgia-based provider with Northeast Georgia Health System, a not-for-profit community health care organization.

SunCrest Home Health will rebrand as Northeast Georgia Home Health.

“Our LHC Group family is genuinely excited to expand our services in the state of Georgia by joining forces with a respected, high-quality health care organization like Northeast Georgia Health System,” Keith Myers, LHC Group’s chairman and CEO, said in a press release. “With our combined talent, experience and resources, we will be able to bring effective value-based care to more patients in Gainesville and across the region, and do so in the safest and most preferred location – the comfort and familiarity of their home or place of residence.”

LHC Group also finalized its JV with Augusta, Georgia-based University Health Care System, first announced in August. Under the agreement, the two organizations will work to strengthen the home health and hospice services in that region.

The company estimates annual revenues of $8.3 million from its JV with University Health Care System.

Over the years, LHC Group has gained a reputation for being bullish when it comes to targeting JV opportunities. The company has become the preferred in-home health care partner for nearly 400 leading hospitals across the U.S.

The company has built a wide network of JV partnerships — viewing each deal as unique agreements, according to Myers.

“We now refer to ourselves as a ‘custom builder’ of in-home health care services partnerships, because no two of our hospital partnerships are exactly alike, in truth,” Myers recently said during a panel discussion at the 2020 Home Health Care News FUTURE conference.

In addition to its recent JV partnerships, LHC Group announced plans to acquire Santa Rita Hospice, an Aurora, Colorado-based end-of-life care provider. Under the deal, Santa Rita Hospice will operate under the name At Home Hospice.

The eight-county Santa Rita Hospice has been owned and operated by a local family, based in Denver.

“We see growth potential for hospice services in the Aurora market,” Myers said. “This transaction aligns with our strategy to co-locate home health and hospice services in markets where it makes sense — enabling us to reach even more patients and families with the quality care and service they deserve.”

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