Referral Rejection Rates, Patient Complexity In Home Health Care Reaching All-Time Highs

Home Health Care News / By Andrew Donlan

While referrals to home health care are ballooning, providers are rejecting them at an unprecedented rate.
 
As hospitals scramble to place patients in the hands of appropriate post-acute care providers, skilled nursing facilities’ referral volume has rebounded.
 
Home health referral volume also remains above pre-pandemic levels, but providers are struggling with staffing challenges and sicker patients. Data from WellSky’s 2023 Evolution of Care Report shows just how significant those issues have become.
 
“We’re entering a new era of care delivery and there is a dramatic shift happening in the health care landscape,” Lissy Hu, president of connected networks at WellSky, said in a statement. “Providers, whether it’s the hospital or the doctor’s office, and health plans need to be connected to post-acute and home-based providers as care shifts to home and value.”
 
In April, Hu told Home Health Care News that referral rejection rates “very much remained an issue” at a time when home health referrals were at an all-time high.
 
“Our data shows that it’s truly a care continuum – that what happens in the post-acute setting has a direct impact on the hospital setting and vice versa – so improving patient outcomes requires a holistic cross-continuum approach,” she continued.
 
Specifically, 76% of patients being referred to home health care were not being accepted as of December 2022. That number was up from 54% in 2019.
 
WellSky’s data analysis is based on proprietary data that draws from over 2,000 hospitals and 130,000 post-acute care providers.
 
This issue has forced providers to be more up front with their referral partners in recent years, acknowledging which patients they can take and which patients they can’t.
 
“You just need to be transparent,” Geoffrey Abraskin, a senior vice president at Amedisys Inc. (Nasdaq: AMED), told Home Health Care News. “If you’re truly in a partnership, there’s going to be an understanding. Just like hospitals go on diversion – if their ED is full, for example – home health does the same thing. So, we’re in the same boat as them. We just try to be very proactive and upfront with our capacity or limitations.”
 
Home health providers are also caring for more complex patients than ever before.
 
WellSky data shows that patients are now at least 6% more acute, on average, than they were in 2019 at discharge.
 
Patients are more likely to be experiencing neurological, alcohol-use and drug-use disorders. They are also more likely to be suffering from psychosis or pulmonary circulation diseases.
 
“Anecdotally, we’ve been seeing that for years,” Bud Langham, EVP of clinical excellence and strategy at Enhabit Inc. (NYSE: EHAB), told HHCN earlier this year. “It started a long time ago, but certainly accelerated during COVID because there were fewer inpatient beds and staff to take care of those patients. In the home health industry, we were asked to take care of patients who were sicker than what we were used to.”

Study Highlights Physical Therapy’s Clinical, Financial Benefits Among Medicare Beneficiaries

Home Health Care News / By Patrick Filbin
 
Increased physical therapy (PT) utilization is associated with significant reductions in hospitalizations and emergency room visits, more evidence shows.
 
Meanwhile, home health providers are still grappling with how to manage physical therapy under the Patient-Driven Groupings Model (PDGM).
 
A new study from the Alliance for Physical Therapy Quality and Innovation (APTQI) showed that an increase in PT among Medicare patients could reduce health care spending by $10 billion.
 
PT users were 50% less likely to visit the emergency room or be hospitalized for a follow-up injury in the six months following their initial fall, according to the study.
 
An important distinction, however, is that the data tracked users who had already experienced a fall.
 
“A lot of people are going to end up in home health because after you fall, you may be homebound for a bit,” Nikesh Patel, executive director of APTQI, told Home Health Care News. “I think what this shows is that whatever setting those PT sessions are happening post-fall, you’re going to have a significant decrease in the likelihood of falls in the next six, 12 and 18 months.”
 
The results confirm what physical therapists have known for a long time, Patel said: that PT is a safe and effective method for helping seniors build the strength and other necessary skills to avoid future falls and reduce costly expenditures.
 
The U.S. Centers for Medicare & Medicaid Services (CMS) implemented PDGM on Jan. 1, 2020. Prior to PDGM, home health agencies were paid per therapy visit under the home health benefit in Medicare Part A. Now, payment is tied to patient characteristics.
 
At the beginning of 2020, many believed there would be an inevitable disruption to home health therapy utilization.
 
Today, it’s still unclear exactly how PDGM has impacted therapy utilization. Following the implementation of the new payment model, providers were naturally less likely to offer therapy services because they were not as incentivized to do so.
 
The study’s findings are another example of how PT can offer savings to the entire health care sector.
 
“For me, the most telling statistic was that for every 100 Medicare beneficiaries, we average in the U.S. about 21 hospital stays,” Patel said. “Of those hospital stays, 40% of those are fall-related. If you have a decrease of four to six hospitalizations and inpatient stays for a year, the costs are staggering.”
 
According to the study’s authors, increased PT use by 100 beneficiaries prone to falls could result in an offsetting reduction in total health care spending of as much as $61,400 to $91,900 per member.
 
When considering the 13.5 million Medicare beneficiaries who are not enrolled in physical therapy, that could create $10 billion in savings.

Home Health Value-Based Purchasing Model Sixth Annual Report - Key Takeaways:

The original Home Health Value‐Based Purchasing (HHVBP) Model provided financial incentives to home health agencies for quality improvement based on their performance relative to other agencies in their state. The goal of HHVBP is to improve the quality and efficiency of delivery of home health care services to Medicare beneficiaries. Nine states were randomly selected to participate in the original HHVBP Model CY 2016-CY 2021. Home health agencies in these states received performance scores for individual measures of quality of care that were combined into a Total Performance Score (TPS) to determine their payment adjustment relative to other agencies within their state. CMS first adjusted Medicare payments by up to ±3% in 2018, using agencies’ 2016 TPS. Payment adjustments increased each year, peaking at up to ±7% in 2021, the last year of the original HHVBP Model prior to the nationwide expansion of the model in January 2023. This document summarizes the impact observed in 2016 through 2021, the complete six years of the original model, including all four payment adjustment years.

The six years of the original HHVBP Model resulted in cumulative Medicare savings of $1.38 billion, a 1.9% decline relative to the 41 non-HHVBP states, as well as improvements in quality. These impacts were observed during 2021, the fourth and final year for quality-based payment adjustments, as well as in the preceding five years of the original model.

The Two Page Overview:

• Findings At-a-Glance (PDF)

The Report (includes an Executive Summary):

• Sixth Annual Evaluation Report (PDF)
• Go directly to the Executive Summary (PDF)

Additional Supporting Materials:

• Appendix: Data Sources and Quality Measures  (PDF)
• Model Page: Home Health Value-Based Purchasing Model

Changes to Form 1-9 and New Options for Employers to Remotely Examine Employees’ Documents

SESCO Management Consultants

USCIS and DHS Announce a Revised Form I-9 and a New Option for Employers to Remotely Examine Employees’ Documents

The U.S. Citizenship and Immigration Services (“USCIS”) has announced that a revised version of Form I-9, Employment Eligibility Verification will be available starting August 1, 2023. The current version can be used through October 31, 2023; however, as of November 1, 2023, only the revised version may be used.

Additionally, the U.S. Department of Homeland Security (“DHS”) has announced that employers who are enrolled in E-Verify will have the option to remotely examine employees’ identity and employment authorization documents. The revised Form I-9 will have a checkbox designated for E-Verify-enrolled employers to indicate when the employer has remotely examined an employee’s documents. This new flexibility option also goes into effect on August 1, 2023.

To take advantage of the new option for remotely verifying employees’ identity and employment authorization documents, the employer must:

• Be enrolled in E-Verify;
• Examine and retain copies of all documents;
• Conduct a live video interaction with the employee; and
• Create an E-Verify case if the employee is a new hire.

DHS is considering expanding these flexibilities to even more employers, but for now, employers who are not enrolled in E-Verify must comply with DHS’s previous deadline of August 30, 2023, to perform all required physical examination of identity and employment authorization documents for employees hired on or after March 20, 2020, if the employee’s documents were examined only virtually or remotely as was permitted under prior COVID-19 temporary flexibilities.

In its announcement, USCIS also highlights the following new features of the Form I-9:

• Sections 1 and 2 are consolidated into a single page.
• The I-9 is available as a fillable form on tablets and mobile devices.
• The “Preparer/Translator Certification” section is now a standalone supplement of the form, permitting employers to provide employees a copy of that single page as needed.
• Section 3 for reverifications and rehires is now a standalone supplement of the form that employers can print whenever a rehire or reverification is required.
• “Acceptable Documents” include receipt notices for certain filings that automatically extend employment authorization, along with related guidance and links to information.
• The form instructions are reduced from 15 pages to 8 pages.
• A checkbox has been added for employers enrolled in E-Verify to use in performing remote examination of employees’ identity and employment authorization documents (as previously noted above).

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