Payer and provider trends in home health care
Five trends impacting home health payers and providers
Keeping up with trends in the homecare industry is not only important, but everywhere from water cooler chats in the office to social media healthcare groups, trending topics seem to be all the buzz. In the home healthcare industry, you have to be aware of the industry and localized trends as they can affect your business positively or negatively. Many changes are on the horizon in 2023, and in this blog, we’ll catch you up on the latest in what’s happening this year with providers and payers.
Though as a nation we are closer to a “normal” now than in years past, the COVID-19 pandemic caused a major shift in how things are handled operationally in home care at the individual state and the national level. The good thing is so far 2023’s regulatory changes are providing many opportunities for new developments and expansion in your home health business. In this article, we will discuss five of the biggest trends, from staffing shortages and software to new bills, and Medicare.
- TREND #1 – MORE HEALTHCARE RESOURCES AT THE FEDERAL LEVEL
President Biden has committed more resources and funding to home- health and community-based care. The key areas will involve funneling more resources into specifically those in the nursing home sector and the homecare sector. Due to the growing continuously aging segment of the population, the administration has proposed a plan that helps more nursing home residents to transition back home and subsequently receive care in their place of residence. To meet these needs, an increase in staffing, training, and resources is necessary. Here is what you’ll need to know:
- An initiative was launched for better access to good-paying union jobs in the nursing home industry, with the intent to create “double dignity” for both workers and patients
- 80 million dollars in grants for workforce stakeholders is available right now to increase the number of educators, train healthcare workers and prepare them for advancement in their careers
- Section 9817 of the American Rescue Plan Act of 2021 focuses on strengthening and investing in home and community-based services for Medicaid beneficiaries
TREND #2 – MEDICARE CHANGES IN 2023
There are some major changes to Medicare happening this year for home healthcare. These changes include premium and deductible increases for Part A and lower rates for Part B while expanding coverage for Part D coverage.
- Enrollees in Medicare Part B will see a decrease in the standard monthly premium by 5.20 dollars
- Medicare Part A beneficiaries will see a rise in their inpatient hospital deductible from $1556 to $1600
- A total of 801 Medicare Part D stand-alone prescriptions will be offered this year
- The Centers for Medicare and Medicaid Services (CMS) presented their 2023 calendar year final rule for Home Health Prospective Payment Systems. This will update medicare payment policy rates for home healthcare agencies, estimating payments to HHAs will increase by 0.7%
TREND #3 – SOFTWARE AS A SERVICE IMPROVEMENTS
The industry-wide use of software as a service for agencies and related healthcare entities will help combat everything from staffing shortages to workplace management challenges. With staffing shortages increasing from many people leaving the healthcare field, the role of software in recruiting, training, and maintaining the home health care workforce has become more pronounced
After being on the front lines of the pandemic, working short-staffed and underpaid as well as feeling underappreciated, many caregivers and nurses began looking to change their careers. Even with the rise in rates for caregivers, comparatively, these somewhat essential workers began to view healthcare as a less viable and worthwhile career. This opened the door for tech providers to identify gaps and fill them, creating or enhancing existing software capable of alleviating the stress of workers and administrators.
- Better Home Health Software: In the last decade the industry has seen many advances in the functionality of home care software offerings in the open market. These solutions are built to help with financial management, office management, clinical management, billing and coding, and patient management. Compliance with state by state EVV system requirements can also be addressed with an EMR Software for home health care that features built-in electronic visit verification integration. This home health care technology is almost essential, with tools and features spanning every stage of the patient journey and administrative workload beginning from patient intake to authorization, scheduling, secure messaging, reporting, and the entire home health care journey.
- Better workforce software: Additionally, healthcare workforce management tools like TeamBridge, RC teambuilder, and others, allow businesses access to a mobile app that helps automate workforce scheduling, attendance, and payroll
TREND #4 – IMPACT OF THE NEW OASIS, OASIS-E
Oasis-E launched on January 1, 2023. The OASIS is the patient-specific assessment required by the CMS to plan care for home health care patients. OASIS-E will continue the collection of this data by introducing many new assessment items in the following categories:
- SPADES: Standardized Patient Assessment Data Elements
- BIMS: Brief Interview for Mental Status
- SDHS: Social Determinants for Health
So far, the homecare industry’s response to the new OASIS-E has been mixed, with some stakeholders welcoming the changes and others raising concerns about the potential impact on agencies and patient care. Those who have welcomed the changes in OASIS-E stated that it reflects current best practices and better aligns with the goal of improving patient outcomes. For example, OASIS-E includes new questions about patients’ mental health and social determinants of health, which are important factors in providing holistic care. Additionally, OASIS-E has streamlined some questions, resulting in a reduced number of overall questions and allowing for more focused assessments.
Those less enthusiastic about the OASIS changes have expressed concerns about the new requirements and their impact on home health agencies. Some have argued that the increased data collection and reporting requirements are burdensome for agencies, particularly smaller ones. Others have raised concerns that the new questions about mental health and social determinants of health may not be adequately supported by reimbursement structures and could lead to underfunded care.
TREND #5 – HOME HEALTH EMERGING AS THE PREFERRED METHOD
The reputation of Home Health as a resource and cost-saving alternative to hospitalization and nursing home care is on the rise. This is good news for home care agencies and homecare professionals! Hospital at home or SNF at home is a big topic right now, for patients, doctors, and insurance companies. These models became popular almost immediately after the pandemic ensued. This has opened the door for home healthcare businesses to expand and grow, even if they choose not to take advantage of all of the resources and financial enticements available through various federal and state-level initiatives.
- According to a report from the Centers for Medicare and Medicaid Services (CMS), spending on home health services increased by 12.6% beginning in 2020 and beyond, which was higher than the growth rate for any other healthcare sector
- The number of Medicare-certified home health agencies increased by 3.8% in the last couple of years
- A survey conducted by the National Association for Home Care & Hospice (NAHC) found that 76% of home health agencies reported an increase in patient volume during the pandemic
- The use of telehealth services in the home health sector has increased dramatically since the pandemic began, as more patients have sought to receive care remotely. According to the NAHC survey, 87% of home health agencies reported using telehealth in 2020, compared to just 4% in 2019
Overall, the home health sector has grown significantly since 2020, driven by increased demand for home-based healthcare services and the use of telehealth technology to deliver care remotely.
Summary
All things considered, 2023 is about expanding your business horizons with new technology, identifying and capitalizing on government-created opportunities, and finding innovative ways to ease tension on your staff while making the home health field enticing again. Establishing a trademark brand in the home healthcare industry is a very realistic and achievable goal this year, as providers and payers are well-positioned for growth and expansion with lucrative possibilities.
Additional blogs on related topics:
Emerging technology in home health care
Challenges in 2023 for home health executives
Choosing the best home health software
Non-medical In-home Trends in 2023
Improving staff retention in homecare
Best Practices for Home Health Intake
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