According to Lena Nilsson, vice president of clinical operations for OSF HealthCare Home Care Services, the home setting is the future of healthcare.
The home health sector experienced a rise in services during the COVID-19 pandemic with patients needing—and in some cases preferring—to receive care in their homes. A continued interest in home health services among patients and the industry has persisted as the COVID-19 pandemic becomes endemic.
HealthLeaders spoke with three executives from OSF HealthCare Home Care Services: J.J. Guedet, vice president of operations; Lena Nilsson, vice president of clinical operations; and Matthew Nieukirk, director of skilled nursing facility about the focus on home health and predictions about the market.
HealthLeaders: What are the benefits of a health system having its own home health service?
J. J. Guedet: There are several benefits of owning our own home health service. The first and maybe the most simplistic benefit is that our home health team is accountable to and responsible for the same mission, vision, and values as the rest of the health system. This helps foster a community of caregivers aligned to the same goals and work. A key aspect in our mission, vision, and values is ensuring access to care to all patients, regardless of payer source or other factors that make care delivery more complex. We accept Medicaid and Medicare Advantage patients, and we make them a priority to speed up the discharge process. Not all private home health agencies can afford to take on large volumes of Medicaid patients. Our home health team prioritizes getting patients home from our hospitals as soon as possible to ensure that our hospitals can provide more access to care to patients.
In this work, not only are we collaborating to make the transition process to home smooth and timely, we are taking on more medically complex patients and helping them continue their recovery processes at home. As part of the health system, we have access to technology and robust education services that enable our home health team to serve patients who traditionally would remain in the hospital for several more days. We have our own home infusion pharmacy as well, and they work closely with our home health team.
HL: Why do you think more systems are interested in offering home health options?
Lena Nilsson: The future of healthcare is in the home setting, evident by the development of 'hospital at home' alternatives and recent proposed Choose Home legislation. Furthermore, I believe the ability to ensure continuity of care and minimizing care gaps allows for efforts focused on managing and treating patients to meet needs and goals, limiting unnecessary rehospitalizations.
Guedet: We need to make sure our hospitals and emergency departments can serve our communities. Part of that work is to help lighten their burden by offering robust home care services, including home health and home infusion pharmacy. The cost of keeping a medical patient in the hospital is often more than $2,000 per day with no additional reimbursement.
HL: What are some challenges or pain points you've identified or predict the sector will have to deal with in the future?
Matthew Nieukirk: The biggest pain point is the new minimum staffing levels that are being placed on the facilities. They have to increase the RN coverage to provide better outcomes. The other issue will be that Medicaid rates were not increased enough to help with the increased staffing levels. So many facilities, especially in rural areas, are facing closures. The other ones are closing wings and reducing staff, and by doing this are decreasing expenses to help offset the staffing increases for more acute patients. The issue for health systems is that by reducing wings or beds, patients are forced to remain in hospital beds longer or until beds become open in the facilities. So, increased staffing levels and closing off beds or wings are the biggest impact to our health system.
HL: How would current legislation to change Medicare/Medicaid reimbursements affect home health patients?
Guedet: Home health is certainly impacted by reimbursement models and rates. Medicare Advantage programs are one of the most challenging for us to work with. Many of these payers do not cover the costs of providing care to patients, or the return is so small that many home health agencies will not accept or will cap what they can accept to a certain volume. We don't have that luxury, as the majority of our referrals are coming from our own health system, and deferring a referral just hurts the system in other areas. What we see happening is that as more home health agencies make the decision to limit Medicaid and Medicare Advantage volume, our volume with those payers grows disproportionately. We are being asked to take on patients who are much more medically complex than they were five years ago, and we are asked to take rate reductions to do it.
Neither Medicaid nor Medicare have been able to adjust reimbursement to recognize the cost of nursing growth over the last three years. We've seen our labor costs grow by 10%–15% for nursing, and the cost for traveler nurses has almost doubled. Long term, we expect to see many smaller, privately owned home health agencies close and even more burden pushed to health system–owned home health.
We are working hard to innovate and to provide great patient care through alternate means, such as digital health, but the current home health benefit does not recognize digital health as a billable service. Even though much of home health services is focused on patient education and teaching independence, there is no reimbursement for utilizing these digital solutions.
Because OSF Health owns its own home health service, patients are able to coordinate more of their care within the system.
More systems are beginning to offer home health options due the patient preference for 'hospital at home' alternatives.
Staffing continues to be an issue in home health, Medicare/Medicaid reimbursements often don't cover the cost of care.