Home Health Poised for More Growth as Patient, Physician Preference Rises

A new report details the healthcare industry's new emphasis on home health and its place in the health care continuum.

When the Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care At Home Program in 2020, the goal was to allow patients to receive intensive treatment in their homes to  alleviate the strain hospitals were facing due to the COVID-19 pandemic.

Now,  two years later, numerous health systems have begun offering home health services, which have been received with enthusiasm from patients.

A recent Wellsky report on post-acute care noted a significant increase in home health referrals versus skilled nursing facility referrals between 2019 and 2022. The data, gathered by the Partnership for Quality Home Healthcare, showed that in 2021, some 86% of adults preferred to receive "post-hospital, short-term healthcare" at home, while only 5% preferred a nursing home.

In addition to the Hospital at Home program, the Choose Home Care Act also allows for patients to receive care at home for a period of about 30 days.

HealthLeaders spoke to Sharon Harder, president of C3 Advisors, and author of the Wellsky report about the possibility of programs like Hospital at Home and Choose Home becoming permanent. With both pieces of legislation holding a lot of promise and having bipartisan support, she said she doesn't see why they wouldn't pass at some point.

"It would clearly require a new set of conditions of participation and new rules and reimbursement structure, but all of that would essentially be accomplished during that period during which the secretary of health and human services needs to come up with regulations, and that's part of the bill as it’s written," she said of the Hospital at Home program.

Many health systems are adding home health to the services they offer, something Harder believes would have happened eventually but was expedited by the pandemic.

"If you look back 10 years or so, hospitals that owned home health agencies got out of that business," she said. "Now they're coming around full circle and getting back into those lines of business because it suits them in terms of patient outcomes."

Health systems have to make sure that once a patient leaves a hospital,  they don't come back for an avoidable event, Harder said. That can result in readmission penalties, which many hospitals struggle with, she said.

"As they enter into risk-based contracts, [patient] outcomes and bundling are really important," she said. "So if they control more of the stops on the continuum, if they can control all of those providers in terms of delivery and how a patient moves along the continuum of care, they have more control over patient outcomes and more control over total cost of care."

Like other sectors of the industry, post-acute providers are also struggling to recruit and retain talent. The extraordinarily high rate of COVID-19 cases and deaths in nursing homes, which was widely publicized in the early months of the pandemic, is  contributing to potential talents’ reluctance, Harder said.

"The other reality is that neither skilled nursing facilities, nor home health providers, can offer the kind of remuneration that hospitals can," she added. "They cannot come up with the signing bonuses that hospitals are able to offer, and they cannot come up with some of the salary differentials that hospitals and other organizations are offering,  so they're hamstrung in the marketplace because they just don't have the dollars to compete."