Not a ‘Temporary Blip’: Home Health Agencies Gaining Greater Share of Hospital Discharges

Staffing Reclaims Title of Home-Based Care Industry’s Biggest Challenge

The anecdotal claims from home health insiders were true: Across the country, home health agencies gained a greater share of discharges from short-term acute care hospitals during the public health emergency.

Specifically, the percentage of patients discharged into home health care rose 1.8% from March to May of 2020, from 17% to 18.8%. That would mean, theoretically, that over 10,000 more patients went to home health agencies in May than they would have otherwise.

“In the first couple months, we did see some patients shifting from SNFs to home health,” Conner Esworthy, an advisor at Washington, D.C.-based research and advisory firm ATI Advisory, told Home Health Care News. “It’s about figuring out where these patients are going and how these trends are going to fall [into place].”

The discharge information is from a new analysis conducted by ATI Advisory.

While helpful to understanding evolving post-acute care referral patterns, it also comes with a few caveats. For one, the observed Medicare fee-for-service claims data is only from the beginning of the public health emergency.

In addition, as more data becomes available, some trends will become more solidified and others will become evident.

“As we get more data, we definitely expect this story to evolve even more,” Esworthy said. “And this is all on a national basis as well. So in local trends, we could see different shifts happening as well, but I don’t think this is a temporary blip.”

That is the question moving forward — whether home health agencies have gained a greater share of discharges permanently, or just temporarily, as patients shied away from skilled nursing facilities during the COVID-19 crisis.

It all depends on how SNFs are able to manage their patient populations moving forward, especially considering how financially vulnerable they have become during the pandemic.

Home health agencies also gained a slightly higher share of COVID-19 patient discharges from March to May, from 7% to 8%.

“I do expect to see some changes as we continue to look at these patterns over the course of 2020 and heading into 2021,” Tyler Cromer, a principal at ATI Advisory, told HHCN. “I think what we are also seeing in the data is that — at least in the case of long-term care hospitals — they were taking care of those patients that really had a high level of need. And I think you’re going to see home health taking care of patients who sort of appropriately could be cared for in the home, given the circumstances.”

Because patients were going to hospitals less during the early stages of the pandemic, the ones that did were more likely to be very sick.

Even then, home health agencies were gaining that greater share of discharges. When the patient population returns to a normal and “less sick” baseline, that could mean that home health providers will be able to take care of an even larger amount of post-acute care patients.

“We saw home health agencies and long-term care hospitals sort of help to manage some of the flow of patients that maybe without the pandemic would have been headed into the SNF environment,” Esworthy said. “A takeaway for home health is that there is a really important role for it during the pandemic and after it ends.”

On the long-term care hospitals’ end, they were discharging patients in April and May to home health about 15% of the time.

Moving forward, a goal of both long-term care hospitals and home health agencies should be to work together to get those patients into a safe setting at the home in the most efficient way possible, Esworthy said.

Overall conclusions

The discharge process has changed — arguably for the better — during the public health emergency.

“What we really hope is that this sets the stage for his future conversations,” Cromer said. “Are there parts of the disruption that have laid bare opportunities or initiatives in terms of things that have happened on a local basis that we should actually think about pursuing for the long term?”

An example of that would be the necessary breaking down of silos during the pandemic that has sped up patient discharges to the appropriate post-acute care setting, she added.

Home health agencies, for now, seem to be benefiting from that clarity in communication that came during the disruption. When the pandemic does subside, that meticulous discharge process should continue.

“One of the biggest takeaways from this preliminary research is that there should be a public health imperative of maintaining a flexible provider asset class that the health care delivery system can activate … during public health crises,” Esworthy said.

The major conclusion from the ATI analysis was that COVID-19 highlighted the importance of post-acute care and “reinforced the roles of long-term care hospitals within the health care ecosystem.”

“It puts an emphasis on the fact that every part of the care continuum has a really important role to play, and that those roles shift in different times,” Cromer said. “Hopefully we learned from this how to get the most out of each part of the post-acute care continuum. I think that that’s our biggest hope.”

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