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Home is Where the Focus Is

Seems as though CMS has taken a page out of Dorothy’s book with the mantra, “there’s no place like home.”  And those of us who have been in healthcare for any extended period of time can say, “We aren’t in Kansas anymore!” 

Times are certainly changing – and COVID has expedited that change more than ever – but with Medicare and Medicaid spending being such a heavy focus, the proposed Choose Home Care Act of 2021 comes as no surprise to many.  The bill is exactly as it sounds – it allows eligible Medicare beneficiaries who meet a certain criteria to choose where they receive their post-acute care: in the comfort of their own home vs. a skilled nursing facility.  The rationale is obvious – the average cost of treating a patient under homecare is far less when compared to that of a Skilled Nursing Facility, however we know that the overall services provided and clinical utilization provided by Skilled Nursing Facilities are more comprehensive than that of Home Health Agencies, in most markets.  But that could change with the adoption of the Choose Home Care Act. 

That is the future of the healthcare landscape – rising acuity of patients, with the expectation that spending will not increase proportionately alongside acuity.  Home Health Agencies will need to consider how to expand clinical capabilities, increase staffing (amidst a national staffing crisis), and manage the logistics of essentially operating a 24-hour Skilled Nursing Facility at home model. 

While this change could (and undoubtedly will) pose some risk to Skilled Nursing Facilities initially – it is now more important than ever that post-acute providers ban together and stand united to successfully work within the confines of a future that may encompass the Choose Home Act by leveraging each other’s strengths. 

See below for our thoughts on how to best prepare – regardless of where you land on the spectrum of care!

We see an opportunity for each setting in this evolutionary change. This legislation is coming whether it is in 2022 or the near future. Let us help you prepare today as we go through some of the questions you need to ask yourselves.

Questions worth asking for Skilled Nursing Facility Providers!

  • When was the last time you reviewed your home health partner’s data + outcomes?
  • When was the last time you sat down with your home health partners to review the patient experience + outcomes of your shared referrals?
  • Are you currently leveraging the 1135 waiver for direct admissions – not only from the hospital but also downstream partners such as Home Health agencies?
  • Do you have an effective process in place for communication, acceptance, and admittance of direct referrals from Home Health partners?
  • Are you equipped to take on a higher acuity individual – knowing that many Skilled Nursing Facility patients could opt for home in the future – shifting potentially “stable hospital” patients to a Skilled Nursing Facility to act as a TCU?

Questions worth asking for Senior Living Providers!

  • When was the last time you reviewed your Home Health partner’s data + outcomes?
  • Have you reviewed your state’s AL/IL regulations to ensure you are able to meet the needs surrounding a revamped admissions process while remaining compliant under regulatory guidance?
  • Are you equipped to take back your residents at a higher acuity than they return now? While they will receive add-ons to traditional Home Health benefits (to include transport, meals, caregiver support, and remote patient monitoring) – they will still pull from some of your IDTs resources.
  • Do you have the spectrum of care provided on-site? Having a robust skilled rehab provider that can “change hats” and provide both part A + part B services will be critical to the success of your patients as they transition from the initial 30 days to consecutive 30 days and beyond.
  • Do your staffing patterns support 24/7 patient needs with proactive wellness services to improve successful aging in place?
  • With some of the add-ons of the Choose Home Act including transportation, meals, and personal care assistants – can you act as a solution to Home Health operational considerations while simultaneously enhancing your revenues for the support services through this carve-out?
  • On the flip side – could you provide additional services to residents (i.e. transport, caregiver support) through leveraging Home Health amenities under this act to alleviate any of YOUR operational challenges?

Questions worth asking for Home Health Partners!

  • How do you manage, monitor and share your outcomes and publicly reported data?
  • How do you work with surrounding Hospitals and Skilled Nursing Facility partners to assist with direct admissions when needed and able?
  • Do you leverage partnerships today that can mitigate staffing concerns under a 24/7 model?
  • Do you utilize clinical pathways as standards of care for all patients today?
  • How can you collaborate with Hospitals and Skilled Nursing Facilities to grow your network and boost census?
  • What partnerships can you begin to explore to facilitate the supplemental services (i.e. transportation, meals, personal care) provided under the Choose Home Care Act?

While this bill remains in Congress, many speculate that it will pass while others are skeptical that Congress can make it happen now.  It would be a huge step in the direction of a unified payment system – and help to force hands of those providers who may be resistant to change to have to jump in feet first in order to remain viable.  While some may feel a bit of panic (i.e. a Skilled Nursing Facility provider already struggling with census + occupancy), we are confident that you will still have a strong foothold in the spectrum of care- albeit looking different than it does today. 

We at HealthPRO Heritage feel strongly that this can help elevate post-acute providers. Open dialogue and strategic conversations around this topic and many others should be happening now. Reach out to us to start that discussion today. Change can certainly be unsettling – but we are used to that in healthcare.  Besides, as the old Socrates saying goes, the secret of change is to focus all of your energy not on fighting the old, but on building the new”. 

For additional insight on what the Choose Home Care Act of 2021 means for you, contact us today.