Not a “temporary blip”: Home health agencies win a larger share of hospital discharges


Anecdotal claims by home health insiders were true: Across the country, home health agencies won a larger share of discharges from acute care hospitals during the public health emergency.

Specifically, the percentage of patients referred to home health care increased 1.8% from March to May 2020, from 17% to 18.8%. This would mean, theoretically, that over 10,000 more patients visited home health agencies in May than they otherwise would have.

“In the first two months, we saw some patients transitioning from SNFs to home health,” said Conner Esworthy, an advisor at the Washington, DC-based research and consulting firm ATI Advisory, told Home Health. Care News. “It’s about figuring out where these patients are going and how these trends will evolve. [into place]. ”

The exit information comes from a new analysis conducted by ATI Advisory.

While useful for understanding the evolution of referral patterns to post-acute care, it also comes with a few caveats. On the one hand, the data observed on claims for fee-for-service Medicare only dates from the onset of the public health emergency.

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

“As we get more data, we expect this story to evolve even more,” Esworthy said. “And all of this is also on a national basis. So in local trends we could also see different changes, but I don’t think this is a temporary accident. “

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

It all depends on how well the SNFs are able to manage their patient populations in the future, especially given their financial vulnerability 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 expect to see changes as we continue to examine these trends through 2020 and into 2021,” Tyler Cromer, director of ATI Advisory, told HHCN. “I think what we also see in the data is that – at least in the case of long-term care hospitals – they were taking care of patients who really had a high level of need. And I think you’re going to see home health taking care of patients who could sort of be treated at home, given the circumstances. “

Because patients went to the hospital less during the early stages of the pandemic, those who did were more likely to be very sick.

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Even then, home health agencies were gaining the largest share of outings. When the patient population returns to a normal and “less sick” baseline, it could mean that home care providers will be able to manage even more patients in post-acute care.

“We have seen home health agencies and long-term care hospitals somehow help manage some of the flow of patients who, but for the pandemic, might have been directed to the SNF environment,” he said. said Esworthy. “A takeaway for home health is that there is a very important role for it during the pandemic and after it is over.”

In long-term care hospitals, they referred patients in April and May to home care about 15% of the time.

Going forward, a goal for long-term care hospitals and home health agencies should be to work together to place these patients in a safe setting at home in the most efficient way possible, Esworthy said.

General conclusions

The discharge process 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 exposed opportunities or initiatives in terms of things that have happened on a local basis that we should really consider pursuing in the long term?” “

An example of this would be the necessary breaking down of silos during the pandemic that accelerated patient exits to the appropriate post-acute care setting, she added.

Home health agencies, for now, appear to benefit from this clarity of communication that occurred during the disruption. When the pandemic subsides, this meticulous discharge process is expected to continue.

“One of the main lessons from this preliminary research is that there should be a public health imperative to maintain a flexible provider asset class that the healthcare delivery system can activate … during crisis. public health, ”Esworthy said.

The main finding of the ATI analysis was that COVID-19 underscored the importance of post-acute care and “strengthened the roles of long-term care hospitals within the healthcare ecosystem.”

“This emphasizes that each part of the continuum of care has a very important role to play and that those roles change at different times,” said Cromer. “I hope we’ve learned from this how to get the most out of every part of the post-acute care continuum. I think this is our greatest hope.


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