Home health utilization across the country has plateaued, marking the end of a growth spurt that lasted seven years, according to data compiled by Healthcare Market Resources. Still, rates varied significantly by state, perhaps indicating room for growth on a more granular level.

The national average for home health utilization in 2014 was 8.76%. This is lower than the 12.41% recorded in states including Alabama, Connecticut, Florida, Illinois, Louisiana, Massachusetts, Michigan, Mississippi, Nevada, Oklahoma, Pennsylvania, Rhode Island, Texas and Utah; but higher than the 4.75% noted in Alaska, Arizona, Hawaii, Idaho, Montana, Nebraska, North Dakota, Oregon, South Dakota, Washington, Wisconsin and Wyoming.

The rates were calculated as the number of home health patients served versus the number of Medicare fee-for-service enrollees, based on data from 2014.

Overall, home health utilization nationally declined by nearly 0.3% from 2013 to 2014, yet four states saw home health use grow by up to 0.6% and another three made gains of 0.1%. An additional four kept their rates the same year over year.

Regardless, most states experienced a decrease in home health utilization at drops of 0.2% or more, and three states were at or near a 1% decline.

“Agencies cannot sit back and expect the ‘good times’ of the last decade to be repeated,” Healthcare Market Resources states. “Low utilization markets, such as the Upper Midwest, will have the greatest potential for growth, while high utilization markets, like Texas and Florida, could decline as length of stays for community referrals shrinks.”

Despite increased regulatory barriers like face-to-face requirements, home health could still see some gains moving forward.

“The pay for performance efforts in other parts of the health care delivery system, which includes more flavors of Accountable Care Organizations and mandatory bundled payment demonstration for joint replacement, could mean increased home health utilization, as at-risk parties seek the least expensive site of care—the home,” the report states. “And, readmission penalties allow home health organizations to partner with hospitals and ACOs to reduce readmission threats, as well as avoiding the higher costs of using a skilled nursing facility for post-acute care.”

Written by Kourtney Liepelt