Home Health and SNFs Should Lean On, Learn From Each Other

Despite the competition that often exists between home health care agencies and skilled nursing facilities (SNFs), the industries have more similarities than differences. As such, they should be leaning on and learning from each other, experts say. 

“I know that home health is struggling in a lot of ways — there are a lot of challenges [and] many of the challenges are similar [to challenges SNFs face],” Cory Rutledge, managing principal at CliftonLarsonAllen LLP said during a panel discussion at the National Association for Home Care & Hospice (NAHC) Financial Management Conference earlier this month in Chicago. “If there is someone in the skill-nursing space in your local community, go out, have a beer with them and talk about how you’re in a similar boat.”

Minneapolis, Minnesota-based CliftonLarsonAllen is a national financial auditing firm that has 90 locations across the U.S. and offers wealth advisory, outsourcing and public accounting services.


The workforce shortage is a pain point for both skilled nursing and home health providers, with registered nurses (RNs) roles being particularly difficult for SNFs to fill. Meanwhile, home health sees high turnover and low retention rates with caregivers.

Rutledge was joined on the conference panel by Keith Boroch vice president at McBee Associates, where Boroch leads the post-acute consulting practice.

McBee Associates is a Wayne, Pennsylvania-based health care consulting firm that has more than 3,000 clients and works with health systems, hospitals, home care agencies and hospice organizations across the U.S.


Boroch discussed opportunities for home health agencies and SNFs to collaborate, given the similar regulatory challenges both industries are facing.

Similar to the patient-driven groupings model (PDGM) for home health, the patient-driven payment model (PDPM) is just a few months away for skilled-nursing providers.

Under PDPM, reimbursement for Medicare Part A patients in SNFs will be driven by patient condition, instead of therapy minutes provided to that patient.

Looking across models, asking questions and attempting to understand payment will be key — and will allow SNFs and home health providers to work together, according to Boroch.

“The question goes back to where the opportunities lie,” he said. “As we talk about PDPM, I’m thinking about some of the impacts of PDGM. With PDGM, if we start thinking about it from taking care of patients with longer-term needs and the way those care criteria then reimburse, that could end up driving opportunities as well.”

In other words, home health care providers and SNFs can work together to optimize patient care, in turn, maximizing reimbursement.

Meanwhile, Aaron Tripp, LeadingAge’s vice president for reimbursement and financing policy, also previously emphasized the importance of branching out of industry silos.

“Really, the foundation of PDPM is very similar to PDGM — and is also similar to the conversations that are going on around a potential unified post-acute payment system that could come out in the future,” he said during a panel discussion at the 2019 Skilled Nursing News Summit in Chicago last month. “We need to be talking to each other as a continuum of care — not just in our own four walls.”

Washington, D.C.-based LeadingAge is a nonprofit advocacy organization that represents a wide variety of aging services providers.

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