Home Health Care Tops Skilled Nursing as Most Likely Referral Destination

Throughout 2019, multiple post-acute care leaders have argued that the great SNF-to-home diversion wave has hit its peak. New data suggests they’re right.

Home health care has officially surpassed skilled nursing facilities (SNFs) as the most likely post-acute referral destination, according to the latest quarterly trends report from Atlanta-based analytics and metrics firm Trella Health, formerly known as Excel Health.

Specifically, 23.3% of in-patient discharges in the first quarter of 2019 were coded for home health care, while 21.1% were coded for SNF stays.


“The decrease in SNF referrals reflects a broader trend within the industry,” the report reads. “A lower percentage of in-patient discharges to skilled nursing and decreased SNF utilization over the past four quarters could portend continued challenges for SNF providers.”

Trella Health releases its trends report every quarter to help reveal national and state-level insights into Medicare demographics plus post-acute discharge and admissions patterns.

The latest report marked the first time the organization dug into SNF data.


Overall, the percentage of episodes discharged from a hospital stay without post-acute care instructions dropped slightly in Q1, dipping from the previous quarter’s 48.9% to 47.8%. While the decrease suggests good news for home health providers in the near-term, the fact that roughly half of all hospital patients are discharged home without any kind of post-acute care plan suggests there’s still work to do in terms of education and outreach.

East Coast states — Massachusetts, New Hampshire, New Jersey and Maine among them — often had the highest rates of home health referrals in Q2 2019. In New Jersey, for example, nearly 60% of in-patient discharges were sent to home health providers.

Conversely, Great Plain states often had the lowest home health referral rates, according to Trella. Montana, North Dakota, South Dakota and Wyoming all saw in-patient discharges to home health at rates lower than 10%.

Nationally, hardly any patients were discharged to long-term care hospitals (LTCHs) in Q1.

Admissions up, utilization down

Excel Health formally rebranded to Trella Health in August as a way to better reflect its goals and offerings. The move was also made in order to grow past the basic connotations of spreadsheets and numbers that “Excel” carries with it.

“While we do provide access to the industry’s most recent and complete set of Medicare claims data, our solutions go well beyond raw numbers,” Trella CEO Ian Juliano said at the time. “Our workflows and insights empower customers to transform their marketing and sales efforts, grow their care networks and serve more patients while optimizing costs.”

Within its trends report, Trella featured new data on home health admissions growth, though the most recent quarter is Q4 2018 due to delays associated with claims reporting and processing.

Year over year, home health admissions grew 2.1% in Q4 2019, climbing from about 909,500 to nearly 929,000 nationally. Yet changes in home health admissions by market ranged from 18% growth in Utah to a 25% decline in Washington, D.C.

While admissions grew year over year, home health utilization — or the number of patients discharged from an in-patient stay and admitted to home health — decreased from 31.3% for the four-quarter period ending in Q4 2017 to 27.8% for the period ending in Q4 2018.

“So, although the amount of home health admissions increased, a lower percentage of patients entered home health when compared to the total number of hospital discharges,” the Trella report reads.

The total number of Medicare beneficiaries grew by 1.4 million from the first quarter of 2018 to Q1 of this year.

Traditional Medicare enrollees, however, declined by 0.4%, while the number of Medicare Advantage (MA) enrollees grew by 7.7%.

“MA enrollment has grown consistently over the past decade and is expected to continue as additional plans are made available,” the report states.

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