CMS Plan to Resume Elective Procedures Could End Home Health Business Lull

Some health systems will soon be able to begin performing elective procedures again, thanks to a new set of guidelines from the Centers for Medicare & Medicaid Services (CMS) released Sunday.

A return of elective procedures could be a boost for home health providers, who have experienced a decrease in revenue during the COVID-19 public health emergency. Home health agencies that have historically cared for a large number of hip and knee patients post-surgery have been hit especially hard.

In March, CMS recommended reducing “non-essential” medical and surgical procedures in order to preserve personal protective equipment (PPE), beds and ventilators. The recommendation was also meant to help ensure a health care workforce was available to care for those most in need during the COVID-19 emergency.


For home providers, though, an overall decrease in elective procedures has meant fluctuations in patient volumes and other bottom-line challenges.

“Home health agencies often care for patients who have had elective surgeries, such as joint replacements,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News in an email. “The suspension of elective surgeries has had a significant revenue impact for home health agencies.”

Some home health agencies have reported reductions in revenue exceeding 25%, according to Dombi.


“When those surgeries return, agencies can be counted on to be there for post-surgical care,” he said.

CMS’s new guidelines are for states or regions that are seeing a relatively low or stable number of coronavirus cases. The guidelines are part of the first phase of the Trump administration’s “Guidelines for Opening Up America Again.”

“Today, some areas of the country are experiencing fewer cases and lower incidence of the virus, necessitating a more tailored and flexible approach,” CMS Administrator Seema Verma said in a statement. “Every state and local official will need to assess the situation on the ground to determine the best course forward, but these guidelines provide a gradual process for restarting non-COVID-19 essential care while keeping patients safe.”

CMS’s guidelines specify that health care organizations that have the resources to do so should provide non-COVID-19 care. These decisions should align with public health information and be made with state public health authorities.

Additionally, the guidelines address evaluating care based on clinical needs, screening all patients for COVID-19 symptoms and following the Centers for Disease Control and Prevention (CDC) recommendations surrounding PPE.

About 88% of medical personnel in more than 200 U.S. cities do not have an adequate supply of PPE, according to a U.S. Conference of Mayors survey. A lack of PPE has been particularly challenging for in-home care providers, often left off equipment prioritization lists.

“I’ve heard interesting stories about providers reaching out to construction supply stores, baby supply stores, restaurant supply stores, beauty supply stores and wherever they can get masks and gloves,” Dean Chalios, president and CEO of the California Association for Health Services at Home (CAHSAH), previously told HHCN. “One agency even reached out to a tattoo parlor because they had gloves. It’s all hands on deck.”

CMS made several specific recommendations for what health care facilities need to do to open back up for non-coronavirus care.

Those recommendations, for example, included establishing non-COVID Care (NCC) zones where patients and staff are routinely screened for symptoms. Additional recommendations included creating administrative guidelines that uphold social distancing and establishing rigorous sanitation protocols.

As more health systems begin implementing reopening efforts, it’s likely that home health providers will see a surge in patients in the next few months, according to Mark Sharp, a partner at BKD, a Springfield, Missouri-based accounting services firm.

“Elective procedures will likely begin to pick back up soon due to the reopening efforts,” Sharp told HHCN in an email. “It may not pick back up as much as we would like due to the continued fear of COVID-19. We also anticipate there could be a new trend of sicker patients coming to home health as these patients and their families are trying to stay out of institutional care at all costs.”

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