How Intrepid USA, VNSNY Refined Their Referral Processes Following Pandemic-Related Volume Swings

For home health providers, one of the many impacts of the COVID-19 emergency was a sudden drop in referrals last spring.

Eventually, though, a nationwide effort to shift more care into the home led to an increase in referrals for the home health industry. Providers are now trying to navigate the increased referral volume while maintaining their traditional level of high-quality care.

One of the main reasons home health agencies saw a drop in referrals last year was the pause on elective surgeries and non-essential care. To protect patients from COVID-19 exposure and reserve necessary resources, for example, most hospitals and health systems canceled procedures like hip and knee replacements.


That took a toll on agencies that have historically cared for a large number of those patients.

Intrepid USA saw a 30% dip in its admission volume between March and May 2020, Mike Gregory, chief patient advocacy officer at the company, said during a recent webinar hosted by WellSky.

“At that time, we were running about 50% community referrals and 50% institutional,” he said. “We realized we needed to make a shift because the patients that qualify and benefit from home care are still out there. We put an increased focus on community-based referrals. We saw a gradual increase and were back to showing some year-over-year gains around the September, October timeframe.”


Dallas-based Intrepid USA has 75 local care centers across 17 states. The company provides home health, hospice and personal care services.

Due to its location, New York-based home health and hospice provider the Visiting Nurse Service of New York (VNSNY) was hit hard by COVID-19. New York was an early hotspot for the virus, but quickly became a central hub for pandemic care solutions as well.

“The shift was dramatic and fast,” Susan Caputo, vice president of business development at VNSNY, said during the webinar. “Then we did start to see recovery for a while and some return in elective surgeries. Unfortunately, we started to go into a bit of a second wave again as we went into the fall season. It was kind of a roller coaster, up and down.”

VNSNY is one of the largest nonprofit home- and community-based services providers in the U.S.

When referrals began to see an uptick again, Intrepid USA leaned on technology tools to improve the company’s referral partnerships with hospitals and physician groups, specifically by closing gaps in communications.

“Hopefully we’ll see a difference in the numbers for 2021 versus 2020 because people are getting more proactive in figuring out how to replace the face-to-face,” Gregory said. “There’s nothing like that warm transfer of a patient knowing who they’re going home with from a hospital or skilled nursing facility, but we have to figure out ways around that so we can continue to help those patients get the care they need.”

One of the keys to a timely and successful transition into home health is the provider having all of the key patient information they need.

To this end, the COVID-19 emergency has created an environment that has allowed providers to re-educate referral partners on the importance of clinical information, according to Caputo.

“We’re not asking it to be annoying, we’re asking it because it’s really going to give us the documentation we need regulatorily … to get that patient on as quickly as possible,” she said. “[Referral partners] saw it with very different eyes. It felt like they were way more open to learning and understanding our side of the business.”

At Intrepid USA, the goal has become simplifying the referral process for the company’s partners.

“We have to make it easier for them to refer the patient to us — televisits, Zoom, webinars — whatever it may be, with our referral sources, with the patients, with the families, within our own business lines,” Gregory said.

Gregory noted that even within an organization with multiple service lines, such as home health and hospice, the internal transfers can be tricky.

“We try to carry that message to our referral sources, saying even … under the same umbrella things still get missed without continuous improvement in your collaboration, your communication, your coordination of that care,” he said. “We are also continuing to invest in all systems within our organization.”

Overall, providers should also continue to work to improve their referral process, at a time when the types of patients entering home health are more complex than ever.

“The nursing homes just have not recovered, so we continue to get those patients,” Caputo said.

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