New Data Highlights Growing Gap Between Home Health Referrals, Agency Acceptance Rates

Post-acute care volume trends continue to suggest that the shift to home is here to stay. Other data, however, also suggests there’s a widening gap between hospital referrals to the home health setting and agencies’ ability to accept new cases.

“Since COVID began in April of 2020, we have seen amongst our roughly 1,000 acute care clients that referral volume to skilled nursing has yet to recover,” Tom Martin, director of post-acute care analytics at CarePort, a WellSky company, told Home Health Care News. “And the referral volume to the home health industry has increased and sort of maintained [a level of] about 10% above the 2019 baseline.”

Hospital-to-home health referrals have remained strong throughout the public health emergency, apart from a pronounced dip in the spring of 2020. Throughout most of this year, referrals have been anywhere from 5% to 11% higher compared to 2019 norms, CarePort data shows.


July and August did see slight decreases in hospital referrals going to the home health setting, but that was mostly due to hospital in-patient volumes being down overall, Martin explained. In other words, there simply weren’t as many patients to go to home health agencies those months.

“In August of 2021, what we’re seeing is that our acute clients are again dealing with another wave of COVID in their hospitals,” he said. “That led to them not caring for patients like elective care surgeries, right? The type of patients who would then need post-acute care follow-up.”

Source: CarePort, a WellSky company

In contrast, hospital referrals to skilled nursing facilities (SNFs) have remained below pre-pandemic baselines throughout 2021. SNF-referral volume did show signs of a steady recovery from May through June, even getting to within 13% of the 2019 baseline.


But that recovery hit a snag in July and August as well, according to CarePort.

Other data paints a similar picture of what SNFs have faced this year.

Despite the fall drop, overall SNF occupancy is still 355 basis points above its low point in January, when it came in at 71.5%, according to NIC MAP data, released by NIC MAP Vision.

“There remains cautious optimism about improving occupancy trends, but there remain challenges including the rapid spread of the contagious COVID-19 Delta variant in the summer and fall months as well as labor shortages, which have caused some properties to limit new patient admissions,” NIC MAP Vision authors noted in a recent report.

Home health acceptance rates

It’s more than just numbers that has Martin believing the shift to home is permanent.

CarePort recently hosted an event with some of its hospital clients. During that event, many of the participants openly discussed how they plan to refer more patients to the home health setting even after the public health emergency subsides.

“I said to our customers, ‘We have seen, you know, a shift in your referral patterns. Do you think that you’re ever going to go back?’” Martin said. “And largely, the answer was, ‘No. We have not experienced any sort of jump in readmission rates or any sort of negative consequence to discharging more patients home.’”

While that’s likely music to the ears of home health providers, it’s also a pretty daunting statement. Already, most home health providers are in a position where they have to decline new referrals because of labor challenges – and those aren’t expected to go away anytime soon.

A CarePort analysis again sheds some light on that conundrum.

Source: CarePort, a WellSky company

Historically, hospitals have been able to refer patients to their network of home health agencies with confidence.

In the month of January 2019, for example, CarePort hospital partners sent an average of 46 referrals to their home health partners. The acceptance rate of those home health agencies was 49%.

CarePort’s analysis is based on data from 1,000 home health agencies.

Even early last year, hospitals didn’t have a major problem finding available home health partners. In the month of May, CarePort hospital partners sent an average of 50 referrals to their home health partners – with agencies’ acceptance rate at 51%.

The ongoing and accelerated shift to home has created an increasing gap between hospitals and home health care, though, where agency acceptance rates are going down as hospital referrals are going up.

“That’s the other thing we’re hearing from our customers: that they are sending out more referrals to a larger network to ensure that someone can care for their patients,” Martin said. “And this, I’m quite sure, comes as a result of some of the staffing challenges post-acute providers are having to face. They need the staff to care for these patients.”

CarePort’s analysis flags this gap starting to worsen in July 2020, when the average number of referrals to home health agencies was 67, with an acceptance rate of 47%. By June 2021, the average number of referrals to home health agencies was 84, with an acceptance rate of just 36%.

“As the demand for [home health] services is increasing and agencies are strapped staffing-wise, their acceptance rate is decreasing,” Martin said. “So we’re seeing them just turn down more and more patients.”

At this point, it’s unclear whether that widening gap will become a long-term trend.

“We hope not,” Martin added. “But that gap does look like it’s growing some.”

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