8 Quotes That Tell The Story Of Home-Based Care In 2022 — And Beyond

The quotes that cracked this Home Health Care News list were not only memorable, frank and informative, but they also paint a complete picture of the home-based care landscape in 2022.

The words from the industry leaders highlighted here weigh in on everything from tensions with Medicare Advantage (MA) plans to staffing shortages kneecapping industry growth and more.

Perhaps most importantly, the statements are indicative of what’s in store for home health and home care in 2023 and beyond — as many of these issues raised remain unresolved.

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“The main thing we’re looking at is the rate reduction of 7.69% – will it happen or not? We have been engaged in the most intense advocacy effort I’ve experienced in my lifetime. And I’ve been around a few years advocating. The effort that we have underway brings in all forms of advocacy.”

— William A. Dombi, President, National Association for Home Care & Hospice (NAHC) (Oct. 24, 2022)

This quote from NAHC’s Dombi set the scene for the home health payment rate battle that would consume 2022.

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As things stand, the final rule includes an estimated increase to 2023 home health payments of 0.7%, or $125 million, compared to 2022 aggregate payments. The final rule also included a cap on negative wage index changes, and a recalibration of the case-mix weights and Low-Utilization Payment Adjustments (LUPA) thresholds for 2023.

But more importantly, the final rule locked in major reimbursements cuts moving forward.

NAHC and other advocates will continue to urge CMS to reconsider its plan. They’re also appealing to members of Congress directly. Litigation is another avenue NAHC may take, though it’s not the organization’s first strategy.

“We haven’t hit and been predictable on earnings, so that’s the reason I’m back. We need to stand by what we say and deliver on our numbers. And there’s no reason, with these initiatives, that we should not deliver on our numbers and beat our numbers.”

— Paul Kusserow, CEO and Chairman, Amedisys (Dec. 6, 2022)

The home health world was rocked when it was announced that long-time Amedisys Inc. (Nasdaq: AMED) CEO Paul Kusserow would be returning to the helm of the company after then-CEO Chris Gerard served for less than a year. The move even drew comparisons to the recent leadership change taking place at mass media and entertainment conglomerate The Walt Disney Company (NYSE: DIS).

These words show how despite skyrocketing demand for home-based care services, many providers struggled to meet their financial benchmarks. That struggle was mostly due to headwinds stemming from staffing constraints and reimbursement challenges. Amedisys was not immune to these challenges.

The company’s failure to meet its own expectations prompted this quote from Kusserow during his first major appearance following his return as CEO. More generally, his statement also clued in stakeholders about what led to his return.

Looking ahead, Amedisys is looking to rebound by leaning into staffing and improving its MA contracts.

“I think we’ve done a lot more with managed care [because of our JVs with hospitals], and I have really good relationships with executives. … But I think our biggest problem are the conveners in the middle of all of this.”

— Keith Myers, Chairman and CEO, LHC Group (July 26, 2022)

With relationships between MA and home health already being shaky, many providers believe that conveners add even more fuel to the fire. In other words, working with conveners isn’t always practical for providers.

Conveners are meant to serve as a middleman between payers and providers, but providers have told HHCN — both on and off the record — that coveners “skim off the top of” their bottom lines. This is especially alarming because home health providers struggle with low MA rates. For context, MA plans have paid up to 40% to 60% less than fee-for-service Medicare.

This quote from LHC Group’s (Nasdaq: LHCG) leader captures that tension.

“I think it’s the same reason that consumer brands spend so much money on the younger segment where brand loyalty is seeded, right? … If we’re not with our seniors as they begin utilizing their Medicare Advantage benefit, we’re going to miss the opportunity to be with them when they exceed the hours Medicare Advantage pays for and they need private pay.”

— Shelly Sun, CEO and Founder, BrightStar Care (Nov. 17, 2022)

Since 2019, there’s been this question of whether MA is truly an opportunity for home care agencies. Instead of weighing in on this debate, Sun’s statement moves past this and explains why it’s imperative for providers to plant seeds now, as an investment in the future.

There’s no question that MA enrollment is on the rise. As of 2022, more than 28 million people are MA enrollees. This is almost half of the Medicare population, according to Kaiser Family Foundation data.

Signs only point to further increases in the future, which will make it impossible for home care to ignore MA.

“It’s not just about the clinics; it’s now about the home and the community.”

— Andrew Witty, CEO, UnitedHealth Group (Dec. 1, 2022)

As HHCN begins to look back at 2022, UnitedHealth Group’s plan to purchase LHC Group is arguably one of the biggest deals to take place. 

And while these two giants, in their respective sectors, coming together is a big enough story on its own, the news also represents a major shift in health care at large, and Witty’s statements get to the heart of this.

It speaks to where UnitedHealth Group sees health care going, and the company’s investment in being at the center of this change.

“Health care workforce challenges are not stabilizing, they are intensifying [in regards to] how organizations are experiencing recruitment and retention, wage pressures, benefit incentives, and just trying to manage staffing in this environment right now.”

— Joanne Cunningham, CEO, Partnership for Quality Home Healthcare (Oct. 21, 2022)

When considering the issues home health providers are facing, it’s seemingly one thing after another. Still, staffing remains the No. 1 issue.

In her above statement, Cunningham breaks down why the staffing landscape continues to worsen and explains how this has created a perfect storm of care delivery barriers for providers.

In October, the Partnership for Quality Home Healthcare conducted a labor cost study with Dobson DaVanzo & Associates. It found that only 59% of positions at agencies were filled in Q1 2022. On top of this, home health agencies often reported that they often struggled with competition with hospitals that can pay higher wages for staff.

Additionally, in the survey, 71% of respondents said that having to turn down referrals altered the amount of care services their organization was able to deliver.

“I think home health, in the past, [it] has been a bit exploited because it’s been a very fragmented industry. … There’s been an element of treating it like a commodity by some of the payers, knowing that if one agency wouldn’t care for the patient, well, there’d be others that would be willing to step up.”

— Mark Tarr, CEO and President, Encompass Health Corporation (May 11, 2022)

Much has been said about the difficult relationship between MA plans and home health providers. And Tarr’s comments speak to why he believes this has become the status quo between providers and payers.

Tarr isn’t alone in his belief that providers often get the short end of the stick in these partnerships. But as more leaders in home-based care speak out, and as companies begin to increasingly turn away MA business that doesn’t make sense in light of capacity constraints, it’s likely that providers may slowly begin to see change in the future.

In July, Enhabit Home Health & Hospice (NYSE: EHAB) completed its spinoff from Encompass Health. Tarr still serves as CEO of the latter while Barb Jacobsmeyer is CEO of Enhabit.

Now, Enhabit is one of the largest home health entities in the country. Its footprint includes 35 states and more than 350 locations.

“The biggest trend in 2023 is the rising cost of private pay home care services. Over the last year, our rates have increased between 20% and 40%. So even though the need for home care has grown, the market of individuals that can afford care on a long-term basis has shrunk.”

— Ryan Iwamoto, President and Co-founder, 24 Hour Home Care (Dec. 16, 2022)

For all of the reasons touched on above and more, the cost of home care services has risen dramatically in 2022. Iwamoto, president and co-founder of the Los Angeles-based 24 Hour Home Care, captures that trend with his words here.

According to Genworth’s annual Cost of Care Survey, the monthly median cost of homemaker services was $4,957 nationally last year, with the monthly median cost of home health aide services being $5,148. Those figures are based on clients needing 44 hours of care per week.

At least in 2022, skyrocketing home care prices haven’t outpriced clients yet. Beyond Iwamoto, home care executives have told HHCN that their families have been able to dig deeper without stopping service.

But if labor dynamics, economic factors and general demand exacerbate the issue, 2023 could see more older adults priced out of home care – causing the overall home care market to shrink. It’s a problem that more home care operators should be thinking about.

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