With the shift to Medicare Advantage (MA) in home health care intensifying, some providers are struggling with the operational adjustments required to adapt.
Even for the ones that recognize the need for that adaptation, there seems to be inherent road bumps in home health-MA relationship building.
“I’m sure Medicare Advantage is full of great people,” Healing Hands Healthcare CEO Summer Napier said during a Home Health Care News webinar last week. “Health care is full of great people, but from a provider standpoint, Medicare Advantage is really hard to deal with. We struggle with Medicare Advantage. Because I used to be of the mindset that you just don’t mess with them, right? We just wouldn’t take them. But that doesn’t necessarily align with our mission of bringing health care to the home.”
The Texas-based Healing Hands Healthcare provides home health, hospice and private-duty home care services across 22 counties in North Central Texas.
Over the past few years, MA clients have gained a larger share of Healing Hands’ business. Traditional Medicare used to take up about 70% of that business. Now that number is closer to 60%, Napier said.
As that’s transpired, Napier said Helping Hands has struggled in some instances. Because of that, the company plans to be more aggressive at the negotiating table with MA plans moving forward.
“We decided that we’re going to have to start playing with them,” Napier said. “When you start playing with them, you start losing a lot of money. And if you don’t play with them and you’re out of network, then you’re almost at a 100% audit rate. Then we made the decision to get in network, and it went great, but then you take a significant rate decrease because in order to get in network, you don’t get full PDGM rates. You have to negotiate that.”
The transition has been time-consuming and costly, Napier said. It’s also been a challenge from an employment standpoint as well.
“We had to ask ourselves if we were going to be able to keep up with the revenue cycle team. We had to add new people for every 20 or 30 Medicare Advantage patients we took,” Napier said. “You have to compile all the audits, do the appeals, file the appeals and then they still don’t pay. So you have to really look at the pros and cons of, ‘How hard is this MA plan to deal with and how much easier is it going to be if we do get in network?’”
One reassuring aspect of this process, Napier said, is that dealing and negotiating with MA plans on a higher scale is new for everyone in the industry. Healing Hands is not alone in its struggle.
“I think a lot of people probably struggle because they think that they’re the only ones who aren’t figuring it out when the reality is that none of us have it figured out,” Napier said. “We sit in rooms with the top executives from the top companies and they can’t figure it out either. We’re all in the same boat, and I think people should not get discouraged.”
Despite some of the early struggles Healing Hands has experienced, there is no denying MA will be a bigger part of their future.
“There are people who need us to figure out how to deal with them, so we need to learn how to work with them,” Napier said. “We have to change the mindset. We have to learn to collaborate instead of compete, because right now, we’re not competing against each other. We’re competing against these payers and we have to join forces.”
Keeping the patient – and staff – in mind has been part of Napier’s ethos when considering MA relationships.
“There are lives caught in the middle, but it’s not just the patients,” Napier said. “You have to fight so ferociously for your staff. If we continue to lose funding and we’re not in a place where our employees can enjoy their lives, if they don’t have great benefits or they can’t thrive, then we’re not going to be able to sustain. You have to know who you’re fighting for and that includes the people that you show up for and that come to work every day.”
Other than some difficulties with MA-related transitions, Healing Hands has taken other changes in stride.
Two months into OASIS-E, Napier said the staff has seamlessly been able to handle the new system without much issue.
“Our education team did a great job of rolling it out,” Napier said. “It’s part of the business we’re in. It’s another piece that changes every year and something we have to learn how to figure out, but it’s not a problem for us.”
In terms of those MA negotiations and looming rate cuts from the Centers for Medicare & Medicaid Services (CMS), Napier believes the entire staff should be in the loop on any operational adjustments the company has to make – from the start.
“Because we’re smaller, we can turn the ship faster,” she said. “We focused on operational excellence [from top to bottom]. Historically, in a health care system, we would silo out positions and tell our nurses to go be great nurses, therapists be great therapists, and we never teach them about the business of health care. Even though every decision they make impacts how well the company runs.”
A major focus this year has been teaching every level of the staff how the business operates.
Letting caregivers, nurses and other staff members in on the nuts and bolts of the business has created a strong and more productive environment, Napier said.
“A clinician of ours recently said, ‘You can’t love what you don’t know, and the fact that y’all are teaching us this has made such a significant impact,’” Napier said. “We are seeing really great fruits come from [being more open].”