Referral Rejection Rates, Patient Complexity In Home Health Care Reaching All-Time Highs

While referrals to home health care are ballooning, providers are rejecting them at an unprecedented rate.

As hospitals scramble to place patients in the hands of appropriate post-acute care providers, skilled nursing facilities’ referral volume has rebounded.

Home health referral volume also remains above pre-pandemic levels, but providers are struggling with staffing challenges and sicker patients. Data from WellSky’s 2023 Evolution of Care Report shows just how significant those issues have become.


“We’re entering a new era of care delivery and there is a dramatic shift happening in the health care landscape,” Lissy Hu, president of connected networks at WellSky, said in a statement. “Providers, whether it’s the hospital or the doctor’s office, and health plans need to be connected to post-acute and home-based providers as care shifts to home and value.”

In April, Hu told Home Health Care News that referral rejection rates “very much remained an issue” at a time when home health referrals were at an all-time high.

“Our data shows that it’s truly a care continuum – that what happens in the post-acute setting has a direct impact on the hospital setting and vice versa – so improving patient outcomes requires a holistic cross-continuum approach,” she continued.


Specifically, 76% of patients being referred to home health care were not being accepted as of December 2022. That number was up from 54% in 2019.

WellSky’s data analysis is based on proprietary data that draws from over 2,000 hospitals and 130,000 post-acute care providers.

This issue has forced providers to be more up front with their referral partners in recent years, acknowledging which patients they can take and which patients they can’t.

“You just need to be transparent,” Geoffrey Abraskin, a senior vice president at Amedisys Inc. (Nasdaq: AMED), told Home Health Care News. “If you’re truly in a partnership, there’s going to be an understanding. Just like hospitals go on diversion – if their ED is full, for example – home health does the same thing. So, we’re in the same boat as them. We just try to be very proactive and upfront with our capacity or limitations.”

Home health providers are also caring for more complex patients than ever before.

WellSky data shows that patients are now at least 6% more acute, on average, than they were in 2019 at discharge.

Patients are more likely to be experiencing neurological, alcohol-use and drug-use disorders. They are also more likely to be suffering from psychosis or pulmonary circulation diseases.

“Anecdotally, we’ve been seeing that for years,” Bud Langham, EVP of clinical excellence and strategy at Enhabit Inc. (NYSE: EHAB), told HHCN earlier this year. “It started a long time ago, but certainly accelerated during COVID because there were fewer inpatient beds and staff to take care of those patients. In the home health industry, we were asked to take care of patients who were sicker than what we were used to.”

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