In home health care, there’s value in fighting for things to be a certain way. At the same time, there’s also value in accepting things for how they are right now.
John Kunysz, the president and CEO of Intrepid USA, is looking for proactive strategies to address how things are right now. He’s found some of those already.
Based in Dallas, Intrepid is a home health and hospice provider with more than 60 locations across 17 states.
Kunysz doesn’t think home health visits should be treated “like it’s 1965.” Intrepid has adapted remote working in its back office, and he sees that back office as a way to drive efficiencies that will result in higher margins and higher wages for nurses.
And while home health payment cuts are already in full swing, he believes hospice is the next sector that’s going to see proposed and finalized cuts from the Centers for Medicare & Medicaid Services (CMS).
HHCN sat down with Kunysz to talk about all of that and a lot more, including Medicare Advantage (MA) plans, forward-thinking technology and finding synergies between the sales and operations teams at Intrepid.
Below are highlights from that conversation, edited for length and clarity.
HHCN: What’s top of mind for you right now as you consider industry trends?
Kunysz: We’re not getting a ton more nurses. So, we have to find ways to use technology to supplement and to support what they’re doing in a way that makes them more efficient, effective and better documenters in a way that’s also cheaper.
They’re upset about the amount of hours they’re spending with documentation, they’re not used to doing it in the driveway. We have to invest in stuff like that. We’re facing revenue cuts next year on home health, and that’s coming to your favorite hospice provider near you soon. We’re not going to keep counting on these endless increases in hospice revenues.
We need to plow 8% to 10% wage increases into our models for wage costs that most people can’t afford. And we’ve got to use better technology to create that margin throughput, that makes us more efficient, helps with the clinical documentation, avoids costly reimbursement denials from payers, and lets us make more money as an industry so we can maintain margins and staff.
What have you done in that area thus far?
We’ve created a lot of virtual back office support teams that are really good at analyzing the inbound referrals.
They make sure they monitor the scheduled visits to avoid any unintended LUPAs, and they monitor the amount of visits that are given clinically to provide effective care based upon that primary diagnosis, so you’re at least hitting your 50% gross margin targets. A lot of people aren’t doing that.
Some still schedule every single Medicare admission like they did in 1965. Pre-PDGM, everybody got 12 PT, eight skilled nursing and four OT visits. Post-PDGM, everybody gets eight PT, eight skilled nursing visits, etc. That isn’t necessary.
And we’re also distinguishing between a skilled nursing visit at an RN level and one at an LPN level, so that you’re aligning your resources more correctly based upon the visit needs.
What else is working well right now at Intrepid?
I think the biggest thing is seeing how the sales and ops teams are starting to work together. It’s taken five years to break down some of those silos. They realize they have to have a better partnership.
Because they’ve got to go get the right kind of referrals, in the right geographies, with the right complexities, to give them the right lengths of stay.
It isn’t just getting volume, it’s about getting the right kind of volume. And that’s both on hospice and home health. We’ve had record admission months for hospice, without any movement in our census on hospice, because they were getting patients that were passing away within five to 15 days. And it was just burning out staff doing new starts to care on hospice patients. That’s hard.
But I think that’s probably the biggest thing that’s working well now, having the sales and ops teams working well together.
We’re also hiring people everywhere now, which is really helping with our back office.
What’s a present day challenge you’re working on?
Our geographic dispersion is a challenge for us. We’re in 17 states, and we’re making sure we get better density. I think that’s going to be a longer-term goal for us. We want higher census levels in the location areas that we already have.
Are there any other service lines that you’re excited about? Or do you really want to stay with your bread and butter for the most part, on home health and hospice?
I think for right now, we’re going to be continue to be focused on our hospice and home health sides.
We do have personal care. And I do think that personal care will ultimately be the entry point for people entering what I call our concierge family medical home care continuum. It doesn’t need to start with a discharge from a hospital.
A lot of people in our industry still run around looking for a Medicare patient discharged following an acute care state. That’s not how most people are going to enter in the future with payers.
You’re an at-scale home health provider that’s independent. There were more of those types of companies years ago. Now, some of those companies are with payers. Has that changed your standing at all?
Not yet, but I do wonder how that’s going to shake out.
What do Medicare Advantage plans need to change, in terms of how they deal with home health providers?
We need payers to stop playing what I call the home health care billing or revenue cycle “Uno” game, where it’s always, “Back to you.”
Because, in the future, we’re going to be direct contracting with payers. We should be providing care for these patients in home, taking care of things that normally would not be reimbursable by Medicare. For example: putting in ramps; changing furnace filters, so they don’t get lung infections or COPD aggravation; spending time with their medications, and ironing those out.
Ultimately, it will be less costly if payers do this.