‘It’s Not All Rainbows And Butterflies’: Basin Health Looks To Rebuild Amid Home Health Cuts, Value-Based Purchasing

Entering the home health industry wasn’t always a part of Vince Moffitt’s plan.

Before taking the helm of Basin Health Companies as CEO, he already had a career as a battalion chief in the fire service. Over the years, he would be involved in the company, which his family owned, in various ways. This included helping the company in its efforts around safety training and first aid.

When Moffitt eventually retired, he began to see the connection between his past and future industries. Namely, that both centered around serving others.

Now, Moffitt is focused on rebuilding his business after the lasting impacts of the COVID-19 pandemic, including regrowing the company’s census. He recently spoke about this on the latest episode of the Home Health Care News Disrupt podcast.

During the conversation, Moffitt also chatted about how tracking and staying on top of data allowed Basin Health Companies to feel prepared for value-based purchasing.

Founded in 1992, Basin Health Companies is a Farmington, New Mexico-based home health and hospice provider that serves four counties.

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Below are takeaways from that conversation, edited for length and clarity.

HHCN: From what I understand you serve a pretty rural market. What is unique about this service area? What are some of those challenges that come with serving that type of area?

Moffitt: Our county population is about 100,000. Here within the county, the city of Farmington is about [50,000], but we go out beyond that. We go into the reservation.

One of the biggest issues is lack of connectivity. There are times where we do not have any kind of service out there, which creates challenges when trying to make contact with the patients and using our EVV systems. Not everything’s mapped, and so trying to find some of the places where people live in the residences can be a challenge, too.

We think it’s kind of an adventure sometimes, when we send our clinicians and caregivers out to find some of these residences. Some of our patients out here don’t have running water, or they do not have electricity. Home health doesn’t just happen on the visit. The way home health really makes a difference is what happens in between the visits, making sure that we’re training and educating.

We’re now less than a month removed from CMS publishing its final rule on home health reimbursement. What were your first impressions of the final rule? Secondly, how will it affect your business specifically?

I was really glad that we didn’t see the major cuts that were originally being projected. I think that was one of the things we were all watching and worried about.

We’re in a weird predicament. I think the latest stats I saw were that over 50% of the agencies out there are operating in the red. They’re not even breaking even. Further cuts, I don’t really think are something that we can sustain.

It’s really going to challenge us. Between the temporary adjustments and calculations, we’re going to lose a little bit of funding and money there. But I think the biggest thing is the changes to the wage index. For us, we’re going to see a decrease in regards to that. I think it’s never as bad as you think it is, and it’s never as good as you think it is going into this. We’re going to continue to find ways to survive, but it does make it challenging for anybody to want to grow or add additional programs. Overall, I was just really glad that we didn’t see those over 8% cuts that were being presented.

What are some of your near-term growth goals for the company, as it stands now, in the late stages of 2023, and maybe looking ahead to 2024?

I’ll be totally transparent here — if there’s some of the listeners out there, hopefully, they can resonate with this. It’s not all rainbows and butterflies. For a lot of us, we’re still recovering from COVID. I’m really grateful for things like the PPP program and the Cares Act, things that helped us make it through COVID.

I made a commitment to all my employees that we were not going to lay anybody off and not going to put a tremendous amount of pressure on them through COVID. It was so stressful for everybody. Now coming out of it, we’re still kind of trying to regain our footing. I know that our census has shrunk considerably through COVID, and we have yet to regain the kind of numbers we had pre-COVID.

When I look at what we’re doing, we’re really focusing on rebuilding a strong foundation of solid skills sets, policies and processes to face one of the biggest challenges we’re going to have: value-based purchasing, and making sure that we can be as effective and efficient as possible.

We saw our 5-star quality rating dropped a little bit. We’re trying to rebound now by rebuilding things, and it has taken a strong commitment. When 2025 hits, and we start to see those changes based on our outcomes, I think a lot of people are really going to be surprised if they’re not looking at it already.

We’re coming up towards the end of the year, and it’s really hard to make a lot of changes in the last month and a half of the year. But you’re going to be farther behind if you’re not looking at that – and not preparing for what’s going to happen two years down the line with our payments.

Shifting gears, again, to some of the value-based care conversations. I feel like data is a buzzword that gets thrown out a lot when talking about the future success of home-based care. How do you view that hurdle of collecting the right data, and leveraging it in a way that is both beneficial to the operation side of things and just financially for your business?

I think that’s a tough one. We’ve tried different types of software out there and looking at ways we can track it; we’re still doing it. A lot of the information when it comes from CMS is delayed. You’re not getting a clear picture of what’s happening right now; you’re getting a picture of what happened a few months ago, a couple of quarters ago. It’s even worse with the Medicare Advantage information and data out there, but it is beneficial.

You can see trends, and we can use that information to go to our referral sources saying, “This is where we’re able to help and make a difference. Please continue to refer your patients to us.”

One of the biggest things is seeing where we’re maybe missing the mark. Looking at data and saying we’ve got to find a way to improve these outcomes — X, Y and Z. We know with value-based purchasing, what they’re looking at and what those metrics are. A big one is rehospitalization. Being able to track this real-time within our system is very important. We even track it to the point where if we have a patient that goes back in the hospital we know that. We immediately start to look at that and say, “Where did we miss the mark here? Is there anything that we could have done that could have prevented this?” I think those systems are really important, because we’re going to be measured by them, and CMS is using them. We’ve got to be tracking it.

The downfall, obviously, as we talked about earlier, is costs and trying to figure out what’s the best bang for your buck. You’ve heard that old adage, if you can’t measure, you can’t manage it, and I think that’s absolutely true.

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