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As home health patients become sicker and more complex, providers have been forced to find ways to keep their care models financially viable.
In order to combat some of those “acuity creep” challenges, industry leaders are leaning on technology, data-driven decision making and more value-based care.
“We continue to navigate through a very regulated industry,” Janice Riggins, chief clinical officer at VitalCaring, told Home Health Care News. “That continues to pose issues for us, in addition to expenses for training and education. The recruitment and retention of qualified staff that have that clinical expertise is a financial implication. All of these aspects are at a very heightened level. Now more so than ever.”
The Dallas-based VitalCaring provides home health and hospice services across six Southeastern states.
Staffing costs and physician engagement
When taking care of the sickest and most complicated patients, it’s imperative that clinicians and caregivers are properly trained and that staff resources are optimized.
“Training and education is an investment that needs to be considered,” Riggins said. “It’s really important for our staff to have continuous training in order to handle these complexities of the sicker patients, which add to that overall operational cost.”
In this care environment, clinicians must be operating at the top of their licenses, McBee Associates President Mike Dordick told HHCN.
“Unlike going in and changing a wound or basic injections, you’re going to the sicker patients where there’s a lot more that clinicians have to be able to to deal with,” Dordick said. “Your resource allocation and your staffing strategy has to be at a higher level than if it was a lower-acuity patient.”
McBee Associates is a consulting firm that works with hospitals and post-acute care providers.
Maintaining an adequate staffing level will always be a struggle for providers. The same goes for covering the costs that are necessary to take care of new-age patients.
“Sicker and more complicated patients require not only a higher frequency of visits and costly supplies, but also additional disciplines such as home health aides and social workers to meet their individual complex health care needs,” April Coxon, EVP of quality at Healing Hands Healthcare, told HHCN. “Accompanying social factors such as financial constraints, food insecurity, complicated family dynamics, poor living conditions and lack of transportation create a more substantial challenge in improving or stabilizing health conditions in home care settings.”
Healing Hands provides home health, hospice and private-duty home care services to over 20 counties in North central Texas.
Under the Patient-Driven Groupings Model (PDGM), Coxon said rates fail to sufficiently cover the costs associated with providing this level of care.
“These challenges, along with more stringent quality performance expectations, have created the need for agencies to develop innovative approaches and partnerships with acute care facilities to safely care for patients with complex medical needs in the home,” Coxon said.
Optimizing clinical resources and emphasizing the importance of physician engagement are two areas that VitalCaring has been specifically focusing on.
Timely response to changes in condition can sometimes be a challenge for physicians dealing with complex patients, especially after hours, Riggins said.
“With more physicians working in hospital systems and going away from specialty physician groups, that presents challenges,” she said. “Who really wants to own that plan of care and that ongoing collaboration?”
One of the ways VitalCaring and other providers have adapted is by going toward value.
“Aligning with value-based programs and ACO relationships helps overcome regulatory challenges,” Riggins said. “This alignment expands your team’s capabilities, enabling the establishment of protocols and best practices. It can also create a referral stream. By aligning closely with ACO or value-based initiatives, you not only enhance loyalty with referral partners, but also reduce patient spending in these relationships, opening up opportunities for shared savings. This allows for reinvestment in people, which is our top priority.”
Value-based opportunities and data
There are benefits to taking care of the sickest patients, especially if providers are in the business of value-based care and taking on risk.
“If you’re in a world of value-based purchasing, you need to show improvement,” Dordick said. “You’re going to have more opportunities to show improvement if at the beginning of your OASIS process, the patient is sicker. If you’re eventually going to look toward going into risk-based contracting, there’s risk of having these patients re-enter the hospital, but on the positive side, you have a chance to be able to prove your agency’s worth.”
When considering the risks providers take when navigating the acuity creep, Dordick emphasized the importance of data in showcasing agency performance to payers who — as agencies well know — are increasingly looking for evidence of improved patient outcomes and satisfaction.
“When you start looking at whether you want to take on risk or take on a sicker population base, you should know your own data,” Dordick said. “If you have the data, use it to make your decisions. But providers have to be careful to go down that path, especially if you’re going to go into some type of risk model. If you’re taking on risk in something that you don’t have historical results in, that’s a pretty dangerous proposition.”
New developments, implementations
In order to take better care of complex patients, providers have to innovate. For Healing Hands, innovation today looks like a hospital-at-home program.
“Patients in our hospital-at-home program may require intermittent periods of daily visits and close monitoring to control acute and chronic exacerbations,” Coxon said. “These types of programs create a high level of visit utilization and resources.”
At the same time, its hospital-at-home program isn’t covered by Medicare, which creates “a significant impact on staffing resources and substantial financial burdens” on agencies, Coxon explained.
Other implementations, even those that include new technologies, can often look more simple.
“Sometimes it’s about getting back to the basics,” Riggins said. “It’s about having touch points and discerning what type of touch points are necessary at the right time. Telephonic outreach, making sure that the patients are safe, not showing decline or significant issues that we need to then address in person. We can explore and invest in technology and innovation all day long, but at the end of the day, it’s not about the new shiny toy. It’s really about having technology that can be deployed and adopted across our enterprise that makes the biggest positive impact on our patient care.”
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