‘Not About A Shiny New Toy’: How Home Health Providers Are Succeeding With More Complex Patients

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,” […]

Why Some Home Health Providers Are Still Struggling With Low-Utilization Payment Adjustments

Following the implementation of the Patient-Driven Groupings Model (PDGM) – and during the height of the COVID-19 pandemic – home health providers struggled significantly with Low-Utilization Payment Adjustments (LUPAs). Since then, some providers have found ways to mitigate them, and others haven’t. Broadly, LUPAs occur in fee-for-service Medicare when a provider does not meet a […]

‘They’re David Without The Slingshot’: How Small Home Health Providers Can Gear Up For MA Negotiations

Getting to the negotiating table with Medicare Advantage (MA) plans and coming away with a good deal is tough enough for even the biggest players in home health care. For smaller providers, it’s an even more daunting and intimidating task. However, there are steps those smaller providers can take in order to become more attractive […]

‘No Contract Is Better Than A Bad One’: Home Health Providers Share Their MA Strategies

Although home health providers want to see as many patients as possible to keep up with demand, it is impossible to do so under current circumstances. With that in mind, providers are questioning why they would willingly take on Medicare Advantage (MA) beneficiaries knowing they’d be sacrificing dollars. Some industry experts believe providers should, at […]

How Home Health Agencies Can Optimize Outcomes, Avoid LUPAs Under PDGM’s 30-Day Billing Periods

The switch to the Patient-Driven Groupings Model (PDGM) was always going to be a hurdle for home health agencies, but the onset of the COVID-19 crisis has exacerbated the woes associated with it. For instance, managing 30-day billing periods and avoiding low-utilization payment adjustments (LUPAs) have been pain points for providers across the country over […]

Home Health M&A Experts Seeing Fewer ‘Fire Sales’ Tied to PDGM, COVID-19

The historic wave of consolidation that home health M&A experts predicted ahead of the Patient-Driven Grouping Model (PDGM) hasn’t fully panned out, largely due to the COVID-19 emergency and the billions in federal relief dollars that have come with it. There was some degree of contraction within the industry, however. Going into 2020, there was […]

An ‘Awkward Transition Year’: Why 2021 Will Look Different in Home Health with New RAP Adjustments

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its final 2021 home health payment rule in late October. When it came out, some providers were less than pleased. On one hand, the Patient-Driven Groupings Model (PDGM) wasn’t substantially altered to balance out its flawed behavioral assumptions. On another, there are also a few […]