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With referral rejection rates skyrocketing to new highs in recent years, home health providers have to be more intentional about maintaining strong relationships with referral sources.
In 2022, the industry saw a 76% referral rejection rate, compared to 54% in 2019, according to WellSky data.
With this in mind, providers are employing a number of strategies to sustain positive relationships with key referral sources.
Relationship upkeep
Last year, American Advantage Home Care saw its referral rejection rate reach roughly 56%.
American Advantage Home Care provides skilled nursing, rehab and specialty care services. Currently, the company serves seven counties in the Southeast Michigan area and has a census of 200 patients.
The company’s referral rejection rate was partly driven by an influx of patients with higher acuity levels, according to President and CEO Cleamon Moorer Jr.
“Higher-acuity patients decrease our overall bandwidth because they require higher frequencies and more disciplines,” he told Home Health Care News.
For American Advantage Home Care, staying in consistent communication with referral sources has become vital.
The company also provides monthly and quarterly updates to its referral network to maintain good rapport.
“We like to send out information about programs, whether that be a CHF program, a diabetes management program, or even updates about some of our personnel,” Moorer said. “If we have personnel that recently received training, or a certification in wound care management, we try to let our referral contacts know that.”
Large provider strategies
AccentCare chooses to enter every referral they receive. Tad Kendall, the company’s chief growth officer, pointed out that this isn’t industry standard.
AccentCare itself only began doing this a few years ago.
“We want to see what our true conversion rates or selection rates are, and so we’ve made a choice to do that,” Kendall told HHCN.
Dallas-based AccentCare delivers home health, hospice, palliative care and care management services. As part of its network, the company has 30,000 employees that deliver care in more than 250 locations across 30 states and the District of Columbia.
The company found that it had an acceptance rate that is in between 30% and 40%.
Clinical capacity is one of the biggest contributors to that. Medicare Advantage (MA) is another driving factor, according to Kendall.
“[MA] plans have significantly underfunded home health in the market, which creates a real challenge to service all of the patients coming out of the referral sources that we have,” he said. “The economics just don’t pencil out. The lack of funding really hampers the ability to then have the investment available to hire really quality clinicians, as well as build the capacity.”
Given these realities, there’s been a concerted effort to maintain strong relationships with referral sources.
“We invest heavily in our client-facing teams, so our sales teams,” Kendall said. “We have clinical liaisons that are in a number of the facilities that we work with. We have what we call patient care navigators that basically helps a patient be brought on to our services. We’re really investing in what is our front door. The client-facing team is a critical part of it.”
Another strategy AccentCare employs is targeting key referral sources. In order to pull this off, the company partners with Trella Health.
“Even though we’re probably going to a fewer set of individual referral sources, it allows us to go deeper and build more meaningful, long-term relationships with those referral sources,” Kendall said.
On its end, Bayada Home Health Care has seen a consistent uptick in referrals since 2020.
“[That year] was probably the biggest catalyst for it — clients that are looking to … go directly home for care, and not always appropriately,” Kaitlyn Catenacci, a regional sales director at Bayada, told HHCN. “I would say that is another challenge, right? You have high-acuity patients who are looking for home health services, straight from the hospital discharge. It puts a lot of pressure on agencies to increase capacity to serve those clients.”
The Moorestown, New Jersey-based Bayada – like AccentCare – is one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.
Though Bayada couldn’t quantify its rejection rates, Catenacci noted that with the increased demand the company is seeing, staffing has been challenging and conversion rates have dropped.
This has forced Bayada to get really creative and very flexible with referral partners, especially when it comes to being able to triage patients.
“For example, we may not have a nurse in this particular geography, but we might have a therapist that can start services,” Catenacci said. “It’s really important to not only maintain a positive referral relationship, but also to work with them to make sure that we can get creative around providing care for those clients coming home.”
In the end, all of the aforementioned leaders agreed that it is imperative in this day and age for home health providers to not bite off more than they can chew when it comes to accepting patient referrals.
Editor’s Note: A previous version of this story suggested that a 76% referral rejection rate meant that 76% of patients were unable to receive home health services. That is inaccurate. The data suggests that 76% of referrals are being rejected, but generally, patients are eventually able to find a care provider.
Companies featured in this article:
AccentCare, American Advantage Home Care, Bayada Home Health Care
