Pennant completes acquisition of Signature assets

The Pennant Group (Nasdaq: PNTG) has completed its acquisition of Signature Healthcare at Home’s Washington and Idaho assets. With an $80 million purchase price, the transaction was the largest in Pennant history.

The deal was first announced in early July, and is just one of many deals Pennant has recently executed on.

“This period of expansion provides insight into our potential as a provider of choice in our local communities, a best-in-class operator across our industries and a disciplined – yet bold – growth company with the sophistication and adaptability to become a key solution in the health care continuum,” Pennant Group CEO Brent Guerisoli said on the company’s second-quarter earnings call. “Since the beginning of the year, we have entered into the Muir Home Health joint venture; closed an additional two home health and two hospice transactions; initiated a management agreement with Hartford HealthCare; announced the largest acquisition in our history with the Signature transaction; and completed three senior living deals.”

Based in Eagle, Idaho, Pennant is a holding company with independent operating subsidiaries that provide health care services through 117 home health and hospice agencies and 54 senior living communities across 13 states.

Pennant had previously acquired other Signature assets in 2020.

The transaction allows Pennant to expand further in the Pacific Northwest, where it already has a strong footprint. It also allows it to expand its home health footprint in Certificate of Need (CON) states.

Aging Advocates CNY acquires Senior Home Care Solutions

The care management practice Aging Advocates CNY announced in late July that it had agreed to acquire Senior Home Care Solutions. The deal goes into effect on Jan. 1, 2025.

Based in New York, Senior Home Care Solutions is a non-medical home care provider led by Sheila Ohstrom, who will stay on as a consultant post-acquisition.

“This is an exciting time for both organizations and the Central New York area,” Ohstrom said in a statement. “By combining our strengths, we can better serve our clients and help more seniors remain in the safety and security of their own homes for as long as possible.”

As part of the deal, Aging Advocates will gain 60 employees from Senior Home Care Solutions, including caregivers and an office management team.

“This acquisition aligns with our mission to promote dignity and independence for our clients while providing peace of mind for their families,” Aging Advocates founder and CEO Melissa Murphy said in a statement. “We have a great working relationship with Senior Home Care Solutions and deeply respect their service to the community. As our population ages, it’s crucial to maintain quality in-home care providers in Central New York.”

Cardiovascular Associates of America acquires home-based care company

Earlier this month, Cardiovascular Associates of America (CVAUSA) announced the acquisition of Novolink Health, which provides care services to complex patients in the home.

Based in Orlando, CVAUSA is a physician-centered cardiology company with a mission of “saving lives, reducing costs and improving patient care through clinical innovation.” The Fort Lauderdale, Florida-based Novolink, meanwhile, aims to fill care gaps between the hospital and home. As a division of CVAUSA, it will “offer a proven alternative to traditional hospital-based care,” according to a press release.

“Our mission has always been to provide exceptional and personalized care to our patients. Joining CVAUSA, one of the largest US cardiology networks, allows us to leverage the extensive resources and reach in our journey to revolutionize healthcare delivery,” Novolink President and Chief Medical Officer Michael Shen said in a statement. “We are very excited to work closely with Tim and the CVAUSA family to bring our innovative model to more communities and improve the quality of care for all patients in the comfort of their homes.”

Prior to the COVID-19 pandemic, Novolink developed a “high-risk care at home” model, which piqued CVAUSA’s interest in the company.

“I have known Dr. Shen since 2005. He’s an excellent cardiologist and is always experimenting and exploring ways to provide better and lower-cost care,” CVAUSA CEO Tim Attebery said in a statement. “Years before the term ‘hospital at home’ was coined, Dr. Shen realized that remote monitoring technology and home-based diagnostic services could create an Amazon-type solution, allowing certain high-risk patients to receive high-quality and safe care at home instead of being in a hospital or skilled care facility.”

Adena Health and AHSN form home health, hospice JV

The Ohio-based health system Adena Health has agreed to form a home health and hospice venture with Alternate Solutions Health Network (ASHN).

The JV will be branded as Adena Home Health and Hospice, and will focus on caring for seriously and terminally ill patients in South Central and Southern Ohio.

“This is an exciting and significant step forward in our home health and hospice care delivery,” Adena Chief Clinical Officer Dr. Shaheed Koury said in a statement. “Building on our long-standing commitment to providing compassionate, patient-centered care to our communities and leveraging the breadth and experience of Alternate Solutions Health Network, our caregivers will be well-positioned to offer patients even more convenient and personalized care options.”

ASHN provides home health and hospice care primarily through partnerships. It has partnerships with more than 40 health systems and more than 90 home health and hospice providers.

Spectrum Brands plan to spin off home health, personal care business

In early July, Spectrum Brands Holdings (NYSE: SPB) – a “home essentials” company – announced that it had filed a confidential Form 10 registration with the U.S. Securities and Exchange Commission (SEC) to spin off its home care business.

“As previously announced, Spectrum Brands has accelerated its efforts to separate its HPC business from its remaining businesses through a spin-off, sale, merger or other strategic transaction,” the company wrote in a statement. “The filing of the confidential Form 10 registration statement with the SEC represents an important step forward in this process. The filing of the Form 10 registration statement does not obligate Spectrum Brands to complete the spin-off or engage in any other transaction.”

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Home health operators each year have to adapt on a number of different fronts, from relatively minor coding updates to major payment adjustments. But in addition to the more run-of-the-mill items, providers occasionally have to navigate macro-level forces that literally change the industry itself.

At least four such forces will redefine home health care in 2022, I believe.

Based on post-acute care dealmaking activity in the second half of 2021, it seems likely that next year will usher in the age of consolidation that everyone anticipated leading up to the Patient-Driven Groupings Model (PDGM), before the COVID-19 pandemic turned the world upside down. The consolidators won’t just be the usual suspects, however.

“I used to get four or five calls a month,” Stoneridge Partners President Rich Tinsley said at FUTURE. “Now, I get two to three a day, and it’s hard to keep up with them.”

Along with consolidation, the ongoing shift to value-based care will take center stage in the form of the Home Health Value-Based Purchasing (HHVBP) Model and Medicare Advantage (MA). Other, more innovative changes within fee-for-service Medicare, such as Choose Home, also have the potential to redefine the traditional home health model.

“I really haven’t yet met with a single congressional staffer or member of Congress since we’ve started where there’s been a response other than, ‘We like this idea conceptually. Now tell us more,’” Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare (PQHH) told me in November in regard to Choose Home.

While consolidation, value-based care and care innovation present exciting opportunities for home health operators, labor forces and the public health emergency will continue to make their mark as well.

Post-acute care consolidation

Home health M&A activity rebounded in 2021, after PDGM and COVID-19 uncertainty combined to create somewhat of a drag in 2020. This momentum between buyers and sellers is set to continue heading into next year.

Despite some recent market turbulence, the key public players like Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (Nasdaq: LHCG) and Addus HomeCare Corporation (Nasdaq: ADUS) will assuredly remain active in the home health space. Some of the newer public players have been especially busy from a dealmaking perspective, too, and I anticipate them taking on an even greater role moving forward.

Atlanta-based Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) — a public company since early 2021 — is a prime example. Aveanna has acquired more than $290 million in revenue in 2021, far more than its usual target of between $150 million and $200 million.

The company most recently acquired Accredited Home Care, a private-duty services company based in Southern California, for a base purchase price of $180 million. Accredited isn’t exclusively a home health deal, but Aveanna has been very vocal about its intent to strategically expand in that area.

Shortly before landing Accredited, for instance, Aveanna also purchased the home health and hospice provider Comfort Care for $345 million.

“Each of the transactions [came in] highly competitive environments,” Aveanna Executive Chairman Rod Windley said during a third quarter earnings call. “We are fortunate to have them under contract. That deal flow has not slowed down in either segment. The strategic community along with private equity continues to make every transaction highly competitive.”

It’s not a hard-and-fast rule, but newly public companies often like to get off to fast starts. In 2022, that group may include BrightSpring Health Services, which filed the paperwork for a $100 million IPO in October, or whatever business that the special purpose acquisition company (SPAC) DTRT Health teams up with.

Outside of the public acquirers, regional home health players backed by PE have been noticeably more aggressive in 2021. That is all but guaranteed to continue in 2022, with private investors still sitting on an enormous amount of cash.

One related post-acute care storyline that I’m following: Consolidation is also happening in the skilled nursing facility (SNF) space, partially driven by PE dollars. That’s also primed to pick up in 2022.

“I’ve had more offers on deals than I ever have, over the past six months or so,” Matthew Alley, managing director at Senior Living Investment Brokerage, told Skilled Nursing News. “Capital has been sitting on the sidelines for a really long time, and they’re eager to get money invested.”

The shift to value

The U.S. Centers for Medicare & Medicaid Services (CMS) confirmed in November that it’s moving forward with the nationwide expansion of the HHVBP Model. The first performance year under the expanded initiative will be 2023, making 2022 a year for home health providers to focus more heavily on quality of care and internal processes.

For some, that will mean investing in stronger data and documentation tools. For others, it will mean devoting more resources to clinician education and training.

That’s exactly what the Kirkland, Washington-based EvergreenHealth Home Care did prior to the nine-state HHVBP demonstration beginning in 2016.

“Build an army of experts who are actually doing the work,” Brent Korte, the chief home care officer for EvergreenHealth, told me in August. “Have your clinicians be front and center. Make sure they know the answer to, ‘What is HHVBP’? Make sure they know, ‘How does my charting, how does my clinical care relate to the success of our agency?’”

I expect HHVBP to have a much larger impact once its upward or downward payment adjustments kick in a few years from now. But in 2022, its weight will start to be felt in how home health agencies carry themselves.

At the same time, increased MA penetration across the U.S. — and in the home health industry — will also make value-based care an important force in 2022. MA enrollment in 2022 is projected to reach 29.5 million people, up from 26.9 million in 2021, according to CMS.

“There’s a real opportunity for home health agencies because MA plans actually have more flexibility in terms of how they reimburse and utilize home health services,” Carter Bakkum, a senior data analyst at Trella Health, recently told HHCN.

Within the intersection of MA, value-based care and home health care, Humana Inc. (NYSE: HUM) may end up being a force in and of itself in 2022. Within the next five years, Humana wants to have 50% of its total MA population under its value-based home health model, CenterWell Home Health.

That makes next year a critical year for the Louisville, Kentucky-based insurer, which also happens to be the owner of the nation’s largest home health enterprise.

“Our efforts to transform home health to a value-based model come at a pivotal time for the industry,” Humana CEO Bruce Broussard said in November.

A new way of thinking

Care innovation, in the sense of rethinking the old home health model, will be a prevailing force next year.

Compared to a decade ago, home health patients are older and far more medically complex. Over one-quarter of patients, in fact, are over the age of 85 and about 43% have five or more chronic conditions, such as COPD, diabetes or heart disease, according to the latest Home Health Chartbook.

As if that didn’t make the job of home health providers challenging enough, over 37% of patients live alone, with over half having incomes at or under 200% of the federal poverty level.

Home health providers parachuting into a patient’s home after a hospital stay to deliver intermittent nursing or rehab services often isn’t enough anymore.

Choose Home embodies the degree of care innovation that’s needed to take home health care to the next level, I believe. Introduced in the Senate in July and the House in October, the legislation — championed by AARP, PQHH and the National Association for Home Care & Hospice (NAHC), among others — has a good chance of making it out of Washington, D.C., too.

Currently, supporters are monitoring opportunities to successfully pass Choose Home, whether that means attaching the bill to an end-of-year package or something else that comes along.

Broadly, Choose Home seeks to create an add-on to the traditional home health benefit to enable providers to care for more patients who would have otherwise been sent to a SNF to recover post-hospital discharge. The add-on would reimburse providers for services like telehealth support, transportation assistance and personal care services aimed at activities of daily living (ADLs).

“[Choose Home] would really allow us to add an additional benefit and have more appropriate patients going home versus, say, a short-term stay in a skilled nursing facility,” Chad Creech, chief integration and strategy officer at Alternate Solutions Health Network (ASHN), told me last month. “With the hospital partnerships, we are seeing higher-complexity cases, higher-acuity cases coming out of the hospital, even pre-COVID. And with COVID, when it hit, we started to see even more patients being sent home.”

What Amedisys is doing via its acquisition of Contessa Health is another good example of the kind of much needed home health care innovation that will become an even larger trend next year.

Familiar foes

Probably like most home health operators, I felt a lot better about 2022 a month ago than I do now, as of writing this on Dec. 2. I know we’re still waiting to learn a lot about the Omicron variant, including how contagious or severe it is compared to other variants, but this feels a lot like the days before the Delta surges.

On Wednesday, the first Omicron case was identified in California in an individual who traveled from South Africa on Nov. 22 before travel restrictions were put in place. To try to stay ahead of another surge, President Joe Biden on Thursday is expected to outline a new pandemic plan, which will include a focus on booster shots, new vaccination centers, tighter travel restrictions and insurance reimbursement for at-home COVID-19 testing.

If Omicron ends up being worse or just as bad as Delta, it could stretch home health providers even thinner in the new year. I’m particularly worried about what Omicron could mean from a staffing perspective.

Already, a shortage of in-home care clinicians has severely hampered providers’ ability to admit new patients. Many have turned to contract labor to reinforce their operations, but that’s an unsustainable resource at current rates.

“We’re living in an environment that has been disrupted by the pandemic,” Aveanna CEO Tony Strange said recently. “COVID-19, vaccinations and vaccination mandates have all played a role in disrupting business as we know it. The world in general — and health care, specifically — is being affected by what we refer to as a COVID-19 hangover. Magnify that with the political and social issues surrounding vaccinations, which are further complicated by a wide variety of mandates, and you will find yourself in a world where 3 million Americans have left the workforce.”

Unfortunately, the health care worker-vaccination issue just got more complicated this week, thanks to two main outcomes in federal court.

The post The 4 Forces Shaping Home Health Care in 2022 appeared first on Home Health Care News.

Home health stakeholders have been lobbying for the Choose Home Care Act of 2021 ever since it was introduced in the U.S. Senate at the end of July. That push has now reached a critical juncture.

Beginning last week, the Partnership for Quality Home Healthcare (PQHH) and its provider members have been holding virtual meetings with key Senate and House lawmakers, along with their staffers. The goal of the meetings, which will continue into early December, is to solidify bipartisan support so Choose Home can attach itself to a future legislative package when the time comes.

“We just want to make sure that we are ready for any legislative opportunities as we move along in this process, whether that’s an end-of-year package or something else,” Joanne Cunningham, executive director of the Washington, D.C.-based PQHH, told Home Health Care News. “We just want to make sure that we are doing our due diligence so we’re ready for anything.”

In the Senate, Choose Home is sponsored by Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.). Reps. Henry Cuellar (D-Texas) and James Comer (R-Ky.) are the sponsors of Choose Home in the House, where the bill was introduced in early October.

As of Nov. 15, there were 30 total co-sponsors of Choose Home, with political affiliation split close to even at 12 Republicans and 18 Democrats.

“I really haven’t yet met with a single congressional staffer or member of Congress since we’ve started where there’s been a response other than, ‘We like this idea conceptually. Now tell us more,’” Cunningham said.

If enacted, Choose Home would create a pathway for eligible Medicare patients to receive extended care services as an add-on to the existing Medicare home health benefit for 30 days post-discharge. In addition to core home health offerings, those services include transportation, meals, home modifications, remote patient monitoring, personal care services and more.

The idea, Cunningham explained, is to give people a greater ability to choose how and where they recover, whether that’s in a skilled nursing facility (SNF) or at home.

“I’ve been working in the home health space for a long time,” she said. “And there’s always been this question of, ‘OK. What percentage of SNF patients could be appropriately and safely cared for in the home?’’’

Building a case

At least nine unique organizations and dozens of individual lobbyists have registered to lobby on Choose Home, an HHCN review of OpenSecrets data shows. Among those organizations are PQHH and the National Association for Home Care & Hospice (NAHC), in addition to provider giants like Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (LHCG), Elara Caring and Bayada Home Health Care.

In many ways, the massive advocacy push reflects the kind of collaboration and well-orchestrated campaign that the home health industry has become known for.

“What we’re seeing today — that we didn’t see years ago — is the industry continuing to work on these things collectively before making any decisions about what the advocacy approach is going to be,” Angelo Spinola, the co-chair of the home health and home care industry group at the law firm Polsinelli, previously told HHCN. “I believe that’s here to stay.”

Other organizations lobbying on Choose Home include AARP and the National Multiple Sclerosis Society. The American Health Care Association (AHCA) is also registered to lobby on the bill, which it has publicly opposed.

Since last week, Cunningham said she has had dozens of conversations about Choose Home, with dozens more in her pipeline.

“My schedule is jam-packed,” she said.

Chad Creech, chief integration and strategy officer at Alternate Solutions Health Network (ASHN), has been equally busy setting up meetings to talk about Choose Home. Launched in 1999, the Dayton, Ohio-based ASHN delivers home health and hospice services in Ohio, Florida, Virginia and Michigan.

“We’ve had multiple talks over the past week and have more scheduled this week as an organization, mostly with the districts that we work directly with,” Creech told HHCN. “What we’re trying to do is to convey truly what patients and families are requesting of us. We’re giving [lawmakers] specific patient case scenarios.”

An real-world example of a possible Choose Home patient: an independent, 65-year-old man that had scheduled mandibular cancer surgery on his jaw.

“When they were getting ready to be discharged, they had a [feeding tube] and were going through all these different factors,” Creech said. “The family and the patient really wanted to go home, but there’s not enough services … to make sure we have a safe [experience] with the traditional home health benefit. So they were required to go to the nursing home for 20 days, then come home and continue their rehab.”

‘A great bridge’

In the past, the home health benefit has been viewed in a mainly post-acute care context. Lately, though, health care experts have argued for the modernization of home health care in the U.S.

“Like all the other sectors, [home health agencies] are not only in a dynamic state given COVID-19, but also given consolidation and a change in the role of home health in the orbit of the care continuum,” Karen DeSalvo, chief health officer at Google Health and a member of the Medicare Payment Advisory Commission (MedPAC), said last December. “It’s going to be an interesting few years, as we continue to understand whether home health is one sector, or if it’s evolving into one … where there’s multiple pieces.”

Choose Home alone wouldn’t be an overhaul of the traditional home health benefit. Instead, it would serve as an important bridge that gets the benefit one important step closer to where it ultimately needs to be.

“I think this is a great bridge,” Creech said. “It’s a great start to really modernizing the benefit.”

Choose Home would be particularly impactful for providers like ASHN.

Originally founded as a privately owned community-based home care company, ASHN made the decision about a decade ago to exclusively work with hospitals on joint ventures to lead their home health and hospice programs.

Its most recent JV was in September with Memorial Healthcare System in South Florida. A month prior, ASHN likewise announced a partnership with The Ohio State University Wexner Medical Center.

“[Choose Home] would really allow us to add an additional benefit and have more appropriate patients going home versus, say, a short-term stay in a skilled nursing facility,” Creech said. “With the hospital partnerships, we are seeing higher-complexity cases, higher-acuity cases coming out of the hospital, even pre-COVID. And with COVID, when it hit, we started to see even more patients being sent home.”

Having “more pieces to help solve that puzzle” is critical, he said.

“Maybe personal care services in the home or telemonitoring, all those different factors,” Creech said. “Those conversations are happening on an ongoing basis with the executives inside of our hospital systems.”

As PQHH, ASHN and their peers continue to meet with lawmakers, home health stakeholders are also working to get a formal price tag attached to Choose Home via the Congressional Budget Office (CBO).

“We’re obviously in the queue,” Cunningham said. “Our champions made sure that Choose Home was in the CBO queue, which it needs to be.”

An independent analysis found the Choose Home model would save up to an estimated $247 million annually by offering facility-level services in the home setting instead of a SNF or other institutional setting.

It’s unclear when CBO will score Choose Home, partly because there’s so much other significant activity happening in Congress, from the major infrastructure package to historic investments to the country’s social safety net.

Cunningham doesn’t see all the other legislative conversations as roadblocks, however.

“There’s a big, huge robust Medicare conversation taking place,” she said. “And we’re all sort of seeing that play out as part of the broader Biden administration priorities. Choose Home is very compatible with that entire [mission] of doing a better job of providing opportunities for more care in the home when it’s safe and appropriate. I actually think the bandwidth issue is not an issue. It’s not a challenge.”

President Joe Biden is expected to sign the more than $1 trillion bipartisan infrastructure plan into law on Monday.

The post Inside the Home Health Industry’s Choose Home Lobbying Push appeared first on Home Health Care News.

Kettering, Ohio-based Alternate Solutions Health Network is a national provider of post-acute solutions, including home health and hospice services.

Meanwhile, The Ohio State University Wexner Medical Center is a Columbus, Ohio-based multidisciplinary academic medical center. The health system operates seven hospitals.

The new home health joint venture is slated to launch by August. The organization will be owned by OSU Holding Corp., an Ohio State-affiliated entity, and Alternate Solutions Health Network.

“We are proud to partner with The Ohio State University Wexner Medical Center to expand its top-quality care into the home,” David Ganzsarto, CEO of Alternate Solutions Health Network, said in a statement. “This partnership brings together a top academic health system and a leading post-acute care provider to serve the growing needs of the patients in our community. Ohio State University Wexner Medical Center and Alternate Solutions Health Network have an aligned commitment to clinical excellence guided by innovation.”

Under the joint venture, the organizations will deliver skilled nursing care, skilled therapy, home health aide services and social work services across the Columbus market.

All patients coming out of the university health system will have the opportunity to continue their care in the home, Rachit Thariani, chief population health officer at Wexner Medical Center, told Home Health Care News.

“This would include patients who are recovering from surgery and need home health care, patients with certain chronic or acute conditions, including cancer,” Thariani said. “[Also] seniors, as well as patients who would require some sort of nursing care or rehabilitation services.”

The joint venture has its roots in a previous partnership between The Ohio State University Wexner Medical Center and Alternate Solutions Health Network.

For the past couple of years, Alternate Solutions Health Network has been one of Wexner Medical Center’s preferred providers. About a year ago, the organizations began early talks to form a home health partnership, Chad Creech, chief strategy and integration officer of Alternate Solutions Health Network, told HHCN.

“We had ongoing conversations, as a preferred provider, and they knew we exclusively do joint ventures with health systems,” he said. “We found it natural to start talking through some strategies on how we could provide patients with higher quality care — aligning with their goals of preventing rehospitalizations and closing care gaps.”

Similarly, Thariani stressed that the home health joint venture was born of a mutual desire to expand access to care.

“Home health is a critical component of the care continuum for our patients,” he said. “As our chancellor would say — when it’s done right, it improves outcomes. That’s something we, as a system, have been really looking at very actively, as we construct our broader health platform. The ability to provide care for people in the home is a key part of our health platform.”

For Alternate Solutions Health Network, the prospect of collaborating with an organization that was at the forefront of post-acute value-based payment models was another selling point, according to Creech.

“We see that home health is really moving in that direction with many alternative pay models, and we were really interested in connecting and building relationships and partnerships with health systems that are always thinking innovatively,” he said.

Another factor that sets The Ohio State University Wexner Medical Center apart is its position as an academic institution.

In general, academic institutions are known for being enclaves of discovery. Typically, home health providers that operate as part of university-affiliated health systems have greater access to the resources of their respective institutions.

This can range from being on the front lines of cutting-edge research to a more seamless referral process.

Ultimately, Thariani believes that the organization’s position, within an academic institution, will give them the opportunity to introduce unique forms of care.

“We have the ability to create new models of care,” he said. “We have the ability to then integrate some of these emerging care models into our educational curriculum. The obligation then is in serving the community, training the future generation of health professionals, and identifying and introducing innovations in care. The combination of those three, with our ability to provide the highest quality connected care to our patients, is something that truly differentiates us.”

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In spring, operators had hoped that the job market’s volatility during the COVID-19 crisis would help on those fronts. With tens of millions of individuals forced out of work, they thought, the home-based care labor pool was likely to grow.

There have been some positive signs for recruitment and retention. For example, the Indeed Hiring Lab previously found that home-based care was no longer a job seeker’s market, suggesting agencies were finding the workers they needed.

Anecdotal conversations that Home Health Care News has had with providers — and more recent data from myCNAjobs — is now painting a different picture.

“I think we have to respectfully disagree with that point, because it is challenging for us to find caregivers — and very challenging for us also finding the right one,” Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, told HHCN in September. “That has been probably the biggest challenge that we’ve had.”

24 Hour Home Care is an independent, non-medical home care provider with 20 locations spanning California, Arizona and Texas. Despite its consistent growth and success, recruiting and retention has remained a pain point.

That’s also reflected in a recent, pre-election survey conducted by myCNAjobs, a professional caregiver network that works with home care and home health workers, as well as providers in both fields.

Of 282 respondents in the myCNAjobs’ survey, the majority of agencies — nearly 60% — said they were struggling with recruiting. Over 70% of the agencies said they had recently turned down cases because they were unable to staff them.

Despite more workers looking for jobs in 2020 than any time in recent history, 87% of respondents said COVID-19 has made recruiting harder than it was before.

“COVID will reshape the labor market in many industries for quite some time,” Brandi Kurtyka, the CEO of myCNAjobs, said at the Home Care Association of America (HCAOA) Virtual Leadership Conference in October.

Riding the momentum

Even if recruiting and retention remains an issue for home-based care agencies, they have had the luxury of gaining recognition from political figures in the election cycle and during the COVID-19 crisis that they never have gotten before.

On his end, for example, presidential hopeful Joe Biden announced in July a $775 billion plan to boost the caregiver economy and support in-home care providers.

“One positive thing that I think came out of COVID — and I think this is just a real positive thing for the whole industry — is home care careers are suddenly on the map,” Kurtyka said. “Senior care just got the biggest ‘Got Milk’ campaign that we’ve ever seen.”

Before COVID-19, 19% of caregivers were considering leaving the home care industry, according to myCNAjobs. Only 22% of caregivers saw themselves continuing or exploring a career within home care.

But that could start to change, according to Kurtyka.

“I think we’re starting to see these numbers shift,” she said. “I think it’s really interesting to be a home care agency right now. You have a strong, strong story to tell.”

Home-based care providers have been able to — or are expecting to be able to — gain new clients after COVID-19 has hit institutional-based settings hard. They may start seeing the same from workers.

In other words, health care workers who didn’t used to find home-based care attractive from a career standpoint may start reconsidering.

Finding workers from other industries

For agencies that are finding workers coming from different industries, they’re beginning to realize trends in their hiring practices.

Amy Smith, the corporate VP of revenue cycles at Alternate Solutions Health Network, has had success with hiring restaurant workers on the company’s back-end, for instance.

“After we had already had them on staff, we realized, ‘Oh gosh, why do they work differently?’” Smith told HHCN. “And they would reference skills that they acquired from working as a server.”

Dayton, Ohio-based Alternate Solutions Health Network is a provider of home health care and one of the largest post-acute solutions operators in the country.

When COVID-19 got bad, so did unemployment for restaurant workers. Of the 20.5 million people who lost their jobs in April, 5.5 million of them were from the bar and restaurant industry. While a considerable amount of jobs have been added back since then, the number is still far off from that of pre-pandemic levels.

In cases where a former restaurant worker made it into home care, their restaurant skills enabled them to transition more seamlessly, strapped with the ability to multitask and start certain projects while in the middle of others.

“If an applicant expresses the ability to multitask, regardless of their background, regardless if they’ve ever worked in health care before, it’s great,” Smith said. “It’s about their ability to start, pause, start something else, pause, and go back to something that was started weeks ago.”

Alternate Solutions Health Network wasn’t as interested in hiring early on in the COVID-19 pandemic because its volume had dropped. Now that volumes have picked back up again, the unemployment rate has helped it fill open positions.

The hiring experience during COVID-19 has reaffirmed for Smith and her organization that they need to keep an open mind during the process.

“There are folks who interview who have a specific medical records field degree, and those people aren’t necessarily successful in this job,” Smith said. “They’re not as successful as somebody who’s willing to just work hard. So don’t be discouraged by that lack of experience.”

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The slicing of billing periods from 60 to 30 days has raised the stakes when it comes to obtaining signed orders. During the COVID-19 crisis, it has been doubly difficult to get signatures from physicians on time, especially from the ones that are less technologically inclined.

“For orders tracking, the fact that we’re reducing those billing periods from the 60-day episodic claim now to those 30-day payment periods, in most cases, the one piece that’s going to be holding those bills up from getting billed out are going to be the signed orders,” Nick Seabrook, the managing director at BlackTree Healthcare Consulting, said during a recent webinar. 

Home health agencies are now seeing the value in adopting technology to decrease the turnover time of physician signatures.

Alternate Solutions Health Network, for instance, has continued to add on to its technological capabilities to address these issues with the help of its tech partner, WorldView LTD.

WorldView helps home health agencies increase efficiency by automating medical records processing, assisting with inventory management and supporting billing departments.

On its end, Kettering, Ohio-based Alternate Solutions Health Network is a national provider of post-acute solutions, including home health and hospice. Because Alternate Solutions operated in a state with Review Choice Demonstration (RCD), workflow efficiency is even more crucial.

“One of the technologies that we adopted — with the help of WorldView — was segregating out the incoming plan of care versus subsequent orders, so that we could put a faster priority on indexing, processing and getting it back into the system, because of RCD and the timeliness needed there,” Amy Smith, the corporate VP of revenue cycles at Alternate Solutions Health Network, said on the webinar.

That change has allowed Alternate Solutions to achieve a 99% RCD success rate.

The coding changes under PDGM have had a huge impact on providers across the country, but orders tracking — which has somewhat gone under the radar — continues to be a pain point for agencies adjusting to the new payment system.

“If you’re starting to see any spikes in your days to file claims, or if you have been experiencing that, chances are it’s probably an issue with your orders tracking,” Seabrook said.

With half the time to collect necessary signatures than before, agencies are tweaking their methods to make sure they’re seeing fewer outstanding orders, Rachel Wennekamp, an account executive at Worldview, also said on the webinar.

“Agencies that may not have been utilizing the orders tracking solution at WorldView are now seeing the value in leveraging that technology to track and gather physician signatures on all their outstanding orders,” Wennekamp said. “Utilizing an auto-fax schedule to ensure timely delivery of all orders into the physicians’ hands helps ensure quicker turnaround time for getting those signed orders back.”

COVID-19 impact

For obvious reasons, the COVID-19 pandemic has exacerbated the orders tracking pain point.

“Really, the primary challenge has just been access to physicians for a number of different reasons,” Samantha Soulas, BlackTree’s orders tracking expert, said on the webinar. “Because especially right in the beginning of the pandemic, physicians and staff in offices and facilities weren’t even there to receive or sign orders.”

There are a lot of offices that still prefer hand-delivery methods. During COVID-19, that was either not allowed or not possible.

That left providers in the dark when it comes to orders tracking and physician contact generally, which has forced them to instead begin investing in new strategies.

“I know that my clients left a lot of voicemails in the early months of COVID,” Soulas said. “And we’ve obviously seen since then offices and facilities opening up more. They’re now seeing patients, but they’re still a little less available. Physicians are still not visiting the office as many days as they were and there are a lot of telemedicine visits going on.”

Even if home health providers have adopted more technology since COVID-19 hit, without the physicians doing so as well, their efforts are often all for naught from an orders tracking perspective.

That’s why it’s been encouraging to see some physicians that prefer hand delivery begin to open their minds a bit more to alternate forms of delivery over the last few months, which many have, Soulas said.

“They’re now actually starting to adopt fax, portals or email, which has been one silver lining here,” she said.

Overall, agencies should focus on building positive relationships with physicians, shift to automated services as much as possible to free up productivity for workers elsewhere and set goals for faster documentation processing.

The post Home Health Agencies Continue to Struggle with Orders Tracking appeared first on Home Health Care News.

“It’s a definite trend,” Mark Kulik, managing director at mergers-and-acquisitions advisory firm The Braff Group, told Home Health Care News. “The theme is [that] it’s hard to be great at everything. Your core competency as a hospital is acute care. Home care is very different.”

From 2016 to 2018, 177 hospitals or health systems acquired home health agencies, according to proprietary data from The Braff Group. Additionally, during the same period, there were at least 25 joint venture announcements between home health companies and hospitals or health systems.

Already in 2019, at least four more large health systems have followed suit, with the most recent being Geisinger Health System, which announced a joint venture agreement with LHC Group (Nasdaq: LHCG) in February.

When the deal is finalized, Lafayette, Louisiana-based LHC Group will take majority ownership and management responsibility of Pennsylvania-based Geisinger’s home health and hospice services, as well as Geisinger affiliate AtlantiCare’s New Jersey locations.

LHC Group also teamed up with Searcy, Arkansas-based Unity Health for a JV in January.

LHC Group will take over both of the health system’s home health locations, which employ about 50 full-time workers who care for nearly 300 patients.

While many hospitals and health systems have chosen to augment their home health businesses by acquiring or partnering with home health agencies, several others have also opted to sell their businesses to up-and-coming providers outright.

Reimbursement struggles and financial hardship

On Jan. 1, Beaumont Health — one of Michigan’s largest health systems — teamed up with Kettering, Ohio-based Alternate Solutions Health Network to form a new JV to take over its home health and hospice offerings. Alternate Solutions Health Network is a national provider of post-acute solutions.

With a net revenue of about $4.5 billion, Southfield, Michigan-based Beaumont had more than 175,600 inpatient discharges in 2017. Alternate Solutions, which will manage the JV’s daily operations, has more than 20 JVs under its belt in Florida, Ohio, Virginia, West Virginia and — now — Michigan.

The goal of the joint venture is to deliver care at a reduced cost to roughly 16,000 patients in southeast Michigan, John Kerndl, executive vice president & CFO of Beaumont, told HHCN in January.

“Working with a specialized provider with home health and hospice expertise improves our ability to serve current and future patients,” Kerndl said, noting that Michigan has a “challenging commercial reimbursement market.”

One way the JV will presumably tackle those challenges is by cutting payroll costs. Under the new model, employee compensation will be structured “more like a home health company” than a health system, Kerndl said.

While most hospitals pay employees hourly, home health agencies commonly compensate workers based on visits per day, with varying compensation rates for travel and mileage, Kulik said.

“[Home health agencies] have engineered the economics differently to accommodate reimbursement so that they can stay in business,” he said. “A lot of the hospitals have kept the symmetry inside and outside the hospital the same, and that makes for a very difficult time trying to keep your head above water.”

Financial struggles also contributed to Oregon-based Samaritan Health Services’ decision to outsource its home health offerings earlier this year, according to President and CEO Doug Boysen.

In February, the nonprofit healthcare system — which operates five hospitals throughout Oregon — sold its home health division, which served patients in the state’s Benton, Lincoln and Linn counties.

Wilsonville, Oregon-based Signature Healthcare at Home — which provides home health, hospice, personal home care, palliative care and rehabilitation therapy to patients in the Pacific Northwest — took over March 1.

Ultimately, workforce challenges made Samaritan’s business model difficult to sustain, Boysen said when the news was announced.

“It is a challenge to recruit and retain the specialized workforce needed,” Boysen said. “In addition, the size and scope of our three-county service area requires significant staff travel time and prevents us from leveraging economies of scale. The result of all these factors is annual financial losses over multiple years, with no indication that the situation will improve.”

Meanwhile, home health agencies build their around businesses around those economies.

Outsourcing from the start

University of Maryland St. Joseph’s Medical Center (UMSJMC) was an early adopter of the home-based care outsourcing trend.

Rather than attempt to tackle workforce and reimbursement challenges alone, UMSJMC chose to outsource its home-based services from the start four years ago.

The decision came after the state of Maryland created a readmission reduction incentive program in an attempt to lower the state’s historically high readmission rates and, in turn, cut Medicare costs.

UMSJMC turned to Maryland-based Maxim Healthcare Services — a nationwide provider of home health, medical staffing and other services — for help.

As part of the partnership, Maxim pairs recently discharged high-risk patients with community health workers who provide personal care and help clients tackle social determinants of health.

“For us to have done this initially on our own with no experience with regard to what’s really going on in the home, we wouldn’t have anticipated the workforce challenges — how to go about creating the workforce, the issues with licensing in the home, the rules and regulations around that [or] the healthcare needs of patients in their homes,” Dr. Gail Cunningham, chief medical officer at the UMSJMC, told HHCN. “This allowed us to pretty quickly stand up a program that provided immediate benefit to a lot of patients.”

So far, the program has cut high-risk patient readmissions in half and reduced hospital spending for the same group by 35%.

As the health care system shifts toward value and the home-based care landscape becomes more complicated due to the caregiver shortage persisting and reimbursement models changing, the outsourcing trend will likely continue, Kulik predicts.

“Don’t be surprised if you see more announcements coming this year,” Kulik said. “I think you’ll see those [hospital and health system] CEOs more and more seeking partnerships or at least evaluating the benefits of those partnerships today in 2019 and 2020.”

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The new JV is between the Southfield, Michigan-based Beaumont Health and Alternate Solutions Health Network, a Kettering, Ohio-based organization that specializes in rolling out joint ventures with health systems akin to the eight-hospital not-for-profit Beaumont. Since its founding in 1999, Alternative Solutions has teamed up on at least 20 JVs and partnerships across Florida, Ohio, Virginia and West Virginia.

The new organization between Beaumont and Alternate Solutions, which was publicly announced a day after it began operations on Tuesday, is branded as Beaumont Home Health and Hospice.

The JV will serve roughly 16,000 patients living in southeast Michigan, John Kerndl, executive vice president & CFO of Beaumont, told Home Health Care News.

“Working with a specialized provider with home health and hospice expertise improves our ability to serve current and future patients,” Kerndl said. “Patients are our No. 1 priority. We are always evaluating ways to serve them better.”

The partnership with Alternate Solutions will allow Beaumont to deliver compassionate care at a reduced cost, according to Kerndl. While the new JV will deliver both home health and hospice services, home health care is typically needed more than hospice in its market, he said.

Reimbursement challenges

Formed in 2014, Beaumont Health has a total net revenue of about $4.5 billion. Its system-wide network includes 3,429 hospital beds, 187 outpatient sites, nearly 5,000 physicians and 38,000 employees. Beaumont had more than 175,600 inpatient discharges in 2017.

Crain’s Detroit Business reported that Beaumont was looking to outsource its home health and hospice business in December, weeks before an official announcement came from the health system.

Beaumont declined to comment on the news to HHCN at that time, noting that the joint venture was still in the process of being finalized.

In its initial report, Crain’s claimed that reimbursement difficulties also factored into Beaumont’s decision to partner with Alternate Solutions. Although Michigan “has a challenging commercial reimbursement market,” Beaumont had “more strategic” reasons for the move, Kerndl told HHCN.

Under the Beaumont Home Health and Hospice joint venture, employee compensation will be structured “more like a home health company,” Kerndl said, adding that there will be no across-the-board pay cuts.

Crain’s previously reported that home health nurses, physical and occupational therapists, social workers and other caregivers could have pay cut by up to 40% as a result of the joint venture.

Beaumont’s medical equipment, home infusion and personal assistant service employees will remain with the health system. The health systems expects the JV with Alternate Solutions to create new jobs for home health and hospice workers throughout southeast Michigan.

Alternate Solutions will handle day-to-day operations of the JV.

“The vast majority of home health and hospice positions have transferred to the new company,” Kerndl said. “Those whose current positions did not move forward with the joint venture have received assistance to find another position within Beaumont.”

What the future holds

Reductions in re-hospitalizations and increases in revenue are among the two main benefits health systems have seen in partnering with Alternative Solutions, according to the company.

Specifically, Alternative Solutions’ technology and analytical capabilities have been shown to identify a patient’s risk of re-hospitalization with an accuracy of 85%, while increasing partners’ revenues by up to 35% within the first year.

Inova Health System in Virginia and Memorial Health in Georgia are among the other health care organizations that Alternate Solutions has partnered with over the past several years.

About 20% of all Medicare patients are readmitted to the hospital within 30 days of discharge, while chronically ill beneficiaries are up to 100 times more likely to have a preventable re-hospitalization, according to Alternate Solutions statistics.

Overall, inadequate care coordination resulted in as much as $45 billion worth of wasteful spending last year.

“We look forward to working with Beaumont to serve patients who need home health or hospice care,” Alternate Solutions Co-CEO and founder Tessie Ganzsarto said in a statement. “Our team is impressed by the compassionate care delivered by the Beaumont team, and we are eager to offer home health and hospice services to more patients in Michigan.”

From a growth perspective, home health providers in Michigan, Florida, Illinois and Texas have often had to get creative when looking to break into new territories or markets.

The Centers for Medicare & Medicaid Services (CMS) has repeatedly extended a temporary moratoria on new Medicare home health agencies from opening in those states. Initially implemented in 2013, the moratoria can, at times, restrict organizational growth, industry insiders say.

It was last extended in July 2018.

Moving forward, Beaumont expects the Alternate Solutions joint venture transition to proceed smoothly and without any hindrances to quality or accessibility of care. Despite those sentiments, other reports surfacing Thursday raised questions about Beaumont and the availability of pediatric home health services under the JV.

“Alternate Solutions Health Network as extensive experience in these transitions,” Kerndl said. “We are working closely with [Alternate Solutions], our staff, patients and families to ensure they do not experience any interruption in the care they receive.”

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