CMS proposed a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067% back in June. All in all, the agency proposed a 1.7% cut to aggregate home health payments next year.

Providers have experienced cuts in the previous two years, but have also seen CMS back off more severe cuts in the time between the proposed and final payment rules in 2022 and 2023.

“[CMS] thinks, ‘How much can we threaten to reduce the current payment rate, so that when we drop a few breadcrumbs [in the final rule], providers will feel good about picking a little something up?” Pinnacle Home Care CEO Shane Donaldson said on stage at Home Health Care News’ FUTURE conference last month. “History tells us that the final rule will probably be a net neutral event.”

Based in Oldsmar, Florida, Pinnacle Home Care is one of the largest home health providers operating in its home state. The New York-based HCS-Girling recently acquired Pinnacle Home Care, which plans to significantly expand in the coming years.

While providers are hoping that they at least see those breadcrumbs in the final rule, they’re not banking on it.

Instead, they’re working toward becoming sustainable shops in spite of a turbulent payment environment.

“If you’re not really good at something – whether that is collecting your AR, doing your coding, OASIS review – it’s time to look at people who are really good at that, and maybe make some different decisions,” Interim HealthCare President and COO Rexanne Domico also said on stage at FUTURE. “What I would really suggest to people at this stage in the game is to think about your efficiency in all of your locations.”

Based in Sunrise, Florida, Interim HealthCare is a home health and home care franchise with more than 330 locations across the U.S.

Efficiency is a broad term, but Domico was specifically referring to outsourcing certain tasks, reducing redundancies and also exploring home health-applicable AI.

AI was a major talking point at FUTURE, and the vast majority of providers were bullish on what new technology could do for the industry in terms of efficiency, especially in light of recent rate cuts.

On top of that, Domico mentioned utilization as an area for providers to keep an eye on.

“I think there’s a lot of times we don’t focus on utilization,” Domico continued. “And I think there’s a tremendous opportunity to focus on there. And that can be part of your increase, if you work it the right way.”

Donaldson added that clinicians should be working at the top of their licenses, which also helps drive efficiency.

“What we’ve got to do is improve our margins, and that means we’ve got to get evaluating clinicians to do as many evaluations and assessments as possible, and we’ve got to get the non-evaluating clinicians doing the majority of the straight visits,” he said.

There are home health providers trying to do more to be a better partner to payers and referral sources. But, sometimes – to Domico’s point – less is more.

In general, providers agreed with the idea that they should focus on their strengths, and find a way to outsource their weaknesses, or at least level up in those areas.

“If [that margin] is not going to be given to you, how are you going to get it?” Domico said. “I think you get it by really being an expert at what you’re really good at, which is delivering care. And if those other things are not working for you, then I think it’s time to look at doing something different.”

Working with other payers

As those fee-for-service rates become less reliable than they’ve been in the past, providers are having to spend far more time thinking about their Medicare Advantage (MA) strategies.

With less growth in traditional Medicare payment, it’s paramount to avoid MA payers that reimburse at a subpar rate. For the most part, providers don’t expect – but do hope for – MA rates on par with traditional Medicare rates.

But 40% lower, for instance, is unsustainable.

“In the state of Florida, we have 850 home care agencies, and so Medicare Advantage plans still consider us to be largely commodities,” Donaldson said. “When they can find an agency next door that’s willing to do a visit for $80, they’re not going to pay us $130. Irrespective, it seems, to how much we can prove that our quality is better than any of our neighbors.”

Pinnacle has had success with one MA plan, however. That plan has agreed to pay the company with some upside opportunity.

That came about when the plan moved from being managed internally to being managed by a third party.

“We had a good relationship with the third party,” Donaldson said. “In negotiating, we said, ‘Look, this really needs to be an episodic relationship, even if it’s at a percentage of Medicare. Give us the opportunity to control our own destiny, give us a pot of money and let us run with it.’”

While some improvements have been made in home health contracts between MA plans and providers of late, Domico still sees providers largely as “price takers” in the relationship.

“I think we are price takers, and I think the negotiations are really very one-sided,” she said.

But she also believes that there’s still plenty of opportunity out there for providers to be paid more fairly, and that starts with regional plan partnerships.

Well Care Health COO Rebecca Higbee, also on stage at FUTURE, said her company has seen most success with those local-level health plans.

“Some of our best partners are those regional partners,” she said. “Those local partners where you can speak to the actual decision makers of the plan.”

Well Care Health provides home health and hospice services across North Carolina and the upper part of South Carolina.

Higbee also emphasized that health plan relationships need to be nurtured on a daily basis.

“It still takes years to make progress,” she said. “We have made progress of late. There’s a handful of payers that are finally seeing the value, while at the same time, there’s also payers that in years past have seen value and are now looking to move backwards. It’s really a mixed bag. I think it’s something we have to be working on daily, and something we have to be thinking about daily.”

The post Top Home Health Operators: If You’re Not Really Good At Something, Ditch It appeared first on Home Health Care News.

She became the president of Interim HealthCare in January of 2019, and Home Health Care News caught up with her shortly thereafter to discuss the journey that took her from being an ICU nurse to a health care CEO.

In early July, Sheets stepped down from the CEO role.

“I have spent the last 25 years of my life dedicated to ensuring that patients and families across the globe have access to high quality care that they need and deserve, and I think that’s where I’ll continue to be.” Sheets told HHCN earlier this month. “I’ve decided to just partially step back for a period of time. I have traveled, on average, three weeks out of every single month for the last 10 years. Right now, I need to take some time to focus on my family and their needs.”

The travel was especially tough given Sheets’ role as the primary caregiver for her mother.

She was at the helm of Interim HealthCare during a time where it solidified itself as one of the largest home health providers in the country. The Sunrise, Florida-based company – a part of Caring Brands International, which Sheets also was the CEO of – also provides personal care, hospice care, palliative care, pediatric care and staffing services. Through its over 330 U.S. locations, it cares for about 200,000 individuals per year.

Paul Mastrapa, the former CEO of the home care company Help at Home, has stepped in as the CEO of Interim. Mastrapa had already been a member of Interim’s board.

For the time being, Sheets will be dedicating much of her time to board work. She is the head of the board at the Research Institute for Home Care (RIHC) and a part of the board at the National Association for Home Care & Hospice, where she also serves as the co-chair of the new Medicaid council.

She’s open to similar board roles in the near-term future.

“I’ve had several people reach out, which is good, and am certainly open to serving anywhere where I can add value in the health care arena,” Sheets said.

In addition to Interim, Caring Brands International also includes the U.K.-based Bluebird Care and the Australia-based Just Better Care. She was in charge of all of that, in addition to hundreds of franchisees operating semi-independently.

Sheets is proud of the impact that her company was able to make globally, as it brought more care to the home in England, Ireland and Australia.

But, looking back, she’s also proud of how far home-based care and Interim have come.

“I think I’m most proud of the place that we have grown to in the industry,” Sheets said. “And, quite frankly, getting Caring Brands at a table with all the rest of the industry leaders, to where it should have been – that’s probably what I’m most proud of.”

For now, more than anything, Sheets is on a break from roles in daily leadership. It’s likely that she’ll be back at the top of a company sometime in the future, however.

“I will always be involved in this industry, this has been my passion for my entire career,” she said. “I’ll be involved with advocating, consulting and board roles for now. But, I have a feeling I’ll I’ll be around for a long time.”

Home-based care’s future

Sheets has a unique perspective on the U.S. health care system’s problems.

She started her career as a bedside nurse, but she’s also held executive roles in both acute and post-acute care settings. Even within home-based care, she led a company in Interim that had a significant census in both home health care and home care.

With that in mind, Sheets still sees a significant market need for end-to-end, home-based care continuums.

“I think that the biggest opportunity that we have right now in the health care industry is to focus on unmet health care needs with integrated care connected to community and support resources,” she said. “So, wherever you’re starting in the industry, it doesn’t matter which piece your focus is, but more about how you are coordinating care and how you are driving that full continuum.”

That would mean not just focusing on one payer source, or one home-based care service. Doing so will enable providers to grow sustainably in a value-based context, and will ultimately lead to better, less interrupted care for patients.

With that in mind, in home health care specifically, Sheets believes that providers are actually beginning to take a different approach toward managed care plans and value-based care overall.

“We’re not completely focusing on just a conversation about bringing the rates up anymore,” Sheets said. “It’s more about figuring out how we both get the rates that we need, but also demonstrate the value and the cost savings that [these plans] are looking for.”

Sheets’ mother recently said to her – after being discharged from the hospital – “I wouldn’t have known what to do if it wasn’t for you.”

Even after stepping away from Interim, Sheets’ ultimate goal is for no patient to leave the hospital facing confusion, or an inability to receive seamless home-based care.

The post She Stepped Away From Her Role As Interim HealthCare CEO, But Jennifer Sheets Isn’t Going Anywhere appeared first on Home Health Care News.

A few months after making its first acquisition, the caregiver training platform CareAcademy is adding to its leadership team to support its next stage of growth.

CareAcademy announced that Laura Bottino will serve as the company’s CFO; Kristin Relyea will serve as the vice president of product, design and engineering; and Tracy Huckabee will serve as the vice president of content and quality.

The Boston-based CareAcademy’s platform provides home care agencies with professional development training and upskilling for direct care workers. This past summer, it secured a Goldman Sachs-led $20 million funding round.

“Our new leaders bring decades of collective experience in scaling high-growth companies in health care, e-commerce, SaaS and education, that offer both mission and margin,” Helen Adeosun, CEO and founder of CareAcademy, said in a statement. “As we double down on product development and user experience within our platform, Laura, Kristin and Tracy will be instrumental in our next stage of growth as a product company.”

CareAcademy is used by over 2,000 home care, home health and assisted living providers.

Interim HealthCare’s CEO named home care board chairperson

The leader of Interim HealthCare Inc. has been named chairperson of the Research Institute for Home Care’s (RIHC) board of directors.

Jennifer Sheets, CEO and president of Interim, will begin a two-year term on the board in February. She has been a member of the board since 2019.

Based in Sunrise, Florida — and a part of Caring Brands International — Interim is a franchise that provides home health, hospice, palliative care and other services across 330 locations in the U.S. and Saudi Arabia.

“I’m honored to guide this organization in its commitment to elevating home health care as the patient-preferred care option,” Sheets said in a statement. “We are at a pivotal point in our fight for enhanced recognition and federal funding for home health care services and the work Research Institute for Home Care does is integral to the industry’s continued growth.”

RIHC is a nonprofit group of home care providers and organizations that invests in research and education regarding home health care.

CVS Health exec returns to UnitedHealth Group

The former president of health care delivery at CVS Health (NYSE: CVS) has rejoined his former company.

Amar Desai — after six months with CVS Health — will return to UnitedHealth Group (NYSE: UNH) where he will reportedly advise CEO Andrew Witty.

Desai joined CVS Health in October 2022 to lead its clinical delivery strategy for retail health, chronic disease management and behavioral health.

Desai previously served as president and CEO of UnitedHealth Group’s Optum Pacific West.

CVS Health recently completed its $8 billion acquisition of Signify Health (NYSE: SGFY). The deal was completed just weeks after UnitedHealth Group – and its subsidiary Optum – completed the $5.4 billion acquisition of LHC Group.

PopHealthCare names former Optum exec as new chief administrative officer

The Franklin, Tennessee-based PopHealthCare has named Nick Snoply as its new chief administrative officer (CAO) where he will lead human resources, growth and strategy initiatives.

PopHealthCare is a subsidiary of GuideWell Mutual Holding Corporation. The company offers home-based primary care, risk-adjustment solutions and in-home assessments.

Snoply will also focus on diversity, equity and inclusion (DEI) initiatives at PopHealthCare and its value-based national medical group, Emcara Health.

“Nick’s leadership experience is well-aligned for PopHealthCare and Emcara Health’s long-term growth,” PopHealthCare CEO Eric Galvin said in a statement. “The focus and energy Nick brings to this role are invaluable to enhancing our position as an employer of choice and enabling us to deliver more care to more of the patients who need us.”

Before joining PopHealthCare, Snoply served as CAO for the American Health Network at Optum and has more than 15 years of executive experience.

“Given the momentum that PopHealthCare and Emcara Health have experienced, we have an opportunity to strengthen our human resources and development infrastructure,” Snoply said in a statement. “I’m inspired by our mission to reimagine how health care is delivered and most importantly in the people who are delivering on this mission every day.”

Sutter Health names new COO

The nonprofit health system Sutter Health has named Mark Sevco its new chief operating officer.

Based in Sacramento, Sutter Health is a nonprofit health system with 24 acute care hospitals and over 200 clinics in Northern California.

Its network and service offerings include hospitals, medical foundations, ambulatory surgery centers, walk-in care centers, as well as home health and hospice care.

“Mark has proven operational experience integrating and aligning care delivery models and teams across large health systems, and in both hospital and ambulatory settings,” Sutter Health President and CEO Warner Thomas said in a statement.

Sevco will officially join Sutter in June.

The post CareAcademy Hires 3 New Executives; Interim HealthCare CEO Joins RIHC Board appeared first on Home Health Care News.

Aveanna closes $345 million Comfort Care deal

Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) has completed its acquisition of Comfort Care, an adult home health and hospice company with operations in Alabama and Tennessee. The $345 million deal included $55 million in estimated net tax benefits.

Comfort Care is expected to be fully integrated into Aveanna during 2022, with the majority of the integration process occurring in the first 180 days of next year.

“The addition of Comfort Care advances Aveanna’s strategy of expanding our home health and hospice segment by adding density in demographically attractive markets for skilled adult care services,” Rod Windley, executive chairman of Aveanna, said in a press release. “Comfort Care has an established reputation in Alabama, a growing presence in Tennessee, and a strong management team that will allow us to bring Aveanna’s high standards of care to even more patients and families.”

The Atlanta-based Aveanna delivers a broad range of pediatric and adult health care services – including home health and hospice care – throughout locations in 30 states.

Meanwhile, Comfort Care provides both home health and hospice services to a Medicare patient population through a network of 31 locations in Alabama and Tennessee. Comfort Care generates about $100 million in annual revenue, with roughly 47% of its revenues derived from home health and about 53% derived from hospice.

Interim acquires California location

Interim HealthCare Inc. has purchased one of its locations – Interim HealthCare of Sacramento Hospice – for an undisclosed sum. The move marks Interim’s third acquisition of 2021, according to the company.

First opened 46 years ago, Interim HealthCare of Sacramento Hospice provides end-of-life services throughout the Sacramento, California, area. David Klaeser has been the owner of the franchise since 2007; he will continue leading the business in the role of CEO.

Interim HealthCare Inc. previously acquired Interim HealthCare of the Treasure Coast in November and Interim HealthCare of San Diego in January. The three transactions are part of the franchiser’s movement toward “a hybrid model of both franchises and company-owned branches,” the company noted in a press release.

“2021 was a big year for Interim HealthCare. We are glad to have had the opportunity to purchase not only Interim HealthCare of Sacramento Hospice, but two other highly successful franchises in San Diego, California, and West Palm Beach, Florida,” Jennifer Sheets, president and CEO of Interim, said. “These three acquisitions further Interim HealthCare’s unwavering commitment to meeting individuals in their most preferred care setting – the home.”

The Sunrise, Florida-based Interim HealthCare has over 330 locations servicing the U.S. and Saudi Arabia. Its services include home health, hospice and palliative care, plus pediatric care and health care staffing support.

Graham Healthcare Group buys InTeliCare

Graham Healthcare Group – a provider of home health, hospice and palliative care services – has acquired InTeliCare Health Services for an undisclosed sum. The agreement was finalized on Dec. 15, 2021.

InTeliCare Health Services is a provider of home health services in central Florida, a new state for Graham Healthcare Group. Moving forward, Graham plans to integrate InTeliCare into its “Residential Home Health” division, which delivers post-acute care services to communities in Michigan, Illinois and Pennsylvania.

Graham Healthcare Group is a subsidiary of Graham Holdings Company (NYSE: GHC).

“More than one-fifth of Florida’s population is over 65, and that number continues to grow,” David Curtis, CEO of home health at Graham, said in a statement. “With the baby boomer generation doubling in size and an increase in comorbidities, this is an ideal time for Graham Healthcare Group to begin serving people in the state of Florida in their own homes with high-quality post-acute and end-of-life care.”

The Residential Home Health division expects to retain InTelicare’s workforce.

Nova Leap strikes again

Nova Leap Health Corp. (TSXV: NLH) has completed the acquisition of a home care business with operations in Texas. Neither financial terms of the deal nor the name of the business were disclosed.

“We’re pleased to enter the Texas market,” Chris Dobbin, president and CEO of Nova Leap, said in a statement. “This acquisition complements our existing businesses in Oklahoma and Arkansas. We expect further growth in the South Central region.”

Nova Leap completed the purchase of a South Carolina home care business earlier in December. The company – headquartered in Halifax, Nova Scotia – has a presence in 11 different U.S. states overall.

Paradigm lands HomeCare Connect

The Walnut Creek, California-based Paradigm has acquired HomeCare Connect, a specialty network focused on home health care, durable medical equipment (DME) and related services, with a focus on servicing catastrophic and complex cases.

This acquisition will broaden Paradigm’s specialty network and clinical solution sets while extending its accountable care management model into the home, according to the company.

In addition to its core home health and DME solutions, HomeCare Connect offers post-acute care, home modifications, prosthetics and IV therapy. The company was founded in 2011 by sisters Teresa Williams, Vonesa Wenzel and Cindy Hailey.

“New technologies, aging demographics and infectious disease-related risks are key factors driving increased demand and new opportunities,” Paradigm CEO John Watts said in a press release. “By extending our offerings into the home health market, Paradigm can support this critical aspect of the recovery journey by providing continuity of high-quality, closely managed care to drive better outcomes for the injured [individuals] we serve.”

The post Transactions: Aveanna Completes Comfort Care Purchase; Interim Announces Third Acquisition of 2021 appeared first on Home Health Care News.

New research from Interim HealthCare and The Harris Poll suggests that trend could be on the horizon.

In a joint study released Tuesday, the two organizations found that more than two-thirds of licensed medical professionals may soon seek a role in home-based care.

“It was absolutely a positive takeaway,” Jennifer Sheets, the president and CEO of Caring Brands International and Interim HealthCare, told Home Health Care News. “Across the board, we’ve seen the demand for home health care increase. People have realized what can be done in the home. And I think as more consumers shift away from nursing and long-term care homes toward home health care, those staff members are going to need to adjust accordingly.”

Based in Sunrise, Florida, and a part of Caring Brands National, Interim HealthCare is a franchise that provides home health, senior care, hospice, palliative care, pediatric care and health care staffing services through over 330 locations in the U.S. and Saudi Arabia.

Wellspring Capital Management announced it acquired Caring Brands National on Oct. 25. The acquisition won’t change Interim HealthCare’s vision, Sheets said.

“We’re just really excited about our new partners, and what that really does is help us continue to execute on the strategy that we already had in place,” Sheets said. “Continuing to focus on recruiting [will be a priority]. Unfortunately, the staffing crisis has increased as a result of overreaching vaccine mandates and policy changes. It really is a top priority for us at Interim to devote a lot of time and resources into boosting our recruiting efforts to ensure that we can continue providing services to a growing number of individuals.”

Interim’s study – conducted in September – did offer some hope on that front, however. It consisted of interviews with over 2,000 adults, 186 of whom were medical professionals, to get a better idea of how their thoughts on health care may have changed during the COVID-19 pandemic.

Of the 186 medical professionals surveyed in the study, 71% of them said that the pandemic had made them consider going into home health care as a way to “reconnect with why they got into health care in the first place.” Even more – 74% – said they had considered making that change at one point in their career, giving credence to the idea that there is desire to work in home-based care.

“I can tell you as a former ICU nurse, I was drawn to home health care because I knew it was where I could best impact the quality of care delivery for people,” Sheets said. “I also wanted better work-life balance and believe others who have been in my shoes will find renewed value and purpose by joining this segment. The health care industry has already begun to experience the effects of individuals quitting, … and instead of these highly skilled individuals moving to a completely different career, we really should be trying to keep them within the industry.”

Interim’s “Made For This” campaign is specifically targeting health care professionals in other industries, hoping they’ll join the home health care sector.

Since it was launched in December, Interim has experienced a 33% increase in job-post viewings and a 12.7% increase in applications. The quality of applicants has also improved, according to the company.

Knowledge of home-based options

Despite a greater spotlight shone on the concept during the public health emergency, Americans are still relatively unaware of what kind of care can be delivered in the home. In fact, only 28% of respondents believed COVID-19 itself could be treated in the home.

The same percentage believed that seniors with chronic conditions could be treated in the home.

Not being aware of options is an obvious impediment to receiving care.

“That’s why the study was so surprising to me, because we have definitely seen a tremendous increase in awareness around the home health care space,” Sheets said.

Of the respondents, 65% said they would have considered home health care in lieu of a hospital visit in their past – had they been aware of the option. Only 29% had talked with a health care provider about home health care as an option for themselves or a loved one in the past, and 19% had been an unpaid caregiver at one point in their lives.

The disparity between the knowledge of home health care and its capabilities was stark between medical professionals and non-professionals. For instance, 66% of the medical professionals had utilized home health care for themselves or a loved one, and 64% had talked to a health care provider about the option.

“We need to provide more education, both on the prescriber and the patient side about the benefits of home health services,” Sheets said. “We need to focus on education and awareness for the clinical side, too. Physicians don’t go through a home health rotation, nor do nurses. I had no idea as an ICU nurse what could be done in the home. And so I think we need more and more studies like this, just to help raise awareness of what we do.”

The post Interim HealthCare CEO: More Medical Professionals Want to Join Home Health Industry appeared first on Home Health Care News.

As of Oct. 1, there had been more than 7 million COVID-19 cases in the U.S. with more than 200,000 deaths, according to federal statistics. A forecasting model created by the Institute for Health Metrics and Evaluation at the University of Washington estimates that there will be 371,509 COVID-19 deaths by January 2021.

To get a better understanding of what home health operators are up against this fall, Home Health Care News asked several CEOs and C-suite executives about their biggest concerns — and their plans for addressing them. In addition to the COVID-19 virus, respondents also touched on staffing challenges, consolidation and more.

Here are the top concerns of seven home health leaders as the industry heads into 2020’s final months.

* * *

The biggest concern that we have is what will happen with COVID-19. We have seen a surge happen as young adults return to college and then spread this into the community. Will that negatively impact our senior populations or reduce the referrals we are seeing from some doctors who have resumed elective surgeries? We are working with doctors’ offices that we regularly get referrals from to discover their plans and plan how we can work together to mitigate the impact for both the agency and for the doctor.

Other referral sources like assisted living facilities have stayed on stringent lockdowns, and we see that continuing throughout the duration of the crisis. The concern here is for access to caregivers and the ability of staff to be able to go in and do their job appropriately to make sure that these seniors are not left behind as a result of the ongoing surge that we expect to continue for several months.

We are mitigating this by working with facilities to reduce exposure potential by assigning specific staff just to that facility, running daily ongoing COVID checks and possibly utilizing some of the testing capacity that we expect to see from the federal government for rapid tests. We also have a standing relationship with local testing facilities to get staff in and tested immediately if needed, so that we can do immediate checks and short-term quarantines. We then utilize backup staff who have office positions as a stopgap until the all clear notice is given.

— Beau Sorensen, chief operating officer at First Choice Home Health & Hospice

* * *

The remainder of the year will be focused on a series of concerns including the need to increase provider support through the Provider Relief Fund, addressing Medicaid support shortfalls, securing support for telehealth reimbursement, and bolstering anticipated needs for PPE and staff testing.

Each of these items can be addressed through the ongoing stimulus legislation efforts or through Congressional action post-election. We have taken steps to cover both opportunities with targeted legislation on telehealth and Medicaid, along with broad supports in health care overall for the Provider Relief Fund, Medicaid, PPE and testing as part of the stimulus packages.

Given the extent of needs in the home care and hospice community, no one single focus is sufficient.

— William A. Dombi, president of the National Association for Home Care & Hospice (NAHC)

* * *

My biggest concern going into the fall is a COVID-19 resurgence coupled with what could be a tough flu season. This puts our staff at greater risk and could have a terrible impact on the elderly and at risk populations.

How do we address this? By working to get 100% of our clinicians vaccinated against influenza, ensuring we have adequate PPE and keeping our staff up-to-date on how to avoid community-based infection while both on or off the job. The health of our staff is our highest priority, and we have to double down on what kept them safe in the early days of COVID.

The pandemic is far from over, and I fear that the fall could be far worse than the spring if we don’t continue to take real action to keep health care workers safe.

— Brent Korte, chief home care officer at EvergreenHealth Home Care

* * *

As we move into fall, amidst this next phase of the pandemic or otherwise, our biggest concern remains caring for all patients with a range of health care needs: from high-acuity medical care to personalized non-medical support.

This means caring for the widest range of those who need our help, including pediatric patients with complex medical needs at home or in school while parents sort out virtual/hybrid learning models. It means setting up seniors with home aides to assist with meals and other chores. We’re also providing clinically based COVID-19 testing and screening services to ensure healthy work, learning and retail environments.

Our aim is that patients with milder COVID symptoms can transition home with the same high-quality care, while freeing up hospitals to support more intensive cases of COVID-19. To do this, we continue to fight the other battle, the caregiver shortage. To care for our patients, we search for and welcome the caregivers who want to give back, support their communities and make a difference in a job that is recession-proof and can change lives. Currently, those candidates could be from the many left jobless by the pandemic, including those from the hospitality, travel and restaurant industries.

Our challenge to meet patients where they are means being there to combat feelings of social isolation, especially as we approach the fall and winter seasons. By caring for our patients’ minds, bodies and spirit through our “Home Life Enrichment” standard-of-care, we can keep them healthy and safe but also connected to their loved ones and the world around them via in-person or telehealth interactions. For those facing end-of-life, meeting patients and their families with the support and comfort care of hospice in their final days and moments is what makes our team different.

— Jennifer Sheets, president and CEO of Interim HealthCare

* * *

What are the top concerns for our home health agency this fall? Is it our star rating? Our patient satisfaction? Maintaining a low re-hospitalization rate? Is it delivering on value or ensuring compliance? Surveys? Staffing? The Patient-Driven Groupings Model (PDGM)? The Review Choice Demonstration (RCD)? Audits, payers, costs, technology or hospital narrow networks? COVID-19?

These are all yesterday’s concerns. Today’s top concern is how hospital systems and the U.S. Centers for Medicare & Medicaid Services (CMS) want the small home health agencies to close. This is good for the large providers that have exclusivity and control a majority of the Medicare revenue, but bad for small providers, which are the great majority of agencies in America. We don’t have a seat at the table regardless of cost, quality or patient’s choice.

The second concern is the volume increase of “low pay,” “slow pay” and “no pay” high case-mix patients who are having issues accessing care. Agencies are going to have to be providing their referral sources with 5-star care. If an agency has a bad referral source, it’s safe to assume they are another agency’s good one. If agencies keep taking bad referral sources hoping that they will turn into good ones, it will most likely accelerate an agency’s closure. Agencies must be continuously looking for partnership opportunities with referral sources that want value — or get an exit strategy.

— Peter Miska, president of Phoenix Home Care LLC

* * *

The biggest concern — and opportunity — we have as an organization is the continued uncertainty, unrest and anxiety facing our communities, our patients, their families and our front-line “heroes” in the field. Adding fuel to “COVID-fatigue” is the unknown impact of the flu season aligning with a possible resurgence of the coronavirus. That requires us to remain vigilant in our support and messaging. We’ll continue to build upon what we have learned so far.

Over the last seven months, we have successfully navigated through the varying challenges of the pandemic to keep our patients, employees and communities safe. The result of this focus led to the implementation of new tools, technology and strong processes that have elevated home health in the continuum of care. We are reaching more patients, more families and serving our communities in different ways than we have in the past, putting us in a strong position to weather additional challenges as they come.

In response to the pandemic, we implemented innovative technology strategies and solutions to assist in keeping everyone as safe and connected as possible. As the flu and COVID-19 collide, we will continue leveraging our technology-based solutions such as remote patient monitoring, virtual visits and medication management delivery to enhance our care plans while supporting infection control measures and social distancing to minimize risk for our caregivers.

Regular COVID-19 training and flu education ensures a consistent approach to proven methodologies that have been implemented to protect our greatest resource – our staff – so they can do their best work for our patients.

We have used and will continue to use analytics to help make data-driven decisions during the pandemic. We have refined processes and implemented changes based on our learnings to ensure the safety of all. We have focused equal effort into providing tools and resources to our front-line caregivers to ensure they are safe, engaged, supported and have what it takes to be resilient in hard times.

— Dan Dietz, president and CEO of CommonSpirit Health at Home

* * *

Trinity Health At Home has seen an increase in home care visits at faster rates than expected this quarter. As patients across our nation continue to seek equal access to health care, the need for home care services continues to climb. As home care providers, we must continue monitoring and improving our processes to ensure current and future patients have access to care. At the start of the pandemic, we adapted quickly across our home health agencies to meet patient needs under new circumstances. Our innovation will continue in the brighter days ahead.

Though we have all adapted to COVID-19, we must continue to take our COVID-19 response and processes very seriously. At Trinity Health At Home, the safety and well-being of our patients and colleagues remain our priority moving forward. Right now, support for our devoted nurses and clinicians is of utmost importance. We are securing additional supplies of PPE, ensuring the safety of staff on home visits and encouraging self-care to limit the stress and uncertainty of our new normal. By keeping our colleagues healthy and engaged, we can ensure proper staffing levels to guarantee high-quality home care and expand access to care within our communities.

— Mark McPherson, president and CEO of Trinity Health At Home

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The proposal — first obtained by Washington, D.C.-based newsroom Roll Call — is viewed as a “skinny” version of the previously released HEALS Act from July. Among its provisions, the Republican plan seeks to provide $300 in weekly unemployment insurance, additional money for coronavirus testing and another $158 billion for the Paycheck Protection Program (PPP), which closed for applications on Aug. 8.

Of note for home health providers and other organizations operating in the long-term and post-acute care spaces, the skinny bill appears to do little to alleviate financial and workforce hardships triggered by the public health emergency. In turn, it offers “no real relief” to the older Americans such providers serve, according to Katie Smith Sloan, president and CEO of the national aging services advocacy group LeadingAge.

“When eight out of 10 COVID deaths are among people 65 and older, and infections in nursing homes are breaking new records, it’s shameful to largely ignore the continued deaths and escalating danger to older adults,” Sloan said in a statement Wednesday.

To some extent, a drop in federal unemployment from $600 to $300 per week could lessen the number of in-home care workers opting out of their jobs during the ongoing crisis due to safety concerns. Those anxieties have contributed to some home health and home care agencies losing several workers over the past few months, despite the fact unemployment rates remain high.

Additionally, a reopening of PPP — with the program stocked with fresh funding on top of leftover funds — would likely go a long way in supporting small and mid-sized home-based care businesses.

Overall, more than 15,000 home-based care entities received PPP loans of less than $150,000 under PPP, according to a review of federal data conducted by Home Health Care News. More than 7,400 entities have received loans at or above $150,000, with dozens receiving loans in the $5 million-to-$10 million range.

“For those Interim HealthCare owners who applied and received funding, the PPP loan allowed them to ensure their teams of home health aides, nurses and other staff members could continue to serve their patients, safely in the comfort of their own homes by front-line staff who had access to the right resources, including proper personal protective equipment (PPE),” Jennifer Sheets, president and CEO of Interim HealthCare Inc., told HHCN in an email.

The Republic plan would also allow for a “second draw” on PPP for eligible businesses that have suffered a 35% revenue loss over a designated period, Roll Call reported.

Beyond those provisions, the plan would allocate a total of $16 billion to support COVID-19 testing and contract tracing. But aging services providers alone need at least $10 billion in testing aid, according to LeadingAge.

That’s especially true for long-term care hospitals (LTCHs), in-patient rehabilitation facilities (IRFs) and others, as testing is directly tied to Medicare payments. New guidance from the U.S. Centers for Medicare & Medicaid Services (CMS) says that such providers who want to get paid for treating COVID-19 patients must include a positive test in that patient’s medical record.

“This isn’t just skinny,” Sloan said. “It’s anemic.”

Moving forward, LeadingAge argues, the “continuum of aging services providers” — home health and home care agencies included — need more PPE, testing supplies and funding to cover “hero pay” for front-line workers, among other measures.

Gary Anderson, CEO of Lutheran Senior Services, echoed that call to action. St. Louis, Missouri-based Lutheran Senior Services is a provider of retirement communities, home- and community-based services and affordable housing.

“COVID has made this the most difficult year in our 160-year history,” Anderson said in a statement. “In the early days of the crisis, we lacked the necessary PPE and vendors did not have the inventory to supply us. It’s still hard to locate PPE — and we are spending tenfold on what we can afford.”

Across the organization, Lutheran Senior Services is on track to spend over $1.5 million on testing alone.

Assisted living communities have been hit particularly hard by the COVID-19 emergency and a lack of federal action.

In a survey of 193 U.S. assisted living providers conducted this month by the National Center for Assisted Living (NCAL), half said they were currently operating at a loss. Another 64% of assisted living providers said they won’t be able to sustain operations another year at the current pace of increased costs and revenue loss.

LeadingAge is not the only aging services advocacy organization to call for more federal support.

The Partnership for Medicaid Home-Based Care (PMHC), for example, is urging Congress to create a fund to help pay direct care workers higher wages during the public health emergency. The National Association for Home Care & Hospice (NAHC) has likewise called for more telehealth assistance, while the Partnership for Quality Home Healthcare (PQHH) is seeking an immediate pause to the Review Choice Demonstration (RCD).

The new “skinny” proposal is expected to cost about half as much as the previous $1 trillion COVID-19 relief legislation, according to The Wall Street Journal. Still, that price tag may be too high for some Republicans.

Meanwhile, House Democrats initially floated a $3.5 trillion plan of their own, though they signaled they’d be open to shaving that by about $1 trillion.

Roll Call noted the proposal text it obtained is subject to change.

The post Senior Care Stakeholders: Latest COVID-19 Relief Proposal Is ‘Shameful,’ ‘Anemic’ appeared first on Home Health Care News.

They have received hundreds of millions of dollars in large PPP loans at or above $150,000 as well, a new follow-up analysis reveals.

Created by the CARES Act, PPP is a potentially forgivable loan program designed to keep small and mid-sized businesses afloat during the economic fallout triggered by the COVID-19 virus. As of Aug. 3, more than 5 million PPP loans have been approved, adding up to more than $521 billion, according to the Small Business Administration (SBA).

Home health and home care providers have, in some instances, turned to PPP to overcome sudden dips in business due to patients and clients refusing service.

Some providers have additionally used PPP funds to better retain workers by financing bonuses, hazard pay and other compensation initiatives.

“With the help of PPP and other smart financial readiness and resources, Interim HealthCare operators have been able to continue paying [their] essential employees on the front lines,” Jennifer Sheets, president and CEO of Interim HealthCare Inc., told HHCN in an email. “It has allowed owners to expand their reach so home care continues to be a vital resource and strategic weapon to battle this public health emergency and to support more people in their local communities across the 41 states we collectively serve.”

Sunrise, Florida-based Interim HealthCare is a diverse home-based care franchise company with hundreds of locations across the U.S.

Combined, businesses delivering some form of in-home care have received more than 7,400 individual PPP loans at or above $150,000, HHCN’s follow-up analysis found. Those loans range from a minimum of $150,000 to a maximum of $10 million.

The amount any small business is eligible to borrow is 250% of its average monthly payroll expenses, up to a total of $10 million.

Congress mainly designed PPP as a way for companies to keep workers on payroll, but it has also been a valuable tool for paying for costly medical supplies during the COVID-19 crisis.

“We continue to see the need for full loan forgiveness for franchise owners, as other expenses during COVID-19, such as PPE, have been very challenging,” Sheets said.

While the bulk of PPP recipients are part of standalone corporations or independent businesses, many individual franchise locations also received support.

More than a dozen Interim HealthCare locations received PPP support to help with the operational challenges of COVID-19, for example.

“As COVID-19 cases began to rise across the country and hospitals experienced a surge in patients, the need for home health care became more important than ever,” Sheets said. “For those Interim HealthCare owners who applied and received funding, the PPP loan allowed them to ensure their teams of home health aides, nurses and other staff members could continue to serve their patients, safely in the comfort of their own homes by front-line staff who had access to the right resources, including proper personal protective equipment (PPE).”

Franchise locations from Right at Home, Senior Helpers, ComForCare and several other major home care franchisers also received PPP support, federal data shows.

The different ranges

To analyze PPP data, HHCN used NAICS code 621610, which includes “establishments primarily engaged in providing skilled nursing services in the home” and a range of other in-home care entities.

In addition to home health and home care agencies, the code includes hospice providers, companies that deliver in-home therapy services and others.

In the PPP loan category of “at or above $150,000,” most in-home care businesses applied for loans in the range of $150,000 to $350,000. In fact, of the more than 7,400 large PPP loans issued to in-home care businesses, more than half were within that range.

About one-third of in-home care businesses that applied for large PPP loans were in the $350,000-to-$1 million range, HHCN’s analysis shows. Slightly more than 12% applied for loans that checked in somewhere between $1 million and $5 million.

A total of 63 in-home care businesses linked to NAICS code 621610 were issued PPP loans in the $5 million-to-$10 million range.

Examples include Nizhoni Health, a Massachusetts-based home health provider that specializes in patients with acute mental illnesses, along with California-based Mission Healthcare, which recently launched an innovative palliative care program meant to keep vulnerable populations “out of no man’s land.”

The data analyzed by HHCN did not provide specific amounts secured by each PPP recipient.

Geographic breakdown

Current law dictated that the Paycheck Protection Program close at the end of Aug. 8. As such, SBA is no longer accepting PPP applications from participating lenders.

When PPP did close, it did so with more than $130 billion in unused funds left on the table. Depending on what Congress does in terms of passing another federal stimulus package, it’s entirely possible that more PPP support is on the way, however.

Overall, about 51 million jobs were saved due to PPP, according to government statistics. S&P Global estimates that number is actually closer to 13.6 million.

When it comes to where PPP funding is going, in-home care companies in Texas received the highest number of large loans, followed by in-home care entities in California and Pennsylvania.

General corporations, limited liability companies and Subchapter S corporations received more than 90% of all large PPP loans that went to in-home care companies. Nonprofit organizations received about 5% of large PPP loans, with sole proprietorships receiving less than 2%.

The post Dozens of Home-Based Care Businesses Have Received PPP Loans of $5M+ appeared first on Home Health Care News.

One of the central pain points sparking disagreement between Democrats and Republicans in the next stimulus package is unemployment benefits.

Previously, individuals who lost their jobs during the public health emergency could receive $600 per week from the federal government, in addition to any state-level benefits.

In many cases, those benefits outpace what home-based care agencies are able to pay their workers.

“The unemployment accelerated benefits definitely have been a challenge,” Jennifer Sheets, the CEO of Interim HealthCare Inc., told HHCN in June. “Early on, we had struggled even with some front-line workers asking to be laid off or let go, which makes you scratch your head and say, ‘How does this make sense?’”

Sunrise, Florida-based Interim HealthCare offers a wide variety of in-home care services, with nearly 300 locations across the U.S.

Part of the Republicans’ proposed HEALS Act has been re-employment bonuses for those who willingly go back to work. Republicans also pitched tax credits for businesses that employ those people.

Additionally, the Republicans’ proposed HEALS Act would cap federal unemployment benefits to $200 weekly until at least October, or cap payouts to 70% of an individual’s previous income.

July 31 marked the end of the CARES Act’s $600 weekly benefit.

In a recent SEIU tele-town hall, more than 80% of the 21,000 home care workers that convened said they felt the federal government had not “done enough to ensure home care workers have what [they] need” during the COVID-19 crisis.

Apart from unemployment-related provisions, home-based care advocates are hoping for more money in the Provider Relief Fund, which previously distributed over $175 billion to health care providers from the CARES Act.

The Democrat-led House of Representatives proposed $100 billion more for the fund. Meanwhile, Republicans suggested a $25 billion infusion in their HEALS Act proposal.

Some believe the latter figure is not even close to where it needs to be. That includes LeadingAge President and CEO Katie Smith Sloan.

“The legislation treats older lives as expendable,” Sloan said in a statement. “The resources provided are woefully insufficient. The package offers only a fraction of the $100 billion that will be needed to help aging services providers protect older adults and offers no specific funds for aging services providers.”

Additionally, multiple organizations have expressed that there needs to be more support for Medicaid home- and community-based services.

The Partnership for Medicaid Home-Based Care (PMHC) specifically did so in a statement on Thursday.

“The financial viability of Medicaid home- and community-based providers is critical to the national health care infrastructure, and the direct care workforce needs financial support to ensure the continuation of these essential services,” PMHC Chairman David Totaro said.

PMHC previously developed a proposal for Congress that included an HCBS Direct Care Workers Fund.

On his end, National Association for Home Care & Hospice (NAHC) President William A. Dombi hopes there may be an extension of the payback timetable and the level of interest under the Centers for Medicare & Medicaid Services (CMS) advanced and accelerated Payment programs.

CMS distributed more than $100 billion in advanced and accelerated payments to all Medicare providers in spring. Home health providers received $1.7 billion.

NAHC is also hoping that the telehealth waivers granted during the public health emergency will become permanent, such as the one that allows the face-to-face requirement to be settled with telehealth technology.

However, for the big domino to fall in telehealth — reimbursement for remote visits — home health providers will need to wait for Congressional action.

“Absence of reimbursement for telehealth [in the bill is a concern],” Dombi told HHCN. “We have significant Congressional support, but the measure may not make it into this stimulus package, and we may need to wait for the next opportunity.”

The post With Stimulus Deadline Nearing, Home-Based Care Industry Scrambles to Secure Additional Relief appeared first on Home Health Care News.

During the coronavirus pandemic, the U.S. health care system has undergone a massive change marked by the skyrocketing use of telehealth technology and the shift away from brick-and-mortar medical appointments. In fact, from April 2019 to April 2020, telehealth claim lines have increased by more than 8,300% nationally, according to FAIR Health data.

For the most part, though, traditional home-based care has felt like a secondary priority over the past few months, with home health providers and home care agencies largely overshadowed by telehealth trends, hospital capacity concerns and the general state of nursing homes, which continue to be devastated by COVID-19.

“I think that [policymakers] have been very responsive to the needs in the hospital setting,” a Maine home health executive previously told Home Health Care News. “I do not feel that they fully understand the complexity of the patients seen by home health and hospice providers.”

Health care stakeholders may have missed the opportunity to aggressively invest in home health and home care during the initial coronavirus spike, but that door is opening wide once again. Or rather, it never really closed.

The country’s rolling seven-day average of daily new COVID-19 cases shattered all previous records on Monday for the 28th day in a row, the Washington Post reported. At the same time, hospitals across the Sun Belt are being overwhelmed by coronavirus patients, with Arizona reaching 89% capacity for intensive care unit beds and California, Georgia, North Carolina, Texas and a handful of additional states experiencing unprecedented hospitalization numbers.

The new coronavirus spikes in the South and West aren’t part of a different, second COVID-19 wave. They’re continuations of the first wave that was never properly addressed.

Overall, the U.S. death toll linked to the coronavirus hit 130,000 this week, statistics from Johns Hopkins University show. The number of total infections is approaching 3 million.

With those numbers in mind, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and a leading member of the Trump administration’s coronavirus task force, is calling for urgent action.

“It’s a serious situation that we have to address immediately,” Fauci said during an online interview Monday with Dr. Francis Collins, who leads the National Institutes of Health as its director.

As part of the nation’s renewed response to the coronavirus, home health and home care need to now be front and center. Fortunately, there are several readily available actions out there that the federal government and other health care players can take to support all shapes and sizes of in-home care providers.

When it comes to home health care agencies, in particular, the U.S. Centers for Medicare & Medicaid Services (CMS) can start by reopening its advanced and accelerated payment programs, allowing operators to focus on patient care and not their finances.

Home health agencies experienced huge financial losses during the early days of the coronavirus due to patients canceling visits and the general suspension of elective surgeries. Cash flow disruptions have somewhat stabilized, but the recent resurgence of COVID-19 cases may retrigger the same anxieties and roadblocks that agencies had to previously overcome.

From March through April, CMS distributed more than $100 billion in advanced and accelerated payments to all Medicare providers. Home health providers received just $1.7 billion of that before CMS shut down the programs — and many home health agencies in emerging hotspots never even had the opportunity to apply for payments, as they’re just now feeling the impact of the coronavirus.

On top of reopening its advanced and accelerated payment programs, CMS should also consider giving home health providers a more robust Medicare rate adjustment. While the National Association for Home Care & Hospice (NAHC) and other industry advocates have called for a 15% rate increase, CMS recently suggested a 2.6% reimbursement bump in its proposed payment rule for 2021.

Many home health providers won’t be able to stay afloat for much longer without additional financial lifelines. In New York alone, home-based care providers expect to lose upwards of $200 million in 2020, according to financial estimates by the Home Care Association of New York State (HCA-NYS).

“These losses have alarming implications for the viability of New York’s home care system and the necessary support it provides for patients,” Roger Noyes, director of communications at HCA-NYS, previously told HHCN.

Meanwhile, when it comes to supporting home care agencies, Congress should start by seriously considering the creation of a fund that helps operators finance hazard pay and other benefits for front-line workers in its next relief package.

It’s an idea that had been floated by House Democrats in their Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act unveiled in May. Specifically, the House bill included a $200 billion fund for hazard pay for all essential workers.

Interim HealthCare Inc. CEO Jennifer Sheets previously told HHCN she would “love to see” government-supplemented hazard pay for health care workers.

“We need to incentivize people to be on the front line, especially in a pool that’s already prone to high turnover,” she said.

Apart from financial assistance, the Trump administration and FEMA should also organize a personal protective equipment (PPE) push for in-home care providers, similar to what they did for nursing home operators back in April. In-home care agencies have had just as difficult a time securing PPE, if not greater, as they’ve been excluded from most priority lists during the COVID-19 crisis.

Outside of the government, hospitals also need to accelerate the shift toward in-home care. Many already have, including North Memorial Health Hospital in Minnesota, which recently partnered with whole-person, home-based care provider Lifesprk to offer a hospital-at-home model.

“With the outbreak and shortage of personal protective equipment (PPE), one of the just really sad things that all of us have witnessed is when someone goes into the hospital right now and is very sick, their loved ones can’t be there with them,” Dr. Carolyn Ogland, North Memorial’s CMO, previously told HHCN. “This is a way to really help our families and our patients stay together when they are sick.”

If the U.S. health care system acts quickly and invests in home-based care, it will emerge from COVID-19 stronger than ever. But the window of opportunity is closing, so stakeholders must act now.

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