In gentle of the growing want for post-acute care, hospitals are grappling with challenges related to making certain sufferers are referred to essentially the most acceptable care setting after discharge.

Whereas referrals to residence care companies are nonetheless larger than pre-pandemic ranges, rejection charges stay a serious ache level for suppliers.

Residence care companies not solely obtain extra referrals general, but additionally see a rise within the variety of referrals per affected person. This improve is a results of acute care suppliers dealing with challenges in shortly arranging post-acute care for his or her sufferers.

The rejection price for residence care companies reached a document excessive – 76% on common – in December 2022. That could be a vital improve in comparison with 54% in 2019.

This matter – the collective capacity of residence well being suppliers to simply accept sufferers – was instantly addressed within the Facilities for Medicare & Medicaid Companies (CMS) 2024 remaining cost rule. Though suppliers consider that CMS price cuts have hindered entry to residence care, the company disagrees.

“CMS has fastidiously reviewed our knowledge to make sure the cost price adequately covers the reported prices [home health agencies], with out creating undue hardship for suppliers and sustaining entry to high quality companies for all beneficiaries,” CMS wrote in its 2024 remaining rule. “Sustaining entry is one among CMS' priorities when making coverage choices. It’s not our intent to impede the supply of residence well being care companies to any beneficiary who qualifies for this profit.”

Whereas residence well being stakeholders foyer Congress to oppose Medicare cuts, they nonetheless query this imaginative and prescient.

“It was slightly complicated to learn within the final line that CMS was taking a little bit of a dismissive tone in relation to referral denial charges,” Bud Langham, the chief vp of medical excellence and technique at Enhabit Residence Well being, instructed me. and Hospice. Residence care information. “I believe as a bunch we had been disenchanted to see that they had been so dismissive of the information being put ahead.”

Dallas-based Enhabit is likely one of the largest impartial suppliers of residence well being and hospice care within the nation. Its footprint contains greater than 250 residence care areas and greater than 100 hospice areas in 34 states.

Well timed entry to care

In recent times, CMS has made it clear that pursuing worth is likely one of the company's most vital missions. A part of that mission is for healthcare suppliers to make sure that they supply sufferers with well timed entry to care.

Residence care companies have made it clear to CMS that the document excessive variety of referral denials is a serious downside for the trade. Sufferers discharged from hospitals are turned away by companies that might in any other case look after sufferers however can’t afford or have the employees to take action.

When companies introduced this knowledge to CMS, it was largely met with a shrug of the shoulders.

“Once you deliver knowledge to CMS, they usually ask lots of questions,” Langham says. “Definitely, their responses within the final line appeared extra dismissive than curious. You hardly ever perceive why whenever you do observational analysis. You simply see one thing and also you go, 'Oh my god, take a look at this pattern. Let's attempt to perceive.' I anticipated CMS to adapt and ask extra questions, however we didn't see that.”

As an alternative, suppliers assume that CMS believes that sufferers who want care will ultimately obtain care. However therein lies one of many issues: When sufferers get care – and the way shortly they get care – is now tied to reimbursement.

That distinction is coupled with the truth that the general variety of conventional Medicare beneficiaries is declining.

The variety of conventional Medicare customers has fallen from 3.1 million to 2.8 million customers since 2021. Spending fell by $800 million between 2021 and 2022.

“Residence well being care utilization is declining, and CMS is aware of this,” Langham stated. “When referral rejection charges are larger than ever, and also you mix that with the shrinking Medicare program, it ought to make you interested by ensuring beneficiaries are getting what they want.”

The Affected person-Pushed Groupings Mannequin (PDGM) divides residence care episodes into cost durations, and initiating care in a well timed method is important to making sure the episode is correctly categorized. Well timed entry additionally contributes to the effectivity of healthcare supply. It may well assist forestall issues or worsening of the affected person's situation, doubtlessly decreasing general healthcare prices.

This additionally performs a job in cost beneath the now nationwide Residence Well being Worth-Based mostly Buying (HHVBP) mannequin.

It must be frequent sense that nobody ought to ever have to attend for well being care, however it’s spiritually vital in residence well being care, Langham defined.

“There’s a distinctive strain on timeliness in our trade as a result of about half of the sufferers who come to the house well being care trade come to us from an inpatient setting,” he stated. “After we get a referral from a affected person, and as soon as they go away the doorways of the healthcare system and start the journey residence, there may be a lot they need to do. Decide up their medicine, fill a prescription, be sure there may be meals within the fridge, that their thermostat is about to the proper temperature. All of this stuff need to be in concord, and so the earlier we will get to their properties and meet them, the earlier we will do this.

The variety of rejections is growing

Well timed entry to care and excessive referral rejection charges aren’t only a residence well being downside; they’re continuum of care issues.

“Any delay in transferring sufferers to the following stage of care leads to an extended hospital keep,” Lissy Hu, president of related networks at WellSky, instructed HHCN. “Well timed entry to care is vital from the affected person stage, it is crucial from the well being care system stage, it is very important the overall price of care, and it is very important be certain that we ship high-quality care and high-quality care on the lowest prices. -cost setting.”

Based on WellSky knowledge, sufferers discharged residence in 2022 noticed an 11% improve of their common size of hospital keep. A few of which will need to do with hospitals and residential care companies caring for sicker and extra difficult sufferers, however the correlation between discharges and rejection charges is simple, Hu stated.

One other knowledge level that Hu identified, suggesting that well timed entry to care is a part of the issue, is that well being care programs are seeing double the variety of referrals per affected person by means of a talented nursing facility (SNF) or a house well being company.

For instance, when a hospital sends a affected person to a house care company, a median of 4 referrals are despatched as a substitute of two.

“If it grew to become simpler to safe residence care companies, you wouldn't anticipate case managers to ship extra referrals for sufferers,” Hu stated. “You’ll anticipate this to be steady or reducing. As an alternative you see a 100% improve.”