Hospitals lose jobs for 4th straight month

New FBI Data Show Violent Crime Continued Downward Trend in 2014 |  FreedomWorks

Hospitals lost 5,800 jobs in April, marking the fourth month of job loss this year, according to the latest jobs report from the U.S. Bureau of Labor Statistics.

The April count compares to 600 hospital jobs lost in March, 2,200 jobs lost in February and 2,100 jobs lost in January. Before January, the last job loss was in September, when hospitals lost 6,400 jobs.

Overall, healthcare lost 4,100 jobs last month — compared to 11,500 jobs added in March — and employment in the industry is down by 542,000 since February 2020.

Within ambulatory healthcare services, dentist offices saw 3,700 added jobs; physician offices saw 11,300 job gains; and home healthcare services lost 6,700 jobs in April. 

Nursing and residential care facilities lost 19,500 jobs last month, compared to 3,200 jobs lost the month prior.

The U.S. gained 266,000 in April after gaining 916,000 jobs in March. The unemployment rate was 6.1 percent last month, compared to 6 percent in March.

To view the full jobs report, click here.

President Biden lays out his sweeping legislative agenda

https://mailchi.mp/097beec6499c/the-weekly-gist-april-30-2021?e=d1e747d2d8

Legislative Agenda

In his first address to a joint session of Congress, delivered on the eve of his 100th day in office, President Biden laid out his vision for two major legislative proposals to follow the $1.9T stimulus package he signed into law last month.

The first, described as an “infrastructure” bill, focuses largely on investing in transportation-related improvements, building projects, and “green” upgrades to the nation’s energy grid, along with a $400B investment in home-based care for the elderly and people with disabilities—which amounts to over 17 percent of the package’s $2.3T price tag.

The second, which he unveiled in Wednesday’s speech, is a $1.8T “families” bill, is largely aimed at expanding childcare subsidies, early childhood education, paid family and medical leave, and educational investments. Included in that package is $200B to extend the temporary subsidies—approved as part of last month’s stimulus law—for those seeking health insurance coverage on the individual marketplaces created by the Affordable Care Act (ACA).

Notably absent from either proposal were two categories of healthcare reform that received much focus and airtime during last year’s election campaign: reducing the cost of prescription drugs and lowering the eligibility age for Medicare to 60 or below. Given the closely divided makeup of the new Congress, and the relatively moderate position staked out by the Biden administration on healthcare issues (with a bias toward bolstering the ACA rather than pursuing sweeping changes), we’re not surprised to see the Medicare expansion go unmentioned. 

But the bipartisan popularity of lowering prescription drug costs seems like a missed opportunity for Biden, who encouraged the Congress to return to it separately, later in the year. We’ll see. For now, with even some Democrats expressing concern about the $4.1T price tag of Biden’s proposals, we would be surprised if all $600B of the healthcare-related spending makes it to the final legislation. In particular, our guess is that some portion of the home-care spending will get traded away in favor of other components of the package. Expect negotiations to be intense.
 

MedPAC calls for 2% bump to hospital payments, no update for docs in 2022

MedPAC March 2019 Report to the Congress Released - ehospice

A key Medicare advisory panel is calling for a 2% bump to Medicare payments for acute care hospitals for 2022 but no hike for physicians.

The report, released Monday from the Medicare Payment Advisory Commission (MedPAC)—which recommends payment policies to Congress—bases payment rate recommendations on data from 2019. However, the commission did factor in the pandemic when evaluating the payment rates and other policies in the report to Congress, including whether policies should be permanent or temporary.

“The financial stress on providers is unpredictable, although it has been alleviated to some extent by government assistance and rebounding service utilization levels,” the report said.

MedPAC recommended that targeted and temporary funding policies are the best way to help providers rather than a permanent hike for payments that gets increased over time.

“Overall, these recommendations would reduce Medicare spending while preserving beneficiaries’ access to high-quality care,” the report added.

MedPAC expects the effects of the pandemic, which have hurt provider finances due to a drop in healthcare use, to persist into 2021 but to be temporary.

It calls for a 2% update for inpatient and outpatient services for 2022, the same increase it recommended for 2021.

The latest report recommends no update for physicians and other professionals. The panel also does not want any hikes for four payment systems: ambulatory surgical centers, outpatient dialysis facilities, skilled nursing facilities and hospices.

MedPAC also recommends Congress reduce the aggregate hospice cap by 20% and that “ambulatory surgery centers be required to report cost data to [Centers for Medicare & Medicaid Services (CMS)],” the report said.

But it does call for long-term care hospitals to get a 2% increase and to reduce payments by 5% for home health and inpatient rehabilitation facilities.

The panel also explores the effects of any policies implemented under the COVID-19 public health emergency, which is likely to extend through 2021 and could continue into 2022.

For instance, CMS used the public health emergency to greatly expand the flexibility for providers to be reimbursed for telehealth services. Use of telehealth exploded during the pandemic after hesitancy among patients to go to the doctor’s office or hospital for care.

“Without legislative action, many of the changes will expire at the end of the [public health emergency],” the report said.

MedPAC recommends Congress temporarily continue some of the telehealth expansions for one to two years after the public health emergency ends. This will give lawmakers more time to gather evidence on the impact of telehealth on quality and Medicare spending.

“During this limited period, Medicare should temporarily pay for specified telehealth services provided to all beneficiaries regardless of their location, and it should continue to cover certain newly-covered telehealth services and certain audio-only telehealth services if there is potential for clinical benefit,” according to a release on the report.

After the public health emergency ends, Medicare should also return to paying the physician fee schedule’s facility rate for any telehealth services. This will ensure Medicare can collect data on the cost for providing the services.

“Providers should not be allowed to reduce or waive beneficiary cost-sharing for telehealth services after the [public health emergency],” the report said. “CMS should also implement other safeguards to protect the Medicare program and its beneficiaries from unnecessary spending and potential fraud related to telehealth.”

The home-based care space heats up

https://mailchi.mp/05e4ff455445/the-weekly-gist-february-26-2021?e=d1e747d2d8

Home Healthcare Market Size, Growth Report, 2020-2027

This week Brookdale Senior Living, the nation’s largest operator of senior housing, with 726 communities across 43 states and annual revenues of about $3B, announced the sale of 80 percent of its hospice and home-based care division to hospital operator HCA Healthcare for $400M. The transaction gives HCA control of Brookdale’s 57 home health agencies, 22 hospice agencies, and 84 outpatient therapy locations across a 26-state footprint, marking its entry into new lines of business, and allowing it to expand revenue streams by continuing to treat patients post-discharge, in home-based settings.

Like other senior living providers, Brookdale has struggled economically during the COVID pandemic; its home and hospice care division, which serves 17,000 patients, saw revenue drop more than 16 percent last year. HCA, meanwhile, has recovered quickly from the COVID downturn, and has signaled its intention to focus on continued growth by acquisition across 2021.
 
In separate news, Optum, the services division of insurance giant UnitedHealth Group, was reported to have struck a deal to acquire Landmark Health, a fast-growing home care company whose services are aimed at Medicare Advantage-enrolled, frail elderly patients. Landmark, founded in 2014, also participates in Medicare’s Direct Contracting program.

The transaction is reportedly valued at $3.5B, although neither party would confirm or comment on the deal. The acquisition would greatly expand Optum’s home-based care delivery services, which today include physician home visits through its HouseCalls program, and remote monitoring through its Vivify Health unit.

The Brookdale and Landmark deals, along with earlier acquisitions by Humana and others, indicate that the home-based care space is heating up significantly, reflecting a broader shift in the nexus of care to patients’ homes—a growing preference among consumers spooked by the COVID pandemic. 

Along with telemedicine, home-based care may represent a new front in the tug-of-war between providers and payers for the loyalty of increasingly empowered healthcare consumers.

Early evidence on disparities in vaccine acceptance

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Distributing a COVID-19 Vaccine Across the U.S. – A Look at Key Issues –  Issue Brief – 9563 | KFF

Although only 17 states are currently reporting data on the racial and ethnic breakdown of vaccine recipients, the early data indicate that there are significant disparities in who is getting vaccinated, with the share of Black and Latino people among vaccinees lower than their share of the total population in those states.

Alarmingly, in our recent conversations with health system executives, those same disparities seem to be present among healthcare workers employed by hospitals and health systems. Anecdotally, across a half-dozen health systems we’ve spoken with in the past week, most report that they’ve had about 70 percent of their workers agree to get the first dose of the COVID-19 vaccine.

However, that number looks significantly different when broken down by race and ethnicity: on average, the uptake rate among White, Asian, and Pacific Islander workers has been closer to 90-95 percent, while among Black and Latino workers, it’s been closer to 30-40 percent. Bear in mind these are employees of health systems—in many cases they’re frontline caregivers—and given their work environments you might expect them to be less hesitant to get the vaccine.

That 30-40 percent uptake rate is very worrisome, in two ways: caregivers outside of hospital settings, especially home care and nursing home workers, likely include a larger number of workers hesitant to get vaccinated. And in the general population, among whom health literacy is presumably much lower than among healthcare workers, it’s precisely those populations who are at highest risk of COVID infection, hospitalization, and death. (A further complication: health systems made it easy for their employees to get the shot. With vaccines for the general population still scarce, at-risk populations will inevitably have the most difficult time getting signed up, even if they want the vaccine.)

If health systems are the canary in the coal mine for vaccine hesitancy rateswe’re in for a tough challenge in getting the most vulnerable populations vaccinated in the months to come.

MedPAC to recommend 2% payment boost for hospitals next year

MedPAC approves 2021 payment recommendations | AHA News

The Medicare Payment Advisory Commission voted Jan. 14 to recommend a 2 percent raise in Medicare payments for hospitals next year.

The commission said it wants to give the payment boost to both acute-care and long-term care hospitals. The 2 percent payment increase will result in about a $750 million to $2 billion increase in acute-care hospital spending for Medicare and about $50 million for long-term care hospitals.  

MedPAC also plans to recommend no change to the payment rate for physicians in 2022 and a 5 percent decrease for home health firms and inpatient rehabilitation centers. 

Although MedPAC will recommend the payment boost, Congress is not required to implement the recommendation.

The vote occurred at MedPAC’s January public meeting. 

Atlanta home healthcare owner gets 5 years in prison for Medicaid fraud

Whistleblower Helps Texas End $20M Fraud Case | The Texas Tribune

The owner of an Atlanta-based home healthcare provider was sentenced to five years and three months in prison for defrauding Medicaid out of nearly $1 million, the U.S. Justice Department said Dec. 2.

Diandra Bankhead, owner and operator of Elite Homecare, admitted to submitting thousands of  claims for services that were never provided to children in the Georgia Pediatric Program between September 2015 and April 2018. Children who are eligible for services under the program  typically suffer from physical and cognitive disabilities.

Ms. Bankhead and Elite Homecare submitted more than 5,400 claims to Georgia Medicaid, receiving $1.2 million in reimbursement. About $1 million was determined to be fraudulent, prosecutors said.

Prosecutors said Ms. Bankhead defrauded Medicaid in several ways, including submitting  fraudulent credentialing information to become a Georgia Pediatric Program provider, submitting claims for in-home nursing services provided to families who had not hired Elite and submitting claims in which employees provided more than 24 hours of services in a day. 

“It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”

Ms. Bankhead pleaded guilty in federal court to one count of healthcare fraud in August 2019. She was also ordered to pay $999,999 in restitution.

CMS seeks to boost hospital capacity during COVID-19 surge

Troy Medicare Signs Contract with CMS for 2020 - Troy Medicare

CMS is giving hospitals facing a surge of COVID-19 patients expanded flexibility to care for Medicare patients in their homes, the department announced Nov. 25. 

The new Acute Hospital Care At Home program will require in-person screening protocols to assess both medical and non-medical factors, including working utilities, before care can begin at home. Medicare patients will be admitted into the program from emergency departments and inpatient hospital beds.

Once at-home care begins, a registered nurse will evaluate each patient every day either in person or remotely, and either registered nurses or mobile integrated health paramedics will have two in-person visits daily based on the patient’s nursing plan and hospital policies.

CMS approved the following six health systems with extensive experience providing acute hospital care at home to immediately participate in the program: 

  • Boston-based Brigham and Women’s Hospital
  • Salt Lake City-based Huntsman Cancer Institute
  • Boston-based Massachusetts General Hospital
  • New York City-based Mount Sinai Health System
  • Albuquerque, N.M.-based Presbyterian Healthcare Services
  • West Des Moines, Iowa-based UnityPoint Health. 

Other hospitals and health systems may submit a waiver request online. 

Back Into the Lion’s Den: COVID-19 and Post-Acute Care

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Back Into the Lion's Den: COVID-19 and Post-Acute Care | MedPage Today

Returning COVID patients to unprepared facilities a “recipe for disaster”

As Florida becomes the new epicenter of the COVID-19 outbreak in the U.S., the state is trying to ensure that nursing homes and rehabilitation facilities aren’t quickly overwhelmed by patients still suffering from the disease.

So far, it has dedicated 11 facilities solely to COVID patients who need post-acute or long-term care: those who can’t be isolated at their current facilities, as well as those who’ve gotten over the worst of their illness and who can be moved to free up hospital beds for the flow of new patients.

One of those facilities is Miami Medical Center, which was shuttered in October 2017 but now transformed to care for 150 such patients. In total, the network of centers will handle some 750 patients.

“We recognize that that would be something that would be very problematic, to have COVID-positive nursing home residents be put back into a facility where you couldn’t have proper isolation,” Florida Gov. Ron DeSantis (R) said during a press briefing last week. “[That] would be a recipe for more spread, obviously more hospitalizations and more fatalities, and so we prohibited discharging COVID-positive patients back into nursing facilities.”

Whether 750 beds will be enough to accommodate the state’s needs remains a question, but it’s a necessary first step, given testing delays that in some cases stretch more than a week. Experts have warned that patients recovering from COVID shouldn’t be transferred to a facility without being tested first.

Without dedicated facilities, hospitals in Florida in dire need of beds for new patients might have had no other choice.

Key Role for Testing

There are no national data on the percentage of hospitalized COVID-19 patients who need rehabilitation or skilled nursing care after their hospital stay.

In general, about 44% of hospitalized patients need post-acute care, according to the American Health Care Association and its affiliate, the National Center for Assisted Living, which represent the post-acute and long-term care industries.

But COVID has “drastically changed hospital discharge patterns depending on local prevalence of COVID-19 and variations in federal and state guidance,” the groups said in an email to MedPage Today. “From a clinical standpoint, patients with COVID-19 symptoms serious enough to require hospitalization may be more likely to require facility or home-based post-acute medical treatment to manage symptoms. They also may need rehabilitation services to restore lost function as they recover post-discharge from the acute-care hospital.”

The level of post-acute care these patients need runs the spectrum from long-term acute care hospitals and inpatient rehabilitation facilities to skilled nursing facilities and home health agencies.

The variation is partly due to the heterogeneity of the disease itself. While some patients recover quickly, others suffer serious consequences such as strokes, cardiac issues, and other neurological sequelae that require extensive rehabilitation. Others simply continue to have respiratory problems long after the virus has cleared. Even those who are eventually discharged home sometimes require home oxygen therapy or breathing treatments that can require the assistance of home health aides.

Yet post-acute care systems say they haven’t been overwhelmed by a flood of COVID patients. Several groups, including AHCA, NCAL, and the American Medical Rehabilitation Providers Association (AMRPA) confirmed to MedPage Today that there’s actually been a downturn in post-acute care services during the pandemic.

That’s due to a decline in elective procedures, the societies said, adding that demand is starting to pick back up and that systems will need to be in place for preventing COVID spread in these facilities.

Testing will play a key role in being able to move patients as the need for post-acute care rises, specialists told MedPage Today.

“You shouldn’t move anyone until you know a status so that the nursing facility can appropriately receive them and care for them,” said Kathleen Unroe, MD, who studies long-term care issues at the Regenstrief Institute and Indiana University in Indianapolis.

AHCA and NCAL said they “do not support state mandates that require nursing homes to admit hospital patients who have not been tested for COVID-19 and to admit patients who have tested positive. This approach will introduce the highly contagious virus into more nursing homes. There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths.”

Earlier this week, the groups sent a letter to the National Governors Association about preventing COVID outbreaks in long-term care facilities. They pointed to a survey of their membership showing that, for the majority, it was taking 2 days or longer to get test results back; one-quarter said it took at least 5 days.

The Centers for Medicare & Medicaid Services (CMS) recently announced that it would send point-of-care COVID tests to “every single” nursing home in the U.S. starting next week. Initially, the tests will be given to 2,000 nursing homes, with tests eventually being shipped to all 15,400 facilities in the country.

Hospitals can conduct their own testing before releasing patients, and this has historically provided results faster than testing sites or clinical offices, especially if they have in-house services. However, demand can create delays, experts said.

Preparing for the Future

Jerry Gurwitz, MD, a geriatrician at the University of Massachusetts Medical School in Worcester, says now is the time to develop post-acute care strategies for any future surges.

Gurwitz authored a commentary in the Journal of the American Geriatrics Society on an incident in Massachusetts early in the pandemic where a nursing home was emptied to create a COVID-only facility, only to have residents test positive after the majority had already been moved.

“We should be thinking, okay, what are the steps, what’s the alternative to emptying out nursing homes? Can we make a convention center, or part of it, amenable to post-acute care patients?” Gurwitz said. “Not just a bed to lie in, but possibly providing rehabilitation and additional services? That could all be thought through right now in a way that would be logical and lead to the best possible outcomes.”

Organizations can take the lead from centers that have lived through a surge, like those in New York City. Rusk Rehabilitation at NYU Langone Health created a dedicated rehabilitation unit for COVID-positive patients.

“We were able to bring patients out from the acute care hospital to our rehabilitation unit and continue their COVID treatment but also give them the rehabilitation they needed” — physical and occupational therapy (PT/OT) — “and the medical oversight that enhanced their recovery and got them out of the hospital quicker and in better shape,” Steven Flanagan, MD, chair of rehabilitation medicine at NYU Langone, said during an AMRPA teleconference.

Flanagan noted that even COVID patients who can be discharged home will have long-term issues, so preparing a home-based or outpatient rehabilitation program will be essential.

Jasen Gundersen, MD, chief medical officer of CareCentrix, which specializes in post-acute home care, said there’s been more concern from families and patients about going into a facility, leading to increased interest in home-based services.

“We should be doing everything we can to support patients in the home,” Gundersen said. “Many of these patients are elderly and were on a lot of medications before COVID, so we’re trying to manage those along with additive medications like breathing treatments and inhalers.”

Telemedicine has played an increasing role in home care, to protect both patients and home health aides, he added.

Long-term care societies have said that emergency waivers implemented by CMS have been critical for getting COVID patients appropriate levels of post-acute care, and they hope these remain in place as the pandemic continues.

For instance, CMS relaxed the 3-hour therapy rule and the 60% diagnostic rule, Flanagan said. Under those policies, in order to admit a patient to an acute rehabilitation unit, facilities must provide 3 hours of PT/OT every day, 5 days per week.

“Not every COVID patient could tolerate that level of care, but they still needed the benefit of rehabilitation that allowed them to get better quicker and go home faster,” he said.

Additionally, not every COVID patient fits into one of the 13 diagnostic categories that dictate who can be admitted to a rehab facility under the 60% rule, he said, so centers “could take COVID patients who didn’t fit into one of those diagnoses and treat them and get them better.”

AHCA and NCAL said further waivers or policy changes would be helpful, particularly regarding basic medical necessity requirements for coverage within each type of post-acute setting.

But chief among priorities for COVID discharges to post-acute care remains safety, the groups said.

“The solution is for hospital patients to be discharged to nursing homes that can create segregated COVID-19 units and have the vital personal protective equipment needed to keep the staff safe,” they said. “Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment and staff to accept COVID-19 patients is a recipe for disaster.”

 

 

 

 

Predicting COVID-19’s Long-Term Impact on the Home Health Care Market

Predicting COVID-19’s Long-Term Impact on the Home Health Care Market

Predicting COVID-19's Long-Term Impact on the Home Health Care ...

The Patient-Driven Groupings Model (PDGM) and its unintended ripple effects were supposed to be the dominant story this year for the nation’s 12,000 or so Medicare-certified home health care providers. But the coronavirus has rewritten the script for 2020, throwing most of the industry’s previous projections out the window.

While PDGM — implemented on Jan. 1 — will still shape home health care’s immediate future, several other long-term trends have emerged as a result of the coronavirus and its impact on the U.S. health care system.

These trends include unexpected consolidation drivers and the sudden embrace of telehealth technology, the latter of which is a development that will affect home health providers in ways both profoundly positive and negative. Unforeseen, long-term trends will also likely include drastic overhauls to the Medicare Home Health Benefit, a revival of SNF-to-home diversion and more.

Now that providers have had roughly three full months to adapt to the coronavirus and transition out of crisis mode, Home Health Care News is looking ahead to what the industry can expect for the rest of 2020 and beyond.

‘Historic’ consolidation will still happen, with some unexpected drivers

Although the precise extent was often up for debate, most industry insiders predicted some level of consolidation in 2020, driven by PDGM, the phasing out of Requests for Anticipated Payment (RAPs) and other factors.

That certainly appeared to be true early on in the year, with Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (Nasdaq: LHCG) and other home health giants reporting more inbound calls related to acquisition opportunities or takeovers of financially distressed agencies.

In fact, during a fourth-quarter earnings call, LHC Group CEO and Chairman Keith Myers suggested that 2020 would kick off a “historic” consolidation wave that would last several years.

“As a result of this transition in Q4 and the first few months of 2020, we have seen an increase in the number of inbound calls from smaller agencies looking to exit the business,” Myers said on the call. “Some of these opportunities could be good acquisition candidates, and others we can naturally roll into our organic growth through market-share gains.”

Most of those calls stopped with the coronavirus, however.

Although the vast majority of home health agencies have experienced a decline in overall revenues during the current public health emergency, many have been able to compensate for losses thanks to the federal government’s multi-faceted response.

For some, that has meant taking advantage of the approximately $1.7 billion the U.S. Centers for Medicare & Medicaid Services (CMS) has distributed through its advanced and accelerated payment programs. For others, it has meant accepting the somewhat murky financial relief sent their way under the Provider Relief Fund.

In addition to those two possible sources of financial assistance, all Medicare-certified home health agencies have benefitted from Congress’s move to suspend the 2% Medicare sequestration until Dec. 31.

Eventually, those coronavirus lifelines and others will be pulled back, kickstarting M&A activity once again.

“We believe that a lot of the support has stopped or postponed the shakeout that’s occurring in home health — or that we anticipated would be occurring around this time,” Amedisys CEO and President Paul Kusserow said in March. “We don’t believe it’s over, though.”

Not only will consolidation happen, but some of it will be fueled by unexpected players.

With the suspension of elective surgeries and procedures, hospitals and health systems have lost billions of dollars. Rick Pollack, president and CEO of the American Hospital Association (AHA), estimated that hospitals are losing as much as $50 billion a month during the coronavirus.

“I think it’s fair to say that hospitals are facing perhaps the greatest challenge that they have ever faced in their history,” Pollack, whose organization represents the interests of nearly 5,000 hospitals, told NPR.

To cut costs, some hospitals may look to get rid of their in-house home health divisions. It’s a trend that may already be happening, too.

The Home Health Benefit will look drastically different

With a mix of temporary and permanent regulatory changes, including a redefinition of the term “homebound,” the Medicare Home Health Benefit already looks very different now than it did three months ago. But the benefit will likely go through further retooling in the not-too-distant future.

Broadly, the Medicare Part A Trust Fund finances key services for beneficiaries.

While vital to the national health care infrastructure, the fund is going broke — and fast. In the most recent CMS Office of the Actuary report released in April, the Trust Fund was projected to be entirely depleted by 2026.

The COVID-19 virus has only accelerated the drain on the fund, with some predicting it to run out of money two years earlier than anticipated. A group of health care economics experts from Harvard and MIT wrote about the very topic on a joint Health Affairs op-ed published Wednesday.

“COVID-19 is causing the Medicare Part A program and the Hospital Insurance (HI) Trust Fund to contend with large reductions in revenues due to increased unemployment, reductions in salaries, shifts to part-time employment from full time and a reduction in labor force participation,” the group wrote. “In addition to revenue declines, there was a 20% increase in payments to hospitals for COVID-related care and elimination of cost sharing associated with treatment of COVID.”

Besides those and other cost pressures, Medicare is simultaneously expanding by about 10,000 new people every day. The worst-case scenario: the Medicare Part A Trust Fund goes broke closer to 2024.

There are numerous policy actions that can be taken to reduce the financial strain on the trust fund. In their op-ed, for example, the team of Harvard and MIT researchers suggested shifting all of home health care under Part B.

In 2018, Medicare spent about $17.9 billion on home health benefits, with roughly 66% of that falling under Part B, which typically includes community-based care that isn’t linked to hospital or nursing home discharge. Consolidating all of home health care into Part B would move billions of dollars away from Part A, in turn expanding the Trust Fund’s lifecycle.

“Such a policy change would move nearly $6 billion in spending away from the Part A HI Trust Fund but would put upward pressure on the Part B premium,” the researchers noted.

Of course, all post-acute care services may still undergo a transformation into a unified payment model one day. However, the coronavirus has devastated skilled nursing facility (SNF) operators, who were already dealing with the Patient-Driven Payment Model (PDPM), a payment overhaul of their own.

Regulators may shy away from introducing further disruption until SNFs have a chance to recover, a process likely to take years — if not decades.

Previously, the Trump administration had estimated that a unified payment system based on patients’ clinical needs rather than site of care would save a projected $101.5 billion from 2021 to 2030.

Telehealth will be a double-edged sword

The move toward telehealth was a long-term trend that home health providers were cognizant of before COVID-19, even if some clinicians were personally skeptical of virtual visits. But because the virus has demanded social distancing, telehealth has forced its way into health care in a manner that would have been almost unimaginable in 2019.

In late April, during a White House Coronavirus Task Force briefing, President Donald Trump indicated that the number of patients using telehealth had increased from about 11,000 per week to more than 650,000 people per week.

Meanwhile, MedStar Health went from delivering just 10 telehealth visits per week to nearly 4,000 per day.

Backed by policymakers, technology companies and consumers, telehealth is likely here to stay.

“I think the genie’s out of the bottle on this one,” CMS Administrator Seema Verma said in April. “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

The telehealth boom could mean improved patient outcomes and new lines of business for home health providers. But it could also mean more competition moving forward.

For telehealth to be a true game-changer for home health providers, Congress and CMS would need to pave the way for direct reimbursement. Currently, a home health provider cannot get paid for delivering virtual visits in fee-for-service (FFS) Medicare.

Sen. Susan Collins (R-Maine) has floated the idea of introducing legislation that would allow for direct telehealth reimbursement in the home health space, but, so far, no concrete steps have been taken — at least in public. With a hyper-polarized Congress and a long list of other national priorities taking up the spotlight, it’s impossible to guess whether home health telehealth reimbursement will actually happen.

While home health providers can’t directly bill for in-home telehealth visits, hospitals and certain health care practitioners can. That regulatory imbalance could lead to providers being used less frequently as “the eyes and ears in the home,” some believe.

A new SNF-to-home diversion wave will emerge

Over the past two decades, many home health providers have been able to expand their patient census by poaching patients from SNFs. Often referred to as SNF-to-home diversion, the approach didn’t just benefit home health providers, though. It helped cut national health care spending by shifting care into lower-cost settings.

At first, the stream of SNF residents being shifted into home health care was like water being shot from a firehose: In 2009, there were 1,808 SNF days per 1,000 FFS Medicare beneficiaries, a March 2018 analysis from consulting firm Avalere Health found. By 2016, that number plummeted to 1,539 days per 1,000 beneficiaries — a 15% drop.

In recent years, that steady stream has turned into a slow trickle, with more patients being sent to home health care right off the bat. In the first quarter of 2019, 23.3% of in-patient hospital discharges were coded for home health care, while 21.1% were coded for SNFs, according to data from analytics and metrics firm Trella Health.

Genesis HealthCare (NYSE: KEN) CEO George Hager suggested the initial SNF-to-home diversion wave was over in March 2019. Kennett Square, Pennsylvania-based Genesis is a holding company with subsidiaries that operate hundreds of skilled nursing centers across the country.

“To anyone [who] would want [to] or has toured a skilled nursing asset, I would challenge you to look at the patients in our building and find patients that could be cared for in a home-based or community-based setting,” Hager said during a presentation at the Barclays Global Healthcare Conference. “The acuity levels of an average patient in a skilled nursing center have increased dramatically.”

Yet that was all before the coronavirus.

Over the last three months, more than 40,600 long-term care residents and workers have died as a result of COVID-19, according to an analysis of state data gathered by USA Today. That’s about 40% of the U.S.’s overall death toll.

CMS statistics place that number closer to 26,000.

In light of those figures and infection-control issues in congregate settings, home health providers will see a new wave of SNF-to-home diversion as robust as the first. As the new diversion wave happens, providers will need to be prepared to care for patients with higher acuity levels and more co-morbidities.

“[That’s going to change] the psyche of the way people are going to view SNFs and long-term care facilities for the rest of our generation,” Bruce Greenstein, LHC Group’s chief strategy and innovation officer, said during a June presentation at the Jefferies Virtual Healthcare Conference. “You would never want to put your parent in a facility if you don’t have to. You want options now.”

One stat to back up this idea: Over 50% of family members are now more likely to choose in-home care for their loved ones than they were prior to the coronavirus, according to a survey from health care research and consulting firm Transcend Strategy Group.

Separate from SNF-to-home diversion, hospital-to-home models will also likely continue to gain momentum after the coronavirus.

There will be a land grab for palliative care

Over the past two years, home health providers have aggressively looked to expand into hospice care, partly due to the space’s relatively stable reimbursement landscape. Amedisys — now one of the largest hospice providers in the U.S. — is the prime example of that.

During the COVID-19 crisis, palliative care has gained greater awareness. Generally, palliative care is specialized care for people living with advanced, serious illnesses.

“Right now, we are seeing from our hospital partners and our community colleagues the importance of palliative care, including advanced care as well as appropriate pain and symptom management,” Capital Caring Chief Medical Officer Dr. Matthew Kestenbaum previously told HHCN. “The number of palliative care consults we’re being asked to perform in the hospitals and in the community has actually increased. The importance of palliative care is absolutely being shown during this pandemic.”

As community-based palliative care programs continue to prove their mettle amid the coronavirus, home health providers will increasingly consider expanding into the market to further diversify their services.

Currently, just 10% of community-based palliative care programs are operated by home health agencies.

Demand will reach an all-time high

The home health industry may ultimately shrink in terms of raw number of agencies, but the overall size of the market is very likely to expand at a faster-than-anticipated pace.

In years to come, home health providers will still ride the macro-level tailwinds of an aging U.S. population with a proven preference to age in place — that hasn’t changed. But because of SNF-to-home diversion and calls to decentralize the health care system with home- and community-based care, providers will see an increase in referrals from a variety of sources.

In turn, home health agencies will need to ramp up their recruitment and retention strategies.

There’s already early evidence of this happening.

Last week, in St. Louis, Missouri, four home-based care agencies announced that they were hiring a combined 1,000 new employees to meet the surge in demand, according to the St. Louis Dispatch.

Meanwhile, Brookdale Senior Living Inc. (NYSE: BKD) similarly announced plans to hire 4,500 health care workers, with 10% of those hires coming from the senior living operator’s health care services segment.

Bayada Home Health Care likewise announced plans to ramp up hiring.

“We are absolutely hiring more people now than ever,” Bayada CEO David Baiada previously told HHCN. “The need for services — both because of societal and demographic evolution, but also because of what we anticipate as a rebound and an increase in the demand for home- and community-based care delivery as a result of the pandemic — is requiring us to continue to accelerate our recruitment efforts.”

The bottom line: The coronavirus may have presented immediate obstacles for home health providers, but the long-term outlook is brighter than ever.