Readmissions penalty presents a business opportunity for home care companies

April 01, 2013

By Stephanie Bouchard, Managing Editor

NEW GLOUCESTER, ME – Home care companies have an opportunity to expand their businesses and shape coordinated care efforts by offering their services to hospitals seeking to avoid patient readmissions, say home care experts.

The Affordable Care Act imposes a penalty on hospitals based on 30-day readmissions for certain conditions. That penalty can be stiff. Currently, the maximum penalty is 1 percent of hospitals’ regular Medicare payments. The maximum penalty increases to 2 percent starting in October and to 3 percent next year.

Hospitals don’t want patients to be readmitted, said Lenny Verkhoglaz, the CEO and founder of Executive Care, a home care franchise based in Hackensack, N.J. If home care companies position themselves well, those hospitals will turn to them to help avoid unnecessary readmissions.

“The case managers and hospitals and rehabs are looking for well established, well disciplined agencies that provide good care to whom they can make safe referrals,” Verkhoglaz said.

“We provide a lot of needed services and these organizations, like hospitals and nursing homes, are looking for people like us to continue the care. We tell them ‘we want to make you look good – just put the load on us’ and ‘we’re performing everything that’s needed.’”

The National Association for Home Care and Hospice (NAHC) has been hearing about more home care agencies seeking partnerships with hospitals, emergency departments, accountable care organizations and other organizations participating in bundled payment projects, said Mary St. Pierre, vice president of regulatory affairs for NAHC.

“Home health agencies are really trying to get in there, make sure that their role and how they can help is understood and appreciated by the hospitals and the other organizations,” she said. If they don’t, they’ll get left behind as care delivery models evolve under health reform.

“They need to identify themselves so that referrers – the hospitals that are referring to them, the ACOs that are referring to them – are using them, involving them in all of their aspects of care. If they do it, and do it well, they’ll be guaranteed a place,” she said.

To position themselves as suitable partners, home care agencies need to evaluate their own performance and determine how they can improve and then offer their performance data to hospitals, said St. Pierre.

They should also understand the needs of the hospitals they are attempting to work with, and offer those hospitals a solid strategy for how they will help meet the hospitals’ needs. If needed, home care agencies should develop new programs and offer training to their staff to make sure they can deliver the services and care sought by hospitals.

If home care agencies really want to reduce hospital readmissions, there is one simple thing they can do that they often don’t, said Diane Omdahl, RN, co-founder of 65 Incorporated, an organization helping seniors understand Medicare, and that’s to see patients on the same day of discharge.

Omdahl spent more than 20 years in the home care field and says the same misconception about not seeing patients on the day of discharge persists as much today as it did 20 years ago.

Home care agencies often do not see the patient on the day of discharge, she said, because they are under the misunderstanding that Medicare will not cover a visit on discharge day. But that is not the case, Omdahl said. Medicare will cover visits to patients on the day of admission and the day of discharge.

“That’s one of the things that home care agencies have to realize,” she said. “The sooner they can get out there to see the patient after discharge, the better off they’re going to be and patient’s going to be.”

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