“Hospitals are good at driving volume to their home health agencies that they own from a discharge perspective, but at the same time, I don't know that they're terribly successful or good at it, it's just not their expertise,” said Anne Tumlinson, the president and CEO of consulting firm ATI Advisory.
VCU follows a nationwide trend of hospitals seeing a growing aging population coupled with policy movements that allow Medicare to cover more services beyond institutionalized settings. Medicare Advantage plans also largely prefer paying for lower-acuity post-acute settings. Forecasting data from Vizient-subsidiary Sg2 estimates that in 10 years home care admissions will grow by 15%, while SNF volumes will decrease by 5% in the same period.
VCU Health is not alone in testing this new model. Ascension in late 2019 partnered with private equity firm Towerbrook Capital Partners to buy national hospice, palliative care and home care provider Compassus.
University Hospitals in Cleveland decided to cease running its own three-year-old hospice company. Anne McKinney, chief nursing officer and agency administrator at UH Home Care Services said they weren’t seeing the results they wanted and there was already a strong foothold by an existing hospice provider.
“Hospice of the Western Reserve is pretty much embedded in northeastern Ohio, so the competition was tough, so we just decided to do a joint venture,” McKinney said.
University Hospitals still has its own home health agency, which has seen between 15% to 20% increase in admissions over the past year, due largely to the pandemic. On any given day, home health workers see 2,000 patients, more than all of its inpatient facilities combined.
There are definite benefits to keeping care in one system where data can be more easily shared. Electronic medical records usually aren’t integrated between hospitals and post-acute providers, which often creates hiccups in transitions between inpatient and home. For instance, Bayada Home Health Care CEO David Baiada explained for most of their relationships with hospitals, they’ll receive faxed medical records and notes for a patient. Sometimes the records aren’t complete, and sometimes they receive it the day an intake nurse is set to visit a new patient at home.
“And that nurse is now in a complex environment with a very sick person and a nervous, anxious family, trying to figure out how to help this person stay safe and stable and independent,” Baiada said, adding this can lead to unnecessary readmissions because the home health provider doesn’t have all the information they need so they err on the side of caution and send the patient to the ER.
Bayada’s ventures with hospitals, where information is shared usually via a tablet or computer, is a much smoother transition, Baida said.
“It's a totally different experience with patients,” Baida said.
There can still be challenges. At University Hospitals, work is ongoing to educate doctors about what they can do in home health.
“We were the best kept secret for the system and even our hospital partners don't necessarily realize what we can do in the home,” McKinney said. “If a patient got a little debilitated, the thinking by doctors was, let's send them to a SNF, and then from SNF to home.”
University Hospitals now has a goal of sending up to 80% of patients who need post-acute care to home health. Last year, McKinney created three new post-acute ambassador positions, who go into the hospital setting and educate physicians on the care they provide at home.
“It’s just changing the mindset to, let's get these patients from hospital to home,” McKinney said.