New NAHC National Survey: Home Health Care Severely Disrupted by Pandemic

POSTED ON MONDAY, July 6, 2020 

NAHC conducted a national survey of home health agencies from early-to-mid June 2020 and found that the COVID-19 pandemic continues to severely impact the delivery of care, causing financial pressure that has barely eased since a similar survey was conducted in mid-April. This new survey contains important new information on the admission refusal rate of prospective admissions and cost increases imposed on agencies by the COVID-19 Public Health Emergency.

The new survey was done by NAHC from June 3 to June 18 and requested responses for May 2020.  “The recent, follow-up survey continues to strongly suggest that home health agencies need financial support and Medicare policy relief in order to continue to serve COVID-19 infected patients, as well as the other 3.5 million Medicare beneficiaries who utilize cost effective, high quality care at home each year,” said NAHC President William A. Dombi, in response to the findings of the new survey.

“The findings of both surveys indicate serious continuing concerns about the financial stability of home health agencies as operations and revenues are still severely affected in multiple ways. These findings below, with the earlier survey findings in parentheses, include:

  • 4% (85%) of respondents report revenue reductions with a median reduction between 15 and 20%.
    • 2% (31.7%) report reductions in excess of 20%
    • 45% (53.%) report reductions in excess of 15%
    • “hot spots” such as NY and NJ report even higher reductions with the NY/NJ region indicating 45.8% (67.9%) with greater than 15% and 37.6% (46.3%) greater than 20%

While the survey responses indicate a slight decline in the level of revenue reductions, the continuing impact remains significant. Anecdotally, the explanations for the slight change vary widely, but include reduced hesitancy to accept services and increased patients choosing care at home as an alternative to nursing home care.

  • Revenue reductions are primarily related to two factors: decreases in new patient admissions and patient refusal to accept all of the physician-ordered care visits to avoid virus transmission risks.
    • 2% (79%) report decreases in admissions with 49.5% (56%) indicating reductions greater than 15% and 38.9% (37.3%) reporting reductions in excess of 20%
    • “hot spot” locations report much higher losses of new patients with 62.1% (92.8%) of HHAs in NY/NJ reporting decreases and 48.3% (75%) indicating a decrease of 15% or greater and 45.2% (57.1%) indicating a decrease of greater than 20%
    • 4% (96.9%) of HHAs report patients’ refusals of care

The reduced reluctance of patients to allow HHA staff in their homes especially shows in the NY/NJ hot spot. HHAs report that improved availability in PPE and better communications with prospective patients contributed to the increased willingness to accept care and caregivers.

    • Refusals of all of the physician-ordered care visits have triggered payment reductions through the Low Utilization Payment Adjustment (“LUPA”). LUPA rates reduce average reimbursement by approximately 75% or $1500 over the 30-day period payment unit.
      • 39% (52%) of HHAs with below national average LUPAs in March 2019 report at least a tripling of LUPAs in May 2020
      • 47% (67%) of all HHAs report at least a doubling of LUPAs
    • NEW INFORMATION: The admission refusal rate of prospective patient admissions in May was 9.38% of referred patients. Of those patients on service, 9.51% of the physician-ordered visits were rejected by the patients.

The improvement in the proportion of LUPAs compared to March 2019 corresponds with the reduced hesitancy of patients to accept care. Still, the high volume of LUPAs continues to contribute greatly to the reduced revenue outcome for HHAs. The June survey found that 57.5% of all HHAs had LUPA volume in excess of a pre-Covid national total of 8% of patient episodes as LUPAs.

  • The revenue and care demand reductions have cost HHA employees’ jobs
    • 6% (54%) of HHAs report reductions in clinical staff
    • 47% (52.8%) report reductions in administrative staff
  • NEW INFORMATION: Respondents to the June survey indicate that the Covid-19 related cost increases are expected to lead to an annual service cost increase of 9.69% for HHAs. This cost increase alone far exceeds the financial supports that have been provided to HHAs through the CARES Act Provider Relief Fund through which Medicare HHAs received an April distribution equal to 6.2% of 2019 Medicare fee-for-service revenues.
  • Respondents indicate that the same top three concerns about their future as reported in the first survey. Those are:
    • Significantly reduced revenues
    • Patient safety with inadequate supply of Personal Protective Equipment (PPE)
    • The inability to fully utilize telehealth services as an adjunct to in-person care that is reimbursed by Medicare
  • With respect to PPE, availability has improved notably, but it is far short of what is needed currently and the availability is at high risk in the event of a surge as is being experienced in a number of states in late June.
    • 42% (65%) of HHAs report less than 20 days supply of PPE
    • 71,6% (81.6%) of HHAs report less than a 30 day supply on hand
  • Even without direct reimbursement for telehealth services as an alternative to in-person staff visits to patients, the responses indicate a slight uptick in telehealth use by HHAs.  In the March-focused survey, 39.5% of HHAs reported using one or more modalities of telehealth. The May survey shows a slight rise to 43.6%.

Overall, the recent, follow-up survey continues to strongly suggest that home health agencies need financial supports and Medicare policy relief in order to continue to serve COVID-19 infected patients, as well as the other 3.5 million Medicare beneficiaries who utilize cost effective, high quality care at home each year. “

Source: NAHC


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