Despite the hope that COVID-19’s effect on the world would wane in 2022, the year started with the highest case counts that home health and home care providers had seen, both among patients and staff.
But as Home Health Care News’ top stories of the year suggest, COVID-19 did not define what went on in home-based care in 2022. Instead, a trend that had been bubbling under the surface for years – perhaps even prior to the pandemic – came to fruition. Some of the largest companies in the country invested in home health care.
Yet, all the while, the home-based care world faced existential threats: payment rate cuts in home health care, plus cost of care rising in home care.
Reflect back on this year in home-based care by revisiting 10 of HHCN’s most widely read stories.
1. CMS Backs Off Severe Cuts, Finalizes 0.7% Increase To 2023 Provider Payments (Oct. 31)
Home health providers were likely part relieved, part disappointed after multiple months of advocacy against the Centers for Medicare & Medicaid Services’ (CMS) proposed rule ended up in a 0.7% increase to aggregate home health payments for 2023.
Without inflation adjustments – that many argued were not sufficient – the final rule ended up in, for all intents and purposes, a payment rate cut.
“It’s important to understand some of the politics of what happened in this final rule,” National Association for Home Care & Hospice President William A. Dombi later said. “CMS went with a headline saying they were cutting over $800 million — in one year alone — from home health care spending to a headline that now says they’re increasing spending by $125 billion. That was a strategic, tactical move by CMS to put out a positive headline.”
2. How Home Care Providers Are Widening the Talent Pool with ‘Non-Traditional’ Caregivers (Jan. 31)
Given the vast and urgent need for more caregivers in home care, agencies have begun to look for workers that traditionally have not ventured into health care for careers.
Whether through targeted recruitment measures or otherwise, some have found success in finding “non-traditional” caregivers to fill part of the void in the workforce.
“I have always been quite interested in looking at the role and responsibility for whatever position that I’m hiring,” Pete Morrissey, co-owner of Right At Home Gainesville, told HHCN. “I’m not so focused on the person’s prior experience. I’m much more interested in whether they bring the requisite skill set, the requisite attention to detail and a willingness to engage. We’re really taking an industry-agnostic approach to hiring.”
3. How the PE Nursing Home Crackdown Could Affect the Home Health Industry (March 31)
The pandemic has left a sour taste in just about everyone’s mouths. For federal watchdogs, the specific failures of the health care system during the height of COVID-19 rubbed them the wrong way.
In turn, those watchdogs have begun to go after private equity (PE) players in the nursing home industry. And what happens in one post-acute sector generally ends up carrying over to others as well.
“Too often, the private equity model has put profits before people — a particularly dangerous model when it comes to the health and safety of vulnerable seniors and people with disabilities,” the White House said.
Throughout 2022, the home health industry saw warnings signs of higher scrutiny coming to the space, whether through a crackdown on PE forces or otherwise.
4. LHC Group’s Keith Myers: To Fix the Medicare Advantage Problem, Cut Out the Middle Man (July 26)
Executives’ gripes with Medicare Advantage (MA) plans’ rates for home health services were a big theme of 2022.
In July, they took a turn, as LHC Group Inc. (Nasdaq: LHCG) CEO Keith Myers suggested that conveners – “the middlemen” between providers and plans – may be escaping more blame than they should.
On and off the record, executives agreed with Myers assessment, saying that conveners were “skimming off the top” of revenue and also hurting negotiations between providers and plans.
5. UnitedHealth Group Agrees to Buy LHC Group for Over $5 Billion (March 29)
The deal is not yet final, but UnitedHealth Group’s (NYSE: UNH) agreement to purchase the aforementioned LHC Group for close to $6 billion was arguably the biggest news of the year in home health care, and definitely the biggest agreed-upon deal, excluding CVS Health’s (NYSE: CVS) $8 billion deal for Signify Health (NYSE: SGFY).
Once it is final, the integration of LHC Group into UnitedHealth Group’s Optum could change the home health industry for years to come. In essence, one of the largest players in the industry will be joining forces with one of the largest companies in the country.
While it did show the strong perception of home health care’s worth, it also will place one of the largest home health companies within an organization with the largest MA market share.
6. ‘The Stability of Home Health Care Is at Risk’: CMS Proposes 4.2% Decrease to Provider Payments in 2023 (June 17)
The result is final, but the mayhem that the home health proposed payment rule brought with it in 2022 will not be something providers soon forget.
For one, the fight is not over. Looming and continued cuts are still a part of CMS’ plan moving forward, which home health providers want to avoid at all costs. That’s the advocacy angle.
From an operational standpoint, thousands of providers had to face the risk of going into the red. As they did, they had to consider how to drive efficiencies while cutting costs. That is an organizational trend that will likely continue in 2023.
7. At-Home Care Provider DispatchHealth Raises Over $330 Million In Latest Funding Round (Nov. 15)
Amid a major slowdown in the market for fundraising, DispatchHealth – an at-home care services company – raised $330 million. It did so through support from Optum Ventures, Humana (NYSE: HUM), Oak HC/FT, Echo Health Ventures, Questa Capital, Adams Street Partners, the Olayan Group, Silicon Valley Bank, Pegasus Tech Ventures and Blue Shield of California.
That brought its fundraising total to over $730 million since its founding in 2013.
“We’ve planted a few flags across the country over the last several years,” Mark Prather, the CEO and co-founder of DispatchHealth, told HHCN. “The next several years will be about building out the entirety of our high-acuity ecosystem in each of those markets.”
8. CenterWell to Take Center Stage for Humana After Restructuring (July 27)
Humana’s complete takeover of Kindred at Home left no doubt about its commitment to at-home care solutions moving forward. However, there were still many questions to be answered.
What ultimately came to be was “CenterWell,” Humana’s all-encompassing health care services arm that includes home health care and primary care.
After partially divesting Kindred’s personal care and hospice lines, it also created a new player in the greater home-based care space with a familiar name – “Gentiva.”
9. Why Home Health Providers Are Producing High Referral Rejection Rates (Feb. 16)
The pandemic brought with it a more intensified demand for home health care services. But it didn’t necessarily bring with it more workers. What that ultimately led to was some of the highest referral rejection rates that operators had ever witnessed.
In January, the home health industry’s rejection rate was all the way up to 58%, according to a data analysis from CarePort.
“This is telling us that [providers] can’t take this high volume of patients looking for home health services, and they’re starting to turn down more and more patients from their referral partners,” Tom Martin, director of post-acute care analytics at CarePort, told HHCN.
10. Home Health Providers Are ‘Getting Their Clocks Cleaned’ on MA, Grandstanding on Risk-Sharing (Feb. 17)
Home health providers were certainly aware of MA plans’ lesser rates – compared to fee-for-service Medicare – prior to February of 2022. But one could argue that’s when they really began to talk about it more seriously and publicly.
“We’re losing. This is a really serious moment in time for all of us,” LHC Group Chief Strategy & Innovation Officer Bruce Greenstein said. “I’ve been up on these panels and [at] endless conferences talking about the benefits of value-based care and all these cool programs that we’re doing. … But I have to say, we’ve been glossing over this as an industry for far too long … We are getting our clocks cleaned. And we just tend not to talk about it.”
Since then, there’s certainly been talk of it, including after LHC Group itself agreed to integrate into UnitedHealth Group’s Optum.
Other companies, meanwhile, have prioritized getting better contracts with MA plans. In some cases, given a lack of clinical capacity, home health providers even considered deprioritizing MA patients.
What comes of the talks between the premier home health organizations and MA plans at the negotiating table in 2023 will undoubtedly be a theme to watch.