As more care moves into the home setting, systemic changes may be necessary to keep that momentum going.
Demand for home-based care was creeping upward before 2020, but the pandemic that broke out that year accelerated the trend. More patients, providers, and payers realized that a wider range of services could be delivered in the home, which aligns both with patient preferences and the goal of reducing costs.
In addition to traditional home-based services like hospice, home health, and personal care; community-based palliative care is on the rise, as are emerging high-acuity models like hospital-at-home and skilled nursing-at-home programs.
But these home-based providers are working within a system that was built and oriented around facility-based care. To fully leverage care in the home to its full potential, legislative, regulatory, and financial change may be necessary, according to Tim Ashe, chief clinical officer for the post-acute technology firm WellSky.
“I think [the health care system] is rapidly being challenged to be ready and to be prepared, but there’s going to need to be a number of changes — beginning with legislation that better aligns everything from ease-of-use, to payment methodology, and administrative requirements that better align the obvious incentive to provide care to patients and individuals at home with the overall system reality,” Ashe told Hospice News.
As much as $265 billion in health care dollars could shift from facilities to the home setting by 2025, according to a McKinsey & Company survey. Respondents were physicians who care predominantly for Medicare fee-for-service or Medicare Advantage patients.
WellSky cited the McKinsey study in its recent report, “Opportunities and Challenges: The Transformation of Post-Acute Care in America.” The report identified five key trends that researchers expect to influence the course of post-acute care in the years following the COVID-19 pandemic.
These included declining hospital admissions, rising demand for post-acute care, the shift of more care into the home, and capacity constraints due to the labor shortage. A fifth trend was that the patients who come to post-acute care are sicker than those in the past, WellSky reported.
WellSky collected these data through the company’s CarePort platform, which tracks admission, discharge, transfer, and referral numbers sourced from more than 1,000 hospitals and 130,000 post-acute care providers across the United States. The research also included staffing data from other sources and information from Medicare.gov.
Hospice providers have been largely insulated from the changes in hospital utilization and the severity of illness among the people they serve, according to Ashe. Hospices and palliative care operators are accustomed to caring for some of the sickest patients, such as the terminally ill.
“Hospitals and facility-based care settings had to some degree pretty well-hardwired referral patterns to hospice and palliative care organizations, whether those were within the walls of the facility or whether those were home-based programs, or a combination therein,” Ashe said. “There’s a general reduction in elective procedures that may have led to a decrease in referrals in some of these end-of-life care settings, but I think the expansion in the concept of admitting the patient into the best possible care setting, I increases the referrals into those palliative and hospice programs.”
As hospice and palliative care providers look ahead, the industry’s labor shortfalls will almost certainly be their tallest mountain to climb. Workforce headwinds are a significant threat to growth as well as patients’ access to care.
Referral rejection rates are reaching record highs throughout the post-acute space — with workforce pressures as a leading culprit. During the past two years, these rates reached 88% among skilled nursing operators and 71% for home health providers, according to WellSky. Hospice rejection rates hit an all-time high of 41%.
“The labor shortage is so complex. There are a bunch of different dynamics that lead to the labor shortage. But I think that’s a primary driver as we see referral rejection rates increasing dramatically across the public health emergency timeline,” Ashe indicated. “But it’s those dynamics that lead to capacity constraints, really affected all care settings, and continue to do so pretty dramatically over the last two to three years.”
