Home Health Agencies Grapple With ‘Acuity Creep’ As Patient Needs Become More Complex

Home Health Care News | By Patrick Filbin 

In recent years, due to factors like the pandemic and the reinvention of hospitals, home health agencies are having to take care of much more complicated patients.

As the demand for home-based care continues to rise, so does the need for more intensive care plans as patients continue to be sicker and more complex.

Home health agencies are feeling this “acuity creep,” and they’re adjusting. But at times, it’s hard to keep up.
“When I’m talking about acuity creep, I’m thinking about how much need do the patients in our care models require?” Michael Johnson, president of home health and hospice at Bayada Home Health Care, said. “It’s not just medical needs, either — there’s a social need as well. We’ve seen a definite increase in the needs of our patients.”

The Moorestown, New Jersey-based Bayada is one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.
In order to find out if the acuity creep had affected Bayada, Johnson recently dug through the last four years of PDGM data for patient diagnoses and found a noticeable decrease in categories like musculoskeletal rehab and an increase of patients who needed neuro rehab, cardiac and complex behavioral health.

The last three categories can be filed under “more need,” Johnson said. With the need for intense care comes the need for more nurses, home health aides and other caregivers.
“When they’re sicker — as we’ve seen it — we need nursing care for the same person,” Johnson said. “In the case where there’s a nursing shortage, that becomes a bit of a crunch, so from a staffing perspective, that’s been a challenge. When I think about need, I think about workforce.”

Eric Gommel — chief strategy officer at Virginia Health Services — is also focused on workforce development due to this acuity creep.

Virginia Health Services is a provider of home health, palliative and hospice care, and also offers senior housing and other nursing services.

The company has invested heavily in apprentice programs and career ladder initiatives as a way to combat the acuity creep.
“They’re the primary people taking care of our seniors,” Gommel said. “It’s the sad reality of our society that we expect the most out of our children and these caregivers – and we pay them the least.”

Many of the issues that arise when trying to take care of more complex patients, Gommel has found, are in the preparation and education of staff members…

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Panel Considers Potential Changes to Home Health Model

American Hospital Association
 
The Centers for Medicare & Medicaid Services Dec. 29 released a report on the Expanded Home Health Value-Based Purchasing Model that summarizes input from the first two meetings of a technical advisory panel considering potential refinements to the model’s methodology, measures and approach to health equity. Launched in 2022, the expanded model includes Medicare-certified home health agencies in all 50 states and in U.S. territories. The model’s measure set currently uses data already reported by HHAs through the Home Health Quality Reporting Program or Medicare claims and Home Health Care Consumer Assessment of Healthcare Providers and Systems surveys. 

The 2024 Adult Vaccine Schedule Changes Are Here

Medscape | By Sandra Adamson Fryhofer, MD

This segment of Medicine Matters by Sandra Fryhofer, MD, highlights updates in the 2024 Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule.

The biggest change for 2024 is that you don't need to wait till January 1, 2024, for these schedules go into effect. Both schedules were published and became available in November 2023 and became effective immediately. They include ACIP recommendations approved by the Centers for Disease Control and Prevention (CDC) director through October 23, 2023.

Subsequent recommendations (before publication of the 2025 schedule) will be added to the addendum, a new Step 5, Section 5 in the schedule. The addendum should make Affordable Care Act (ACA)–compliant insurance plans cover ACIP-recommended immunizations sooner.

This year's schedule includes more vaccines with new recommendations and new color code keys for the schedule's vaccine tables. The newest vaccine additions to the schedule include respiratory syncytial virus (RSV) vaccines, the mpox vaccine (Jynneos), a new MenACWY-MenB combo vaccine (Penbraya), and the new 2023-2024 formulation of the updated COVID vaccine (both mRNA and protein-based adjuvanted versions).

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We Need To Go Where The Patients Are’: How Home Health Agencies Are Adjusting To Medicare Advantage

Home Health Care News | By Patrick Filbin

Medicare Advantage (MA) enrollment has been on a steady climb over the last two decades. As such, home health agencies have started to adjust operations to better fit the payer landscape in the future, and not just now.

Agencies in states like Michigan, Hawaii and Alabama have already had to do that — and those transitions haven’t been seamless.

Cleamon Moorer Jr., the president and CEO of the Detroit-based American Advantage Home Care, has been molding his company’s strategy around one of the greatest NBA point guards of all time.

“We’re understanding that we need to take a lead position and meet patients where they’re going,” Moorer told Home Health Care News. “It’s like the ‘80s Lakers with Magic Johnson. He threw the ball where Worthy was going to be, not where he was at. We need to go where the patients are going to be.”

American Advantage Home Care provides skilled nursing, rehab and specialty care services. Currently, the company serves seven counties in the Southeast Michigan area and has a census of 200 patients.

Changing of the tides

In 2023, 30.8 million people were listed as enrollees in a Medicare Advantage plan — which made up 51% of the eligible Medicare population — and $454 billion (or 54%) of total federal Medicare spending, according to KFF.

The share of Medicare beneficiaries enrolled in Medicare Advantage varies widely across states and counties, however.
Providers are concerned about MA plans’ reimbursement rates for home health services. Meanwhile, patients have some reason to be concerned over the home health access they’ll have underneath an MA plan.

“One concern that certainly comes up is that one in 10 Medicare Advantage patients say they have trouble accessing needed care,” Jennifer Schiller, executive director at the Research Institute for Home Care (RIHC), told HHCN. “It’s a coverage [issue] — but I think everybody is constantly aware of the fact that Medicare Advantage is not going anywhere.”
The tides have already started to shift in favor of MA.
Enrollment in MA has seen gradual increases (8% in both 2021 and 2022) and there is no sign of it slowing down.

“I think you’re going to see some more changes — especially over the next few years with various regulations that may impact who is using home health and who is using Medicare Advantage,” Schiller said.

In order to capitalize on that shift – or survive it – home health providers have had to adjust.

Challenges in MA…

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