10.19.2021

Today’s post-acute care market requires comprehensive solutions for complex issues.

In the grip of a lingering COVID-19 public health emergency, organizations across the post-acute care spectrum are feeling the slow squeeze of falling profit margins and the pinch of nationwide worker shortages. Agencies are struggling to develop recruiting and retention strategies to find and hold onto savvy leadership and top talent. SimiTree Healthcare Consulting shores up the home health and hospice industry with talent solutions and knowledgeable interim management services.

Profitability in this market is tied to expertise and innovation. Agencies are scrambling to find innovative solutions, from leveraging technology to effectively using telehealth services that can’t yet be billed under Medicare. It’s a challenge to stay abreast of increasingly complex regulatory requirements for both home health and hospice billing and coding. More new processes are ahead, with 2022 ushering in a new Notice of Admission (NOA) for home health billing, and accelerating the need for clinical and coding expertise in order to see full reimbursement. For many agencies, outsourcing coding or the revenue cycle is the only viable solution. 

PDGM, Medicare’s complex new reimbursement methodology, has upended business as usual since its 2020 launch, replacing home health’s previous therapy-driven prospective payment system with a complex reimbursement framework dependent upon shorter billing timeframes, greater diagnoses specificity and multiple patient-specific variables. Home health reimbursement is hostage to comprehension of the nuances of the complex payment model, and an agency’s success hinges on how well its coders and clinicians perform. PDGM continues to evolve with revisions of the case weight mix, new pairings of comorbidities and other variables, increasing the need for coding and OASIS accuracy.

Hospice hurdles
Hospice has its own compliance hurdles. New policies are re-shaping the field and holding agencies to greater levels of accountability. From new hospice survey requirements to a more stringent Hospice Quality Reporting Program with a Hospice Care Index, the regulatory and compliance scrutiny on hospice continues to intensify, and survey readiness development is crucial. Hospice agencies are also adjusting to a new initiative to assess the patient experience, including a new star rating program for Hospice Consumer Assessment of Providers and Systems (CAHPS) program, a multi-year initiative of the Agency for Healthcare Research and Quality (AHRQ). Having in place an effective QAPI program can help boost star ratings, but many agencies struggle with implementation and the labor-intensive monitoring and updating required. SimiTree Healthcare Consulting offers a fully outsourced QAPI program. 

Performance metrics
Tracking and understanding key performance metrics is crucial for success for both home health and hospice. Agencies are increasingly seeking data analytics services to measure their performance against state and national norms, monitor ongoing performance and make more effective, data-based decisions. 

The Centers for Medicare and Medicaid Services (CMS) is taking home health performance metrics a step further, ramping up the importance by tying performance to payment. A nationwide expansion of a Value-Based Purchasing model will incentivize home health agency behavior with performance-based payment adjustments. Agencies will see payments adjusted in 2024 based on 2022 performance data.

The makings of a volatile market
The challenges are taking their toll on the market, prompting a flurry of home health and hospice mergers and acquisitions, new strategic partnerships and joint ventures. Stakeholders are pondering important questions: Should I buy? Sell? How much is my home health agency actually worth? How can I diversify to create new revenue streams? They need trusted guidance for a professional valuation, market assessment, targeted acquisition search and more.

A full spectrum of support
SimiTree Healthcare Consulting offers a full spectrum of clinical, financial and operational support to help organizations answer these questions, meet their challenges, adapt to changes and grow in today’s complex and confusing market.

We’ve merged Simione Healthcare Consultants, with its 50-year legacy of financial consulting expertise and stellar industry reputation, with BlackTree Healthcare Consulting, an innovative leader in market solutions, to deliver top-notch services and approaches.

Together, we have the resources, expertise and multi-faceted solutions to raise performance levels for our clients and position them to realize revenue potential.

We’re committed to change the post-acute industry by aligning business and care in a way that makes organizations stronger, healthier and better able to focus on patient needs.