The healthcare landscape has changed dramatically over the past two decades due to advancing digital technology, population changes and evolving federal policy. For the home health industry in particular, Medicare’s payment policy has moved away from Fee-for-Service (FFS) to Managed Care. This shift has initiated Home Health agencies to adapt and change their business model towards more efficient and effective care providers. It has also fundamentally transformed how agencies present themselves to physicians and get referrals.
Work culture at HHAs, Circa 2006
Let’s quickly remind ourselves what Home Health marketing looked like circa 2006. The physicians’ selection criteria for a HHA were simple. HHA’s team routinely visited physicians’ offices and presented strategy alongside an elaborate luncheon. For selection of the agency, physicians relied on their “gut” feeling along with a few questions: “Can I trust these people?”, “Will they take care of my patients?”, and “Did I like their presentation.” If the presentation and food impressed the Physicians, agency was assured to see a few patients trickle in from their office. The referrals were based on a one-on-one, trust-based relationship. Once the right equation was in place concerning quality of work and trust, the relationship grew with more referrals and increased patient census.
Back then, Medicare’s payment system, FFS, was simple. Home Health Care agencies got paid hefty money per visit. However, this system did not always incentivize the right behaviours from healthcare providers and was often abused by agencies. By 2011, the system was in need of some big change.
Introduction of PO and ACO in healthcare
Around 2011, new legislation was passed to substantially improve care and reduce costs, Medicare brought in big changes. The new legislation was centred around three goals:
- Improve patient care
- Improve patient outcomes
- Reduce costs
In order to achieve goals, the legislation pushed physicians to join Physician Organizations (POs) and Accountable Care Organizations (ACOs). Under the new law, these organizations aimed to attain huge cost savings while alongside the defined key goals.
The POs were not keen to deal with many home health agencies. they wanted to build a preferred network of few providers they could trust. Main objective was excellent care with reduced costs and reduced hospitalization of patients. The writing was on the wall; getting referrals and strong relationships with individual physicians could no longer sustain a growing agency.
To get patients and referrals agencies needed to invest in marketing to the newly formed POs and Accountable Care Organizations (ACOs). Livelihood of POs’ and ACOs’ depended on keeping patient costs low, their selection criteria were entirely on statics. They required evidence to join hands hand with your HHA, and assurance of lower cost of medical care. HHAs were carefully scrutinized regarding their processes and procedures, to ensure highest quality of patient care.
Guidelines for a successful HHA
I am eager to briefly share some tips to reach-out the POs and ACOs and ensure that your agency not only survives, but thrives under the new paradigm.
- Home Health Compare: Home Health Compare is Medicare’s repository of information on health care providers. The website displays your star rating. It is the first thing any organization looking to partner with you, will evaluate. Get to know this tool, and make sure your numbers reflect the standard of care you provide.
- Documented Processes and Procedures: 50% of healthcare costs comes from 5% of the patients, so you must show POs, your process to identify that 5% at mitigated the patient risks. Also show the organizations what your agency does to manage high-risk patients.
- Involve the physician: Doctors need to have visibility into the care of their patients. Show them your process of regular updates, and how this helps prevent hospitalizations through fast, effective intervention. At our agency, we use HOME HEALTH NOTIFY to keep our physicians up-to-date in real-time.
Field staff is the life-line of your organization, make sure they are of the superior quality. At TONE HOME HEALTHCARE SERVICES, we only use the highest level of clinicians, no LPNs or PTAs. They communicate with patients, physicians and represent your company in every interaction. Ensure, that they have the right resources and training to accomplish their job. Educate your staff on Medicare policy, else there will always be struggle during execution no matter the best of intentions.
Smooth marketing may get you into a preferred network, but only great performance will keep you inside one. If you want a sustainable stream of referrals from your partners, you must perform and your HHC numbers will reflect that Make sure you have effective and efficient staff, processes, and tools to follow through your promises made to the POs and ACOs.
We wish you all the best in your Home Health adventure. Please reach out to us with any questions or comments!
We are keen to understand the challenges, and see if our platform can help progress your agency.