Home Health Specializations Boost Performance, Bottom Line

A team of competent, compassionate, and qualified clinicians forms the backbone of every profitable home health business. Successful agencies recognize that long-term success depends on meeting required clinical regulations and having staff with the home health specializations to meet shifting client needs.

Keeping an eye on your case mix is important with Medicare reimbursement shifting to value-based purchasing. The Centers for Medicare and Medicaid Services is planning to implement the Home Health Value-Based Purchasing (HHVBP) model nationwide in 2023. This model enhances the focus on patient needs and outcomes accompanying the Patient-Driven Groupings Model (PDGM) for home health, implemented in January 2020.

The regulations focus on serving holistic patient needs, as opposed to therapy service thresholds. In other words, having competent staff to provide specialty care is now essential to document that you are providing the range of care needed by a specific patient rather than focusing on the amount of therapy provided.

Investing in clinicians and caregivers to ensure they have specialized education and training appears to be the best way to stay compliant. But planning for success requires a clear understanding of why specialty education is so important in the long term.

Is your home health agency evolving to stay on top of patient acuity trends to avoid scrambling to catch up later?

Why Focus on Enhancing Home Health Specializations

Align With Value-Based Reimbursement

In 2020, PDGM changed reimbursement by focusing more on patient characteristics. In 2023, your agency and staff must adapt to HHVBP requirements as well, which decrease or increase Medicare reimbursement percentages based on CMS home health quality measure performance.

Positioning your agency to capitalize on the higher reimbursement for specialty care will require clinicians, therapists, and caregivers trained to meet those needs.

Having staff equipped to handle home health specializations such as wound care, respiratory therapy, dementia, or diabetes has benefits that add up:

  • Providing a higher level of specialized care based on a patient’s needs
  • Expanding the variety of conditions and clients a home health agency can serve
  • Capturing the higher Medicare reimbursement potential that PDGM provides for those conditions
  • Increasing agency profitability

Aligning with shifts in patient acuity levels and PDGM reimbursements requires an agency to look at current internal processes, assess current staff, and retrain or hire staff with specialty certifications. But most importantly, it involves developing a workable plan that sets up your agency for long-term success.

Specializations Can Enhance Care Team Competency

Some business-focused reasons to build your specialty teams include higher reimbursement levels for certain conditions under PDGM and for quality outcomes under HHVBP.

Clinical competency has always been an essential element of high-quality patient care. With PDGM and HHVBP directing Medicare reimbursements, a patient-centered approach by competent staff can pay off in even more ways.

Patient-centered care requires staff with the appropriate home health specializations to match varied patient needs. For example, having staff with wound care certifications can make a difference in outcomes if you frequently have patients with pressure ulcers or other skin and wound conditions.

In this scenario, you might encourage several nurses to obtain wound care certification. They can then educate other care team members about how best to prevent pressure injuries and treat various wounds. Wound care certified clinicians can provide evidence-based patient care and advocate for this approach within the care team.

Specialization Training Lets You Shift Your Case Mix

When staff members have more specialized education, they can handle patients with higher-acuity health issues. If your team is prepared to serve a more comprehensive range of patients, your agency is positioned to earn higher Medicare reimbursements for that specialized care.

As a current example, consider how COVID-19 affects older adults with chronic health issues more severely. This situation provides a significant opportunity for home health agencies to step up and serve that client population. Appropriate training will allow clinicians more flexibility to care for additional comorbidities among home health clients.

Strengthening your business may require staff to specialize in hospice and palliative care or respiratory therapy, for example, if demand for those services increases. Hiring or training specialized clinicians who can handle higher-acuity patients allows for optimal patient care and leads to higher Medicare reimbursements.

Specialization Provides Avenues for Professional Growth

Recruiting talented home health staff takes time and effort. But after finding great candidates, screening them, and guiding them through the hiring process, the last thing you want is to lose them and have to start over again.

Many healthcare professionals have reported feeling undervalued and underpaid amid the high demands of the COVID-19 pandemic. But raising salaries can be a challenge with tight profit margins among home health agencies and the high cost of turnover. Providing specialized training is a different approach that can pay off on both sides of the employer-employee dynamic.

Employees value employers who invest in them. And professional development, such as specialization training, can open up new career paths for them. Employer-supported specialization training also shows talented employees that managers respect their potential. That may help stem turnover because employees feel respected, take pride in their professional accomplishments, and gain satisfaction using their higher-level skills to improve client outcomes.

Steps To Help You Add Specialties in Your Agency

As regulations evolve, adding specialties can help your agency continue to adapt. Consider a strategic approach to decide which specialties make sense for your agency’s business goals.

1. Analyze Your Current Case Mix

The first step is to do a deep dive into your current case mix. Do you see any areas where you need specialized talent?

For example, after evaluating your current patient population, you find that 70% of the patients your agency treats have diabetes. Implementing specialized training or continuing education in diabetes nursing care would be a great place to start. You may even want to consider rewarding staff who earn certifications as diabetes specialists.

Remember, you can expect a return on your investment in terms of Medicare reimbursements if you serve more patients with diabetes and show improved outcomes.

2. Make Learning Accessible and Sustainable for Clinicians

Providing access to training is ideal. But if this isn’t possible, encourage your staff to seek training on their own.

Solidify learning with systems to keep staff members working with the patients they are best trained to serve. It is important to reinforce training through repeated on-the-job application — building muscle memory — for long-term benefits.

There are many specialization areas to consider, such as:

  • Memory care
  • Respiratory therapy
  • Palliative care
  • Hospice care
  • Intellectual and developmental disabilities
  • Respiratory therapy

3. Incentivize Staff Education

Many clinicians thrive in a learning environment. Without education, professional growth can remain stagnant, and staff members may become less enthusiastic about their work. You may want to consider offering a financial benefit for staff members who earn specialty certifications, such as increasing hourly pay.

Higher pay shows clinicians and caregivers on your staff that you value their professional growth and offers them a financial reward for their eagerness to learn on the job.

Specialized Staff Training Is a Win for Everyone

Professional development in the form of specialized training is a win on multiple levels. Patients get a higher standard of the comprehensive care they need most. Clinicians are better prepared and happier in their work. By providing training, you demonstrate that you value your staff, which fosters long-term retention. Your agency benefits by retaining talented employees, providing high-quality care, optimizing Medicare reimbursements via quality outcomes, and drawing in more clients who can benefit from the specialized care you provide.

How will you build resilience in your home healthcare business in the coming years?

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Sarah Jividen, RN, BSN, is a trained neuro/trauma and emergency room nurse turned freelance healthcare writer. As a journalism major, she combined her love for writing with her passion for high-level patient care. Jividen is the creator of Health Writing Solutions, LLC, specializing in writing about healthcare topics, including health journalism, education, and evidence-based health and wellness trends. She lives in Northern California with her husband and two children.

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