NAHC Head: Possible Silver Linings in Pandemic

BIRMINGHAM, Alabama (July 28, 2020)—While the pandemic has been tough on homecare and hospice companies, the future could bring good changes to the industry, the head of the National Association of Home Care & Hospice (NAHC) said at the organization’s Financial Management Conference and Expo, which opened Tuesday.

“I may sound Polyanna-ish in all of this, but I do see more positives than negatives coming out of this,” NAHC President Bill Dombi said at the general session of the conference, which was originally scheduled to take place in Chicago but was conducted virtually due to COVID-19. “There are lots of silver lining elements coming out of this.”

Those include improving public awareness of what homecare and hospice workers are capable of, he said.

However, the next few months could be turbulent for the industry, especially given the fast-changing numbers of illnesses reported in various areas of the country, continued shortages in personal protective equipment (PPE) and increased low-utilization payment adjustments (LUPAs).

Dombi initially painted a dire picture, saying that admissions, revenues and case mixes have been down for home health agencies and hospices since the outbreak of the novel coronavirus, both because of lack of access to patients and because of an initial pause of elective surgeries. Personal care services, too, experienced reduced demand, driven primarily by patients and families trying to avoid letting someone in their home.

“We saw just a dramatic change in patient volume and revenues,” he said.

A NAHC survey conducted in May found that in some virus hot spots, more than 85% of home health agencies were serving patients with COVID-19. Some areas, like Florida, had lower figures then but are expected to see much higher numbers as reported cases increase.

At the same time, he said, the cost of providing patient care has gone up 9.7% on average, largely due to the need to purchase PPE for employees. He estimated there are about 5 million patient encounters in the home on a daily basis, which requires as many as 7 million-10 million masks per day, plus other equipment like gowns, gloves, face shields, etc.

More than 40% of agencies reported having fewer than a 20-day supply of PPE, he said.

“This is not something that is going to change overnight, despite heavy increases in manufacturing,” Dombi said.

Another area of concern, Dombi pointed out, is that more flexible regulation of clinical services could open the door to physicians and non-physician practitioners—who are rapidly expanded into telehealth—becoming competitors for homecare. Additionally, rural health clinics and federally qualified health centers have been able to provide some care at home during the crisis.

“We really can’t quantify the level of competition that has come from them,” he said. “The instability, though has created a potential environment affecting acquisitions and consolidations.”

On the up side, he said, in-home care will likely benefit from the public’s hesitancy to use nursing homes and other communal living environments. In fact, in the long term, there could be a push for home health to take up some responsibilities from hospitals in order to reduce infection—for pre-acute as well as post-acute care—and for more palliative care at home.

“There are more patients being served in homecare today that are COVID-19-positive than are being served in hospitals around the country,” Dombi said. “They may not be at the same acuity or same risk of dying, but they are being served in a home setting.”