What Hospital Systems Want From Home Health Providers

Maintaining solid referral pipelines is essential for home health operators – and health systems know what they want.

Ascension, a non-profit, faith-based health system, prioritizes home health providers with quick response times – getting into the patient’s home the same day or the next day – as well as the ability to provide care for every discipline a patient is ordered and high acceptance rates.

“We’re working really hard to get patients out of the hospital as quickly as possible. And if we can, to the right level of care, the lowest cost level of care, the most appropriate level of care, and again, if we can, to their home. We want to return them to their family and to where they’re most comfortable,” Lisa Musgrave, senior vice president of post-acute and at-home services at Ascension, told Home Health Care News. “That’s where they get to eat their own food, be with their pets, be with their family. We’re working really hard at supporting understanding their goals, their caregiver situation, their home environment and what they need to get them to home as quickly as possible.”

St. Louis, Missouri-based Ascension operates in 17 states and Washington, D.C. The organization employs approximately 97,000 workers, operates 90 wholly-owned or consolidated hospitals and maintains partnerships with another 29 hospitals. Ascension also operates 22 senior living facilities.

Ascension works to move patients out of the hospital as quickly as possible, Musgrave said, and to the most appropriate level of care with the lowest cost. While not always possible, ideally, the health system works to move patients to the home setting.

Accepting referrals quickly – and following through

When moving patients to the home, the organization prioritizes a prompt response from the home health providers it works with. Ascension needs a provider to accept a referral almost immediately. While its service-level agreement is two hours, Musgrave seeks an acceptance timeline of about seven to 10 minutes rather than one to two hours.

After a prompt response, home health providers then need to follow through on their word – and quickly.

“When we send a referral, we need somebody to say I can take it or I can’t take it. And if you say you’re going to take it, take it,” Musgrave said. “What we often hear is, ‘Yeah, we’ll take the referral,’ but then you don’t get out there for four or five days. We need our patients seen today and tomorrow. If you can’t get out there today or tomorrow and really care for them in the way they need, don’t accept that patient. So staff for today or tomorrow. And that is a hard sell, but to prevent readmissions and do the right level of care, it needs to be ASAP.”

Ascension prioritizes providers with high acceptance rates – ideally greater than 85%. That figure is a great deal higher than most agencies have, Musgrave said. She usually sees agencies have acceptance rates lower than 60%.

The health system often struggles with home health providers accepting a patient, only to turn around and say they cannot, in fact, care for that patient. This creates inefficiencies and undermines the intended patient-choice model, Musgrave said, and can impact patient choice. Because agencies are sometimes unable to care for a patient after accepting a referral, case managers now often blast a referral to many agencies, and several will accept. Case managers then present these agencies as choices – but some may not ultimately accept the patient. This is not how patient choice was designed, Musgrave said, and it has resulted in a broken process.

In instances where providers must send back a referral, communication is crucial. Musgrave recommended letting the health system know what the issue is specifically, whether that’s an issue with staffing, insurance, timeliness or discipline availability.

“We see a lot that our home care [providers] will ask us to take a discipline off, and that is a struggle for our patient care,” Musgrave said. “As an industry, we’ve got to get to the place where, if a discipline is ordered, there’s a reason for that discipline, and have those disciplines there.”

Ascension’s home health strategy

Musgrave is tracking and supporting a pointed move of care into the home. Making the home the destination makes sense for patients, who desire to be in their own spaces with their loved ones, and makes sense for outcomes and costs.

As part of its home health push, Ascension developed a joint venture with Compassus and has developed a liaison program in which dedicated liaisons work directly with discharge teams and case managers at the time of discharge. This allows for the liaisons to get upstream and prepare a spot for the patient in home health or hospice, as well as to have conversations with the patient and family members.

These conversations include helping the patient and their family understand if home health or hospice is a fit, what agency is appropriate for them, offering them a high-quality, in-network option, discussing the home environment and then working with the patient’s agency of choice to reserve the patient’s spot.

This process results in a smoother, more timely transition, Musgrave said.

Overall, the health system is committed to supporting patients moving out of the hospital and, ideally, into their homes.

“Really, for us, we’re moving care out of the hospitals into other settings. Ascension is committed to an ambulatory strategy,” Musgrave said. “We know that acute care is going to be fewer and fewer patients, that those will be the high acuity patients. We are completing a purchase of ambulatory surgery centers. We are growing our outpatient rehab areas. We are growing home care. We believe in this, and we understand that to lower the total cost of care, we’re going to have to move patients from higher cost of care settings to lower cost of care settings.”

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