What we hear: September, 2015

September is going to be a test for agencies to see if they will make it or begin to slowly become a closure statistic.  Larger agencies understood the changes months ago and are very well prepared for them.  Many smaller agencies did prepare as well, but there are still some that will ‘wing it’ and fly by the seat of their pants. These are the agencies that are going to likely face a tough decision: struggle or close.


ICD-10 is just the beginning.  ACOs are becoming much more prevalent and an ACO will only accept an agency who is on top of the game. This means you need to have a 4 or 5 star rating, clinical expertise, solid patient statistics, and actually be able to realistically prove those statistics.  Saying you will improve or slowly improve isn’t going to cut it. You must be proactive, not reactive.  Reactive agencies are likely smaller with less than 50 patients who haven’t caught on to the fact that they must move right now to be around next summer.


In the 9 states that have been selected for value based purchasing reimbursement trials, smaller agencies who are not up to speed will once again be on the short end of the stick.   Agencies that actively market and play by the book, because they are on top of the changes, will fare much better than those who still think we are in the mid 2000’s when PPS reimbursement flowed like tap water.


We recommend you prepare and be ready. CMS and MedPac the advisory board to Congress on the state of Medicare have home health in their cross hairs due to years of rampant abuse in certain areas.  This micromanagement and micro-scrutiny of home health agencies is only going to continue.


But one more thing – don’t assume the biggest agencies are saints, or the be all, end all. Time and time again, we have pointed out how local agencies can gain an upper hand on centrally managed, multi-state conglomerates with no ties to the community they serve other than to sweep through a community burning through referral sources like a wild fire.


As history has shown in the past, we have seen time and time again that, upon close examination, these giant agencies crack. The bigger they are, the bigger target they are and the more likely they are to commit acts in order to meet stock analysts calls on Wall Street.  It only takes a couple of whistleblowers to bring them down.  With Encompass’ constant swallowing of agencies across the country, we can expect some of their agencies to be put to the test, just as Amedisys was during their rise to the top.  If you remember, the big agencies at the top don’t stay there for long.  There is something to be said for the safety of being a larger, mid-size agency that knows what’s going on versus trying to be home health’s Napoleon only to have it blow up in your face like the Battle of Waterloo.