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Financial Management in Home Health

Effective Home Health Budgeting and Financial Management

Home health agencies provide vital care services to individuals in their homes. However, agencies must manage their finances effectively to ensure long-term sustainability and success. This blog will cover effective budgeting and financial management strategies, including those necessary in response to the 2023 changes with OASIS-E.

Budgeting: The Backbone of Financial Health

Budgeting acts as the financial compass for home health agencies, illuminating their path and bolstering their financial stability. Here’s why budgeting is an indispensable element of a home health agency’s financial management:

  • Financial Planning: Budgeting aids in forecasting future financial needs, establishing practical goals, and determining the revenue required to cover expenses and attain desired results.
  • Resource Allocation: A well-structured budget helps agencies distribute resources judiciously, focusing on crucial areas like employee training, equipment, technology, and marketing initiatives.
  • Decision Making: Budgeting serves as a tool for informed decision-making by offering a clear snapshot of the agency’s financial standing, thus enabling leaders to assess potential investments, expansions, or cost-saving initiatives.


Crafting an Effective Budget

An accurate budget lays the foundation for efficient financial management in home health agencies. Suggestions for creating a home health agency budget are the following.

  • Gather and Analyze Financial Data: Collect and analyze past financial data to spot trends, expenditures, and revenue streams, allowing for the identification of areas for improvement.
  • Set Realistic Goals: Establish realistic financial goals that align with the agency’s mission and the community it serves.
  • Estimate Revenues: Identify revenue sources like Medicare, Medicaid, private insurance, and self-pay clients, and develop a revenue projection.
  • Track Expenses: Categorize and track expenses meticulously to comprehensively understand the agency’s expenditures.
  • Incorporate Contingency Plans: Incorporate a contingency fund in the budget to account for unexpected costs and potential revenue shortfalls.
  • Involve Key Stakeholders: Involve key stakeholders such as department heads, finance professionals, and staff members in budgeting.


Effective Financial Management Strategies

Home health agencies must implement effective financial management strategies with a budget in place. Some suggested strategies are the following.

  • Monitor Key Performance Indicators (KPIs): Identify and track KPIs aligned with the agency’s financial goals.
  • Control Costs: Identify areas for cost reductions without compromising care quality.
  • Revenue Cycle Management: Improve billing and collection processes to enhance cash flow.
  • Embrace Technology: Implement EMR homecare systems, home health software, and financial management software to streamline operations.
  • Staff Training and Development: Invest in training to ensure staff have the necessary skills and knowledge. Staff training is essential to implement OASIS-E and its associated revenue changes.
  • Contract Negotiation: Secure optimal reimbursement rates by negotiating favorable contracts with insurance providers.
  • Regular Financial Review: Conduct regular financial reviews to assess the agency’s performance and identify areas for improvement.
  • Compliance and Audit Readiness: Establish robust internal controls and conduct regular audits to minimize financial risks.
  • Strategic Partnerships and Collaborations: Home health agencies should partner with other healthcare organizations, community resources, and technology providers for cost savings and expanded service offerings.


Regulatory Changes and Reimbursement: Navigating the 2023 Landscape

Healthcare is an evolving field, and home health agencies must adapt to changes in regulations to ensure optimal reimbursement. One of the critical tools agencies use for this purpose is the Outcome and Assessment Information Set (OASIS). With the introduction of OASIS-E in 2023, home health agencies must understand the implications of this new system for their financial management.

A home health agency’s financial management plan must address the changes and challenges of OASIS-E implementation and its impact on reimbursement. Staff training for OASIS-E is essential to home health agency financial planning.

Implementation of the January 1st, 2023, OASIS-E assessment has instigated significant transformations for home health organizations. The simultaneous deployment of the home health value-based purchasing model (HHVBP) has intensified these changes. As per the payment regulations enacted earlier this year, home health payments have decreased by 4.2%, along with a 2% reduction in the fixed loss. These measures were designed to augment the predictability of home health payments, incorporating a 5% cap on negative wage index changes. For home health agencies that received Medicare certification before or post-2021, their baseline year for payment scoring was established as 2021 or 2022, respectively. This baseline data has been instrumental in revising low utilization payment adjustment (LUPA) thresholds, functional points, and impairment levels by clinical groups.

The new payment score timing (PST), introduced at the beginning of this year, has been influencing payments based on patient satisfaction regarding OASIS-E, hospitalization and SNF activity, and five crucial HCAHPS measures. As a result, an agency’s performance in these areas this year will shape the course of future payment adjustments. Regarding the HHVBP model, it is structured to foster enhanced care quality and efficiency. During its five-year testing phase, it displayed an average 4.6% boost in performance scores and generated $141 million in annual savings. The expansion of this model is anticipated to maintain the downward trend in Medicare spending while improving patient care quality. Notably, agencies with superior performance under this model are reaping payment increases, while those performing lower are not.

Financial Challenges Home Health Care Agencies Face in 2023

Running a home health agency in 2023 comes with several financial challenges due to the newly implemented regulations and evolving industry dynamics.

  1. Decrease in Home Health Payments: According to the new payment rules implemented this year, home health payments have decreased by 4.2%. This decrease in revenue can significantly impact the financial stability of home health agencies.
  2. Fixed Loss Reduction: The fixed loss, which used to be 0.08%, has been reduced by 2% this year, further affecting the financial footing of these organizations.
  3. Implementation of OASIS-E: The implementation of the OASIS-E assessment required considerable investments in training and technology. Ensuring that this system is correctly implemented and utilized has been a financial hurdle for many agencies.
  4. Home Health Value-Based Purchasing Model (HHVBP): The introduction of the HHVBP model shifts the focus from the volume of services provided to the quality of patient care. Transitioning to this model requires investments in staff training, process improvements, and potentially new technology.
  5. Patient Satisfaction Influence on Payments: The new Payment Score Timing (PST) introduced in 2023 has made patient satisfaction a significant factor in determining payments. Agencies must invest resources into improving patient satisfaction to avoid payment reductions.
  6. Increased Regulatory Compliance: The industry has seen an uptick in regulatory oversight, requiring additional resources to ensure compliance, which can add to the financial burden.
  7. Net Reduction in Payments: As per the new rules, there was a net reduction in home health payments by $810 million in 2023 compared to the 2022 baseline. This drastic decrease has had a significant impact on the financial health of these organizations.
  8. Economic Instability: Broader economic challenges, such as inflation and potential economic downturn, can affect an agency’s profitability and financial stability.
  9. Cost of Technology: The increased reliance on technology for patient care, record keeping, and regulatory compliance demands significant investment.
  10. Staffing Challenges: The industry has been facing a shortage of qualified healthcare professionals, driving up wages and recruitment costs.

These financial challenges require strategic planning, efficient operation, and effective resource management to ensure the financial viability of home health agencies in 2023.

In summary

Financial management, effective budgeting, and readiness to adapt to regulatory changes, such as OASIS-E in 2023, are crucial for the success of home health agencies. Budgeting acts as a roadmap, guiding agencies in financial planning, resource allocation, and decision-making. A comprehensive budget, together with regular monitoring of Key Performance Indicators (KPIs), identification of cost-saving measures, improved billing processes, staff development, advantageous contracts, and regular financial reviews, is key to financial success. Adapting to regulatory changes, especially those impacting reimbursement rates, is equally crucial. The advent of OASIS-E in 2023, which will affect case-mix adjustment and Home Health Resource Groups (HHRGs) calculations, underlines the need for agencies to understand and adapt to these changes for optimal reimbursement. The focus should remain on providing quality patient care while maintaining financial sustainability.

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