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Home health care a growing Lowcountry need
By Jessica Johnson
Contributing Writer
As the Lowcountry population ages and as hospital stays get shorter, the need for certified home health care is growing.
While the number of certified home health care agencies across the area have remained stable, and will likely remain unchanged, the need within those agencies is growing.
Certified home health care agencies provide skilled nursing care in the home. Doctors make the referrals, which occur most often after a patient has been released from the hospital.
“As we continue to see shorter hospital lengths of stay, there will be a greater need for home health care,” said Linda Cantu, statewide director for Home Health Management Inc.
But Cantu said she sees individual agency growth rather than an increasing number of certified home health care agencies.
There are 79 licensed agencies in South Carolina. In 1998, 13 such agencies served the tri-county area. Now 10 agencies are licensed to serve Charleston, Berkeley and Dorchester counties. South Carolina is a certificate of need state, meaning home health care agencies need to show a deficit in the community before increasing the number of licensed facilities.
Historically, South Carolina’s home health care patient numbers have grown from 17,000 served in 1980, to 83,000 served in 2004. However visits per patient have dropped.
Albert Whiteside, director of DHEC’s Division of Planning and Certification of Need, said the same number of South Carolina agencies made 4 million visits to patients in 1997 and just 1.2 million visits to patients in 2003.
The decreased number of visits came after Medicare—the primary payer of home health care visits—changed its reimbursement formula in 2000.
In 2000, instead of Medicare reimbursing agencies a flat fee per visit, Medicare would reimburse a flat fee per diagnosis, regardless of the number of visits.
In 1997 11,000 agencies were licensed in the United States. That number steadily declined to 7,000 in 2003.
Home health care veterans left the field, Cantu said.
“Those who made it through came out better and stronger. We are doing a better job I think,” Cantu said.
South Carolina’s state health plan hasn’t expected agency growth, which is why Cantu thinks agencies will see individual growth as the area grows and the population ages.
Staffing shortage
The demand for staffing is one of the issues that local home health care agencies continue to face.
A home health care professional dropping off a resume at Home Health Management of the Low Country May 4 barely made it to her car before an administrator could run her down.
“We suffer from the same nursing shortage everyone else is,” Cantu said.
While patients served by certified home health care agencies fluctuate, Cantu said agencies do have less nurses and therapists to work with patients.
Home health care agencies are employing a growing number of nurses and therapists. The U.S. Department of Health and Human Services reported 548,000 home health care aids were employed in 2000. Four years later, the number of employees grew to 750,000.
“Staffing is critical,” Cantu said.
So much so that Home Health Care Management has had to turn patients away and refer them to other health care agencies in the area.
Chris Richardson, marketing representative for Winyah Home Health Care for the Lowcounty, an Amedysis company, said all three of Amedysis’ Charleston offices continually hire staff.
“Our patient load also continues to increase,” Richardson said.
New Medicare payment method
Soon, the Center for Medicaid and Medicare Services plans to reimburse home health care visits on a payment-based-on-performance method, which will likely affect the industry, but no one is sure how. The new reimbursement method was scheduled to go into effect in 2007, but it may be pushed to 2008, said Pat Thomas, director of Home Health Services for DHEC.
“Pay for performance is going to be a big one. They haven’t said how they are going to do it,” Thomas said.
Discussions have included putting a percentage of each home care patient’s Medicare payment into a pool. Each year, the agencies that performed better would receive funds from the pool.
“The lower performing agencies will pay the higher performing agencies,” Thomas said.
However, the Center for Medicaid and Medicare Services has not decided what those performance measures will be, Thomas said.
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