The nation’s 3.3 million home healthcare workers are front-line heroes in the war against COVID-19. The impact of COVID-19 and the healthcare workforce has been devastating in all sectors of the healthcare industry. Home health agencies are facing severe declines in revenue and workforce. Physicians have closed approximately 243,000 offices average and have suffered a 60% drop in patient volume. More aides and personal care workers are needed but lack Personal Protective Equipment. Stretched by challenges, new regulations and waivers are giving some hope to the home care industry.

A survey by the National Association for Home Care and Hospice between April 6 and April 17 to 1119 home health agencies (HHAs) across the U.S revealed the devastation of reduced revenue, patient’s refusal to accept physician-ordered care, and a loss of the workforce.

Reduced Revenue

Two factors contributed to revenue reductions: decreases in new patient admissions and patient refusal to accept all physician-ordered care to avoid virus transmission risks.

  • 79% report decreases in admissions, with 56% indicating reductions greater than 15%. 37.3% reported reductions of 20%.
  • Depending on location, higher losses of new patients were experienced. 92.8% of HHAs in New York and New Jersey report decreases and 75% indicate a decrease of 15% or greater. 57.1% indicate a decrease of greater than 20%.
  • 9% of HHAs report patients’ refusals of care.

85% of respondents report revenue reductions with a median reduction between 15 and 20%.

  • 53% report reductions of 15%.
  • 7% report reductions of 20%.
  • New York and New Jersey have higher reductions. 67.9% with greater than 15% and 46.3% greater than 20%.

Physician Ordered Care Refused

Payment reductions through the Low Utilization Payment Adjustment are a result of the patients refusing physician orders. LUPA rates reduced average reimbursement by approximately 75% or $1500 over a 30-day period.

  • 52% of HHAs with below national average LUPAs in March 2019 report at least a tripling of LUPAs in March 2020.\
  • 67% of all HHAs report at least a doubling of LUPAs.

Workforce Loss

Revenue reductions and low care demand have cost HHA employees jobs.

  • 54% of HHAs report reductions in clinical staff.
  • 8% report reductions in administrative staff.

Home Health Agencies’ Future Concerns

The top three concerns from the survey respondent’s future are:

  • Significantly reduced revenues.
  • Patient safety with an inadequate supply of Personal Protective Equipment (PPE).
  • The inability to fully utilize telehealth services as an adjunct to in-person care that is reimbursed by Medicare.

On April 29, 2020, CMS issued temporary waivers and regulations for home health agencies to better respond to COVID-19.

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