Senior man stands with visiting nurse

National Association for Home Care & Hospice President William Dombi presented a rosy outlook on Thursday, predicting home healthcare census will exceed pre-pandemic levels next year.

William Dombi

“The COVID pandemic has painted a very positive position for home care in the delivery of healthcare services, demonstrating their essential worker status, frontline capabilities and also the ability to care for very complex patients,” Dombi said during a webinar on the state of home health.

Dombi pointed to increased demand for in-home services by an aging population coupled with strong industry support in Washington as tailwinds that will help the nation’s more than 11,600 home healthcare agencies thrive in 2022 and beyond.

Moving through Congress now is the Build Back Better plan, which would provide $150 billion in funding for home-and-community-based services in the form of increased Medicaid reimbursements to states, $1 billion in planning grants to develop the caregiver workforce and $90 million to train hospice and palliative care workers. Dombi was optimistic Congress would pass the reconciliation package by the end of the year.

He was also cautiously optimistic that the Centers for Medicare and Medicaid Services would extend the moratorium on automatic Medicare payment cuts to providers, known as sequestration.

“Intelligence that we have at the moment is that there is in development a healthcare extenders bill to extend some of these protections for providers and beneficiaries that are expiring at the end of the year,” Dombi said.

Despite his sunny forecast, Dombi said some clouds remain on the horizon for home healthcare agencies, including a workforce shortage that has been exacerbated by a looming federal vaccine mandate for healthcare workers. He said NAHC will be developing a public awareness campaign in the new year that will highlight the value of caregivers and help drive recruitment for the industry.

The national rollout of home health value-based purchasing is another wild card. The rule, which is intended to deliver better, less costly care, was supposed to go into effect in 2022, but has been delayed until 2023 to help agencies better prepare for the change.  Payment adjustments are based on how well home health agencies perform against each other. Those agencies that overperform receive upward payment adjustments; those that underperform are penalized. NAHC has questioned the fairness of that approach.

“We are concerned that they are shifting to a nationwide kind of competition instead of statewide because there are practice differences across the country,” Dombi explained.