Top 5 Challenges Facing Home Health Care Agencies

Guiding The Home Healthcare Industry to Value-Based Purchasing Thru Clinical Documentation Improvement (CDI)


It’s no secret that growth in the home care industry is on the rise. More new agencies emerge on the scene every day. In fact, it’s one of the largest growing trades nationwide, with individual and franchise businesses popping up from coast to coast.  But, it’s also one for the most difficult business opportunities to get a handle on.  Partly because of the tremendous growth and partly because of the numerous fundamental changes occurring simultaneously, the home healthcare industry could be classified as particularly volatile (Kenyon Homecare Consulting, 2014). But despite the challenging nature of the industry, there are some bright spots on the horizon. Most of you agree, for example, that the movement to value, the rise of consumerism, and the use of new technologies could transform the industry for the better—it’s just a matter of turning that potential into reality (Brown, 2014). Here are five of the heaviest hitters:

Increasing Demand
America is home to an aging population. By 2020, an estimated 17% of the entire population will be 65 or older. That’s 50 million men and women who will be increasing their reliance on the healthcare industry as a whole (Halvorson, 2013). With more aging individuals preferring to receive care in the comfort of home, many home care agencies will struggle to meet the growing demand with qualified staff and capable caregivers (Kenyon Homecare Consulting, 2014).

Advances in Technology
The home health care industry is in the middle of a tremendous technological revolution. In fact, figures released by Lucintel predict over $29 billion in growth by 2017. Older, outdated systems are being replaced with faster, less-intrusive and more powerful equipment. And the home health care industry is struggling to keep up.  Learning how to correctly and effectively use these new gadgets takes a considerable investment of time and effort.  While some agencies are leading the pack, others are lagging behind – put off by either the added cost of the added hassle (Halvorson, 2013).

Political Pressure
With the ongoing debate about who is right and who is wrong in Washington raging, healthcare is a big fat target for political movers and shakers (Halvorson, 2013). With a Trump Presidency political pressure is at an all-time high. President Trump has promised a repeal of the Affordable Care Act (Obamacare) but, has not outlined how or when. In a debate Tuesday night, Senator Ted Cruz made it clear that nothing is happening yet (Newkirk, 2014).

Accountable Care Organization (ACO)
Establishing an accountable care arrangement with a payer means entering into a total-cost-of-care system that rewards or penalizes based on the total cost of a patient population. These complex arrangements are growing even faster than bundled payments. There were approximately 500 ACOs as of year-end 2013. CMS announced 123 new ACOs that would start in January 2014. According to a Premier survey, ACO participation has almost quadrupled since spring 2012, and should continue to grow with participation projected to double by the end of 2014 to 50 percent of all hospitals participating (Brown, 2014).

Home health agencies should be encouraging discussions among provider leaders of all levels of the care continuum. Patient ultimate outcomes should be shared by all providers. Establishing those mutual patient outcomes is a primary step in a strategic alliance between ACOs and PCMHs. It may be wise for some organizations to ease into the ACO world incrementally by starting with P4P and bundled payments. Entering into shared savings agreements is one of the main strategies hospitals must pursue to survive in this environment.

Value-Based Purchasing
However, the number one most challenging factor impacting Home Health Care agencies is the transition to value-based purchasing. Moving to value-based reimbursement continues to be a top challenge, according to our survey. While most respondents said their organization has at least started shifting its operations toward value, nearly one out of every five said they have not yet started transitioning and are “waiting to see what works for other organizations.”

How does Select Data improve your Agency’s quality?

Select Data improves your Agency’s quality through our Clinical Documentation Improvement (CDI) system. Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patient’s health.

Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider.

For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW!

You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information.


Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from:

Brown, Bobbi (2014) Healthcare Payers and Providers: The Best System for Process Improvement. Retrieved from: Top 5 industry challenges of 2016

Halvorson, Chad (2013). Top 7 Challenges Facing Home Health Care Agencies in 2013. Retrieved from:

Kenyon Homecare Consulting (2014). Top 5 Challenges Facing Home Care Agencies in 2014. Retrieved from:

Newkirk, Vann (2017). Republicans Don’t Know How or When to Repeal Obamacare. Retrieved from:

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