Medicare Advantage (Q4 2018 -Q4 2019)
- National Volume: Patients are using Medicare Advantage (MA) at a rate of 34% of Medicare, a 4% increase over the prior period
From Q4 2018 to Q4 2019, the growth in Medicare Advantage enrollment as a percentage of Medicare grew steadily. This upward trend is expected to continue through 2020, in part, due to the highest number of plan options for the average beneficiary in a decade. Ms. Miller told us that this number varies greatly by state. Mississippi, for example, has increased more than 13 percent during this period while Florida is leveling off at a one percent growth rate. “It may be that Florida has reached a temporary saturation point or his a ceiling that the rest of the states will one day experience. Or, more likely, it is a reflection of efforts by health plans to push Medicare Advantage in one area more than another.
Q4 2019 Home Health Insights
Year over Year Growth
- Nationally: 2.45% decline in home health admissions, based on volume
- By State: Range of 19.0% decline to a 19.0% increase with twelve states over 0%
Similar to Q3 2019, the benchmarks continue to validate transition from traditional Medicare to Medicare Advantage and demonstrate the ongoing enrollment increase in Medicare Advantage utilization. “Along with admissions, MedPAC reported 3.6 percent fewer HHAs on 12/31/19 than on 12/31/18,” Miller added. “That may not seem like a lot but it means more than 450 agencies closed their doors or were acquired.”
PDGM Admissions Source
- Nationally: 60.0% of home health referrals were from community sources, while 40.0% of referrals were from institutional sources
- By State: 41.0%-75.9% of home health admissions came from community sources
Slight increases in institutional referral sources from Q3 2019 indicate agencies are actively preparing for PDGM and the higher reimbursement rates from hospital discharges, per CMS. “This is where 2020 data will tell us the most,” she continued. “The slight increase in Q4 is likely to become a major factor under PDGM.
Q4 2019 Hospice Insights
Year Over Year Growth
- Nationally: 6.0% increase in hospice admissions, based on volume
- By State: Range of 2.8% decline to a 19.8% increase in hospice admissions
Average Length of Stay
(*PlayMaker Health LOS calculation only includes patients who have discharged)
- Nationally: Average hospice length of stay was 56 days, with a median of 16 days
- By State: Average hospice length of stay ranged from 32 to 72 days
LOS benchmarks remained the same in Q4. Both benchmarks continue to demonstrate the opportunity for patients and families to receive the full benefit of hospice from a longer length of stay. “We will have to wait for 2020 Q1 and Q2 data to be sure, but it appears that states with decreased admissions or slower than average increases are seeing more hospices offering palliative care services,” Miller added.
A final factor CRO Miller advises HHAs and hospices to watch for is the effect of both PDGM and the COVID-19 pandemic on sales and marketing teams. “They are now virtual,” she explained, “which means they must leverage data at an unprecedented pace. For this reason, the next evolution of our platform, Market Insights, developed as a response to client feedback and market demand, will have more value than we originally anticipated. It will give marketers greater access to mobile-first, fully searchable, 360-degree physician referral profiles. They will be able to build a highly targeted book of business in minutes.”
PlayMaker Health CEO Gregg Boyle added, “As agencies begin to plan beyond the pandemic, they need in-depth data visibility and efficient sales and marketing processes to maintain strong referral relationships and accelerate opportunities. Our focus for the future is to continue to innovate quickly by giving agencies near real-time market and business intelligence and accelerate development to meet and exceed client expectations.”
About PlayMaker Health
For 12 years, PlayMaker Health has provided a post-acute growth platform for more than 2,300 home health, hospice, HME, Infusion, and long-term care agencies and organizations nationwide. PlayMaker delivers comprehensive and current claims data within its purpose-built CRM platform, including Medicare Parts A and B, Medicare Advantage, Medicaid, and Commercial. It also offers EMR integration and processes CMS data through proprietary algorithms before embedding it in client software.