The Skilled Vs. Private Duty Conundrum

PIC - MEDICARE CARDSkilled home health care is not new in America.  For decades companies have obtained certification after a survey process and obtained Medicare provider  numbers.  Generally a recently discharged hospital or nursing home patient or someone with a new and/or chronically limiting diagnosis can benefit from the visits of nurses, medical social workers and rehabilitative therapists.  Its all a fee-for-service arrangement these days and services rarely last longer than one, (1) certification period, often 4 to 8 weeks.

This makes the marketing relentless.  Reminds us of the comments made by members of the U.S. House of Representatives who have to be re-elected every two (2) years.  The campaigning literally never stops and often they are relying upon the same voters with the hope that someone else’s message does not steal too many votes away.

PIC - DOCTOR WRITING ORDER FACELESSMost skilled agencies also rely on referrals from physicians and others with whom they have a relationship, often relatives.  Of course in the event that medical practice takes a turn or its dynamics change in any way, referrals could dry up.  These is also no shortage of unscrupulous operators looking to pay physicians for referrals and those who bill for services to someone who never received them.  Click Here for examples of how far this has gone.

Add to the challenges facing skilled agencies the frequency with which hospitals seek to make usage of their own home health agencies which shuts out the independent provider.  Put it all together and you end up with what could be a rather challenging business model.  Some agencies hate for a patient to go into a hospital, knowing the likelihood that when they come out another agency will be put in place.

Private duty home care is quite different.  Having spent close to twenty, (20) years in this business I came to appreciate one of the foremost advantages, building long-term relationships with those you serve.  While you may serve a skilled patient and be Medicare reimbursed for eight, (8) weeks and never see them again, I served one, (1) case for 8.5 years.  By then you are truly family.

With much pride I supervised the care of the late Anne Hodge for 8 1/2 years.  During that time I probably utilized 4 skilled agencies for differing needs of her’s. They were in and out!

Of course those served long-term, often 4-24 hours per day can span the range of the medically fragile elderly, disabled veterans, those injured in auto and work accidents and dementia sufferers.  Payment may be via Medicaid waivers, a client’s own assets, long-term care insurance policies, the Veterans Administration or in some cases Title III funds.

With some twenty-four, (24) hour cases the bi-monthly earnings can be greater than what you earn in an entire certification period on certain skilled cases as Medicare cuts, cuts and cuts.   This also has some skilled agencies second-guessing their choice of business models.

A number of skilled agencies have decided to explore the private duty side, even setting up new companies in order to have two, (2) divisions.  For many its a question of survival.  Click Here for a brief presentation about a few private duty success elements.

PIC - NURSING HOME DISCHARGESkilled home health care was supposed to be an extension of the hospital for the discharged patient.  Ultimately the goal was to assist a person to remain medically stable in their own homes and to heighten the likelihood of compliance with physician orders and minimize the likelihood of self-neglect.  This is why some hospitals have their own agencies; for them its about care along the continuum.  Of course it also helps to keep the patient rotating through their system.  Hospitals are a business too.

Private duty companies still need standards, professional operating procedures and the credibility that comes from accreditation.  Click Here for accreditation information.  Under no circumstances should anyone entering feel that strategic planning and accountable execution of services are not warranted.

Those rendering professional guidance should ensure that a new provider is put on a path to the most credible delivery of services.

No one is saying that the day of skilled in-home services are over.  However, with more clinical model small-scale group living cropping up and private duty companies offering a wider variety of services, their dominance in the marketplace will likely continue to wane and the challenges we just referenced will intensify.

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