PlayMaker Health reveals industry home health, hospice, and MA benchmarks
NASHVILLE, Tenn. – March 31, 2020 – PlayMaker Health, the industry-leading post-acute sales enablement and business intelligence platform, today announced its Q3 2019 Post-Acute Market Data Update, containing Home Health and Hospice data released in February 2020 with claims through September 30, 2019.
“The beginning of 2020 has brought the official implementation of the new Patient-Driven Grouping Model (PDGM), and providers are finding themselves navigating new waters. It is more vital than ever to understand the competitive landscape and gain expanded visibility into market trends,” says Holly Miller, chief revenue officer of PlayMaker Health. “As our clients continue to innovate to meet those regulatory requirements, it’s imperative for us to evolve by proactively delivering and executing more in-depth benchmark analytics and real-time insights so providers and their sales teams can adapt quickly.”
Medicare Advantage (Q3 2018 -Q3 2019)
- National Volume: Patients are using Medicare Advantage (MA) at a rate of 29% of Medicare
From Q3 2018 to Q3 2019, the growth in Medicare Advantage enrollment as a percentage of Medicare is on par with national trends and is expected to continue as 28 additional plans become available in 2020. The percentage of patients utilizing MA for paid services is also expected to grow as more patients adopt condition-specific MA flex benefits.
Q3 2019 Home Health Insights
Year over Year Growth
- Nationally: 3.38% decline in home health admissions, based on volume
- By State: Range of 15.6% decline to a 12.6% increase with eight states over 0%
The benchmarks validate the transition from traditional Medicare to Medicare Advantage and demonstrate the ongoing enrollment increase in Medicare Advantage utilization.
PDGM Admissions Source
- Nationally: 59.9% of home health referrals were from community sources, while 41.1% of referrals were from institutional sources
- By State: 40.2%-76.6% of home health admissions came from community sources
Because institutional admissions are reimbursed at a higher rate under the PDGM payment model, it is essential to understand where admissions are coming from, so agencies can make minor mix adjustments where possible to positively impact cash flow.
Admissions from Questionable Encounter Codes
- Nationally: 5.4% of admissions included codes no longer billable under PDGM
- By State: 2.3% -10.7% of home health admissions included questionable codes
These benchmarks serve as a reminder that Questionable Encounter Codes (QECs) will not be paid under PDGM. Agencies must continue to educate referral sources on alternative diagnoses to ensure the services they are providing are reimbursable under PDGM.
Q3 2019 Hospice Insights
Year Over Year Growth
- Nationally: 3.8% increase in hospice admissions, based on volume
- By State: Range of 7.7% decline to a 19.3% increase in hospice admissions
Average Length of Stay (LOS)
(*PlayMaker Health LOS calculation only includes patients who have discharged)
- Nationally: Average hospice length of stay was 55 days, with a median of 16 days
- By State: Average hospice length of stay ranged from 35 to 72 days
The median value indicates that 50% of hospice patients were on hospice service for 16 days or less. Both of the LOS benchmarks demonstrate a significant opportunity for patients and families to receive the full benefit of hospice from a longer length of stay.
Number of Visits in Last Seven Days
- Nationally: Average number of visits was 16
- By State: Average number of visits ranged from 8 to 26
As the impact of PDGM, the COVID-19 pandemic, and consolidation continues, home health and hospice agencies who proactively leverage a deeper, more in-depth view of actionable competitive and referral data will be the ones who thrive. PlayMaker Health’s Market Insights, the next evolution of the platform, already in use with several customers provides both predictive and personalized analytics, delivering the performance and business intelligence agency leadership requires to strategically differentiate and grow market share.
“Our ability to provide actionable insights on claims data trends empowers our clients with a competitive advantage that goes beyond simply purchasing market data,” says Gregg Boyle, CEO of PlayMaker Health. “We will continue to enhance the platform and work toward real-time data to deliver more value to our client partners as they work to expand their business.”
PlayMaker Health clients are encouraged to contact the Client Success Team with any questions at firstname.lastname@example.org.