Specialty Solutions Spotlight: Shortages and Rising Costs Influence on Home Health in Workers’ Comp

How do specialty solutions help injured employees receive home health care despite shortages?

When injured employees are struggling with a difficult transition home, they need compassionate healthcare professionals, who are highly skilled and trained in caring for those who may have experienced a severe or life-altering work injury.

Today, there are significant challenges, including persistent staffing shortages, facing home health, which could affect the industry’s ability to meet the needs of injured employees. One survey done by the Pennsylvania Homecare Association found that 93% of Medicare-certified home health and hospice agencies and 98% of licensed agencies said they had refused referrals during the past year. Nursing services are also becoming more expensive overall. When shortages exist, nurses need to be enticed to take shifts, and when they can’t vendors are forced to go outside their network to look for replacements.

In addition, staffers who schedule shifts have to make dozens of calls to vendors only to be told over and over there are no available nurses for a request. This adds up to valuable time lost that could have been spent handling other patients. To combat delays, financial incentives are becoming part of the solution to draw a balance between higher prices, staff, patient, and employer impacts. When the average cost of a 3-day hospital stay is around $30,000 offering an extra dollar an hour for home health services post-surgery may be cheaper overall and lead to a better outcome for the injured employee.

Effective cost containment requires coming up with creative solutions that include evaluating the actual needs of injured employees to meet somewhere in the middle. For example, with a request for a Registered Nurse (RN) for 24 hours a day for three weeks after a surgery an experienced specialty program like Apricus might determine that 12 hours with a Licensed Practical Nurse (LPN) and 12 hours with an RN could open the pool of available nurse resources with a similar outcome.

To proactively address such issues, payers can partner with Apricus to access our broad national network of home health and home care agencies.

Apricus assists in matching the injured individual’s medical needs to the appropriate skill level required. If necessary, home care coordinators will speak to the treating physician or case manager to get clarification on patient needs. They will assess and facilitate total home care, as well as specialty service requirements, in a comprehensive plan. If possible, they will also speak to the injured employee and family members to assess social, lifestyle, and environmental factors that can affect the match. We also ensure that the agencies we work with have a track record of dependability and consistency, and appropriate policies in place.

Over time, our care coordinators may consult with the treating physician and case manager to see whether the caregiver skill level can be reduced—perhaps from a nurse to a home health aide which can help save significant costs, especially over the life of a claim requiring 24/7 care.

Across its many agency partnerships, Apricus has access to a deep bench of expert home health professionals. Due to the volume of business and favorable terms it provides agency partners, we can obtain prioritized handling of cases. In the end, you can avoid the scenario where you receive a frantic call from a family member, saying a nurse or home health aide has not shown up. Instead, gaps and disruptions in home care are avoided.

This information is meant to serve as a general overview, and any specific questions should be fully reviewed with a health care professional or specialty service provider.

To make a referral for this service and others, call us today at 877.203.9899 or send an email to referrals@apricusinc.com.