Referral drought: Find new sources of business
Hospitals' stream of patients beginning to dry up
By Kevin O'Donnell, MIM
Chairman, Healthcare Resources of America
Lewisville, TX
Deborah A. Randall, Esq.
Partner, Arent Fox Kintner Plotkin & Kahn
Washington, DC
As market changes fueled by managed care and consolidation cut hospitals out of being the major source of referrals to home care, hospital-based home care agencies must take immediate action to secure other sources of business.
As hospitals are compelled to redesign how they deliver patient care resources to compete with their conventional inpatient business, they encounter new markets and new competitors. In the home care arena, hospitals find a fragmented array of national, regional, and local providers that have previously viewed their local hospitals as a primary customer rather than as a direct competitor.
So many types of care now are being done outside the hospital in various settings, in lieu of hospitalization altogether. This is cutting hospitals out of being a referral source to home care, as well as managed care contracts, which lock consumers into using the providers who serve the managed care organizations.
Agencies must be aggressive
Hospital-based home care agencies must take immediate action if they're to stay in the game. They need to align themselves with other outpatient procedures and integrate their services within its hospital, and with other home care providers in the community, instead of waiting for Medicare business to come their way.
They also need to market directly to HMOs, and to sell home care on their own. Provid-
ing home care to managed care organizations means a new world order for home care providers.
Increasing numbers of patients will be treated in alternate-site settings without ever being admitted to a hospital in the first place. This turns physicians' offices and case managers working for payers into the more common point of sale for home care providers now.
Sophistication of home care inevitable
Hospitals that truly transform themselves into integrated health care delivery systems will not look like the hospitals of the past or present. They will have redirected their human and technological assets into an increasingly ambulatory care environment.
In this new environment, home care providers will have to mature and become more sophisticated, by positioning their services as front end providers of care, rather than simply posthospitalization care providers.
In an inpatient-focused system, the hospital social services or discharge planning departments are the filter point for home care referrals. Currently, it is not uncommon for medical social workers or discharge planning nurses to spend 60% to 70% of their time coordinating community home care resources for pending discharges.
We are already seeing the hospital role in discharge planning undergo a phase of redefinition and redesign. As external and internal pressure to reduce hospital lengths of stay have progressively accelerated, the importance of the discharge planning function has increased tremendously.
Get involved in new discharge structure
Hospital-based home care administrators need to be aware of how the discharge plan-ning process is changing in hospitals because these changes affect home care. Home care services and products are no longer limited to patients upon discharge from a hospital, so many hospitals are developing an internal case management function that encompasses their utilization review, discharge planning, and social services departments. If home care doesn't involve itself in these redesigned functions, it will lose out.
Hospital-based home care providers need to understand that the heat is on hospitals to be able to redesign both how and where they deliver care.
Competition with HMOs
In many markets, hospitals will soon not just be competing with other providers, but they also will be competing with health insurance companies as sellers of health maintenance organization (HMOs) products.
In metropolitan markets, hospitals are consolidating and aligning to shore up the oversupply of hospital beds and the demand for risk-based, comprehensive care.
The fact that hospitals possess the clinical resources to compete in their changing health care marketplace does not mean they will be able to compete in business segments such as home care, which require entrepreneurial management skills.
Hospital-based home care administrators should jump on this opportunity to help their hospitals' and health systems compete by strengthening their home care components.
[Editor's note: Kevin O'Donnell can be contacted by telephone or mail at Healthcare Resources of America, 510 Oakridge, Lewisville TX 75607. Telephone: (817) 241-5035. Deborah A. Randall can be reached at Arent Fox Kintner Plotkin & Kahn, 1050 Connecticut Ave. Washington DC, 20036. Telephone: (202) 857-6000.] *
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content