As more operators look for new ways to incorporate at-home services into their model of care, SNF-at-home, while growing, may still have a long way to go.
Securing reimbursement continues to be the most difficult component for SNF-at-home in a managed care environment, according to Contessa Health CEO Travis Messina.
“I do think the lack of reimbursement has created some challenges as well with the adoption because we don’t have a reimbursement source and it’s hard to justify the investment necessary to treat these patients,” he told Skilled Nursing News.
At-home care giant Amedisys, Inc. (Nasdaq: AMED) acquired Contessa last summer in the hopes of expanding its capabilities to reflect growing market demands and evolving patient preference for higher-acuity in-home services.
Overall, there have been 520 admissions for Contessa since the completion of the acquisition, as Amedisys has seen growing interest in its SNF-at-home model, according to Christopher Gerard, Amedisys president and COO of Amedisys.
While Messina is excited to see how SNF-at-home grows in 2022, he felt there may always be a role for SNFs in post-acute care.
Home recovery care programs have continued to expand in acute and post-acute care since the first pilot programs were approved in 2018. The Centers for Medicare & Medicaid Services (CMS) furthered this trend with the acute hospital care at-home waiver, announced in November 2020, which provided hospitals unprecedented regulatory flexibility to treat patients in the home.
Since CMS announced the Hospitals Without Walls waiver in late 2020, more than 175 hospitals from over 80 health systems nationwide have applied in order to provide acute care in the home, with some pushing their model into new states and skilled nursing facilities.
Messina said that the “overwhelming preponderance” of services that Contessa provides in its growing SNF-at-home program are largely therapy-based.
“The patients that we are treating are those that have suffered from medical conditions that have required extensive lengths of stay in the hospital or those that are recovering from surgical procedures where they have limited mobility,” he explained.
Calling 2020 a ‘watershed moment’ for Contessa as the pandemic furthered the need for more robust offerings of hospital-level care at home, 2021 proved to be even more significant for the company, Messina said.
“There hasn’t been until recently, a significant pressure point that required the innovation within the healthcare system to pursue SNF-at-home in an accelerated manner,” he said.
Currently available in its Wisconsin and Pennsylvania markets, Messina plans to add the program to almost all of Contessa’s markets.
Messina said several factors are contributing to SNF-at-home’s growth in 2022 with Covid, staffing shortages and patient preference all pushing the model to new heights.
“Beds just simply aren’t available so that’s creating opportunity, especially for those higher acuity patients and Medicare Advantage plans that need SNF level of care,,” he explained. “The entities responsible for reimbursing for these services – mainly Medicare Advantage plans – they want to create an alternative for their members.”
The bottleneck of patients currently seen in hospitals across the country is further fueling the model’s growth, Messina said.
“Once a patient is ready clinically for discharge, you need to discharge that patient, and right now, because they have no place to send them and they don’t have those support services from a clinical delivery perspective, they can’t send the patient home so they’re sitting in the hospital,” he added.
With staffing challenges creating further capacity issues on the health care system, demand is growing for the service, which is why Messina expects significant growth in the platform in the years ahead.
After acquiring SNF-at-home company Contessa Health for $250 million in July, Amedisys Inc. (Nasdaq: AMED), one of the largest home health and hospice providers in the country, thinks the service line is poised for growth in 2022.
“In the coming months, we expect a number of new health plan contracts for the hospital-at-home and SNF-at-home models, increasing total addressable patients,” Gerard said during the company’s earnings call last month. “We continue to remain encouraged by Contessa’s robust pipeline of additional health system opportunities.”
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