Last week I had the privilege of attending two events that support leadership and advocacy for the post-acute sector, and really got to hear first-hand about the staffing issues and reimbursement concerns hitting this sector – including skilled nursing, home health, hospice, therapy and more. The first is Home Care 100 put on by Lincoln Healthcare Leadership, and the second was Virtual Hill Day coordinated by the National Association in Support of Long-Term Care.

Staffing Issues


The pandemic has certainly created disruption in all of our lives, but in particular it has exacerbated the staffing issues for the healthcare industry. As hospitals start to experience staffing issues, they are using temporary help or may not have enough staff to accommodate the volume of patients. Because of this, we are learning that lower acuity care can be provided in the home. This combined with the fact that more seniors are chronically ill than acutely ill, demand for home care services continues to climb. Yet home health and therapy organizations are experiencing higher than ever numbers of clinicians, nursing staff and therapists leaving the profession. This is not just pandemic aftermath, it is a permanent crisis that is going to affect access to care.

Becker’s Hospital Review reports, “Amid increased demand for healthcare workers, an analysis of data provided by labor market data company Emsi found that there will be a critical shortage of 3.2 million healthcare workers by 2026.”

While staffing was the #1 topic of discussion in almost every session I attended, there really is no clear solution. We cannot just “will” people to return to or enter these professions. However, encouraging words shared with some tangible recommendations for organization to hire and retain clinicians:

  1. Focus on employing a community and create a positive culture amidst difficult times
  2. Implement better engagement and onboarding for new staff members
  3. Don’t succumb to the pressure of high bonuses and wage inflation – wait it out – the reimbursement levels are not there to sustain it


Home care and home health agencies (HHAs) provide services and supports that help individuals remain safely in their homes. Home health refers to clinical services provided in the home, such as occupational therapy, physical therapy, and nursing, as well as personal care assistance services from aides that may supplement the necessary clinical care. Home care is not paid for by Medicare and is optionally funded by state Medicaid plans or through private-pay.

Additionally, more and more seniors are moving to Medicare Advantage instead of Fee-for-Service, which pays much less and often-time with delayed payment.  “If they continue to pay us the way they are now, it is an untenable situation,” said Paul Kussero, CEO and chairman of Amedisys in a recap podcast by McKnights. “Their members are demanding home health, most of their members want to be taken care of in the home, at the same time they can’t continue to pay us a pittance and still expect good quality.”

Panelists in the “Home Care Post-Pandemic Outlook” discussed the bleak outlook for home health reimbursement. “We’re getting our clocks cleaned,” said Bruce Greenstein, Chief Strategy and Innovation Officer, LHC Group. “Our home health services are being provided at a commoditized price- and we’re paid very little for what we do – and there is little on the horizon for Home Health as Medicare Advantage grows – as it stands today.”

Home health organizations can join forces to negotiate with Congress on telehealth and overall reimbursement levels – but with the gridlock in DC right now, Accountable Care Organizations (ACOs) were discussed as a way to increase reimbursement – organizations would have to take on full risk, support risk, or add value to the hospital.

As the Home Care 100 event was wrapping up, NASL’s Virtual Hill Advocacy Day was just kicking off.  On February 9th, NASL Advocates joined together virtually an effective day of advocacy on two of their top legislative priorities for 2022: the 15% therapy assistant cut and telehealth expansion under the Medicare program after the COVID-19 public health emergency (PHE) ends. Overall, 57 NASL Advocates participated in a total of 53 virtual meetings, and eight of those meetings were with Members of Congress, while the remaining meetings were held with Congressional staff.

According to a recent communication from NASL, responses received were generally positive:

15% therapy assistant cut

Most offices we met with sympathized with the issue and understood staffing crisis has hit the long-term care sector the hardest, but some offices were not familiar with the 15% assistant cut issue. NASL Advocates are seeking a Senate champion to lead the effort in the upcoming Continuing Resolution (CR) with the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R. 5536), which would temporarily delay the impact of the impending 15% therapy assistant cut to 2023 and provide for an exemption to the policy for rural and medically underserved areas. A number of Senate offices seemed interested in possibly leading this effort, and some stated they would be supportive if a bill were to eventually be introduced.

Permanent expansion for telehealth

Most, if not all, of the offices we met with agreed that telehealth was the true success story coming out of the pandemic.  A two-year extension, as opposed to a permanent extension, of the telehealth flexibilities granted during the PHE has gained a significant amount of traction on the Hill as of late. NASL Advocates urged the offices they met with to cosponsor either the Expanded Telehealth Access Act (H.R.2168) or the Telehealth Extension Act (H.R.6202), and the offices said they would look into both and likely be supportive of one or the other.

Technology can offer relief

Albeit not a solution to the staffing or reimbursement issue, technology can offer some efficiency gains for clinicians and administrative staff.  With the demand for care exceeding the volume of clinicians to support that care, we need to also evaluate where technology can save on time and money. Electronic communication is already ubiquitous, yet many don’t realize they have these capabilities already embedded into their electronic health record (EHR) system. If they become digitally enabled and embrace electronic data sharing, providers will be able to pull through this staffing and workload challenges addressed in these conferences while they work to lobby for change in reimbursement rates.

Many of the technology vendors who support post-acute care have integrated to Kno2’s suite of powerful healthcare communication APIs that enable providers to reliably and securely SEND, RECEIVE, and FIND patient information with anyone in the healthcare ecosystem.

Contact Kno2 or your EHR to understand what electronic communication capabilities are available.