COVID-19 Home Health Care Challenges

COVID-19 has had major impacts on nearly every aspect of our lives. The past many months have been a challenge for the home health care industry as agencies have worked to refine their roles and change their models in caring for homebound seniors as the pandemic rages on. When the pandemic is under control, it is anticipated that these adjustments in home health care will become permanent policies and procedures.

Prior to COVID-19, there were several regulations and requirements put in place that presented challenges for home health organizations through:

New Medical Regulations and Methods amid COVID-19


The Office of the National Coordinator (ONC) implemented guidelines for patient access to records and medical information sharing between medical systems as put forth in the 21st Century Cures Act.  The Cures Act addresses a couple of main issues: Information blocking, interoperability and Electronic Visit Verification (EVV)

Information Blocking

Information blocking occurs when there is a breakdown of the medical networks in sharing medical information or refusal to share with disputes over ownership of the medical records. The patient is the one who suffers as important information and time is lost.


The sharing and transfer of medical information between physicians and health care networks has been a tremendous challenge as medical health networks have utilized their own IT professionals to document patient’s medical records. As a result, the sharing of medical information between networks has been an obstacle due to the incompatibility of their differing developed systems of record storage. The CURES Act mandated that all networks have interoperability to seamlessly share records while also giving full access to the patient.

Electronic Visit Verification (EVV)

The essence of EVV is technology that streamlines and tracks all phases of the home health care visit. The start time that the visit starts, the services provided and documentation and finally the time the visit ends. The technology has evolved to provide more detailed and up-to-date information. The Global Positioning System (GPS) is a major tool to track home health care professionals' location as well as the availability of digitized records and seamlessly and efficiently document and track the delivery of services with the goal of decreasing fraudulent activity and providing optimum care.

Value Based Purchasing (VBP)

Home health value-based purchasing (VBP) is intended to hold health care agencies accountable for the quality and costs of the services they provide by offering compensatory incentives based on streamlining and improvements of Medicare patient care and cost reduction. The VBP program implementation was a result of The Affordable Care Act of 2010.

VBP is a system of compensation that is based on improvements in care and costs made by health care agencies. This is intended to hold health care agencies accountable for the quality and costs of the services they provide. The goal is to reduce the high costs of inappropriate care and to identify the top-performing agencies as well as increasing the value of services provided.

There are generally 4 domains used to measure agency performance in a value-based purchasing program.

Safety Domain

The Safety Domain consists of measurements of infections as a result of the health care service provided such as, bloodstream infections, urinary tract infections, staph infections, surgical site infections and births not reaching full gestation. Levels of compensation to the home health agency through Medicare are based on documented reduction of occurrences in these areas.

Clinical Outcomes Domain

The Clinical Outcomes Domain measures mortality rates as a result of a surgical complication. 

Instances of heart failure, acute myocardial infarction, pneumonia as well complications that arise during total knee and hip replacements. Compensation is based on improvements of these rates.

Person and Community Engagement Domain

This domain includes eight categories of the Hospital Consumer Assessment of Hospital Consumer of Healthcare Providers and Systems (HCAHPS) experience of patient survey. This domain measures a patient’s communication with hospital or agency staff, nurses and doctors as well as communications regarding medication. The survey also rates the cleanliness and noise level of the hospital or agency, transition of care and an overall rating score. Once again, compensation rates are based on improvements.

Efficiency and Cost Reduction Domain

This domain averages the Medicare spending per beneficiary (patient.)

The Patient Driving Groupings Model (PDGM)

The Patient Driving Groupings Model (PDGM) ,implemented on January 1, 2020 by the Center for Medicare and Medicaid Services (CMS) requires home health agencies to streamline their operational and clinical processes through all of the above guidelines of The CURES Act, and VBP while maintaining a high level of patient care and employee satisfaction.

Home health care agencies were well on their way to becoming more accountable and efficient while streamlining their operations.

Then, COVID-19

Home health care was already well on its way to complying with all that was placed upon them and becoming a major force in the medical industry when the global pandemic hit. Through mobile app technology, home health care will be a leader in the battle against Covid-19.

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