Why Pediatric Care May Be the Key to Growing Your Agency

Monday, February 27, 2017





When most people think of home health care, they think of adults — most likely elderly — receiving services at home. Yet while seniors are most likely to receive home health services, the fact is that people of all ages are likely to need them. In fact, pediatric home health is one of the fastest growing segments in the industry, and it may be worth considering whether your agency should expand into this important market.


Children need home health services for a variety of reasons, whether due to an injury, a chronic illness, or medical complexities present at birth. Depending on how you define special health care needs (in other words, needs that would require home health services) as many as 18 percent of children could potentially qualify for home health care. The problem? There simply aren’t as many pediatric home health providers as there are providers for older patients. In fact, as recently as just 25 years ago, pediatric home health care was rare, and almost impossible to find.


And the problem persists. The fact is, while pediatric home health care is recognized as being more cost-effective and preferable to hospital care for young patients, there are still barriers for patients and providers to access and provide these services. Still, the benefits outweigh these challenges, and as a home health agency, it’s worth considering expanding your services to serve this important patient population.


Why Pediatric Home Health Is Important

The most important reason to consider adding pediatrics to your repertoire of services is the potential demand. CMS has named pediatrics as the fastest growing segment of home health care services, and according to a recent study from the University of Southern California, Boston Children’s Hospital, and the Rand Corporation, family caregivers provide an average of 1.5 million hours of care to children with high medical needs.


Translated into actual dollars, that’s just under $37 billion that’s being provided by parents and other caregivers. While families are often forced to provide care themselves due to the cost, the fact is that they are actually losing earning power by providing these services; on average, a parent loses about $3,200 in income per year when caring for a sick child.


That’s not considering the additional costs that can come from care giving, as well. Like caring for older adults, caring for a child can lead to isolation, exhaustion, and burnout. In fact, some argue that burnout is more prevalent among those caring for pediatric patients, since children cannot typically be left alone or manage many tasks on their own that older adults can. Caregivers for all age groups need assistance, and pediatric home health care can provide a valuable service to ensure everyone remains healthy.


According to the American Academy of Pediatrics, “Home care is an integral and essential part of the medical home that we advocate for every child.” With the closing of many state-run institutions and other facilities, many families are now faced with the challenge of caring for their loved ones, and need the knowledge and support that home health providers can offer.


Challenges to Pediatric Home Health Care

Despite the benefits of home health care to pediatric patients, and the call for services from the AAP, the Affordable Care Act, and others, there are still challenges to overcome. One of the biggest challenges is the fact that caring for children is vastly different than caring for adults. For example, older adults are more likely to rely on assistive technology over time, whereas the goal with children is generally focused on reducing their reliance on machines and other devices. And when that equipment is in use, the requirements are different for children than for adults. Because children are still growing, and need to learn basic skills while still hitting developmental milestones, there can be challenges in finding the right way to care for them and evaluate progress, though home health care software can help make it easier.


Another challenge for many home health care agencies when it comes to offering pediatric services is the cost factor. Simply put, the current payment system is not set up for pediatric home health. The vast majority of families cannot afford to pay for home health services, but most private insurance policies and Medicaid typically offer limited payments for pediatric home health services. Further complicating matters is the fact that home health reimbursement rates are set by Medicare, not Medicaid, and state and insurance payments vary greatly — meaning that many families are left to pay more out of pocket for pediatric care than older patients might.


And finally, there is a great deal of disparity when it comes to defining “medically necessary care” in terms of home health. Different insurers and providers have different criteria, making it difficult for families to determine what they qualify for.


There is a great deal of work being done in Washington and elsewhere to try to overcome these barriers, though. Pediatric providers and the AAP are lobbying heavily for more guidelines related to pediatric home care, and states are looking closely at reimbursement rates in an attempt to more closely align them with Medicare rates.


However, as the idea of a medical home and the cost-effectiveness of home care become more mainstream, it’s likely that more families will be looking for home health services for younger patients. As an HHA, you need to be watching these trends, and considering how you can better position your business to take advantage of a growing market.


To learn more about software and other tools that can help move your agency toward delivering pediatric care, or improve the care you already deliver, checkout Complia Health’s comprehensive family of resources here.