Home Health vs. Outpatient Home-Based Therapy: What’s the Difference, and Why Should PTs Care?

This past year has changed the PT landscape significantly. Clinics are operating differently—and patients are asking for different things, including the option to be seen by their care providers from the comfort and safety of their living rooms. While telehealth is one way to meet this demand, home-based therapy—not to be confused with home health PT—is another excellent alternative. Here’s what you need to know about these two at-home care models, particularly with respect to Medicare:

It all comes down to the plan of care—and the payer.

Traditional home health physical therapy, which is typically billed under Medicare Part A, is different from outpatient home-based therapy, which is always billed under Medicare Part B. But the actual care provided can be very similar. 

In fact, in some cases, the only differentiating factor is whether the patient is being seen under a home health plan of care. As explained in this document, patients are eligible to begin a home health plan of care if they are:

• homebound;
• in need of skilled-yet-intermittent nursing, PT, OT, or SLP care; and 
• under the care of a physician.

Outpatient physical therapy services are always provided under Medicare Part B.

For patients who are not homebound—or whose Medicare Part A benefits are exhausted for the plan year—Medicare Part B covers medically necessary PT services under the standard fee schedule, whether therapy is provided in the home or in the clinic. However, there is no additional compensation for travel, which means PTs receive the same amount of reimbursement whether they go to the patient or the patient comes to them. It’s also important to note that Medicare Part B will not pay for any therapy services if the patient is simultaneously receiving care—even non-therapy care—under Medicare Part A.

Home health agencies can expand their footprint by offering both types of services.

Home health agencies that contract with both Medicare Part A and B can provide both types of services. In fact, this agency managed to increase its revenue and reach during the pandemic by expanding its purview to serve Medicare Part B beneficiaries who preferred at-home visits. This pivot allowed the organization to thrive despite a loss in home health business. After all, postoperative care accounts for a large portion of home health therapy, and most surgeries were canceled or postponed during 2020. So instead of laying off well-trained staff, the agency began providing care to a broader patient base. And it paid off—literally.

Outpatient PT clinics should consider offering home-based therapy, too.

With the pandemic lingering on, outpatient PT clinics would also be wise to expand their offerings by giving patients in-home visit options. And the market is primed for this. According to Dayne Conley—co-founder of the above-referenced organization—once patients knew that his agency was providing at-home outpatient services, patients from other practices canceled their in-clinic visits and switched to seeing his PTs instead. 

Home-based therapy is an excellent way to diversify revenue streams and keep current patients engaged in their care—especially those patients who are reluctant to return to the clinic or who live in rural areas. 

Most brick-and-mortar practices already have everything they need to expand into home-based care.

The best part is that the transition to offering in-home services should be pretty straightforward for most brick-and-mortar practices. With a minimal amount of mobile equipment, reliable transportation, and an EMR that is accessible from the road, you’re all set. You’ll just want to make sure your insurance covers you and your staff when you’re working outside of the clinic.

And because the convenience of at-home visits is so in-demand right now, marketing these services should be pretty easy, too. Start by telling current patients—especially those who have fallen off the schedule—that you could come to them for their next appointment at no additional charge. Also, make sure at-home visit information is prominent on your website—and that all of your referral sources know you’re expanding your offerings. Finally, if you have the budget, consider some paid digital and/or print ads to reach even more prospective patients in your region.

If you’re thinking about expanding your offerings to provide at-home care—or you’ve already taken the plunge—tell us about it in the comments below. We’d love to hear about your experience.