Home Healthcare, Hospice and Telehealth: Industry Report on US Medicare-Centered Care

Summary

Home health, hospice and telehealth form a connected community and post-acute care system, paid largely through Medicare in the United States. Home health remains the most frequent formal post-acute care site after hospital discharge, although the share of beneficiaries receiving it has declined ¹. A vendor compilation of federal data reports Medicare hospice spending of 28.3 billion dollars for more than 1.8 million beneficiaries ⁴. The main findings concern payment pressure, documentation integrity and digital adoption. The latest home health final rule is estimated to reduce aggregate Medicare payments by 1.3 percent ⁷, and a federal audit found that 45 of 100 reviewed hospice certification periods lacked compliant documentation ⁵. Telehealth use is established in home health, but workforce, waiting-time and provider-type data are not verified in the pack. The outlook is for continued policy-driven volatility, with telehealth coverage dependent on temporary extensions and steady growth in remote monitoring and care coordination.

Key findings

1. 1

   Home health telehealth is a measurable Medicare service

   About 375,000 telehealth visits by home health agencies to fee-for-service Medicare beneficiaries were recorded, with skilled nursing care accounting for much of the total. The pack does not state telehealth as a share of total home health visits.

   Confidence: High
2. 2

   Payment pressure is the central financial risk

   MedPAC recommended a 7 percent reduction in the base payment rate for the next calendar year, which is a recommendation rather than an enacted change. The enacted final rule was estimated to reduce aggregate payments by 1.3 percent, or 220 million dollars, after a proposed 6.4 percent cut was substantially reduced.

   Confidence: Medium
3. 3

   Documentation compliance is a material hospice integrity issue

   In an HHS Office of Inspector General audit sample, 45 of 100 initial hospice certification periods reviewed lacked documentation that met Medicare requirements. The agency estimated that 255.1 million dollars in claim payments could have been saved if eligibility review had applied to certain new enrollees. This is an estimate from a sample, not a finding of fraud.

   Confidence: High
4. 4

   Telehealth adoption among home health agencies is widespread

   In a peer-reviewed study, 69 percent of home health agencies used telehealth, mainly for care coordination, virtual visits, monitoring and care initiation. 60 percent used it to connect patients with primary care or specialists, and 39 percent offered remote patient monitoring. The survey period was not confirmed in the search results.

   Confidence: Medium
5. 5

   Hospice margins are projected to remain positive

   MedPAC projects a 9 percent aggregate Medicare FFS margin for hospice. This is a projection, and it should not be read as evidence that every provider is profitable.

   Confidence: Medium
6. 6

   Hospital-at-home outcomes are promising but limited to one reported program

   Advocate Health reported that its hospital-at-home program had readmissions 7 percent lower than expected, compared with 9 percent higher than expected in the hospital. The program period was not stated, and the result comes from a market research summary rather than a peer-reviewed evaluation.

   Confidence: Qualitative

11. Industry definition and scope

This report covers three linked service lines. Home health care includes skilled nursing, therapy and related services delivered in a patient's home. Hospice is palliative and end-of-life care furnished under a benefit paid at a daily rate. Telehealth is remote clinical care delivered by video, telephone or remote monitoring. The primary geography is the United States, anchored on Medicare fee-for-service (FFS) data ¹². Figures reflect the latest available data, and sources report different periods, which is noted where it matters.

Terminology is not uniform across sources. MedPAC figures cover Medicare-participating providers only ¹², so no audited national count of all home health agencies or hospice providers was located. Telehealth market-size figures come from vendor reports and are global ¹³. They are not comparable with US Medicare payment data and are used only as context. The hospice benefit is described in terms of four levels of care under the current payment structure ².

The segments in scope are payment and reimbursement, provider capacity, workforce, digital delivery, and safety and quality. This report describes industry patterns and public data. It is not individual medical, legal, investment or engineering advice.

• Hospice providers furnishing services under the Medicare hospice benefit 6,700providers Observed United States, Medicare, Latest available data [2]

Counts are Medicare-participating providers only and do not represent the full provider universe.

22. Market size, structure and value chain

Direct market size is the hardest figure to verify. The most credible US measure in the pack is Medicare spending: a vendor compilation of MedPAC data reports Medicare hospice spending of 28.3 billion dollars for more than 1.8 million beneficiaries ⁴. The pack does not provide a comparable total for home health spending. Stout reports that FFS Medicare home health users declined to 2.7 million, while hospice beneficiaries reached 1.74 million ¹². The Stout period basis is not stated, so these counts should be read as recent rather than strictly comparable.

Revenue models differ. Hospice is paid a daily rate with four levels of care ². Home health is paid in 30-day episodes: the updated episode rate is 2,038.22 dollars, down 0.1 percent from 2,057.35 dollars ⁸. Routine home care for days 1 to 60 is 230.83 dollars per day under the final rule as compiled by a vendor ⁴. Telehealth is typically paid as a service within a broader clinical or agency payment, so a separate telehealth revenue line is not reported in the pack.

The value chain runs from referral sources (hospitals, physicians and community providers) to certified agencies and hospice providers, then to beneficiaries and caregivers. Medicare is the principal payer in the pack, and telehealth platforms and software vendors sit alongside agencies as suppliers. The global telehealth market was 87.7 billion dollars, with a projection of 187.5 billion dollars for a later period, and North America held 45.2 percent of global revenue ¹³. These are vendor estimates and forecasts, and they include segments beyond home health and hospice.

The table combines different measures and statuses. Each row is labelled with its status so that enacted rules, estimates and recommendations are not confused.

33. Customers, demand and adoption

The main end users are Medicare beneficiaries who need skilled care at home, people nearing the end of life, and patients using remote monitoring or virtual visits. Demand is shaped by the shift toward post-acute care at home. Home health remained the most frequent formal post-acute care site after hospital discharge in the most recent months reported, but the share of beneficiaries receiving it declined ¹. The pack does not explain the cause of the decline, so no causal claim is made here.

Hospice demand has a distinct pattern. Roughly half of Medicare beneficiaries who use the FFS hospice benefit die while enrolled, and almost half of those who elect hospice also use non-hospice Medicare services in each fiscal year ³. These findings suggest that hospice is not a single-episode service and that coordination with other services matters. The pack provides no exact percentages for these two points.

Telehealth demand is measured by volume. About 375,000 telehealth visits by home health agencies to FFS beneficiaries were recorded in the latest year, with skilled nursing making up much of the total ¹. Primary care telehealth utilization appears to have stabilized at 6 to 7 percent after declining from mid-period ¹⁴. This is a primary care figure and cannot be applied directly to home health.

Purchasing criteria for providers are set largely by payers and by compliance rules rather than by patient choice, which the pack does not measure. Access barriers include documentation burden, eligibility review and payment cuts, which can reduce agency willingness to accept complex cases. Waiting times and admission capacity indicators were not located. Equity data by race and ethnicity for hospice use were found only in a secondary source without a confirmed year, so they are excluded.

• Telehealth visits by home health agencies to FFS Medicare beneficiaries 375,000visits Observed United States, Medicare fee-for-service, Latest available data [1]

Visit counts are not shares of total visits. The pack does not supply a denominator.

44. Competitive landscape and key players

The pack describes provider types rather than named competitors. Medicare-participating home health agencies, hospice providers, hospitals running home-based programs and telehealth technology vendors all operate in this space. About 6,700 hospice providers furnish services under the Medicare benefit ². The pack does not include a comparable count for home health agencies. A breakdown of public, private and community providers for home health or hospice was not verified, so ownership-based comparisons cannot be made from this pack.

Business models differ. Hospices and home health agencies are reimbursed through the Medicare payment structures described above, so their revenue depends heavily on regulatory rates and on compliance. Hospital-at-home programs depend on hospital-level payment authorities. The pack notes that the Acute Hospital Care at Home authorities were extended through a later date ⁹. Telehealth vendors sell platforms and services, and their revenue depends on adoption by agencies and health systems. Market-share concentration is not reported in the pack.

Advocate Health is the only named provider example. Its hospital-at-home program is reported to have readmissions 7 percent lower than expected, compared with 9 percent higher than expected in the hospital ¹². This is a single program result with no stated period, and it is a market research summary. It is not evidence that the model generalizes to other providers.

Financial performance is mixed. MedPAC projects a 9 percent FFS hospice aggregate margin ², which is a forecast. The pack does not provide a comparable margin for home health. Competitive pressure is strongest where payment cuts and documentation rules raise compliance costs, which can favor larger operators with more administrative capacity. The pack does not verify this, so it is presented here as an interpretation rather than a finding.

• Projected FFS Medicare aggregate margin for hospice 9percent Forecast United States, Medicare FFS, Projected for the latest period [2]

Comparable examples were limited: only one named provider appears in the pack.

55. Technology, operations and workforce

Telehealth is the most measurable digital practice in this pack. In a peer-reviewed study, 69 percent of home health agencies used telehealth, 60 percent used it to connect patients with primary care providers or specialists, and 39 percent offered remote patient monitoring ¹¹. The chart below shows these three measures. The survey period was not confirmed in the search results, so the chart describes adoption at an unstated time. Adoption is strongest in coordination and virtual visits, which are closer to established practice, while remote monitoring is an emerging practice with lower reported uptake.

Operational quality measures are tied to payment. Agencies that fail to submit quality data face an additional two percentage point reduction ⁸. This makes data reporting an operational requirement, not an optional quality activity. The pack does not evaluate whether this penalty improves care quality.

Workforce data are a major gap. The pack contains no primary source on home health or hospice staffing, vacancies, turnover or wages for the latest period. Workforce shortage is therefore discussed only as a risk, not measured. Skills needed for telehealth and remote monitoring are also not documented in the pack.

Business-model change is visible in the shift toward hospital-at-home and remote monitoring. Primary care telehealth has stabilized at a lower level than its peak ¹⁴, which suggests that some early surge in virtual use has settled. Whether home health telehealth follows the same pattern is not established by the pack.

Chart values are from a single peer-reviewed source with an unconfirmed survey period.

66. Regulation, standards, risk and sustainability

The jurisdiction is the United States, and the primary framework is Medicare. Binding requirements in the pack include the home health prospective payment system. The latest final rule finalized a permanent prospective adjustment of -1.023 percent, recalibrated case-mix weights under the payment model and updated thresholds for low-utilization payment adjustments ⁶. The quality reporting penalty described above is also binding for agencies that do not submit data ⁸.

Telehealth is governed by time-limited statute. The Consolidated Appropriations Act extends Medicare telehealth flexibilities through the end of a later calendar year and Acute Hospital Care at Home authorities through a later September 30 date ⁹. Without extension, Medicare telehealth coverage would revert to the restrictions in Section 1834(m) of the Social Security Act ⁹. Most pandemic-era telehealth flexibilities remain temporary, and only a handful have been made permanent ¹⁰. The Congressional Budget Office scored the extension at 3.8 billion dollars over its period, which is an estimate ¹⁰.

Proposals and recommendations are not binding. MedPAC recommended a 7 percent reduction in the base rate for the next calendar year ¹. This is a recommendation to Congress and is not an enacted rate change. The latest final rule reduced a proposed 6.4 percent cut substantially ⁷, which shows how proposal and final outcomes can differ.

Safety, eligibility and privacy risks are significant. The HHS Office of Inspector General found that 45 of 100 reviewed hospice initial certification periods did not meet Medicare requirements, and it estimated 255.1 million dollars in potentially avoidable claim payments ⁵. The pack contains no guidance on privacy, data protection or environmental impact for these services, so sustainability and privacy are not assessed here. Ethical risk is most visible where eligibility documentation affects access to end-of-life care.

This section describes US Medicare rules as reported in the pack. It is not legal advice, and binding status should be checked against current federal publications.

77. Challenges, opportunities and case examples

The main constraints are payment reductions, documentation compliance, workforce capacity and telehealth coverage that depends on temporary extensions. The estimated 1.3 percent aggregate payment reduction in the latest rule ⁷ adds pressure to agencies already facing compliance obligations. Hospice documentation failures in an audit sample ⁵ show that compliance capacity is a constraint, not just a cost.

Opportunities are concentrated in coordination and remote monitoring. Most agencies in a peer-reviewed survey reported using telehealth for coordination and virtual visits ¹¹. Hospital-at-home programs offer an alternative care setting, and one reported program recorded lower-than-expected readmissions ¹². These opportunities are limited by the evidence: the pack contains one program result with no stated period and no independent evaluation.

Case example 1 is Advocate Health, which reported lower-than-expected readmissions in a hospital-at-home program ¹². Case example 2 is the group of home health agencies in the peer-reviewed telehealth survey, which shows how agencies adopt virtual care functions ¹¹. Case example 3 is the hospice provider population, where documentation compliance is the main audit concern ⁵. The first is a named provider, while the other two describe provider types. Comparable named examples were limited in the pack.

Outcome data for hospice, such as symptom control and caregiver measures, were only partly verified through secondary sources, so outcome claims are not made. Equity analysis of access by public, private or community provider type was not verified.

Case examples were chosen from the pack only. The Advocate Health result is a single reported program and is not a validated outcome comparison.

88. Outlook and strategic implications

In the near term, payment pressure is the most likely driver of change. The latest final rule reduced the expected cut substantially from the proposal, but an estimated 1.3 percent aggregate reduction remains ⁷. MedPAC's recommended 7 percent base rate cut ¹ is a signal of continuing policy debate rather than an enacted outcome. Agencies should plan for variable rates and for compliance costs tied to documentation and quality data ⁸.

In the medium term, telehealth will depend on whether temporary statutory extensions become permanent. The current extension depends on legislation ⁹, and most flexibilities remain temporary ¹⁰. Demand for remote monitoring and coordination is likely to grow where agencies already use these tools ¹¹, but the pack does not quantify that growth. Telehealth market forecasts are vendor projections and should be treated as directional only ¹³.

Hospice is expected to remain a comparatively stable service in the pack's projections, with a 9 percent projected margin ². Its main risk is eligibility and documentation enforcement, as the OIG audit shows ⁵. Hospital-at-home is an emerging model supported by one reported result ¹² and needs independent evaluation before broader conclusions.

Practical implications differ by stakeholder. Payers and policymakers should weigh estimated savings against access and documentation burden. Agencies and hospices should invest in compliance and telehealth coordination. Telehealth vendors should plan for temporary coverage and seek evidence on outcomes. Patients and caregivers should check which services are covered and how eligibility is documented. Key uncertainties include the enacted payment rate, the permanence of telehealth coverage and the lack of workforce and waiting-time data.

Forward-looking statements are the writer's interpretation of sourced policy and data, and they are labelled as such.

99. Conclusion

Home health, hospice and telehealth are established Medicare-centered services under heavy payment and compliance pressure. The most defensible takeaways are that payment policy is the main financial risk, that documentation integrity is a material safety and access issue, and that telehealth adoption is common but depends on temporary coverage. Workforce, waiting-time and equity data remain the largest gaps.

How this was built

Sources

1. 1

   Medicare Payment Advisory Commission, March Report to Congress, Chapter 8: Home health care services

   Medicare Payment Advisory Commission (MedPAC) Official statistics

   medpac.gov
2. 2

   Medicare Payment Advisory Commission, March Report to Congress, Chapter 10: Hospice services

   Medicare Payment Advisory Commission (MedPAC) Official statistics

   medpac.gov
3. 3

   Hospice Monitoring Report

   Centers for Medicare & Medicaid Services (analysis by Abt Global) Official statistics

   cms.gov
4. 4

   Hospice Cost Report Statistics (secondary compilation citing MedPAC and CMS final rule data)

   Soriaga CPA (compiling MedPAC and CMS data) Vendor report

   soriagacpa.com
5. 5

   Hospice Medicare Could Have Saved $255.1 Million Related to Hospice Services for Certain New Hospice Enrollees

   HHS Office of Inspector General Regulator

   oig.hhs.gov
6. 6

   Home Health Prospective Payment System Final Rule fact sheet

   Centers for Medicare & Medicaid Services Regulator

   cms.gov
7. 7

   Home Health Final Rule: 1.3% Cut (Forvis Mazars)

   Forvis Mazars Industry association

   forvismazars.us
8. 8

   Home Health PPS final rule

   Michigan Health and Hospital Association Industry association

   mha.org
9. 9

   Consolidated Appropriations Act Medicare telehealth extension (Baker Donelson)

   Baker Donelson Industry association

   bakerdonelson.com
10. 10

    What to Know About Medicare Coverage of Telehealth

    KFF Industry association

    kff.org
11. 11

    Transforming Care: The Impact of COVID-19 on Telehealth Adoption in U.S. Home Health Care Agencies

    PMC (peer-reviewed article; authors not confirmed in search results) Peer-reviewed

    pmc.ncbi.nlm.nih.gov
12. 12

    Home Health, Hospice, and Personal Care: Outlook

    Stout Market research

    stout.com
13. 13

    Telehealth Statistics Report (global market figures)

    Docva LLC Vendor report

    docva.com
14. 14

    AHA Center for Health Innovation: 5 Key Telehealth Insights

    American Hospital Association Center for Health Innovation Industry association

    aha.org