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Homecare Homebase data presented at the National Alliance for Care at Home’s annual meeting show average revenue of $206 per Medicare Advantage visit, compared with $266 for traditional Medicare. The company’s Hannah Pearson said weekly office workflow for Medicare Advantage patients is about 13% higher, while visit and rehospitalization statistics are approximately similar. Providers are being urged to consider negotiating Medicare-like payment arrangements with plans.
Home health agencies in Homecare Homebase’s dataset received an average of $206 per Medicare Advantage visit, versus $266 for traditional Medicare, while handling about 13% more weekly office workflow for Medicare Advantage patients, the company’s chief revenue officer said at an industry meeting. The figures, reported by Home Health Care News, highlight the financial and administrative pressure providers face as Medicare Advantage accounts for a growing share of their patients.
Hannah Pearson, chief revenue officer of Homecare Homebase, shared the payment and workload comparisons at the National Alliance for Care at Home’s Annual Meeting & Expo. She said weekly visits per patient and rehospitalization rates were approximately the same across the traditional Medicare and Medicare Advantage populations in the company’s data. The figures describe the dataset and comparisons presented at the meeting; they do not establish that every agency or plan has the same payment and workload patterns.
Medicare Advantage made up 49.5% of patients in that dataset, a 31% increase since 2016, according to Pearson. She said many providers built staffing, workflows and payer contracts when traditional Medicare represented a larger share of their business. The changing payer mix, she argued, calls for agencies to revisit how they organize operations.
Nick Seabrook, executive vice president of SimiTree, described a separate margin concern. He said traditional Medicare margins had remained relatively steady since the introduction of the Patient-Driven Groupings Model, while a CMS cost-report category that includes Medicare Advantage and other payers had consistently operated at a loss. Because that category combines payers, it does not isolate Medicare Advantage results. Seabrook also said total registered nurse visit costs had approached $230, about $60 higher than when the payment model began.
The figures point to a mismatch providers say is becoming harder to manage: Medicare Advantage enrollment is a larger part of agency caseloads, but the reported average revenue per visit is lower and the associated office workload is higher. If the figures reflect an agency’s own contracts and operations, that combination can put pressure on staffing, administrative capacity and margins, particularly when visit costs are also rising.
That does not mean every Medicare Advantage contract is unprofitable or that the figures apply uniformly across the sector. The SimiTree margin category includes payers other than Medicare Advantage, and the Homecare Homebase comparisons come from its own dataset. Still, the discussion matters to agencies weighing whether current payment terms cover the work involved in delivering care and processing plan requirements.
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How Agencies’ Payer Mix Has Shifted
Medicare Advantage is a private-plan alternative to traditional fee-for-service Medicare. Home health advocates have raised concerns about lower reimbursement from those plans; the meeting discussion added the burden of administrative work as another operational challenge. The report does not provide a breakdown of particular plan requirements or explain which tasks account for the additional workflow.
Seabrook cited CMS data through 2024 when discussing broader home health margins. He said margins were around 7% when the Patient-Driven Groupings Model was first implemented and had hovered around 3% over the past three years. Those figures concern overall margins and should not be read as Medicare Advantage-specific results. The article also identifies Homecare Homebase as a provider of technology and administrative services to home-based care, and SimiTree as a consulting, technology and billing services firm.
“Medicare is really our only payer source in home health that’s making any kind of a positive margin.”
— Nick Seabrook, executive vice president of SimiTree
What the Figures Do Not Show
The report does not specify the number of agencies or patients in Homecare Homebase’s dataset, the period covered by the per-visit revenue comparison, or how the company calculated the 13% workflow difference. It also does not provide plan-by-plan payment rates, contract terms or a detailed accounting of administrative tasks. The figures therefore cannot establish the experience of every home health provider or Medicare Advantage plan.
The margin data cited by Seabrook have a separate limitation: the cost-report category includes Medicare Advantage and other payers, so its reported losses cannot be attributed to Medicare Advantage alone. It is also unclear how widely plans will agree to episodic, Medicare-like contracts or what payment levels agencies could secure through negotiations.
Contract Talks and Outcome Data
Seabrook’s proposed next step is for agencies to contact their Medicare Advantage plans about episodic reimbursement modeled on traditional Medicare rather than per-visit payment. He said providers should be ready to present clinical outcomes as part of those discussions. The report does not name a negotiation deadline or describe a specific agreement reached by a provider and plan.
For agencies considering that approach, the practical next step is to review their own visit revenue, staffing costs, administrative workload and patient outcomes before approaching payers. Whether negotiations change reimbursement, and whether plans adopt terms that cover agencies’ costs, remains to be seen. The available figures offer an industry snapshot, not a forecast of contract outcomes.
Key Questions
How much less revenue did the report associate with a Medicare Advantage visit?
Homecare Homebase data cited at the meeting put average revenue at $206 per Medicare Advantage visit, compared with $266 for a traditional Medicare visit. The report does not state the comparison period or say the figures apply to every agency or plan.
What does the 13% figure measure?
Pearson said the weekly office workflow for Medicare Advantage patients was approximately 13% higher than for traditional Medicare patients in Homecare Homebase’s data. The report does not break down which administrative tasks made up that difference.
Were patient visits and rehospitalizations different?
Pearson said weekly visits per patient and rehospitalization rates were approximately the same across the two populations in the dataset. The report does not give the underlying rates or sample size.
What payment change did the speaker recommend?
SimiTree executive Nick Seabrook encouraged agencies to ask Medicare Advantage plans about episodic, Medicare-like reimbursement instead of per-visit payment. He advised providers to bring clinical outcome information to negotiations.
Do the reported margin figures isolate Medicare Advantage?
No. Seabrook referred to a CMS cost-report category that includes Medicare Advantage and other payers. The report says its results do not isolate Medicare Advantage performance.
Source: homehealthcarenews.com
