For home-based providers, maximizing the seamlessness of a post-hospital care transition is paramount.

As hospitals are sending more patients than ever to the home, the ones that can take the patient with the most ease are more likely to win out.

RML Specialty Hospital — a long-term acute care hospital that offers critical care — has seen this firsthand through its utilization of the care coordination platform CarePort, which is a WellSky-owned company.

“A smooth transition is of the utmost importance for any patient that is in long-term acute care and transitioning either to the home or a skilled-nursing facility,” Preston Fairchild, manager of care coordination at RML Specialty Hospital, told Home Health Care News.

Given RML Specialty Hospital’s patient population, access to home-based care services is crucial, according to Fairchild.

“We’ve had a difficult time connecting with home health companies that have the staffing [in place],” he said. “We discharged patients that have very complex needs. Some are on ventilators, some require wound care, wound VACs, trach collar, all types of modalities.”

Still, Fairchild noted that the old process of securing quality home-based care was not always effective when the organization was working on its own.

“We have what’s called a list of ‘discharge providers,’” he said. “We would go through that list, which was updated by our secretary. We’d send out referral packages, which would be faxed to these different places. We would then follow up with a phone call, and some would respond and some did not.”

The ability to simplify and streamline this entire process has improved the organization’s ability to work with home- and community-based organizations.

“CarePort has helped us facilitate and connect with multiple home health agencies,” Fairchild said. “We put in the information about the patient, their geographical location, and we can search out as far as they want. Most times, we’ll start with five to 10 miles outside of the range of the patient’s home address. We then communicate with the different home health companies that can review the medical information that we send them. Then they can make a decision if they’re able to take this patient or not.”

The takeaway for home health providers is that efficient care transitions can result in more referrals for their business. And ideally, if both sides – the hospital and the home health provider – are investing in tools for interoperability and technology, those transitions will get better over time. Even when more patients than ever are headed home.

RML Specialty Hospital isn’t an anomaly. Home health providers saw a 17% increase in referrals through CarePort Referral Management.

Overall, CarePort enabled almost 25 million referrals in 2021.

Last year, the company saw record growth when almost 2,500 post-acute providers and 13,000 home- and community-based services organizations joined its network.

“We’ve prioritized the enrichment of CarePort’s provider network by adding more home- and community-based providers such as home health care, transportation services, and dialysis agencies over the last year as care shifts to the home,” Dr. Lissy Hu, CEO and founder of CarePort, said in a press statement.