The 2026 Final Rule hasn’t dropped yet—but the writing is already on the wall. Agencies that wait for CMS to publish the official document will be too far behind to catch up. The reimbursement landscape is shifting, Value-Based Purchasing is tightening, and operational inefficiencies that were tolerable two years ago are about to become unsustainable.
This month’s episode of Gravity Healthcare Hacks breaks down how agencies can position themselves for what’s coming. But the real story isn’t just the proposed rule—it’s the operational transformation home health providers must embrace now, long before the ink dries on the final version.
This companion article expands on the discussion between Melissa Brown and Devin Kassi, offering a deeper look at the practical steps agencies should be taking to prepare for the year ahead.
The Payment Cuts Are Only Part of the Story
Yes, CMS is signaling another round of behavioral adjustment cuts. Whether the final number lands closer to 3% or 6%, the message is the same:
Home health margins are tightening, and efficiency is no longer optional.
The smartest agencies aren’t waiting for CMS to “finalize” the problem—they’re building a 2026 operating model now. And at the center of that model is a hard look at:
- Redundant roles
- Outdated workflows
- Technology that can’t scale
- Manual processes that quietly drain margins
In home health, the real cost of inefficiency isn’t line-item budget impact—it’s the operational drag that compounds year after year.
Your Technology Stack Needs a Hard Audit
Most agencies have been using the same EHR system for 5–10 years. In that time, CMS changed payment models, documentation requirements increased, clinicians became harder to hire, and AI exploded across the healthcare space.
But many agencies are still charting and billing like it’s 2018.
Three core areas deserve immediate attention:
Automated Intake and Referral Processing
If referrals still require manual data entry, you’re not just burning labor—you’re adding days to claim cycles and increasing error risk.
AI-Assisted Documentation
Modern tools allow clinicians to dictate directly into OASIS, auto-build goals, and populate care plans based on coded assessments. Agencies using these tools are reducing documentation time by hours per week, per clinician.
Clean-Claim Optimization
A human reviewer can achieve around 95% first-pass clean claims.
AI-powered claim scrubbing can hit 98–99%.
That difference is massive.
In an era of reimbursement compression, automation isn’t about replacing people—it’s about eliminating wasteful work and redeploying talent to areas that move the needle.
Organizational Structure Has to Change Too
Technology alone won’t fix 2026’s challenges.
Every agency should be performing a full organizational structure review, asking:
- Which positions exist because of outdated workflows?
- Where can technology absorb repetitive tasks?
- What roles can be merged without compromising care?
- How can high-performing employees be redeployed into roles that matter more?
The goal isn’t to “cut staff.”
The goal is to design a structure capable of surviving 2026.
Agencies that thrive will be the ones willing to rethink:
- Intake + Billing roles
- Clinical oversight allocations
- Quality review workloads
- Manager-to-patient ratios
Most importantly, they’ll make these decisions proactively—not as emergency reactions after margins drop.
VBP Is Quietly Becoming the Biggest Risk Factor
The proposed 2026 changes to Home Health Value-Based Purchasing deserve serious attention. CMS is shifting from “soft” patient-experience measures to hard clinical outcomes, especially those tied to functional progress:
- Bathing
- Dressing
- Other ADL components reflected in OASIS
- Medicare spending per beneficiary (claims-based)
This shift is intentional.
These are far harder to manipulate—and far more reflective of actual care quality.
Agencies that haven’t prioritized functional outcomes, therapist mentorship, or OASIS accuracy will feel the impact quickly.
The path forward requires:
• Weekly OASIS accuracy checks—not quarterly
• Outside validation of internal reviewers
• Recurring training for clinicians
• Technology that flags mismatched or clinically inconsistent OASIS responses
This is no longer a “nice to have.”
It’s the difference between moving up or down the VBP curve.
This Is the Year Agencies Must Learn to Trust the Right Technology
Healthcare has historically lagged in tech adoption. Home health even more so.
But in 2026, agencies that rely on manual workflow will be:
- Slower
- More expensive
- Less accurate
- Less competitive
- And eventually, less viable
The winners will be the ones who:
- Embrace AI where it adds value
- Upgrade EHR systems that can’t keep up
- Use automation to reduce low-value tasks
- Invest in actionable BI—not just pretty dashboards
Technology is not the threat.
Obsolete processes are.
Final Thoughts: Prepare Now or Scramble Later
No one knows the exact language the Final Rule will contain.
But we already know enough to act.
The worst-case scenario isn’t payment cuts—it’s being unprepared for the operational and clinical expectations behind them.
Agencies that begin restructuring now—tech, staffing, quality, training—will enter 2026 with confidence, not fear.
And for everyone else?
The Final Rule won’t be the problem.
It will simply expose the weaknesses that were already there.