Home Health Referral Sources, From Medicare Claims

When I talk to agency owners about where patients come from, most say "the hospital." It's the visible part of the business: the discharge planners, the case management office, the liaison badge at the front desk.

Medicare's own claims show a wider picture.

What the 2024 claims show

The Research Institute for Home Care's 2025 Home Health Chartbook (Exhibit 3.5, a KNG Health analysis of Medicare claims) breaks down the referral source on home health stays that started in 2024:

Hospitals are the single biggest source. But physicians and clinics together referred 48% of stays, more than hospitals did.

A second cut points the same way. MedPAC's July 2026 Data Book found that 75% of fee-for-service home health periods in 2024 were community admitted. No hospital stay or institutional post-acute stay came first. The patient was at home, and somebody, usually a doctor's office, decided they needed care there.

These are two different measures, so don't add them together. They agree on the point that matters: most home health starts outside the hospital.

What that means for your referral plan

Don't build your whole plan around discharge planners. They matter. A single planner touches a lot of patients, and a good hospital relationship can carry an agency. But an outreach plan that only targets hospitals is aimed at a minority of Medicare stays.

Physician practices deserve their own campaign. The doctor signs the order, but a practice manager, nurse navigator, or referral coordinator usually decides which agency gets the fax. Those are the people to know. We cover them on our physician practices page.

Skilled nursing is small but steady. At 11% of stays, SNFs look minor on the chart. In practice, one rehab building discharges patients every week, and the social services director sets up the plan for each one. One good relationship there can mean steady referrals for years. See skilled nursing and rehab.

Private pay is different

The chartbook covers Medicare home health. Non-medical home care has no national claims file, and I haven't found a trustworthy national breakdown of where private pay clients come from. Be skeptical of anyone who quotes one.

What owners consistently describe is a different list: senior living communities, aging life care managers, elder law attorneys, hospice teams, and hospital social workers, plus families who heard about you from someone they trust. At Reliable Aid, the agency I'm a partner in, most new clients come from people, not search engines.

Turn the data into a list

Start with your service area. List every hospital, rehab and skilled nursing building, and the larger primary care, geriatrics, cardiology, and orthopedic practices inside it. Then find the people who actually make the call at each one. That's the list we build for clients before any outreach starts. If you want to see yours, book a free referral audit.