Home Health & Hospice Week

Save your hospital referrals with 5 steps.

Home health agencies that poke their heads in the sand wishing the expanded hospital transfer policy would just go away soon could find the bulk of their hospital referrals have gone away instead.

Last fall, the Centers for Medicare & Medicaid Services expanded its post-acute care transfer policy for hospitals' inpatient prospective payment system from only 30 diagnosis related groups to 182 DRGs. That means for hospitalized patients in those DRGs, CMS prorates the hospital's payment if the patient gets discharged to post-acute care--including home care--before the national median length of stay (see Eli's HCW, Vol. XIV, No. 44).

While some hospitals have ignored the new policy so far, others are making changes to their home care referral patterns, notes Mike Ferris of Home Care Marketing Solutions in Chapel Hill, NC. Some hospitals are limiting home care referrals overall, industry members report. Others have used the policy as "another excuse for hospital administration to mandate referrals to the hospital-based agency," Ferris notes.

The policy expansion "cannot be considered a positive for home health agencies," Ferris acknowledges. But the change does offer "an opportunity to be proactive in the sales and marketing message."
 Heed these expert tips for saving your hospital referral stream with marketing savvy:

1. Get the facts. First, understand how the transfer rule works, advises Stephen Tweed, CEO of Leading Home Care based in Louisville, KY. CMS spells out the details in the hospital inpatient PPS final rule at www.cms.hhs.gov/QuarterlyProviderUpdates/downloads/cms1500f.pdf. Note that proration applies only when the transfer to home health occurs within three days of hospital discharge.

2. Assess the impact to you. Evaluate how many of your referrals over the prior year would have fallen under the scope of this policy shift, counsels Heather Rooney, president of H2 Marketing based in Seattle. Remember to take into account that proration occurs only when the hospital discharges the patient prior to the national median length of stay. If the policy would have affected many of your referrals, it's time to take action.

3. Craft your marketing message. The goal of approaching hospitals with a focused marketing message is to prevent or counter problems, not make a new problem by scaring them with the policy. "Try to avoid taking a purely defensive stance--you don't want to create an issue where one does not yet exist," Rooney cautions.

Your marketing message should emphasize the positive things home care does for the hospital, Rooney urges. Those can include preventing emergency room visits and rehospitalizations, which also lead to expensive DRG prorations, Ferris notes. Other good points to stress are condition-specific outcomes, disease management, telehealth and quality of patient care, Rooney advises.

You should also educate the hospital about the policy and propose a plan of action for helping it prevent DRG prorations, Tweed recommends. Set out the policy details and the action plan in a "clear, concise, one-page summary," he advises.

4. Make contact. Set up meetings with hospital discharge planners and physicians who have patients with these DRGs, Tweed counsels. Work with the organization's decision-makers to reap the most benefit. "Review your one-page summary, discuss the situation and look for ways to work together to provide the best possible care to the patient without negatively affecting the hospital's reimbursement," he says.

Now's the time to push home care's benefits to patients and hospitals--especially the financial ones. Pointing out how much money the hospital saves by having home care prevent a congestive heart failure patient's readmission is "a very successful message," Ferris points out.

5. Monitor the impact. Keep track of how the policy is affecting your referrals and adjust your action plan accordingly, Tweed instructs. 

Note: For a copy of the post-acute transfer policy included in the IPPS final rule, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "Transfer Policy" in the subject line.