Home Health & Hospice Week

Now's the time to advocate for your industry.

For home care providers, it's an increasingly difficult world with a lot of competition. But there are opportunities to succeed if you're proactive, said speakers at NAHC's 2012 Annual Meeting & Expo-sition in Orlando, Fla.

With impending decreases in reimbursement and ever more complex requirements for documentation, things can look bleak for the industry. But this environment provides an opportunity to "make home health the most important service out there and the solution to the high cost of healthcare, said the National Association for Home Care & Hospice's Mary St. Pierre during a packed Oct. 23 session, "Home Health Regulatory Round Up."

Now's the time to improve teamwork, whether it's working with other providers, or within agency care teams, St. Pierre said. Other providers may not realize home care organizations are already able to meet the increased expectations of the current healthcare environment. "We need to get this message across."

It's also important to make sure all staff know they don't do piecework, St. Pierre said. Employees must collaborate with one another as well as physicians and other providers.

Coordination of the team, including nurses, therapists, aides, and social workers, is more important than ever. Staff must all communicate back and forth efficiently to act quickly on problems, St. Pierre said.

Be Forward-Thinking To Aim At Hospital Readmissions

HHAs will need new tools to manage chronic conditions so the patient can be independent, St. Pierre said. For example, to help prevent rehospitalizations, agencies will need to be responsive and ready to send a nurse when needed, even if that means at 2 a.m.

And making first visits within 48 hours may not be the best standard for all patients. A newly released patient has "a lot of time to get into trouble" in those 48 hours, St. Pierre said. Responding as quickly as possible can help prevent problems. For some patients who are truly vulnerable that might mean a same-day first visit, she said. Triage will become important.

Innovation: One HHA St. Pierre spoke about has arranged with the ED to have a nurse in the home within eight hours of being called. This might be to help prevent a UTI or to provide IV medication. This agency works with staff to coach these patients to get them more independent. Before this initiative, the agency had a 30 percent rehospitalization rate. After creating this arrangement, it has decreased to 12 percent, she said.

HHAs also face an increased need to make sure referral information is as complete as possible. If you don't find out about a patient's co-morbidities until weeks later, it can have a negative impact on the patient's condition. Work with referral sources to improve this documentation, St. Pierre advised.

Try Visits to Sway Policy Makers

The cuts proposed by the Centers for Medicare & Medicaid Services are based on the assumption that agencies are gaming the system -- based on what CMS says is an increase in case mix, said Susan M. Collins, Republican Senator from Maine during the Oct. 23 General Session. But there are legitimate reasons why the severity of these patients' conditions have increased, she pointed out.

Plus, the cuts are unfair because they are being done across the board -- even for agencies who have shown a decrease in severity. "If an agency is gaming the system -- target that agency!" exclaimed Collins to much applause.

Best bet: If you hope to turn things around for home care, you'll need the backing of policy makers. The best way to establish that support is to take your local congressperson out on a visit -- and do the same for your local senator, Collins suggests. "It will change things immensely."

Agencies should also keep stressing to policy makers the cost-effective nature of home health. According to NAHC data, the average Medicare cost per day of a patient receiving home health is $44 compared to $559 per day in a typical nursing home or $1,932 per day in a typical hospital stay.