Home Health & Hospice Week

Employ managed care tactics with Medicare processes.

To survive and thrive under the growing managed care presence, you'll have to get smart about costs.

"You look at every single thing in your organization" when cutting costs to fit under managed care payment rates, Kristy Wright, CEO of the VNA of Western Pennsylvania, said in an Oct. 17 session at the National Association for Home Care & Hospice's annual meeting in Baltimore.

The scrutiny should last from when a referral hits your organization through when a patient is discharged, Wright urged. You should be looking to eliminate unnecessary duplication of effort and resources.

And smart home health agencies will take those managed care principles and apply them to Medicare business as well, said Greg Roof, director of finance for Adventist Home Health Services based in Silver Spring, MD.

Try this: Now may be a good time to consider lightening your OASIS load, if you haven't already. VNA of Western Pennsylvania doesn't complete OASIS assessments for non-Medicare patients, Wright said.

But for some agencies, eliminating OASIS for those patients may not be feasible. State requirements for assessments make keeping OASIS the most sensible decision for Adventist, Roof explained. VNS and Hospice of Greater Rhode Island also continues to conduct OASIS assessments for all patients, CEO Elaine Stephens said in the session.

Heed these additional tips for how to ready yourself for increased managed care business:

• Diversify. Set up other business lines to offset the managed care impact. VNA of Western Pennsylvania branched out into home medical equipment, private duty, hospice, telemonitoring and other areas, Wright offered.

• Say no. You don't have to do everything the managed care organization asks you to. If the MCO requests unreasonable things, just say no, Wright urged. "Don't be afraid to do that."

• Assess referrals. You may have to turn down some referrals if you don't have the resources for them. But before turning them away, be sure to look at where they're coming from, Roof advised. Don't alienate your best referral sources.

• Educate employees. Staff may chafe at new processes put in place to achieve lower costs. To boost employee buy-in ...quot; and hopefully your bottom line as a result ...quot; share your financial information with clinicians and show them how their practices impact the agency's fiscal health, Roof recommended. Remember, "no money, no mission."

• Beware hidden traps. VNA of Western Pennsylvania was disappointed it couldn't get a managed care payor to reimburse for telemonitoring. But the agency was so sure of the practice's benefits that it placed telemonitoring equipment in managed care patients' homes anyway.

Backfire: When the MCO learned of the telemonitoring practice, it wanted to reduce the number of visits it authorized for its patients because it knew the VNA was providing a free monitor. At that point, the agency had to pull its telemonitors for that payor's patients, Wright cautioned.