Home Health & Hospice Week

Follow this agency's lead to increase your case mix level 20 percent. If you'd like to boost your patients' outcomes and your bottom line at the same time, you should take a good hard look at your occupational therapy utilization.

Real-world results: The "rehab therapy" approach with OTs has done wonders for Peoria, IL-based OSF Home Care and its patients, says OSF director of rehabilitation Cindy Krafft. OSF is a hospital-affiliated home health chain with six offices -- five in Illinois and one in Michigan.

Since Krafft came on board in the newly created position 18 months ago, OSF has hired 30 therapists, bringing its total to 52, and increased the percentage of episodes that "break" 10 visits from 32 percent to 45 percent, Krafft tells Eli. During the same period, OSF's average case mix level has jumped 20 percent from just under 1.0 to about 1.2, Krafft says.

And much of that increase is due to occupational therapy, Krafft relates. In OSF's Peoria office alone, OT visits surged from 70 a month to more than 300 a month in the last year-and-a-half.

Occupational therapy is often an underutilized service in home care, notes Linda Krulish, president of Redmond, WA-based Home Therapy Services. "If the OTs themselves are not experienced and proactive in recognizing and sharing what they have to offer in terms of outcome improvement," the result is underutilization, points out Krulish, a physical therapist.

Home care is a market often dominated by physical therapists, contends Krafft, herself a PT. OTs' potential contributions can get drowned out by the more common skilled nursing and PT services home health agencies are used to focusing on, she warns.

Opportunity: Whenever a patient is having problems with her activities of daily living (ADLs), there's a good chance an OT can help, Krafft stresses. Home health agencies "are really being held to on our outcomes," she says. And OT services can help patients improve or maintain the outcomes profiled by the Home Health Compare Web site and measured by the OASIS instrument.

Here are some places to look for patients who are being underserved for OT, Krafft suggests: PT patients. "If we're doing four or five weeks of PT, you can't tell me there are no ADL issues," Krafft notes.

It may take PTs some time to relinquish control over ADL therapy to OTs, Krafft admits. "I've stepped on more than a few PTs' toes."

But OTs are really the experts on patients' functional abilities. When PTs question OTs' involvement, "my challenge to them has always been 'have you ever given anybody a bath,'" Krafft explains. "In my nine years in home health, I have not met a PT who ever has."

Taking a patient through a "dry run" is very different [...]