Home Health & Hospice Week

With your patient outcomes and even survey results on the line, curbing hospital readmissions should be at the top of your to-do list. And with pay for performance expected around the corner, reducing readmits will become even more crucial.

Your team of therapists can help your home health agency be the exception to the rule with the right tools, industry experts say.

Your HHA should be keeping track of its top reasons for readmissions and target those in staff training. For example, Amedisys Inc., an HHA chain based in Baton Rouge, La., found that falls were one of its biggest culprits for hospital readmissions.

"So we've had a big push in the company to identify fall risk factors, educate the community and our personnel, and follow up with focused interventions," says therapist Kim Marryott Lee, corporate director of rehab research and quality for Amedisys.

Amedisys makes a point to look for fall risks in the physical home environment, such as slippery floors and clutter. But clinicians also are trained to check for other risks, such as vision problems, inner-ear issues, medications that could cause dizziness, and cardiac issues that could contribute to falls, Marryott Lee says.

Other conditions you should always keep on your radar include chronic obstructive pulmonary disease (COPD), chronic heart failure, diabetes, and infections (both wound and catheter infections). And keep in mind that your own HHA's readmission stats may reveal other red-flag diagnoses.

Good idea: To exercise good preventive measures, standardize your care, says therapist Steve Allred, vice president of clinical development for Atlanta-based home health care chain Gentiva Health Services Inc. "For example, when we have a post-joint replacement patient, we do x, y, and z every time -- that way the patient isn't dependent on the skill set and knowledge base of a particular expert clinician."

Suppose a PT walks into a patient's home to do rehab for a hip replacement. The patient exhibits a faint smell of feces and appears to have poor personal hygiene. Due to other comorbidities, the patient is on a Foley catheter, and the therapist notices that the patient's urine is cloudy.

Although the PT may not feel she's responsible for addressing the patient's hygiene and investigating a potential urinary tract infection, she should be tuned in to notice warning signs such as these and should report them to the nurse on the case.

Any mentality such as "these issues are just for nursing; I don't need to pay attention to them" is asking for trouble, Allred warns. "You need to be aware of what's going on so you know when to refer to your nursing partner. This awareness is thinking as a team."

Strategy: Get everyone on the same page regularly. For example, Amedisys holds weekly case conferences. "These meetings are a great source of communication where everyone gets to bring their piece of expertise to the table, discuss it, and figure out what's the best plan for the patient," Marryott Lee says.

Another idea: Ensure all clinicians have access to cell phones and that the minutes are reimbursed so that the therapist feels comfortable calling the nurse and saying, "I'm seeing x, y, and z. When you come in tomorrow, can you look at these things?" Allred suggests.

No matter how good your therapists are at spotting risk factors early, if a patient isn't confident with her condition, she may unnecessarily admit herself to the hospital. "It really gets down to the patient in the home knowing when he needs to go to the hospital and when his condition is something he can manage for himself," Allred says. "We want to help that patient get to a point where he can say, 'I don't need to go to the hospital,' or 'I'm confident that I need to go right now.'"

Here's how: Suppose a COPD patient gets shortness of breath, feels like he can't breathe, starts to panic, and considers going to the emergency room. "A PT or OT on the case is in a unique position because the therapy session is a safe environment where you're taxing the patient's effort and can educate him on what's happening, how to get his breathing under control, and when his shortness of breath is truly a danger that calls for an ER visit," Allred says.

Another example:Apost-joint replacement patient may not know what to expect in terms of pain and swelling, and the therapist can help educate the patient on this so the patient doesn't visit  the hospital for pain or swelling that's normal, Allred adds.

Other tactics: Therapists can also play a huge role in prevention education, namely on fall risks. "We do a lot of community education about identifying fall risk factor, such as throw rugs, poor lighting, cords running across the middle of rooms, how to properly install grab bars, not to use towel racks as stabilizers, etc.," Marryott Lee says.