OASIS Alert

If you're involving the patient only after a crisis occurs, you are playing without your quarterback.

Old way: Many clinicians still have a pre-prospective payment system mentality, where an agency was paid for each visit. But in the current episode payment system, the only prize that goes to the one who makes the most visits is the booby prize.

New way: The new focus needs to be on setting and meeting goals for patient outcomes, says occupational therapist and consultant Karen Vance with Springfield, MO-based BKD. And that requires teamwork and good communication, she emphasizes.

Form a Winning Team

Frequently, agencies will involve patients and families only after problems arise, such as when the patient is non-compliant or the agency is considering closing the case, says consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT.

But smart agencies "make a routine practice of involving both the patient and the care provider from the very beginning," Mc-Namara advises. "There is no question that this will improve outcomes," she tells Eli.

Bonus: The single most important way to prevent errors is for the patient to be an active member of the healthcare team, says the Agency for Healthcare Research and Quality in its publication "20 Tips To Help Prevent Medical Errors." In addition, "research shows that patients who are more involved in their care tend to get better results," AHRQ reports.

Keep Goals in their Proper Perspective

To be sure you arrive at your chosen destination, develop one plan of care for the whole team to use, recommends occupational therapist Carol Siebert with the University of North Carolina in Chapel Hill. This keeps the team focused, targets resource allocation and helps the patient understand the way home care works, she says.
 
Remember to individualize the plan based on the patient's situation and resources available to the agency, the patient and the caregiver.

Key component: The most important piece of information for the team is the patient's goals, Vance says. Before developing your plan of care, you need to know what is important to the patient and where he wants to go, she explains. Then you can determine what is realistic and set expectations for the patient, family and agency right from the beginning.

Remember that during and after the episode, home care patients will need to be able to take over when the agency is not there, experts note.