Health Care Regulations
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Health Care Regulations

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Health Care Regulations Health Care Regulations Presentation Transcript

  • Understanding New Regulations and Home Health
    Presented by:
    Mobile Doctors
  • Mobile Doctors
    Founded in 1996 with the sole purpose of serving patients in their residences.
    Mission
    “We firmly believe that quality, physician- led patient care and coordination at home through doctor house visits improves OUTCOME and REDUCES TOTAL COSTS”
  • National Health StatisticsNew England Journal Medicine Jan 2001
    • United States Healthcare Costs $2Trillion Annually
    Hospitalizations account for 1/3
    Medicare-20% re-admitted within 30 days
    1 in 5 did not see a physician
    COST= $17.4 Billion dollars annually
    Remedies-
    Affordable Care Act Independence at Home
    Accountable Care Organizations
    State Based agencies cCommunities & Hospitals
  • Medicare Hospital Quality Chartbookpublished 2010
    Performance Reports on Outcomes for (3) of the most common causes of mortality (and readmissions) among the elderly:
    Acute Myocardial Infarction (AMI)
    Heart Failure
    Pneumonia
    Study measures 30 day mortality and readmission rates (2006-2008)
  • Summary
    Monetary Penalties will be assessed to hospitals for high readmission rates
  • Partnerships to Improve Care and Lower Costs for AmericansCMS Provider Service 4/13/11
    AFFORDABLE CARE ACT
    Partnerships between Administration, the private sector, hospitals and doctors to make care safer potentially saving $50 Billion dollars
    HEALTH AND HUMAN SERIVCES (HHS)
    -Invested $1 Billion dollars- available through community-based Case Transitions
    Programs
    -Announced Rules for ACO’s (Accountable Care Organizations) By 2015, a portion
    of Medicare payments will be linked to whether hospitals are delivering safer care
    Payments for Performance Penalties for Under Performance
    CENTERS FOR MEDICARE & MEDICADE (CMS)
    -Dedicating another $500 million to reducing hospital acquired conditions
    GOALS: By end of 2013, 20% decrease in hospital readmissions compared to 2010
    GOALS : By end of 2013- 20% decrease in hospital readmissions compared to 2010
    -Adverse Drug Reaction
    -Pressure Ulcers
    -Infections
  • Face to Face DocumentationHealth and Human Services April 1,2011
    Mandated by AFFORDABLE CARE ACT
    Condition for payment
    Face to Face encounter must occur within 90 days prior to start of home health care or within the 30 days after start of care
    If a new condition exists not evident during the 90 days prior to start of care, the certifying physician must see patients and document a new F2F within 30 days
    As part of Certification-or as addendum, physicians must document date of personal encounter, document in writing- and not by checklist- patients clinical condition supporting “Homebound status” and need for skilled nursing services.
    Nurse Practitioner may conduct F2F encounter but the Physician must sign AND it must accompany Certification and Plan of Care
    Hospitalists may certify need for Home Health and POC, but must hand off patients’ care to community based physician
    The certifying physician can dictate the documentation to a support personnel (those who work with the physician on a regular basis) to type or can be generated from electronic health records.
  • F2F continued……..
    Unacceptable for physicians to verbally dictate the encounter to HHA’s where the HHA would document for the physician to sign
    ACA- requires F2F encounter and corresponding documentation as a certification requirement: POC, Certification, and F2F required for payment
    F2F can be performed through telehealth but only in rural areas
    Eligibility: patient must need intermittent skilled nursing care or PT or speech therapy or occupational therapy and be “homebound”
    Recertification for ongoing care is needed after 60 days of HH services
    Whether the F2F document is on the certification form itself, or as an addendum, it must be separate and distinct AND must include: Patient’s name, date of encounter, clinical condition and how it supports need for Home Health, physicians signature (original, faxed copy, copy or original document w/ signature- not stamped, and date of physician signature)
    For the attending physician to sign the certification he/she must also be the physician who performed the F2F encounter. (Different physician can sign the POC)
  • Homebound Status
    Definition: condition or illness restricting ability to leave residence without the assistance of :
    another individual
    aid of supportive device (crutches, walker, cane, wheelchair)
    “should be a taxing effort”
    Acceptable Reasons for Leaving Home
    -need to receive healthcare treatment
    -attend licensed adult daycare
    -attend religious service
    -”anything else of short duration”
  • Mobile Doctors
    Specialize in providing physician home visits to patients who have a physical or mental condition that inhibit their ability to visit the doctor without assistance
    single family homes
    group and small care homes
    Senior Living Communities: AL, IL
  • Primary Focus
    Common Conditions
    Alzheimer's & Dementia
    Cardiac Conditions: CHF, Arrhythmias
    Pulmonary Diseases: COPD, Pneumonia
    Diabetes
    UTI’s and other infections
    Hypertension
    Pain Management
    Wound Care
    Brain Injury and Stroke
    Parkinson’s, Multiple Sclerosis
    Diagnostic Testing
    Blood Tests
    X-Rays
    Echocardiograms
    Venous Doppler studies
    Ultrasounds
  • Mobile Doctors: Efficient, Effective andSimple
    Fax/Phone patient information to office- Face Sheet/H&P
    Verified by our Schedulers same day
    Patient scheduled and seen within 72 hours by a qualified Physician with a medical assistant
    Visit notes faxed to Home Health Agencies and/or PCP or Specialist
    Follow up visits made monthly or as needed
    Insurance is billed- no out of pocket costs
    WWW.MOBILEDOCTORS.COM