Homecare Matters 10

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Homecare Matters 10

  1. 1. July 2011 – Vol. 2, Issue 10 Home Care Stroke Rehab Study Reports Never Events – Extraordinary Findings Impetus for Pay for Performance 10 Medicare stopped reimbursing hospitals for The New England Journal of Medicine reported treating avoidable hospital-acquired complications the biggest stroke recovery rehabilitation study resulting from poor quality and has initiated ever conducted has concluded that home based PT is just as effective as formal rehab programs reimbursement policies that encourage their elimination. Beginning July 1, 2011, under the that use specialized equipment. Additionally, the Affordable Care Act (ACA), state Medicaid study found that recovery does not peak at 6 programs are required to deny payments to months as previously believed. In the study, all providers for costs associated with treating health- groups showed a similar level of improvement post stroke using both facility based and home acquired conditions (HAC). Among those problematic for homecare are falls and trauma and based rehab; however, the home based rehab catheter-associated UTI’s. Several third party program used less expensive equipment, payors have already adopted or are beginning to required fewer therapists, had better compliance adopt the same concepts. These payors include rates and cost significantly less. “I think this is Aetna, Cigna, Anthem BC/CS and WellPoint going to change the management of stroke and among others. third party payors will be interested because it will save a huge amount of money.”- Dr. Richard B. Libman, Chief of vascular neurology at Long These Never Events (never should have happened) are being used as the impetus for Pay Island Jewish Hospital. for Performance (P4P) and will affect homecare. The CareMinders model has been building quality into every process and procedure to prepare for Many Caregivers Flunking this shift in reimbursement policy. The key is to be Medicaid Requirements consistent in the application of the three primary questions during every supervisory visit; i.e. is the The Office of Inspector General (OIG) released an patient the same, better or worse than your estimate in early June that claims for services previous visit and how do you intend to alter the rendered by unqualified caregivers may have outcome if needed? accounted for $724 million in unjustified and therefore, recoupable funding from Medicaid programs nation-wide. OIG has audited records of several hundred caregivers employed by Medicaid agencies (CA, FL, GA among the states audited) and found them to have one or more deficiencies. These deficiencies result in the care rendered was2012 Fee For ServiceVisit Rates Released not qualified under the program rules meaning recoupment is in order. Compliance is a revenue Skilled Nursing 112.99 protection activity; as such, it is important to note Physical Therapy 123.56 that rendering the best care in the world does not Occupational Therapy 124.38 guarantee that you can keep the payments Speech Pathologist 134.25 received. It is compliance documentation that Medical Social Worker 181.14 assures reimbursement. Home Health Aide 51.18
  2. 2. January 2010 Vol. 2, Issue 10 Readmissions: Homecare’s Impact Nursing labor costs average nearly $100,000 perThe reduction of unscheduled hospital readmits is nurse. Actual costs per hour for a full time nursea primary reason homecare can have a positive were reported as 176% of the base hourly wage inimpact on the hospital it serves. During a home a study conducted by KPMG.care admission, make sure patients understandthe importance of calling the nurse first if anythingshould happen. The agency telephone numbershould be posted prominently on the phone and at Medicaid Face-to-Facebedside for ease of contact. Patients who are “at Rule Imminentrisk” of an episode that may require an emergencyintervention should be visited more frequently by While Medicare agencies nation-wide are stillthe nurse and called during those times a visit is struggling with the new face-to-face rules, thenot scheduled. The aides assigned to the case health reform law has mandated the same face-must be aware of the need to contact the nurse for to-face rules for all Medicaid beneficiaries. Someany changes in condition regardless of how states (Ohio and Iowa) have alreadyminimal. The primary goal of homecare is to keep implemented this requirement; however nearlythe patient at home as long as it is prudent to do all other states are waiting for CMS to proposeso. Most common risk factors leading to the rules under which providers must act.hospitalization are: Medicare agencies are experiencing difficulties Multiple hospitalizations with physicians understanding the rules and Frailty factors complying rendering their patients ineligible for Decline in mental, emotional, behavioral services. We will keep a close eye on the rules status as they are released for Medicaid. History of falls Taking 5 + medications Stop and Watch Tool The Role of Data in Readmissions A tool developed by the Georgia MedicalThe number of patients who needed homecare Care Foundation with support from CMSpost hospital surged by 70% between 1997 to reduces avoidable hospital readmissions as2008 according to the Agency for Healthcare evidenced by a demonstration conducted inResearch and Quality (AHRQ). About 1 in 10 of Texas of best practices. The tool wasnearly 40 million hospitalizations in 2008 was developed for paraprofessionals to reportpotentially avoidable. Patients 65 + accounted issues to nurses who could intervene withoutfor 60% of the potentially avoidable a hospital visit:hospitalizations indicating why this is such a hugeproblem for the Medicare program and why there S= seems different than usualis such a strong emphasis on this issue. Over a T= talks or communicates lesstwo year period, roughly ¼ of all hospital patients O= overall needs more help than usualwere readmitted for the same conditions that P= Participates in events /tasks lessprompted their initial hospitalization. According toCMS, among Medicare patients, 42% A= ate less than usualexperienced multiple hospitalizations and 38% Nhad multiple emergency department (ED) visits. D= drank less than usualContrast this to privately insured patients whohad only 19% with multiple readmissions and W= weight change29% with multiple ED visits. Home care can play A= agitated or nervous more than usuala pivotal role in reducing these potentially T= tired, weak, confused or drowsyavoidable readmissions. C= change in skin color or condition H= help with ADL’s more than usual

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