Health Care Regulations


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Health Care Regulations

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