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What Does Your Bottom Line Look Like In PDGM? How Do You Find Out? Are You Scared You Might Sink The Ship?

SuccessIn order to stay ahead in the Medicare home health world, you have to think ahead. If you are reactive, then you can easily find yourself way behind. Moving forward in the PDGM world, you need to understand the formula and how you will be impacted. Make the changes now to prep for success.

How Do Things Look If I Make No Changes:

The first thing you need to do is determine if what you do now loses you a bunch moving forward. CMS has a listing by provider number with what 2017 data looks like if we were in a PDGM model. Check out your provider number and the side-by-side comparison under PDGM Agency Level Impacts. This will help you determine what to do moving forward. Now, most agencies with therapy heavy numbers will see that decline in revenue with the loss of additional monies for therapy visits. You will also see that many subsequent 30-day time frames will resemble something more like a LUPA model for payment.

Don’t Panic If You See A Decline:

The first thing you might want to do is throw up your hands and say you can’t do it. Please don’t. In this time, you need to think ahead to what the vision of CMS looks like as these models progress. The more you do so, the more these changes can resemble the ongoing process to a medical home model base. If you consider the long term picture and not just what you have to do to get through tomorrow, then your whole agency can make changes effectively. It is the difference between hectic change and methodical operational shifts. Make sure you are well-educated on PDGM now so you can be ready in a coordinated way. Educate staff so they understand the process in a way that makes sense for each discipline.

Don’t Forget The Documentation:

As you move through operational change, documentation can get lost in the mix. Know what documentation should look like for PDGM as part of your education to clinical staff. The emphasis on interdisciplinary care planning is crucial and done correctly will only make the transition easier.

Let Us Know How We Can Help:

At Kenyon Homecare Consulting, our focus is the progressive movement of agencies forward with changing trends to help you succeed. Call us today at 206-721-5091 or contact us online to help with your process into the home health of tomorrow!

Chronic Disease Program Management: Are You Ready To Make It Work Instead Of Treading Water Doing The Same Old Thing?

PDGMChronic Disease Program Management is one of those things that is sometimes put on the back burner. You worry about finances, referrals and staffing to cover the patients you have as well as being able to staff new ones. Coding and Oasis and compliance are in there too. It may seem one takes the front burner until it boils, and it just becomes a juggling routine. Sound familiar? It is time to make chronic disease management the answer to it all. 

Moving Into PDGM: 

With ACOs and Value-Based Purchasing, agencies got a taste of outcome-based care. The goal was always for a more coordinated effort to manage care in a cost-effective way. The process always meant managing chronic disease related to the costs associated with it. Process changes meant optimizing all disciplines to function at full scope of practice. It also meant coordinating all those moving parts, so everyone worked together. 

Now, with the 2020 initiation of the new payment rules, agencies will have 30-day payments for care. If your payments significantly drop once a patient is on more than 30 days, what do you think happens to the average length of stay for a patient? The goal from the beginning of skilled care was to get the patient independent and back to previous level of function. Only a small number of patients were intended for multiple episodes of care.

Putting Everything Into Place: 

A more coordinated effort into chronic disease management fits directly into an agency’s fiscal survival in PDGM. In order to make this happen, agencies must move full steam ahead with chronic disease education programs that work. Education for disciplines independently don’t address the coordinated effort towards the care plan. It is the difference between disease knowledge versus a true education about disease. Look at programs designed for the discipline itself as well as the agency. This will help you move operations into a coordinated model focused on the care plan and not on tasks by a discipline. 

Chronic Disease Management With Kenyon: 

At Kenyon Homecare Consulting, we have online chronic disease education programs to help you move in the right direction. We also have senior associates who can help you alter operational process if you want on-site assistance. Call us at 206-721-5091 or contact us online for your free 30-minute consultation with a senior associate. 

How Do You Change The Mindset Of Therapy Care Plans In Preparation For PDGM? One Step At A Time And Start Now Before The Ball Drops On New Year’s Eve!

one step at a timeWhether you are new to homecare or have been around for decades, change is always a given! Now, with the PDGM model, it becomes more important to analyze and see if things can be done more efficiently in your therapy program. Wait, it is more than important. It is crucial. Let’s look at steps to make it happen. 

5 Steps To Therapy Change: 

You need to know where to start. If already in the process, then you may see big change or be frustrated with lack of results. Consider methodically approaching the process. 

  • Check Your Outcomes: The first step is checking the therapy report card. Do you see the improvements you need from an Oasis standpoint? If not, then figure out if therapy is underperforming or the Oasis is being marked improperly on SOC or DC. 
  • Check The Documentation: Does it paint the picture of what the therapist is really doing? Is everything documented back to a functional goal? If you don’t know why each intervention is being performed, then it needs to change. 
  • Talk About PDGM: Whether you have contract or staff therapy, the discipline has been attached to additional payment for decades. The idea of managing visits has been different for nursing than therapy. It is a reality. So, therapy mindset has been different. The mindset with PDGM must change since the payment no longer follows the therapist. 
  • Alter The Paradigm: Now comes the management of the care plan between all skilled disciplines. This has been a big focus of care planning for years. Care coordination becomes completely focused on functional goals between all skills. Not therapy versus nursing versus home health aide. This is crucial for PDGM profitability. 
  • Evaluate The Program Often: This will be a work in progress for you that are just beginning. Others who have started know can be challenging. However, for those who successfully implement a meshed and coordinated care plan, it is just better! It really can function like a well-oiled machine. Evaluate the program by looking at your chronic disease care. It is the single most important tool to advance coordinated care for a PDGM world. 

We Can Help: 

At Kenyon Homecare Consulting, we can help you advance a coordinated care program. Whether you need help with documentation, chronic disease education, or operational change call us at 206-721-5091 or contact us online to see how we can help. 

Combing Through The 2019/2020 Home Health Payment Rule Changes Without Pulling Your Hair Out!

healthcare reformWhenever CMS drops payment changes, home health agencies want to cringe. Over the years, agencies become better at completing documentation and filling out Oasis properly. In response, CMS hits us with terms like case mix creep and then  changes payment for services. It can be overwhelming to jump multiple hurdles and not feel like you reach the finish line. Let’s look at payment and policy reform and how it changes care planning. 

Per CMS: 

CMS states policy changes for 2019 are based upon empowering patients, increasing competition, and fostering innovation.  The goal here is that the changes are supposed to be less about paperwork and more about patient focus. Focus on the condition/needs of the patient and not on the amount of care provided. This is the continued evolution of a value-based purchasing model with advancement of quality reporting. 

30-Day Periods In A 60 Day POC: 

This is a huge stand out for providers. Ultimately, instead of the 60-day episode of care, CMS will begin paying according to 30-day periods. This is a budget neutral plan from CMS to begin calendar year 2020. The therapy thresholds will be gone then as well. If you follow the rationale from CMS, then it makes sense. Value-based purchasing and episodic care are not meant to be based on the volume of visits. However, therapy thresholds are. So, your efforts to push therapy providers to work together in an interdisciplinary manner is not in vain. It is necessity. 

What Does PDGM Ultimately Mean: 

It means you must see each discipline working collectively. Weekly goals are discussed between disciplines and all members know exactly what to work on in the patient care plan that week. Then, progression of care is a systematic effort focused on joint goals. Now, this does not mean everything is going to be easy. If you thought so, you wouldn’t be in home health right now. Correct? Well, in all honestly, this is absolutely the time to advance home health into the next realm of care. This is front-loading of care from all disciplines. It is making the Oasis something you learn from as opposed to a form that must be filled out for payment. It is making the medical home model reality for all home care providers.

Kenyon Homecare Consulting Can Help: 

At Kenyon Homecare Consulting, we are working through these changes with agencies along with you. The senior consulting staff can help you move through operational changes to match the industry standard of care. As we continue to focus on aspects of payment reform, please call us at 206-721-5091 or contact us online to see if we can help you meet your goals.

Navigating The Final Rule: Let’s Look At Some Changes And Positives From Home Health Regulation Changes!

Home Health RegulationsWhether you are a brand-new skilled agency or have been in business for decades, the final rule always makes you cringe a little. Home health regulations can be overwhelming when it comes to implementing them. The industry saw many changes in this final rule. Let’s look at some of them. 

Here Are Some Good Things: 

If it seems there isn’t anything good there, then you should take another look.  Here are 5 things that came from proposed home health regulation change in favor of the good guys! 

  • Home Health Gets A Raise: The standard 60-day episode payment increased 2.2%. Neutrality factors included, the average payment per episode is up. 
  • Physician Certification: The plan of care and additional supporting documentation determines eligibility. If signed and dated by the MD containing all necessary elements, then it is sufficient.
  • Recertification: Length of time estimation is eliminated. Good! This is just extra paperwork and time for the agency and the MD.  
  • Telemedicine: The cost associated with remote monitoring can be an admin cost on cost report. It does not mean additional reimbursement. It does not mean substitution for home health visits, but it does mean accounting for the cost. 
  • RAP Payments: RAP payment will continue to exist for established home health agencies. 

Areas Of Concern For The Industry: 

For everything that is positive with the regulations, there are also areas of concern. Here are 3 things with considerable impact: 

  • Patient-Driven Groupings Model: This is a revised HHGM model. It contains the 30-day periods of billing within your 60-day episode. There are 432 payment groups and it eliminates the therapy volume domain. It will consider timing, admission source, 6 clinical groupings, functional level, and co-morbidity adjustments. There are adjustments up to -6.42% based upon LUPAs, coding, and co-morbidities. Number of agencies are anticipated to decrease in certain regions. 
  • Rural-Add On: The add-on percentage will continue to decrease each year. Add-on is 3 different sub-categories: Low Population Density Agencies, High-utilization counties, and all other rural areas. 
  • Home Infusion Therapy Benefit: These services are provided under Part B and not the home health benefit.  The new considerations are only for certain drugs and only with use of an infusion pump in the home.  If Part A providers adhere only to what the Part B provider allows, then patient care could suffer. There could be side-by-side billing, but what if overlap of nursing care exists? If the patient needs to be taught the infusion, then also needs wound care? It just needs additional clarification so there is no chance of incorrect billing. 

Do Your Homework And Call Us If You Need Help: 

At Kenyon Homecare Consulting, we have seasoned consultants from top administration levels. We help navigate operational changes and work with you through changes. Call us at 206-721-5091 or contact us online for assistance. 

HHABNs Are Gone! Introducing The Supposed More Simplistic HHCCN!

As Elizabeth Hogue, our esteemed colleague and well-known health care attorney explains in this article, The Centers for Medicare and Medicaid Services (CMS) has announced that the Home Health Change of Care Notice (HHCCN) has replaced two notice formats of the Home Health Advance Beneficiary Notice of Noncoverage (HHABN). And the HHABN will be discontinued. Providers using HHABNs understand they have three different notice formats, called “Option Boxes,” given to patients under certain circumstances. The HHCCN will replace Option Box 2 and Option Box 3 formats of the HHABN. The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 will replace the HHABN Option Box 1 format.HHABN

Home health agencies should begin using the HHCCN as soon as possible. There will, however, be a transition period during which agencies can use either the HHCCN or the HHABN. The date for mandatory, exclusive use of the HHCCN will be posted on the CMS website at some unspecified time in the future.

When Is a HHCCN Required?

Reductions or termination of care are triggering events for requirements to provide HHCCNs.

HHCCN’s should be issued to beneficiaries or their representatives for notification of changes in plans of care (POCs). Specifically, agencies must provide HHCCN’s whenever they reduce or terminate beneficiaries’ home health services due to orders from physicians and other providers or limitations of the agency to provide specific services for both covered and non-covered services listed in POCs.

An example of triggering events due to orders from physicians/providers includes: “The POC includes wound care every day. The physician writes a new order to decrease wound care to every other day.”

An example of triggering events due to agencies’ inability to provide specific services includes: “Physical therapy (PT) services are ordered four times per week in the POC. The Agency has an unexpected staffing shortage and can only provide PT services two times per week.”

If termination of services involves the end of all Medicare-covered care and no further care is being delivered, the only notice agencies must issue is the Notice of Medicare Non-coverage (NOMNC), Form CMS-10123.

What Instructions Are Available for HHCCN Completion?

CMS has also provided general instructions for the completion of HHCCNs. Among the instructions are the following:

  • Electronic issuance of HHCCNs is permitted. If agencies elect to issue HHCCNs viewed on electronic screens before signing, beneficiaries must be given the option to receive paper copies. Whether the notice is presented to beneficiaries electronically or on paper, beneficiaries must be given copies of signed HHCCN’s for their records.
  • Agencies may reproduce HHCCNs using a variety of methods, but the HHCCN cannot exceed one page in length.
  • Agencies can customize HHCCNs, including pre-printing agency-specific information to promote efficiency and to help ensure clarity for beneficiaries. Guidelines for customization are included in the instructions for use of the form.
  • When there are changes in care that require HHCCNs, agencies must list changes in the area under “Items/services” on the form and must indicate whether the item/service is being reduced or terminated in language understandable to beneficiaries. Examples are: “On December 17, 2016, we will stop all of your occupational therapy services.” or “On December 17, 2016, the frequency of your wound care will decrease to three days per week.”
  • In the blank area under “Reason for change” on the form, agencies must insert the specific reasons changes in care occur. An example related to changes in physicians’ orders is: “Your doctor has changed your order for this care.” An example related to agency related changes is: “Your dog has repeatedly threatened our staff, so we are unable to safely enter your home.”
  • HHCCNs must be signed by patients or their representatives. When patients’ representatives sign instead of patients this fact must be noted on the form next to representatives’ signatures. If beneficiaries refuse to sign, agencies must note this on HHCCNs and provide copies of annotated HHCCNs to beneficiaries.
  • When delivering HHCCNs, agencies are required to explain the entire notice and its contents and to answer all of beneficiaries’ questions. Delivery of the form in-person is not required.

Conclusion

Detailed information about this change can be found in the Medicare Claims Processing Manual, Chapter 30, Section 60.

Here we go again! Something new that is supposed to make providing care easier, but, at least initially, seems to be just the opposite!

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

ElizabethHogue@ElizabethHogue.net

©2016 Elizabeth E. Hogue, Esq. All rights reserved.

 

Spotlight: What You Need To Know Regarding The New RACs And New Rules!

As Elizabeth Hogue, our esteemed colleague and well-known health care attorney explains in this article, the Centers for Medicare and Medicaid Services (CMS) recently selected five new recovery audit contractors (RACs) and established new rules. RAC audits will undoubtedly resume soon. Performant and Cotiviti were awarded contracts, along with HMS Federal Solutions. A previous RAC auditor, CGI Group, did not bid in the latest round of contracts for RACs. Performant will focus on auditing home medical equipment (HME), home health agency (HHA) and hospice claims.RACs

Contingency Fees and Timing for Overpayments

CMS will continue to pay RAC auditors a contingency fee when identifying overpayments. Providers frequently point out that RACs receive incentives to find erroneous overpayments. These errors have resulted in a multi-year backlog of claims pending appeal, especially before administrative law judges (ALJs). Nonetheless, CMS announced that RAC auditors have recouped $8 billion for the federal government since the audits began in 2009.

Under previous rules, RACs received payments for overpayments they identified in less than forty-five days. Under new rules, RACs will now receive payments for overpayments they identify only after providers have an opportunity to appeal through the second level of an appeal process that provides five stages of appeals. As a result of this change, contingency rates for payments to RACs will likely increase substantially, from the current 9.5% to 12%.

Also under previous rules, RACs could review claims that were up to three years old. Under new rules, claims reviewed by RACs cannot be more than six months old.

Audits by RACs, More of the Same

Audits by RACs have been on “pause” while developing new rules and disputes about the contracting process resolved. When RAC audits resume, providers can expect more of the same, i.e., a focus on vague eligibility criteria, such as home bound status and terminal illness, which are open to broad interpretation.

RAC auditors are also likely to continue their focus on whether care that was provided was reasonable and necessary. Unfortunately, RAC reviewers often seem to evaluate this issue very differently than providers who are “on the ground,” so to speak. It seems reasonable to require RACs to cite national standards of care to support their conclusions that care provided was not reasonable and necessary. Without such support, what constitutes reasonable and necessary care seems to be “in the eye of the beholder.” This pattern makes such determinations extremely difficult for providers to address on appeal.

Name of the Game for all Audits Including RACs

CMS’ initial meeting with new RACs is in November. Audits will begin soon thereafter.

As always, the “name of the game” for providers with regard to all types of audits, including RAC audits, is documentation, documentation and more documentation! Although it is an age-old “story” and most clinicians certainly know how to provide appropriate documentation, consistently excellent documentation appears to remain elusive.

Kenyon HomeCare Consulting is here to help! Are you struggling with overpayments discovered by RAC audits and need assistance with improving your clinical documentation? Contact us to schedule an appointment or call us today at 206-721-5091.

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

ElizabethHogue@ElizabethHogue.net

©2016 Elizabeth E. Hogue, Esq. All rights reserved.

CMS Emergency Preparedness Final Rule: What You Need To Know!

As Elizabeth Houge, our esteemed colleague and well-known health care attorney explains in this article, The Centers for Medicare and Medicaid Services (CMS) issued final rules regarding emergency preparedness. The final rule published in the Federal Register on September 16, 2016, will be effective on November 15, 2016. Providers are not, however, required to comply until November 15, 2017 but best to get started on these changes now!Emergency Preparedness

Emergency Preparedness Rule: Four Core Provider Elements

The four core elements of all providers’ emergency preparedness programs that must focus on continuity of operations, not recovery of operations, must include the following:

Risk Assessment and Emergency Planning

Providers are required to perform a risk assessment that uses an “all-hazards” approach prior to developing and implementing emergency plans. An all-hazards approach is an integrated approach to emergency preparedness planning that focuses on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters. Also, the risk assessment must be used to identify essential components of emergency plans specific to providers’ and suppliers’ geographic locations. Examples include:

  • Equipment and power failures
  • Interruptions in communications, including cyber attacks
  • Interruptions in the normal supply of essentials, such as water and food

Policies and Procedures

Providers and suppliers must develop and implement policies and procedures that support the successful execution of emergency plans and that address risks identified in risk assessments.

Communication Plans

Providers and suppliers must development and maintain emergency preparedness communication plans that comply with federal and state laws. And these communication plans must include systems to contact appropriate staff, patients’ treating physicians and other necessary persons in a timely manner. Therefore ensuring continuation of patient care in a safe and effective manner.

Training and Testing

Providers and suppliers must also develop and maintain an emergency preparedness training and testing program. At a minimum, training and testing programs must include training for new and existing staff in emergency preparedness procedures as well as annual refresher training. Staff must demonstrate knowledge of emergency procedures during annual training sessions. Providers and suppliers must also conduct drills and exercises to test emergency plans in order to identify gaps and areas for improvement.

Emergency Preparedness Rule: Conclusion

These requirements will be mandated for suppliers through Conditions of Participation (CoPs) and conditions for coverage (CfCs), if applicable. CMS will also issue interpretive guidelines to assist providers to comply.

Here we go again! Yet another set of new regulations with which providers and suppliers must comply. Although compliance is not required for more than a year, now is surely the time to get started.

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

ElizabethHogue@ElizabethHogue.net

©2016 Elizabeth E. Hogue, Esq. All rights reserved.

What You Need To Know: Final Regulations Prohibiting Discrimination

OCR Implements Section of the ACA Prohibiting Discrimination

As Elizabeth Houge, our esteemed colleague and well-known health care attorney explains in this article, the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services published final regulations in the Federal Register on May 18, 2016. This final regulation implements Section 1557 of the Affordable Care Act (ACA). These regulations generally prohibit discrimination based on race, color, national origin, sex, age or disability.discrimination

Complying With New Discrimination Regulations Now

Here is what home health agencies, hospices, HME suppliers and private duty agencies need to know about these final regulations, which were effective on July 18, 2016:

  1. The regulations make it clear that discrimination based on sex is prohibited, including, but not limited to, discrimination based on individuals’ sex, including pregnancy, related medical conditions, termination of pregnancy, gender identify and sex stereotypes
  2. All providers who receive Federal financial assistance (FFA) are subject to the regulations, including providers that receive reimbursement from Medicaid and Medicaid waiver programs. This means that many private duty agencies must comply with these regulations
  3. The regulations clarify that providers may use adult family members or friends to interpret for patients with limited English proficiency (LEP) only if family members or friends agree to interpret, providers’ reliance on companions is appropriate under the circumstances, and there are no competency or confidentiality concerns
  4. Providers with more than fifteen employees must designate at least one employee to coordinate efforts to comply with Section 1557 of the ACA, including investigation of any grievances alleging noncompliance
  5. Providers with more than fifteen employees must adopt grievance procedures that incorporate appropriate due process standards and that provide for prompt, equitable resolution of grievances alleging violations of Section 1557
  6. All providers must take appropriate initial and continuing steps to notify beneficiaries, applicants, members of the public, etc. that they:
  • Do not discriminate on the basis of race, color, national origin, sex, age or disability in their health programs and activities
  • Provide appropriate auxiliary aids and services to individuals with disabilities and information about how to obtain them
  • Provide language assistance services, including translated documents and oral interpretation free of charge in a timely manner when such services are necessary to provide meaningful access to individuals with LEP
  • Make available information about the identity of the employee responsible for compliance with Section 1557, including contact information
  • Provide a grievance procedure and information about how to file a grievance
  • Provide information about how to file a complaint with OCR

Discrimination Regulations In Effect On 10-16-16

7. Providers are also required to do the following by October 16, 2016:

  • Post a notice that includes the information described above
  • Display a nondiscrimination statement
  • Post taglines in the top languages spoken by individuals with LEP of the relevant state or states. An example of a tagline is: “Attention: If you speak _________ language, language assistance services are available free of charge to you. Call _________, TTY _____________.”
  • Include notices and taglines in significant publications and communications targeted to beneficiaries, applicants and members of the public in conspicuous physical locations where providers interact with the public and on providers’ websites accessible from the home page of providers’ websites
  1. Employers who are subject to the requirements of Section 1557 and provide health benefit programs to their employees are generally liable for discrimination in the employee health benefit programs they offer employees

Compliance with the above provisions related to non-discrimination is yet another hurdle for providers to get over!

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

ElizabethHogue@ElizabethHogue.net

©2016 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

The Dream For The Future of Home Health Care

Recently I have the privilege of presenting at the annual conference for Kinnser Software. My presentation topic was “Surviving and Thriving in the Midst of a Paradigm Shift.” The evidence is clear – we are in the midst of something never experienced in the health care industry. As I watch our sector, home health care, many are hunkering down and just trying to weather the storm. Procrastinating will not work this time!home health care

Study Proves Home Health Care Is The Future

CMS has made it clear they are moving to home and community based services. Costs are out of control and something must be done to break the current cycle. Undoubtedly the finger is pointing towards home health care. Our time has come, but only if we are willing to change into the organizations of the future.

Using the results of the John Hopkins’s ‘Hospital at Home’ study, the evidence substantiated acute care can be delivered in the home. The outcomes show there is as a much better way to provide services, with quicker results while allowing for major savings to Medicare. Additionally, several chronic care studies are also pointing in the direction of homecare. Although there has been much little change in actual practice, this is the beginning of our future. So let me share my dream for the future of home health care.

Home Health Care Acute Team

All clients admitted to a home health care agency are assigned a Geriatric Care Manager. This manager follows the patient for the current care episode, for all health care readmissions and if the patient’s condition becomes chronic. Potentially this patient gains a case manager for the remainder of life. For this model to work, multiple teams will work from and under the direction of the home health agency.

This acute care team consists of nurses, therapists, physicians, nurse practitioners, and pharmacists. The equipment used in an acute environment is also provided. Nurses work one on one until the home patient stabilizes and ready for the sub-acute team to take over. Physicians, pharmacists, and other allied services are on call and available 24/7 during this acute illness phase.

Sub-acute Home Health Care Team

The sub-acute team, those supposedly providing home health care in 2016, will assume responsibility from the acute team. A hand off to the sub-acute team leader occurs and nurses, therapists and home health aides are scheduled based on patient needs. Unlike how many agencies practice today, staff will no longer set their schedules. The sub-acute team visits daily until the patient stabilizes and is able to manage with less assistance. Aides are assigned 8 to 12 hour in home shifts reducing hours over time based on the patient’s progress.

Patients diagnosed with chronic diseases or conditions not being managed well at home resulting in exacerbations, will be assigned to the chronic care team.  A nurse case manager provides skilled care and the home health aide provides the ADL and IADL support needed for the patient to remain stable at home. However, the chronic care team’s focus will be not only be to provide immediate care. Care will include behavior changes supporting a better quality of life and outcomes resulting in reduced costs.  We know from adult learning and behavior change studies, it takes one to two years to make these new behaviors permanent. Changing the behavior of patients with chronic disease to prevent frequent exacerbations is a long term home health care project.

The Home Health Care Dream

Given this picture of the future, the home health care agency will be the care hub. Contracts will be needed with hospitals, organizations offering acute neuro and orthopedic rehab, transitional care organizations, pharmacies and other allied services. Consequently, with the current bundled payment direction, most likely all organizations involved will be working under a shared risk contract.

Finally, in the future home health aides will be full members of the team. As such, they need advanced education to meet the increased demands placed on them. At a minimum, aides will be require certification in all major chronic diseases. Aides will then have the knowledge required to recognize and report changes in condition early enough to prevent emergency room visits and acute care team interventions.

Contact Kenyon HomeCare Consulting today to learn how we can help you prepare for the home health care future. Ready to provide your homecare aides the in-depth knowledge necessary to provide five-star patient care? Chronic Disease University increases the value of your aides and reduces overall health care costs for your patients.

The future has great opportunities for home health care, but only if we are brave enough to step into the unknown and change.  Are you brave enough to dream?