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February In-Service Agenda MEDX Hospice HHCAPS January Updates Face To Face Encounter 1 NGHHC 7/6/2015 MEDX MD order required for use. MedX must be on the care plan. Intervention would be for PT to use MEDEX to decrease patient’s pain while improving household mobility. MEDX cleaning log is required weekly (send to Mike in Supplies. NGHHC 7/6/2015 Moving from Home Health to Hospice The first factors to consider are the cultural differences which not only result in differing goals of care but also, and very importantly, differing quality measures: Home Health is basically founded on the expectation that the patient will improve in clinical and functional status as measured by required assessments called “OASIS.” In fact, the Center for Medicare and Medicaid Services (CMS) uses OASIS data to publicly report the quality of a home health agency’s care at Home Health Compare. Hospice is founded on the principles of palliation, managing distressing symptoms within the context of expected decline and death. Although there is not yet a hospice equivalent to Home Health Compare, that will likely change as CMS continues its commitment to a value-based payment structure. There is an inherent unfairness to home health in the OASIS model. “Because some patients cannot improve even with excellent care, OASIS scores are not necessarily indicative of quality of care. It is probably not realistic to expect this kind of improvement in a growing elderly population.” Helping the home health providers improve their OASIS scores may well be an entrée for earlier referral to hospice. Recognizing and appropriately referring patients who, in the natural order of things, are not likely to improve, can allow home health providers to offset the inaccurate negative skew to their quality metric. A 2006 Briggs Corporation survey of the top home health agencies in Home Health Compare revealed several common practices. Number 8 on the list of practices by top scorers was referral to specialized support services, including palliative care or bridge programs. NGHHC 7/6/2015 Moving from Home Health to Hospice Pay for performance is looming on the horizon for home health. A key component of quality performance is likely to revolve around acute care hospitalization. From CMS’ point of view, hospitalization of a home health patient is an adverse event. Repeated hospitalizations can be a sign of the normal course of decline with patients (and their families) who are not receiving the support of palliation and a palliative care team. Hospices can help home health agencies reduce their hospitalization rates by assisting home health to identify patients/families more appropriate for palliation than cure. Not only does this give patients and families the support needed to manage escalating symptoms and reduce crises, it also positions the home health agency to share in a greater portion of cost savings if/when pay for performance is in place. While a reduction in home health census is inevitable with a referral, timing is everything. Home health is paid per 60-day episode, with low usage adjustments if patients receive 5 or fewer visits, or if they transfer to a different home health provider during the 60 day interval. Put differently, if a home health patient is to transfer to a non-home health provider after visit 5, the home health agency will receive the full payment for those 60 days. NGHHC 7/6/2015 Moving from Home Health to Hospice Hospice is paid on a per diem basis, with so many frontloaded expenses that many do not break even until day 14. According to NHPCO figures, in 2009, 48% of hospice patients died within two weeks of admission. Not only do hospices encounter financial hardship with late referrals, but families have lost the benefits and support they could have used earlier. An appropriate, wisely-timed referral to hospice can be a win:win:win for home health, hospice and the family. A home health agency will be able to retain 100% of its 60-day episode charge if the patient is transferred to a hospice after the 5th visit in that 60-day interval. Hospice will then have longer time to get to know the patients/families and engage the full level of support. And patients/families will have the benefit of longer lengths of service. (Research shows that 3 months is optimal as patient/family perceived services and benefits plateau out after 3 months of care.) As with all care providers, we get attached to our patients. We don’t like to let them go. And then with the financial loss, it’s even more difficult. But understanding and working with the financial and quality metrics pressuring both organizations can help the two to collaborate more effectively. Much as timely referrals can improve home health quality scores and eventually pay for performance, with appropriate timing, a home-health-to-hospice referral can also be made in a way that optimizes the home health revenue stream. NGHHC 7/6/2015 HHCAPS See HHCAP Presentation File NGHHC 7/6/2015 Indiana Earns ACHC Accreditation! NGHHC 7/6/2015 January Updates Discharge Planning Discharge Planning – 30% Compliance. Documentation of discharge planning includes documentation of patient/family/ caregiver involvement. It is to be documented on the narrative of the SOC note and weekly thereafter. NGHHC 7/6/2015 January Updates Equipment Cleaning Cleaning Logs for PT/INR machines and MEDX are required in Carmel weekly. Updated forms can be found on the Intranet. Ayo is the only Physical Therapist compliant with this requirement for MEDX. PT/INR compliance includes: Scott, Brittany, Renee, Anna, Cheryl NGHHC 7/6/2015 January Updates CPR On line CPR cards are no longer accepted. All staff with online CPR cards must have new CPR cards no later than 31 March to continue to work. HR was successful in scheduling a CPR instructor in the Carmel office. Please contact Melinda Jewell if you are interested in attending. NGHHC 7/6/2015 January Updates G Codes NGHHC 7/6/2015 January Updates Misc Expiring Credentials – Please watch your OFFICE email. HR will contact you when credentials are expiring.( TB, Car Insurance, Ect.) Staff can not work without compliant personnel files. NGHHC 7/6/2015 January Compliance Case Conferences Case conferences are required every 30 days – minimally. They should be initiated by the primary case manager. All disciplines involved with the care should be part of the case conference. The Clinical Coordinator will participate with the case conference is only one discipline is active on a case. Case conferences should be documented on a call log and titled “([appropriate month] CASE CONFERENCE.” NGHHC 7/6/2015 anna Mary Jo Erin Srini tom Nicole Ayo Jeff joe elizabeth Ihab Jeremy raju jun noel nancy mary beth milan sneha Gamal jerry kim j nathan January Case Conferences Therapy Case Mgr’sCompliance 120 100 80 60 40 Series 1 20 0 NGHHC 7/6/2015 NGHHC Angela Tammy Anna Brittany Tracy Lisa Paula Scott Tresa Alina Alice Nickolia Annisa Kala Roxanne Dea Cheryl Karen B Lydia January Case Conference RN Case Manager’s Compliance Series 1 100 90 80 70 60 50 40 30 20 10 0 Series 1 7/6/2015 January Compliance Aide SUP visits 100 90 80 70 60 Series 1 Column1 Column2 50 40 30 20 10 0 Q2, 2010 NGHHC Q3, 2010 Q4, 2010 Jan/Feb 2011 7/6/2015 January Compliance LPN SUP Visits NGHHC 7/6/2015 PT/PTA Daily Supervision Call Logs 120.00% 100.00% 80.00% Series 1 Column2 Column1 60.00% 40.00% 20.00% 0.00% 10.31.2010 NGHHC 1.11/2011 1.27.2011 2/15/2011 7/6/2015 Face to Face Encounters MD must see patient either 90 days prior to home care starting or within 30 days after homecare starting & certify homecare is needed. Without this “face to face” homecare agencies will not be paid for services. Pertains to traditional Medicare patients only. Requirement is effective April 01st, 2011. NGHHC 7/6/2015 What’s New! Medication Profiles NGHHC 7/6/2015 Action Items! RNs – continue to complete LPN sup visits at least monthly Aide Sup Visits are required every 2 weeks for skilled cases, every 30 days for aide only cases. Aide must be present for every other visit. Case conferences are required every 30 days. Keep you personnel file updated – respond to HR request promptly. March 31st is the deadline if you have online CPR. NGHHC 7/6/2015 Action Items! PT/INR logs are required every Monday. Please fax to Mike in supplies. MEDX logs are required every Monday. Please fax to Mike in supplies. Nursing – Be sure to select Teach or Assess/Observe as your visit type as needed. Discharge planning is to be documented in the narrative during the SOC visit AND at least weekly for the duration of the certification period. Be sure you have orders for MEDX use. Include MEDX in your care plan as well. NGHHC 7/6/2015 Action Items! Be alert to the Hospice Option for your patients and families. Contact Hospice for questions and/or consultations as needed. HHCAPS – Improve Communication with your patients and families. Treat all patients as you would want your family member treated. 2 3 NGHHC 7/6/2015