Transcript Slide 1
February In-Service
Agenda
MEDX
Hospice
HHCAPS
January Updates
Face To Face Encounter
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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.
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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.
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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
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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.
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HHCAPS
See HHCAP Presentation File
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Indiana Earns ACHC Accreditation!
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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.
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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
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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.
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January Updates
G Codes
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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.
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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.”
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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
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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
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January Compliance
Aide SUP visits
100
90
80
70
60
Series 1
Column1
Column2
50
40
30
20
10
0
Q2, 2010
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Q3, 2010
Q4, 2010
Jan/Feb 2011
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January Compliance
LPN SUP Visits
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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
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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.
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What’s New! Medication Profiles
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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.
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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.
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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.
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