In this last installment of HHSM’s five-part series on the 2011 PPS Rule and the various reform elements contained therein, we will attempt to recognize how CMS and Med Pac are telegraphing a new direction for the development and delivery of homecare services to the Home Health beneficiary. As stated earlier, the effects of the 2011 PPS Rule are greater than the sum of its parts; the net results will be a re-directed care approach that distills homecare lessons learned in the PPS era, and combines them with medical cost and quality protocols refined at other care continuum sites. Home Health providers struck by the depths and trends of the changes would be encouraged to integrate the new philosophies and refinements into their daily management, supervisory, and delivery models. When these latest industry changes are examined closely for similarities with preceding and comparable reform and programming efforts for other Medicare providers, it becomes evident that these are just the first steps on the road to an entirely different and progressive Home Health delivery model.

 

             Many aspects of the latest PPS refinements can offer new opportunities for homecare providers and clinicians as they limit or alter past homecare practices. Keeping that in mind, what areas in the 2011 (and beyond) reforms must we address in this manner as we identify a roadmap for future success in Home Health? It is important to remember, as we analyze the sum of the installed or proposed CMS changes to our current care model, that the patients and their clinical needs are not going away. Rather, these patients and their traditional care concerns will be addressed in a more efficient and progressive manner established in CMS hospital and SNF refinements of the PPS model. Will your legacy as a Home Health provider restrict the necessary identification and re-tooling of your care model, rendering you obsolete in the homecare landscape as the future? Or will providers and clinicians oversee the remodeling of their clinical identity and approach, allowing them to continue their care mission while identifying patient needs that may no longer be addressable through the Home Health benefit.

 

            The blueprint for future success in Home Health requires a multi-faceted approach that extends into nearly all aspects of the Medicare-certified agency. Some pertinent and required elements for survival include:

 

UTILIZATION REVIEW-MANAGED CARE – When attempting to produce the clinically focused and efficient care CMS has prompted from other care providers; Home Health agencies must internalize that the days when front-line nursing and therapy staff can create and manage their own utilization are over. MDs, Nurses, and Therapists don’t self-manage their utilization in any other care environment, and when homecare providers are required to achieve more clinical gains with less visits (in the name of efficiency), the staff clinician will struggle to perform if not assisted with UR control.

 

IN-EPISODE CLINICAL ROUNDS – The current practice of multi-disciplinary case conferences held once per 60-day certification period will be rendered obsolete by the pace and volume concerns of the prospective CMS reforms, including the Accountable Care Organization and Bundling models. Clinical rounds on an individual basis held quickly and routinely (weekly) will be the order of the day, replicating similar clinical control models employed and refined by other CMS provider types.

 

DISCHARGE PLANNING – Home Health admissions will require the type of comprehensive and inclusive care control that other providers currently utilize, and a focal point of these models is discharge planning. By creating transparent and focused care vehicles that include admission-identified discharge plans, homecare providers and clinicians will improve their connection to goal and outcome achievement, while eliminating much of the confusion regarding covered elements, discharge points, and homecare practices from previous care eras.

 

            Home Health providers would be well served to review and update many areas of their contemporary homecare delivery model for continued success in light of the evolving PPS model. Areas of concern that progressive providers will address:

 

-         Staff Productivity                                          

-         Back Office Efficiency

-         Progressive Programming

-         Fiscal Metrics

-         Clinical Management Skill

-         Staff Efficiency/Manageability

-         Satisfied Patients, Caregivers, Physicians

-         Good/Excellent Clinical Outcomes (OBQI)

-         Decreased Re-hospitalizations

 

The challenge will be to re-tool agency practices while keeping patients,

clinicians, and referral entities satisfied with the Home Health experience. The over-riding theme is that the homecare model of the past decade is quickly evolving, and, in many cases, discarding practices and care approaches that have continued to expand until the recent audits appeared. It is important to remember that the history of CMS reforms have always produced identical results: 1) The patients who were intended to receive the services continued to be served, and 2) Quality caregivers and clinicians experienced improved working conditions.