As Home Health providers begin the New Year, challenged by the mounting pressures confronting the homecare industry, many describe feelings of anxiety as they prepare to navigate an uncertain future. Funding cuts, coding changes, therapy payment regression, co-payment proposals, and futuristic care models conspire to threaten the status quo for all homecare agencies. Clinical delivery staff may also perceive the mounting pressures as care programs of the past fail to achieve expected results under an evolving Home Health PPS model. Professional literature is filled with information relating to these issues and how they will affect providers in 2012. Tales of negative profit margins, broken down on a per state basis, are predicted as a result of the latest PPS Final Rule. Polling surveys, assessing agency responses to reduce the payment cut impacts, describe plans for everything but clinical improvement; cutting salaries, benefits, staff, reducing Medicare case volume, etc. (Benchmark of the Week - Home Health Line – 12/5/11).
On the care front, however, business proceeds somewhat as usual. Clinical delivery continues via protocols developed and modified throughout the entire PPS era. Referral orders often dictate home program content with little connection to OASIS-identified programming targets. Veteran and well-meaning clinicians replicate the care practices honed from earlier Home Health experiences, unaware of reforms that re-value many traditional delivery methods. Most agencies describe declining fiscal stability over recent years as audit scrutiny, payment cuts, and face to face requirements take their toll. Stock valuations of publicly traded Home Health companies reach new lows, and recent regulatory activities involving them have prompted closure or consolidation of under-performing care branches.
But many progressive Home Health Providers exhibit a newfound energy and spirit regarding their future in the industry, having responded to the recent challenges by reinventing their care. With an eye on the quality and cost controls refined by Medicare outside of the homecare world, these agencies have elevated their care production, management, and delivery. As a result, they have been rewarded by improvements in both clinical and financial results as they discover the care paths sought by the latest reforms.
These providers are not gathered in any specific region of the country, nor are they similar in size, shape, or care mission. Some are privately-owned, for-profit agencies; others are non-profit, hospital, or health system-based. Though different in content and character, they share one specific commonality. All develop and deliver efficient and PPS-qualified care programs through use of the progressive UR program that is
S.U.R.C.H.
Developed throughout the PPS era,
S.U.R.C.H. -
Service
Utilization
Review for
Care in the
Home, is the HHSM product currently employed by Providers seeking an answer to the Home Health challenges that confront us both today and tomorrow. Employed to assure Medicare-qualified programs based on OASIS indicators that identify CMS-defined care paths,
S.U.R.C.H. mimics the UR protocols that manage care content for hospitals and SNFs. ALL Home Health Providers who have installed
S.U.R.C.H. have experienced significant changes to their outcomes including:
- Decreased visit totals
- Decreased episode costs
- PPS-compliant programming
- Improved after-cost profit margins
- Elevated clinical outcomes
Most recently, an HHSM client who has installed the
S.U.R.C.H. protocol in the last quarter of 2011 has realized profit margin improvements of
16% to
32%. These outcomes reflect the total control of programming based on Utilization Review principles referenced above, and underscore the power of onset and ongoing clinical management of the PPS model.
But these recent experiences are just the latest in a legacy of Home Health Providers who have focused care in a CMS-approved manner. Diane Levan, RN, former Administrator of South Jersey VNA, described staff response: “Our nurses love
S.U.R.C.H.”as an indicator of the care plan production guidance offered by this UR program. Todd Nelson, MPT, MBA, Rehab and Marketing Supervisor, Loma Linda University Home Health Care, states; “The
S.U.R.C.H. tool has crystallized in my mind the importance of constantly reviewing utilization”. And Residential Home Health, a Madison Heights, MI provider, has developed CHAMP, a CHF/COPD management program with a hospital re-admission rate of 6% that Residential President David Curtis states “…all begins with
S.U.R.C.H.”
So, in closing, there are other opportunities for Home Health Providers seeking solutions to CMS and Med Pac reforms beyond crossing your fingers. By adopting focused care protocols that reflect adherence to the PPS model, you can also re-invent your care. Not only will you strengthen your current clinical delivery today, but you will find your agency, clinicians, and patients on the healthcare path of tomorrow.
S.U.R.C.H. and its content is a copyright of Home Health Strategic Management - © Home Health Strategic Management 2011. All rights reserved.
Arnie Cisneros, P.T., President of Home Health Strategic Management, is the most progressive speaker in homecare today. He provides coaching and consulting services to providers on a national basis (see www.homehealthstrategicmanagement.com) regarding S.U.R.C.H. and other clinical management protocols for quality outcomes.