Over the length of the PPS era, HHSM has developed and employed S.U.R.C.H., their Utilization Review model for Home Health Providers, to outstanding levels of clinical and financial results. Despite an ever-changing PPS model, S.U.R.C.H. has consistently produced increased outcomes, elevated care value, and improved Case-Mix/HHRG results; all while improving quality Star Ratings. Based on CMS Utilization Review philosophies employed by Medicare Providers outside of Home Health, S.U.R.C.H. assures the use of Clinical Acuity to develop an entirely PPS-compliant Plan of Care. By establishing a best-practice care program derived from a focused OASIS SOC patient profile, S.U.R.C.H. produces 5-Star clinical outcomes for agencies who employ this progressive protocol.
Earlier this month, the VNAA Annual Conference in Miami named the S.U.R.C.H. process, and the VNAA member Provider who installed it, as the recipients of the 2016 Innovative New Financial Model Award. Home Healthcare Hospice and Community Services (VNA of HCS), of Keane, New Hampshire, was the VNAA member who installed the S.U.R.C.H. process to outstanding results. Their installation of the Home Health UR process began in July 2015, and the subsequent care redesign and shift to this UR-managed model produced near immediate results. Cathy Sorenson, President and CEO of VNA of HCS, accepted the award based on her agencies performance in both clinical and financial terms since transitioning to UR-managed care.
As the Affordable Care Act matures and transitions to a value rather than volume paradigm, Home Health Providers will confront challenges as they attempt to assure skilled content while acclimating to Alternative Payment Models, Episodic Bundling, Population Health, and other ACA modifications to traditional PPS care delivery. Underlying all of the changes from the new programming models above are a volume to value shift care redesign mandated by the Affordable Care Act. But additional quality-based initiatives are introduced by CMS regularly, and these will challenge Home Health Providers to abandon their traditional care protocols and focus in exchange for a quality and value dynamic. Providers who reference Case-Mix and Star Ratings in lieu of census stats and recert rates are already on the right path; Utilization Review for care program accuracy, value, efficiency and PPS compliance hardwires the process for permanence.
Many of the challenges Home Health Providers confront when rewiring care for the ACA value era can be found in the legacy and silo practices developed in homecare over the last 25 years, and that outlines the difficulty in assessing change areas, not to mention the rewiring of these practices in terms of value. Cathy Sorenson of HCS of Keene, NH, began the installation of HHSM’s S.U.R.C.H. in July of 2015. She sought improvements in clinical efficiency and outcomes, staff scheduling and productivity, outcome measures and the associated elevated Star ratings. In addition, she sought Case-Mix and HHRG improvements that would be reflective of the improved value in patient programming.
HHSM team members spent 3 weeks orienting HCS administrative, supervisory, and front-line clinical staff personnel regarding the ACA reforms and how they affect Home Health both today and in the future. During that time, OASIS SOC training for the S.U.R.C.H. process was provided for all clinical staff performing OASIS admission visits, with particular focus on the real-time collaboration that includes the patient in their POC development, a Medicare Home Heath requirement. Clinical staff are routinely excited at this point of the installation as they confront fresh new delivery ideas, void of the burden of the current clinician-managed care approach. Nurses and therapists, who regularly accept care responsibilities in Home Health they never performed in any other Medicare job, become relieved that HH care production and delivery now resembles their experience outside of homecare. They assess a patient, obtain admission data, someone else (UR) creates a care plan derived from that admission data, and the clinician then staffs the program.
Initial kickoff of the UR model involves HHSM UR personnel assisting VNA of HCS with OASIS accuracy, patient qualification, and data-based clinical frequency and duration orders; all in real-time. This allows HCS, and their patients, to access the UR-produced outcomes (and fiscal results) throughout the installation phase. Over time, HCS personnel are indoctrinated into the process, and the UR quality management practice becomes the cornerstone of their care redesign.
Over the 10 months of HHSM’s S.U.R.C.H. installation, HCS experienced the following changes to program results:
Case-Mix Improvement ——————————————————— > 43%
HHRG Improvement ————————————————————- > 39%
Star Ratings —— (as tracked in real-time by software) ——————- 4.5 of 5
HCS clinicians, patients, and management all enjoy the value-based process and the care advancement the S.U.R.C.H. process promotes. As Cathy Sorenson states; “we tried to do it by ourselves but couldn’t reach the levels of efficiency, value, or Medicare compliance that the S.U.R.C.H. management produces. This process has revitalized and changed our culture in such a way, no one wants to go back to how we used to work.”
VNA of HCS is now on the road to the new care horizons, producing individualized programs that achieve full PPS-compliance on the way to exceptional results and quality ratings. Investigate how installation of a Utilization Review program can advance your agency, your care, your clinicians, and your patients, into the future.
Contact HHSM at (877) 449-HHSM for more information on the S.U.R.C.H. UR Program.