All healthcare clinicians and providers establish practice patterns that act as a roadmap to their care delivery. Consciously or unconsciously, the common factors exhibited by our patients combine with our experiences as professionals to establish a methodology that is unique to each of us. Levels of clinical success, ongoing education, industry reforms, and other factors are integrated throughout a healthcare career; resulting in the standard care approaches we all own. Present in so much of what we do; our individual approach to patient interaction, clinical skills, disease education, and job satisfaction, our practice patterns serve to alter the outcomes of our programs.
Nowhere in the healthcare world are these themes more relevant than in Home Health. The very nature of the care model serves to compromise providers’ abilities in their attempts to support and assist their clinicians through the constant changes that occur in our industry. In addition, our relatively recent developmental history describes the establishment of a flexible, in-home, care alternative to inpatient services. Ultimately, the modification to the acuity-based Prospective Payment System (PPS) re-wired our care to address specific clinical needs in lieu of the decidedly more custodial approach of the fee for service era. These changes occurred in response to clinical advancements developed as the Medicare benefit evolved, and similar programming refinements have occurred at all care levels. The evidence-based, best practice care requirements of PPS will continue to be defined in the Home Health industry as audits combine with funding reductions to cause us to challenge our practice patterns.
The decade since PPS has led us to new changes that will cause homecare clinicians to find new efficiencies in how they work; and this must occur under the recent audit scrutiny that will continue to spread to all providers. Reasonable and necessary requirements have new staying power, and skilled progression is now a component that must be maintained for claim success. The net effect will be the re-examination of all clinical programs, and a re-assessment of the skill level of the clinicians delivering those programs.
Most of these concerns can be remedied by an increased focus on care requirements; the basis of all healthcare advancement and the premise for the decreased utilization that has defined the continuum of care. Discussed at length in previous columns by this author (archived and available on the HHSM website), the reductions in utilization patterns for both acute (77% decrease) and sub-acute (35% decrease) providers has redefined care in those settings. Hardly a new concept, the decrease in utilization will also be expected in our care reform. The direct result is the Home Health clients of today, previously receiving a greater amount of their care as inpatients, are now expected to achieve similar outcomes through homecare programs.
But gaining insight into the actual clinical program is only the first step; helping front-line homecare professionals modify care patterns is the important, and difficult, task before us. The ongoing adjustments necessary on an in-episode basis to maintain skilled progress have the initial effect of stressing many clinicians by removing them from their traditional practice patterns. These patterns have become the cornerstone of their identities as caring professionals, and when they are questioned, the emotional components are real for every one of us in Home Health.
In many instances, the home environment precludes us from visualizing care needs with the same sense of urgency employed by hospitals and SNFs. A commonly heard response from Home Health clinicians when discussing care approaches and challenging their practice patterns is a version of the sentiment “What’s the rush?” Both nurses and therapists describe variations of this emotion when clinical scrutiny reveals in-efficient programs, non-compliant patients, and insufficient outcomes. The clinician feels the effect of the pressure of expected progress, and the need for improved utilization feels as if they are being pushed to deliver care at a faster pace. Acknowledging that this perception is real and consistent, the feeling of being “rushed” isn’t valid in these cases. Instead, the pressure originates from an entirely different philosophy that is far from a “get done faster” approach.
When best practices, compliant patients, and progressive delivery are realized, Home Health clients actually improve at a faster rate when compared to other programming results. So the drive to assure these care components are delivered is actually a focus on efficient outcomes, rather than just an attempt to quicken the pace of delivery. The correct care, delivered with an assertive focus on best practices, is the key to the Home Health care results and practice patterns of the future.