Cisneros Delivers Hard Truths About Home Care’s Future

The article below is reprinted from Tim Rowan of Rowan Consulting Associates in the Home Care Technology Report, originally published on April 23, 2014.

by Liz Seegert

Sometimes reality is not pretty, but it is still reality.

“If home care companies do not change their mindset about how they do business in this post-ACA era, they will not be a viable part of the new health system,” warned Arnie Cisneros, PT, president of Home Health Strategic Management and a keynote speaker at last month’s Healthcare in Transition seminar.

“Where we think home care is headed clashes with the way we do things today,” he advised attendees. “You must prepare for that eventuality.”

Congress could vote out the Affordable Care Act someday, but ACOs and bundled payments will survive, he insisted. That is because Medicare reforms have been in the works for years and were only rolled into the ACA as a matter of convenience.

Patient, not provider, will be central.

Cisneros reminded the audience that today’s payment and delivery system changes allow people to get out of the nursing home or hospital faster than they did 20 years ago. “You want to embrace it because it is an element of good care.” ACOs are now part of the health care landscape – they make more money for providers, for physicians, and they get people better faster. Just as DRGs changed hospital lengths of stay, bundles will change knee replacement home follow-ups from 12 visits to five, he predicted. “You have to understand that the movement toward these new care models is real and permanent.”

For example, “We are headed to an era where, like hospitals now, you will not be paid for a readmission within 30 days,” he said. “You have to get the idea that readmissions are a good thing out of your head.” One strategy to make your services more attractive to ACOs is to find savings and efficiencies in the care transitions model. Getting and managing the right information and re-defining post-acute care are just some ways to do this. Medicare is focusing on care, not on the provider, he explained. So that is what home healthcare companies should also be doing.

Among strategies he discussed were ensuring IT documentation is timely and appropriate, tightening control over personnel schedules, and shifting focus from care dependence to self-care determination. “In the future, you will be paid on how fast you can make the patient independent,” he asserted.

Cisneros also described several additional key concepts and approaches home care agencies must keep top of mind so they can thrive in the shifting payment landscape. Among them: identifying vulnerabilities that may result in patient readmissions, and improved communication and care coordination among all providers. Agencies must take responsibility for talking to their clinicians more often, steering them toward delivering care programs, not just making visits. Data integration, outcome measurement and reporting, and transparency are all vital factors in future success.

“How do we make it work for hospitals instead of just for ourselves?” he asked. “This is something you want to focus on if you expect to partner with Accountable Care Organizations. Reducing emergency room utilization, improving chronic care management and population health are several of the issues home care agencies should be looking at and talking to ACOs and hospitals about. “You’ve got to think in terms of some of the gear shifting that’s going to occur in some of those areas.”

Therapist become consultant become patient

Throughout his presentation, Cisneros, who recently experienced healthcare from the other end of the spectrum as a kidney transplant recipient, stressed that home health care agencies must make a major shift in thinking about how to do business. Like other providers, home care agencies must get away from “the silo effect” of care delivery along the continuum, and consider what is most effective for the patient — delivering the right care, at the right time, in the right place.

“That takes communication among all partners,” he said. It is up to post-acute providers to integrate ACO programming goals to counteract the legacy of silo-oriented care inherent in the PPS care continuum.

New practices in an ACO era must be based on care modeling in home health, according to Cisneros. He explained that this encompasses both development and delivery of home health services. What is called for is patient-centered, case managed care, modified on an ongoing basis depending on patient response to treatment. “It produces levels of fiscal and clinical outcomes not regularly seen in home care, as it creates the episodic programs of the future.”

Cisneros covered much additional ground, ranging from OASIS accuracy to compliance and staff management to clinical case mix. “The home health model is morphing into what makes common sense for us and common sense for where the industry is going,” he said. He challenged the audience to improve their care by managing programs, documentation, clinical staff, and protocols to fit the care, not the clinician. “It’s the opposite of business as usual,” he said.

Extrapolating common sense approaches on top of an evolving Medicare model is what will enable home health care agencies to not only survive, but thrive in the ACO and bundled payment world created by healthcare reform.

©2014 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.

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