As the CEO of a home health agency, you have certain expectations of quality initiatives that are started in your agency. However, back in 1996, as a field nurse for Evangeline Home Health in south Louisiana, I could never have imagined the impact our “root cause analysis” would have on me personally and patients nationally. What started as a quality improvement process culminated in the development of HomeSight®, a low vision rehabilitation program for community-based homebound patients. That certainly wasn’t my expectation. Nor did I expect to be working on collaborative projects and grants 17 years later with Dr. Robert Massof, Professor of Ophthalmology and Neuroscience at Johns Hopkins University School of Medicine/Wilmer Eye Institute improving the HomeSight Program.
As agency owners and administrators, we not only have to constantly evaluate our clinical quality, we also have to protect the financial integrity of our organizations. This provided a unique perspective in developing the training philosophy for HomeSight®. CMS continues to combat fraud and abuse by across-the-board cuts to reimbursement regardless of the integrity of your practice. It is therefore incumbent on those who want to survive the revenue hits to develop proven programs to inculcate skill and competency that result in better outcomes and reimbursement. I recognized and respected the various disciplines and administrative support that was required to address all facets of the delivery of Home Health services: nursing, therapy, marketing, billing, and administration.
Low Vision is No Longer a Specialty
Although I stumbled on the need in our agency for treating the functional deficits in visually impaired patients, we must actively seek out medical needs that respond to skilled intervention. Are you aware that visual impairment affects more patients in home health than diabetes mellitus? In a recent data search by Dr. Massof and HomeSight® involving 70,000 patients in two large national home health agencies, 24% of patients had visual impairment. This research is corroborated in NEI studies as well. If you have 24% of any patient health population requiring special needs assessment and skilled, tailored interventions, the program is no longer a “specialty”, but becomes a “necessity”. Since medical necessity is one of the criteria for home health, it is important that we understand how to properly evaluate, treat, document, code, and bill for patients with visual impairment.
HomeSight and the Agency of the Future
The changing landscape of home health has brought new models of health care management into view, ACO’s, the medical home and others will cause agencies to expand their service base and look for opportunities to redefine their purpose and value in order to remain viable. HomeSight® gives agencies that opportunity. To these new organizations and to today’s consumer, agencies can continue to demonstrate their focus on the medical needs of their patients as well as their innovative mindset by adding programs like HomeSight® to their expertise. Home Health agencies will need these skills to demonstrate their effectiveness in dealing with chronic disease and aging.
The cuts in reimbursement will continue and agencies will need to gain more efficiency, further reduce expenses and find ways to add revenue; each of these with their own big challenges. This is where another unexpected benefit to HomeSight® and our founding agency, Evangeline Home Health, have proven valuable. We recently took a deep dive into our Clinical, Functional, and Service scores on the OASIS with Arnie Cisneros, and his Team at HHSM. Between the collaboration with Johns Hopkins University and the therapy analysis with HHSM, HomeSight® has been able to quantify two elusive healthcare measures: outcomes and ROI. We are in the second year of a 5-year study with Johns Hopkins titled: Comparison of Low Vision Outcomes Measures and our work with HHSM has determined that most agencies can recover their HomeSight® license investment within 3-5 patient episodes of care by accurately scoring the OASIS.
HomeSight® is included in various studies with Hopkins/Wilmer Eye Institute because of our development of a highly organized and replicable training turnkey program at an affordable price and its current use nationally. Our work with Johns Hopkins is focused on developing ongoing low vision education training programs that encompass all participants in the low vision evaluation and treatment continuum.
HomeSight® has stood the test of time, been evaluated by the nations’ leading low vision experts, and found to be a clinical best practice for the care of low vision patients in the home. We have trained hundreds of agencies and their personnel to date in this important element of patient management and treatment. Interested and progressive Home Health agencies can trust our experience, as well as benefit financially and clinically, from the adoption of HomeSight.
Lisi Coleman has been a registered nurse in home care for more than 20 years. As CEO of Evangeline Home Health, she maintains a focus on quality initiatives, reshaping clinical services and promoting the value of Evangeline Home Health to the communities in which they serve. Lisi is the President-Elect of the HomeCare Association of Louisiana furthering the goal of quality home health care in Louisiana. She is the founder of the nationally recognized HomeSight program. She speaks at national conferences and has written several articles and whitepapers on the topic of low vision.