Have you ever reviewed a patient’s medical record and wonder exactly what is going on in the case? Were you able to identify the skilled purpose for home care? Were the 485 goals and interventions clearly identified in the routine visits? Are the goals both progressive and measurable? Does the OASIS justify the skilled need in the home? Did you find yourself thinking, “What exactly is going on here?” You have?? Well, so do surveyors and auditors around the country, and herein lies the problem.
As an industry, we have become focused on staffing, payment changes, procedural items and, to be quite honest, just getting through the day. Agencies all over the country still operate like it was the 90’s, while the industry has forged forward with rate reductions, agency closures, audits, denials and pre-payment reviews; all devastating to an agency, in their own right, if not terminal and final encounters. Healthcare keeps moving forward, as hospital systems across the country are focused on ACO partnerships, including identifying who can best serve their needs. It has become evident that, over this period, quality assurance (QA) took a back seat to this focus of survival. When both State and Federal entities across the country review documentation within 24 hours, why do we wait until we have a survey, ADR, or denial, to address these realities? Or even better, must we wait to find out we were not selected to partner with an ACO or hospital system due to our lack of control and quality outcomes before we address these process issues? Where will patient referrals come from once the new care models are in place, requiring accountability and performance in these areas?
The benefits of initiating a Quality Assurance program coupled with S.U.R.C.H. protocols are plentiful, here is the short list:
- Appropriate/accurate episodic payments based on patient deficits. More often than not, due to the lack of clinician training, agencies are not being reimbursed based on the deficits of the patient; this will be a basic performance element of the ACO model.
- Complete and comprehensive 485 creation that kick-starts the admission off on the right path inclusive of orders, as well as goals and interventions that are both measurable and progressive in nature.
- Real time admission information, adding a layer of agency control to monitor appropriate utilization management of visits provided based on skilled need.
- Reduction and Prevention of hospital readmissions.
Agencies across the country have implemented the Quality Assurance and S.U.R.C.H. protocols with drastic positive changes to financials, outcomes, reduction of readmission, and clinician focused training that allows them to function again in a clinical role. Agencies struggle to figure out how the pieces all fit together, and are often shocked when they learn the truth of how their programs measure up to CMS expectations. You CAN NOT fix what you don’t know, and the staff who are hired to supervise agencies are also labile to the same issues. As mentioned earlier, most agencies operate in a state of survival, misunderstanding the metrics and measures of the industry that manages our content, skill, and efficiency in an attempt to protect the beneficiary; in this case, our patient.
Want to find out more about this? Would you like to hear from others who have implemented these quality protocols in their caseloads? Onsite agency evaluations with detailed review and explanation of the metrics are limited to availability. Call and ask how to get started……you can’t afford to be left behind.
This HHSM article was written by Kimberly A. McCormick. RN/BSN, Associate Consultant of Home Health Strategic Management. Kimberly graduated with 4 years of Dean’s List Honors from Loyola University in 1992 and since then has excelled in all aspects of Home Care and Nursing. Her renowned expertise is based on eighteen years of Home Care experience.