IT’S COMPETITIVE OUT THERE
Do you want more business?
You need an edge
Also… Medicare will be providing financial bonuses to HHAs for good care
IT’S COMPETITIVE OUT THERE…MAINE…
In Maine
25,000 Medicare Home Health patients in 2011
35 certified HHAs
714 patients per agency
IT’S COMPETITIVE OUT THERE…ILLINOIS…
In Michigan
147,000 Medicare Home Health patients in 2011
746 certified HHAs
202 patients per agency
MEDICARE IS ‘IN ON IT’
Has put in place ways to measure quality of patient care
Has starting paying hospitals this way
Get more value for taxpayer dollars
Value-Based Purchasing, Affordable Care Act
AFFORDABLE CARE ACT
The Patient Protection and Affordable Care
Act (PPACA), commonly called
Obamacare, and signed into law in 2010
includes reforms aimed at improving
healthcare outcomes and streamlining
the delivery of health care.
BACKGROUND
VBP FOR HOSPITALS
The hospital-based VBP system went into effect January 2013.
For hospitals, 70% of scores are based on clinical
outcomes such as how well the facility controlled heart surgery patients' blood sugar levels.
The other 30 percent is determined by patient satisfaction.
VBP FOR HOME HEALTH
Efforts were already underway 15 years ago to develop a value-driven healthcare system…OASIS!
OASIS was developed for home health care as part of this effort.
One purpose of OASIS is to compare patient outcomes between admission and discharge.
Certified HHAs started using OASIS in July 1999.
CAHPS implemented in 2010 for patient satisfaction portion.
HOME HEALTH COMPARE
Medicare started publishing OASIS outcomes in newspapers around the country in 2003.
Currently Medicare continues to publish outcomes on its website to help consumers make informed choices when selecting an HHA (Home Health COMPARE).
Discharge planners & insurance companies monitor Home Health COMPARE.
CAHPS
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Home Health Care Survey
One goal of CAHPS: public reporting of survey results will create incentives for agencies to improve their quality of care.
WHAT VBP MEANS TO YOU
Soon, your HHA will receive financial bonuses from Medicare for good outcomes, and penalties for poor outcomes. Outcomes will most likely include those from both OASIS and CAHPS - like hospitals.
How Home Health COMPARE affects you now
Commercial insurers and hospital discharge planners currently use Home Health COMPARE to identify and refer/contract to HHAs with low re-hospitalization rates.
THE BOTTOM LINE…
These outcomes will determine if you get bonuses or penalties from Medicare.
Medicare is doing this to get the best quality for the tax payer.
You need to develop a sales & marketing strategy that is in-line with VBP.
MyHomecareBiz is designed to help you promise and deliver superior clinical and patient satisfaction
outcomes.
TWO STEPS TO BUILDING RELATIONSHIPS WITH
REFERRAL SOURCES
First, convince them to refer to you by promising them exceptional service.
Second, delivering on your promise.
WHO ARE YOUR REFERRAL SOURCES?
Community-based
Physicians
Discharge planners
Each are marketed differently.
UNDERSTAND WHAT MOTIVATES REFERRAL
SOURCES
COMMUNITY-BASED REFERRAL SOURCES
Family, self-referral, community organizations
What – about home health care - is important to a family member or social service agency?
Competency
Experience
‘Word of Mouth’
Loving & caring, yet professional
Market Patient Satisfaction.
CONVINCING THEM TO REFER TO YOU
Sample brochure
DELIVERING ON YOUR PROMISE
CAHPS data is over 1 year old!
Can’t use old data!
Use MyHomecareBiz to monitor patient satisfaction in DAILY…IN REAL TIME with automated telephone surveys
DELIVERING ON YOUR PROMISE
Monitor employee performance daily
Correct issues before the final CAHPS survey
You’ll improve your overall CAHPS scores
PUBLISHING PATIENT SATISFACTION RESULTS
Sample newsletter
Regular newsletters with patient success stories, testimonials.
PHYSICIANS
What – about a home health agency - is important to a physician?
Makes her/his job easier
Competency - ability to stabilize the patient
Ability to keep patient out of the hospital
‘Level II outcomes’
CONVINCING THEM TO REFER TO YOU
Sample brochure
DELIVERING ON YOUR PROMISE
Home Health COMPARE
Level I
Level II
THE OUTCOMES
Level I - 13 ‘Yes’ or ‘No’ OASIS Start of Care and Discharge Questions
Level II - 7 OASIS Questions where answers are compared between Start of Care and Discharge
LEVEL I OUTCOMES OVERVIEW
These are ‘Yes’ or ‘No’ questions on the Start of Care and Transfer/Discharge Assessments.
Compliance should be 100% or close.
After training, testing ~ 100% compliance should be achieved within 2 – 4 weeks.
LEVEL I OUTCOMES QUESTIONS
How often the home health team… began care in a timely manner. (M0102) Start of Care
determined whether the patient received a flu-shot for the current flu season. (M1040) Transfer/Discharge
determined whether the patient received a pneumococcal vaccine. (M1050)
Transfer/Discharge
checked the patient for pain. (M1240) Start of Care
checked the patient for the risk of developing pressure ulcer (M1300) Start of Care
if the patient had heart failure, treated heart failure (weakening of the heart) symptoms (M1500) Transfer/Discharge
checked the patient for depression. (M1730) Start of Care
LEVEL I OUTCOMES QUESTIONS CONTINUED
How often the home health team:
checked the patient’s risk of falling. (M1910) Start of Care
taught patient (or their family caregiver) about their drugs. (M2010) Start of Care
for patients with diabetes, got doctor orders, gave foot care, and taught patient about foot care. (M2250b) Start of Care
treated patients for pain. (M2250e) Start of Care
included treatment to prevent pressure ulcers the plan of care. (M2250f) Start of Care
took doctor-ordered action to prevent pressure ulcers (M2250g) Start of Care
IMPROVE LEVEL I OUTCOMES
Establish Best Practice P&P & procedures - Evidence-Based Best Practices
Train, test staff Best Practices
Track compliance with Best Practices
Add to, change practices to achieve compliance
ESTABLISH BEST PRACTICE P&P
Policy: M0102
Begin care in a timely manner. (M0102)
Ideas?
ESTABLISH BEST PRACTICE P&P CONT…
Policy: All patients are assessed for the following:
(M1240) pain
(M1300) risk of developing pressure ulcer
(M1730) depression
(M1910) risk of falling
Clinician never answers ‘no, always answers ‘yes’ or ‘N/A’
ESTABLISH BEST PRACTICE P&P CONT..
Always ‘Yes’ or ‘NA’
(M2010) taught patient (or their family caregiver) about their drugs.
(M2250b) for patients with diabetes, got doctor orders, gave foot care, and taught patient about foot care.
(M2250e) treated patients for pain.
(M2250f) included treatment to prevent pressure ulcers the plan of care.
(M2250g) took doctor-ordered action to prevent pressure ulcers
ESTABLISH BEST PRACTICE P&P CONT…
Transfer/Discharge Questions
(M1040) determined whether the patient received a flu-shot for the current flu season.
(M1050) determined whether the patient received a pneumococcal vaccine.
Get supervisor, DON or other office person to monitor this.
Before nurse/therapist completes OASIS the information is communicated to them.
ESTABLISH BEST PRACTICE P&P
Full set of Policies & Procedures in
MyHomecareBiz Evidence Based Best Practices
for Home Health Care
Write your own policies
TRACK COMPLIANCE
Are you improving your outcomes?
How you can do it on MHCB
Ideas for non-MHCB users
LEVEL II OUTCOMES OVERVIEW
7 OASIS Questions
Did the patient improve between Start of Care and Transfer/Discharge?
Daily monitoring of the patient’s status is required.
After training, improvement in statistics should be achieved within 6 - 8 weeks.
Data used in sales & marketing for discharge planners and physicians
LEVEL II OUTCOMES
How often the patient improved in
Pain (M1242) Surgical wound (M1342) Breathing (M1400) Bathing (M1830) Transferring (M1850) Ambulation (M1860)
Oral medication management (M2020)
WHAT PREVENTS IMPROVEMENT?
Non-compliance
Patient is not teachable
Treatment doesn’t work
ENSURING IMPROVEMENT
Establish Best Practice P&P & procedures
(P&P)
Patient/caregiver non-compliance
Competent contingency plan
Interventions & goals for the 7 measures
Train, test staff on P&P
Track compliance with P&P
Add, change P&P to achieve compliance
DYSPNEA
Best Practices
1. Teach patient "pursed lip" breathing and "diaphramatic" breathing.
2. Teach patient to avoid very cold air and make sure no one
smokes in the home. Reduce air pollution by eliminating fireplace smoke and other irritants.
3. Tell patient to talk to her/his doctor about pulmonary rehabilitation.
4. Medication teaching
MEDICATION MANAGEMENT
Best Practices
Require repeat demonstrations or explanations about medications that will be taken at home.
Have the patient repeat back the information provided or show that they have mastered drug administration techniques such as measuring liquid medications every visit.
AMBULATION
Best Practices
Balance exercises sitting, standing
Gait training
Transfer techniques
Upper and lower body muscle strengthening exercises
DELIVERING ON YOUR PROMISE
Patient Outcomes Reports
DISCHARGE PLANNERS
What’s – about a home health agency – is important to a discharge planner?
Ability to keep patient out of the hospital
CONVINCING THEM TO REFER TO YOU
Sample brochure
DELIVER ON YOUR PROMISE
LEVEL III OUTCOMES
How often home health patient had to be admitted to the hospital. (M2410)
LEVEL III OUTCOMES
Re-hospitalization rate: did the patient require acute care under your watch?
Most powerful indicator of home care quality
Hospitals are penalized for re-admissions
Discharge planners refer most to HHAs with the lowest re-admission rates
Commercial insurance companies contract with HHAs with the lowest re-admission rates
Data used in sales & marketing for discharge planners and physicians
PREVENTING HOSPITALIZATION
Establish Best Practice P&P & procedures (P&P)
Risk management for known re-hospitalization factors
Live after-hours contact – no answering machines
Patient teaching on managing exacerbations for 16 conditions Train, test staff on P&P
Track compliance with P&P
Add, change P&P to achieve compliance
WHAT CAUSES RE-HOSPITALIZATION?
Patient/caregiver doesn’t know how to manage
exacerbations – goes to ER
IDENTIFYING RE-HOSPITALIZATION RISK
Project BOOST – Re-hospitalization Risk - The 8 ‘P’s
problem medications psychological issues principal diagnoses poly-pharmacy poor literacy patient support prior hospitalizations palliative care M Y H O M E C A R E B I Z
ESTABLISH P&P – PROBLEM MEDICATIONS
Patient teaching regarding high-risk medications
Digoxin
Coumadin
Plavix & aspirin
Insulin
Stat orders related to high-risk medications
ESTABLISH P&P – PSYCHOLOGICAL
Depression & confusion contribute to
re-hospitalization
Track this with each visit
ESTABLISH P&P – DEPRESSION SCREENING
Patient teaching regarding high-risk medications Stat orders related to high-risk medications
ESTABLISH P&P – PRINCIPAL DIAGNOSES
Certain diagnoses contribute to
re-hospitalization risk
Cancer
Stroke
Diabetes
COPD
CHF
Track the status of these at each visit
ESTABLISH P&P – POLY-PHARMACY
5 or more medications contribute to
re-hospitalization risk
Track the status of medication management at
each visit
ESTABLISH P&P – POOR LITERACY
Limited teachability contributes to
re-hospitalization risk
Make sure there is a competent caregiver
ESTABLISH P&P – PATIENT SUPPORT
Limited support contributes to
re-hospitalization risk
Make sure the patient has a competent
caregiver
ESTABLISH P&P – PALLIATIVE CARE
Un-managed/uncontrolled pain contributes to
re-hospitalization risk
Track the status of pain at each visit
TRAIN, TEST STAFF ON P&P
MyHomecareBiz Evidence Based Best Practices for Home Health Care – Clinician Edition
TRACK COMPLIANCE
This is your biggest challenge
How you can do it on MHCB
Ideas for non-MHCB users
EXAMPLE OF MODIFYING POLICY
Your policy on Patient Support: all patients admitted have a competent contingency plan
Compliance rate is 45% after training/testing
Reason: patients admitted with contingency plans
Re-evaluate how to manage patients without support systems
DELIVER ON YOUR PROMISE
Sample discharge report
DAZZLE YOUR REFERRAL SOURCES
Give them a reason not to refer to anyone else!
SALES STRATEGIES
Get your OASIS and CAHPS scores in the top 5% of your State.
• Offer specialized services…board-certified: Diabetes; pain management, cardiac rehabilitation, post-CVA etc • Provide real-time monitoring to physicians: MHCB
Physician Portal displays comparisons between admission & most recent visit
TRADITIONAL MEDIA
Showcase your Superior Care
Newsletter
Brochure
Website
Sales & Marketing staff
WEBSITE
Biggest ‘bang’ for your buck
Showcase your latest statistics
Focus on one outcome at a time; discuss your ‘Best Practices’, i.e. Best Practices for Pain Management
Get patient testimonials
Get employee testimonials
NEWSLETTER CONTINUED
Mail newsletter monthly, bimonthly or quarterly •MyHomecareBiz designs and develops stunning
newsletters.
•Just get us patient testimonials…we’ll do the rest.
BROCHURES
Have a mission statement
List services, locations
Identify specialty areas
Biographies of Agency leaders
Training protocols for Agency Staff
Mention Clinical “Best Practice” System
WEBSITE
Change content so it matches newsletter
Change content no less than every 3 months
IN-PERSON MARKETERS
Owner/administrator is best marketer
Understands and communicates effectively HHA’s Best Practice system
Is knowledgeable about HHA’s COMPARE & CAHPS scores
Has ability to show referral sources real-time monitoring