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(1)
(2)

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

(3)

IT’S COMPETITIVE OUT THERE…MAINE…

In Maine

25,000 Medicare Home Health patients in 2011

35 certified HHAs

714 patients per agency

(4)

IT’S COMPETITIVE OUT THERE…ILLINOIS…

In Michigan

147,000 Medicare Home Health patients in 2011

746 certified HHAs

202 patients per agency

(5)

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

(6)

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.

(7)

BACKGROUND

(8)

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.

(9)

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.

(10)

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.

(11)

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.

(12)

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.

(13)

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.

(14)

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.

(15)

WHO ARE YOUR REFERRAL SOURCES?

Community-based

Physicians

Discharge planners

Each are marketed differently.

(16)

UNDERSTAND WHAT MOTIVATES REFERRAL

SOURCES

(17)

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.

(18)

CONVINCING THEM TO REFER TO YOU

Sample brochure

(19)

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

(20)

DELIVERING ON YOUR PROMISE

Monitor employee performance daily

Correct issues before the final CAHPS survey

You’ll improve your overall CAHPS scores

(21)

PUBLISHING PATIENT SATISFACTION RESULTS

Sample newsletter

Regular newsletters with patient success stories, testimonials.

(22)

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’

(23)

CONVINCING THEM TO REFER TO YOU

Sample brochure

(24)

DELIVERING ON YOUR PROMISE

Home Health COMPARE

Level I

Level II

(25)

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

(26)

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.

(27)

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

(28)

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

(29)

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

(30)

ESTABLISH BEST PRACTICE P&P

Policy: M0102

Begin care in a timely manner. (M0102)

Ideas?

(31)

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’

(32)

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

(33)

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.

(34)

ESTABLISH BEST PRACTICE P&P

Full set of Policies & Procedures in

MyHomecareBiz Evidence Based Best Practices

for Home Health Care

Write your own policies

(35)

TRACK COMPLIANCE

Are you improving your outcomes?

How you can do it on MHCB

Ideas for non-MHCB users

(36)

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

(37)

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)

(38)

WHAT PREVENTS IMPROVEMENT?

Non-compliance

Patient is not teachable

Treatment doesn’t work

(39)

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

(40)

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

(41)

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.

(42)

AMBULATION

Best Practices

Balance exercises sitting, standing

Gait training

Transfer techniques

Upper and lower body muscle strengthening exercises

(43)

DELIVERING ON YOUR PROMISE

Patient Outcomes Reports

(44)

DISCHARGE PLANNERS

What’s – about a home health agency – is important to a discharge planner?

Ability to keep patient out of the hospital

(45)

CONVINCING THEM TO REFER TO YOU

Sample brochure

(46)

DELIVER ON YOUR PROMISE

(47)

LEVEL III OUTCOMES

How often home health patient had to be admitted to the hospital. (M2410)

(48)

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

(49)

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

(50)

WHAT CAUSES RE-HOSPITALIZATION?

Patient/caregiver doesn’t know how to manage

exacerbations – goes to ER

(51)

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

(52)

ESTABLISH P&P – PROBLEM MEDICATIONS

 Patient teaching regarding high-risk medications

Digoxin

Coumadin

Plavix & aspirin

Insulin

 Stat orders related to high-risk medications

(53)

ESTABLISH P&P – PSYCHOLOGICAL

Depression & confusion contribute to

re-hospitalization

Track this with each visit

(54)

ESTABLISH P&P – DEPRESSION SCREENING

Patient teaching regarding high-risk medications Stat orders related to high-risk medications

(55)

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

(56)

ESTABLISH P&P – POLY-PHARMACY

5 or more medications contribute to

re-hospitalization risk

Track the status of medication management at

each visit

(57)

ESTABLISH P&P – POOR LITERACY

Limited teachability contributes to

re-hospitalization risk

Make sure there is a competent caregiver

(58)

ESTABLISH P&P – PATIENT SUPPORT

Limited support contributes to

re-hospitalization risk

Make sure the patient has a competent

caregiver

(59)

ESTABLISH P&P – PALLIATIVE CARE

Un-managed/uncontrolled pain contributes to

re-hospitalization risk

Track the status of pain at each visit

(60)

TRAIN, TEST STAFF ON P&P

MyHomecareBiz Evidence Based Best Practices for Home Health Care – Clinician Edition

(61)

TRACK COMPLIANCE

This is your biggest challenge

How you can do it on MHCB

Ideas for non-MHCB users

(62)

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

(63)

DELIVER ON YOUR PROMISE

Sample discharge report

(64)

DAZZLE YOUR REFERRAL SOURCES

Give them a reason not to refer to anyone else!

(65)

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

(66)

TRADITIONAL MEDIA

Showcase your Superior Care

 Newsletter

 Brochure

 Website

 Sales & Marketing staff

(67)

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

(68)

NEWSLETTER CONTINUED

Mail newsletter monthly, bimonthly or quarterly •MyHomecareBiz designs and develops stunning

newsletters.

•Just get us patient testimonials…we’ll do the rest.

(69)

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

(70)

WEBSITE

Change content so it matches newsletter

Change content no less than every 3 months

(71)

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

References

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