HEALTHCARE AT HOME:
THE  ROWAN TECHNOLOGY REPORT

Serving the home health, home care and hospice industry since 1999.

Untitled Document

by Tim Rowan, Editor

With more than 360 offices in 23 states and 6 countries, some offering Medicare home health services, others focused on other in-home care areas, Bayada turned a good deal of its attention toward those Medicare-oriented locations in 2018 to prepare for PDGM's January 1, 2019 start. When CMS postponed PDGM for a year, Bayada leadership and clinical staff looked at the retooled clinical operations they had already begun to deploy and decided to keep them in place.

Mike Johnson, president of Bayada's home care operations, told us why. "We decided to regard PDGM not as an inconvenient policy change but as a call to do home health better. Once we had put operational changes in place to answer that call, we saw the good they were producing. So, even after CMS delayed PDGM a year, we decided to keep those changes in place."

With regard to the good realized by their new clinical operations, Johnson added during our conversation at this month's Homecare 100 meeting, "By the end of this month, Bayada will have achieved a milestone. Because of our new procedures, one thousand more patients will have stayed home avoiding at least one hospital readmission, than would have done so before the program we initiated last year." Bayada calls their new program...

Other PDGM Ideas

Bayada was not alone in sharing with Homecare 100 attendees their creative ways to cope with 2020's challenges.

CEO April Anthony of Encompass spoke of a new practice of "pre-coding." Coders prepare the way based on intake data. Nurses and therapists are scheduled to perform the OASIS assessment together. They confirm or correct the pre-coder's assumptions.

Both Ms. Anthony and Amedisys COO Chris Gerard described the benefits of a data analysis tool they use to guide care planning and utilization. Result: less utilization uniformity; some patients not get fewer visits, some more; overall, there are fewer total visits but patient outcomes have improved. "After 20 years of PPS," Gerard said, "care planning may have become routine."

Human at Home's Kirk Allen said his group will place more emphasis on the chronically ill and less on joint replacement patients, as the latter are less likely to suffer a rehospitalization. They have also begun to call every patient every Friday afternoon "to remind them to call us first if they have a crisis, not 911."

"The Huddle"

After opening a patient episode, the nurse who completed the OASIS assessment conducts a conference call or in-person meeting with the physical and occupational therapists assigned to the case to discuss the patient and collaborate on creating the care plan. The nurse brings the others up to speed on the patient's situation, including co-morbidities, hospital diagnoses, age, and family and social environment. The conference usually lasts about 10 minutes.

At first, The Huddle was met with some resistance from clinicians. "You want me to start every day on the phone, ten minutes per new patient, instead of getting started on my visits?" management heard. Today, however, both nurses and therapists declare they would not want to do without these daily updates. They see the advantages of gaining insights into a patient's physical and social history and current situation rather than entering a home essentially blind for their respective first visits. Management more often hears, "I love this new system. It gives me a window into the patient. I know almost everything I need to know about a patient before I step foot into the home."

Huddle Solves A Non-PDGM Problem Too

The Huddle was also inspired by managed care contract limitations, Johnson told us. "We have had all these exciting partnership conversations with healthcare systems and payers," he said, "that never went anywhere. The first round of contract negotiations always results in reimbursement offers under our costs. We learned to say, 'thanks but no thanks' and walk away from the table after offers like that. Eventually, the MCO would come back to us with a request to talk some more. When we explained we were not an independently wealthy charity, they would concede somewhat, but the best we ever ended up with was a flat fee per case with all cases limited to 30 days and all payments the same, regardless of diagnosis."

Now Bayada's challenge, if they wanted to take on these MCO contracts, was to balance high cost patients, where the 30 days of care would result in a loss, against low cost patients, where they might be able to make up the losses.

The Huddle was their answer. Carefully coordinated, interdisciplinary care plans, constructed after a 10-minute professional consultation, resulted in the right number of visits for each patient. When therapy was indicated, it was added, but only when appropriate. "We did not lay off any therapists because of PDGM," Johnson emphasized.

Outcomes

For those who are numbers oriented, Johnson laid out the results Bayada has measured over The Huddle's first 18 months with MCO patients. He expects to be able to report the same gains from The Huddle system after PDGM data begins to arrive.

  • High-cost patients continue to receive all the care they need but there are about half as many patients who cost more than the MCO reimbursement as there were before The Huddle system.
    • Johnson's example is, "even if they need 40 visits in 30 days."
  • The statistical "mode" – the number of visits per episode that occurs most often – is higher than before. Five-visit episodes were the most common in the past but today the mode is nine to eleven.
    • Johnson explains: "The visits we 'saved' by reducing the total number of 40-visit episodes became available to the people who needed ten but used to get five."
  •  Total cost vs. revenue has not been harmed but patient outcomes have improved.
    • "Actually," Johnson clarified, "our net profit from these payers went up somewhat."

 

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com