Home Health and the Centers for Medicare and Medicaid Innovation

Posted on August 18, 2010 by blogeditor

 The Accountable Care Act is loaded with changes, many of them less than positive for Medicare home health providers. But one area of funding that could provide fertile ground for those who are forward thinking is the Centers for Medicare and Medicaid Innovation (CMI). The Center is starting with $5million in startup costs for 2010 to design, implement and evaluate models. It will then distribute $10 billion for pilot programs started between 2011 and 2019. Consider that $40 billion is coming out of Medicare home health over those ten years and you can understand why innovation is often ‘disruptive’. But today those models also have to be ‘evidence based’, proven through research.

The advent of a multitude of new models of care all seem to be connected in some way to home health as we have known it. Those include chronic care management, ReEngineering Discharge (RED), Better Outcomes for Older Adults Through Safe Transitions (BOOST), Transition Coaching, Independence at Home, the Patient Centered Medical Home and more. These new models, and others to come, meet the definition of ‘disruptive innovation’, a term coined by Clayton Christensen of Harvard. Innovation is ‘disruptive’ when it disrupts the existing revenue streams and existing relationships. If you want to get a head start on the pack, find a copy of Clayton Christensen’s The Innovator’s Prescription: A Disruptive Solution for Health Care. While the entire book is worth reading, chapter 5 is entitled “Disruptive Solutions for the Care of Chronic Disease.” Care at home is evolving rapidly.

You can read more about the Centers for Medicare and Medicaid Innovation at the Commonwealth Fund website, at the health policy site for the New England Journal of Medicine. Or if you want to perhaps offer expertise in starting up the new Center read the RFP from HHS at FedBizOpps.Gov. Take care.

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Have you seen this situation? Audit/Denial Analysis by HHSM

Posted on August 11, 2010 by blogeditor

The following is a case analysis completed by Home Health Strategic Management:

The patient was a 74 y/o female residing in an assisted living facility and was referred to the Home Health agency after reported falls in her residence. There was no recent inpatient stay and the referral came from her family physician. The MD order was for both Physical and Occupational Therapy, and the Start of Care was performed by the PT. Primary diagnoses included OA, weakness, debility, and CHF. The patient had previously received a 3-visit program (6 months prior) based on safety education and instruction in proper use of the walker. The Start of Care OASIS revealed safe ambulation with a walker (M1860 – 2); it was discovered that the patient had not been using the walker properly and this contributed to the falls. No CHF related concerns were identified; the PT described lower extremity weakness and the OT described upper extremity weakness and reported little change from the prior level of ADL function; “needing some help”.

The PT care plan outlined an eight visit program (2×4) based primarily on exercises, gait training and mobility safety, and home program establishment. The OT care plan identified a four visit program (2×2) to include equipment, exercises, ADL training and home program establishment. The patient ambulated 150 feet with the roller walker on the third visit, and completed the program after four weeks ambulating 350 feet safely. The OT completed the 4-visit program and described improvement in ADL function.

The Fiscal Intermediary denied five PT visits; choosing to cover a program similar to the previously provided 3-visit educational episode. The three visits were considered sufficient to re-instruct the patient and to re-emphasize the importance of correct walker use. Subsequent visits were, “non-covered as they were repetitive teaching and supervision”. The FI clearly felt that the establishment and compliance with a skilled Home Exercise Program designed to maintain safe strength and balance could be re-installed through this three visit vehicle. The entire OT program was denied because, “the PT was addressing the patient’s issues”.

The denials reduced the “S” component of the HHRG score from an “S1”, Equation 2 to an “S1”, Equation 1 LUPA. The agency lost over $3300 in billing income, and combined with delivery costs of the episode, the agency lost over $4000 on this case.

HHSM Analysis

This denial confirms a theme seen consistently in response to a specific patient profile; clients with no recent inpatient stay, declined but safe ambulation, and an ability to exhibit compliance with home program maintenance, are programmed with a 3-visit therapy program designed to address safety education and establish a home program to maximize and maintain outcomes on a post-program basis. The answer to the OASIS M1860 question identifies the patient as safe in ambulation with a two-handed device; any concern regarding safety here is limited by this response.

In addition, the referral for the PT/OT combination commonly utilized to address global declines that may occur in the area of rehab seems to have outlived its’ usefulness. Programming requirements for both of these expensive disciplines now require a specificity regarding declines that compromise the value of this type of referral order. Correct application and implementation of the Start of Care OASIS is required for coverage of any of these specific disciplines.

HHSM Comments

Ambulatory distances greater than 150 feet can be attained through post-DC compliance with the Home Program; this limit to covered distance references the Functional Independence Measures (FIM) System utilized since 1994 as a measure of rehab outcomes. Agencies wishing to provide rehab services to their clients when necessary will have to integrate these new coverage models and requirements. In addition, assertive education of both referral sources and clinical staff will be required to avoid crippling denials that will lead to focus review. This is clearly the direction that CMS is heading regarding covered Home Health claims. The changes to how these services are to be delivered will resemble the difference in how hospitals managed length-of-stay issues from a pre-DRG to post-DRG basis.

Arnie Cisneros, P.T., is renowned for his adaptation of traditional care philosophies to address current and future healthcare initiatives. His status as a practicing clinician provides a working level insight into program development and care consultation needs for Home Health providers. He authors “Home Health Forum”, a bi-weekly column addressing contemporary homecare issues and is a contributor to “The Remington Report”, CARING, and Decision Health publications. He presents nationally on homecare topics including S.U.R.C.H. – UR for Home Health, OBQI Case Conference, and PPS/P4P strategies. He is President of Home Health Strategic Management, a homecare consulting firm in East Lansing, MI.

Copyright 2009 Home Health Strategic Management
www.homehealthstrategicmanagement.com 

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The fastest growing segment on Facebook is 55-65 year-old females. How does that affect your agency?

Posted on August 4, 2010 by blogeditor

Did you know that the fastest growing segment on Facebook is 55-65 year-old females? According to Erik Qualman, author of  Socialnomics-A Social Media Blog, “social media isn’t a fad, it’s a fundamental shift in the way we communicate.“ Check out the rest of the interesting statistics Qualman writes about in his blog article “Statistics Show Social Media Is Bigger Than You Think” and also make sure to watch his video titled “The Social Media Revolution.”

While we are on the subject of social media, you might also be interested in reading how your agency or company can use social media and why its worth it. In the article “Social Media in Healthcare Marketing: Making the Case” author MichelleB talks about the Top 5 tips for using social media in health care. See her full article below.

Social Media in Healthcare Marketing: Making the Case

Author: MichelleB of TopRank Online Marketing

For marketers in any industry—from manufacturing to real estate to banking, and everything in between—making the business case for social media isn’t a quick and easy process.

But in healthcare marketing, it’s an understatement to say that gaining buy-in for social media isn’t easy.

Consider for a moment just what healthcare marketers are up against:

  • A multitude of privacy regulations
  • Nursing and support staff shortages
  • Increasing demand for services thanks to the quickly aging Baby Boomer generation

It’s not difficult to understand why some healthcare decision makers may be slow to adopt social media. But instead of throwing in the towel, consider these 5 tips for making the case for social media in healthcare marketing:

1. The movement has started. Healthcare may not be as quick to adopt social media as some other industries. But there are many hospitals and healthcare organizations that are quietly innovating on the social web, as Digital Influence blogger Rohit Bhargava suggests.

In a recent post, he points out that there are 367 US hospitals using social media. They are responsible for 10,000 Tweets from 267 Twitter accounts. When making your individual case for social media in healthcare marketing, leverage some of the great examples out there:

  • Patients Like Me is an online community site created in 2004 by MIT engineers to allow patients to share information and their personal experiences. The goal is to connect patients with the same or similar diseases so they can rely on one another for support.
  • The Center for Connected Health community website is designed for healthcare providers and policymakers. Community members can discuss controversial topics, and share best practices, new ideas, upcoming events and research.
  • Individual hospitals are involved in social media efforts as well, Bhargava points out.  The Sarasota Memorial Hospital uses Twitter to answer patient questions and provide immediate customers service. In March, the Henry Ford Hospital used Twitter to connect with 1,900 people and answer questions during an actual brain surgery.

2. Patients—and potential future patients—are involved in social networks. A March 2009 report (pdf) from Nielson Online found that 67% of the global online population takes part in online communities. Plus, time spent on social media sites now accounts for almost 10% of all time online.

Clear and simple, patients use social media. Hospitals can utilize social channels to answer healthcare- or illness-related questions or simply provide medical information—just as the Sarasota Memorial and Henry Ford hospitals have done. If the numbers aren’t convincing enough, consider this: Patients are comparison shopping for hospitals, CNN reports.

With the increasing cost of healthcare and a growing number of available hospitals, it’s only natural. Social media is just one tool for hospitals and healthcare organizations to stay top of mind and relevant for patients.

3. Patients are online, and so are physicians. Consider a few statistics from Manhattan Research:

  • As much as 89% of US physicians rely on the Internet as an essential part of their professional practice
  • Approximately 64% of physicians now use smartphones
  • 41% of physicians’ research takes place online The bottom line is physicians and other healthcare personnel are already spending time online.

Additionally, Doctors have their own social network, Sermo, which has over 110,000 practicing MD’s participating.

By embracing social media, hospitals and healthcare organizations can provide their current staff with a mechanism to share information and best practices. Plus, organizations can use their social efforts as an incentive when recruiting new employees.

4. Healthcare is top of mind, in the news and constantly changing. Particularly since the last presidential election, healthcare has been thrust into the public spotlight. From universal healthcare to electronic health records to patient privacy, there’s a new healthcare news item in the headlines every day. Social media can provide an effective mechanism for hospitals and healthcare organizations to stay involved in healthcare legislation discussion.

Take the lead from Boston’s Beth Israel Deaconess Medical Center. The hospital CEO is using his blog to discuss and comment on potential health insurance legislation – among other topics.

5. Social media efforts don’t have to involve a lot of costs. Budget cuts have become a common business practice across nearly all industries—hospitals and healthcare organizations are no exception. But social media campaigns don’t have to include a significant financial investment.

Consider the healthcare marketing success story from the Mayo Clinic. The Mayo Clinic in 2005 began utilizing social media channels to promote and increase downloads of its podcasts. The clinic posts the podcasts, along with video and text, on its blogs. It also leverages a Facebook fan page, a Twitter account and a YouTube channel. Downloads of the podcasts have increased by more than 8,000%, thanks to using three free social channels.

Be sure to read this recent interview with Lee Aase, the manager of syndication and social media for Mayo Clinic, where he offers specific advice for other companies on his “MacGyver-style” testing , developing a social media strategy, winning management approval and measuring social media ROI.

Post Script:  Here’s a newly launched blog in the B2B Healthcare category of Medical Imaging from McKesson (a TopRank client). It integrates with a Picture Archiving and Communication System website.

These tips, of course, are just a starting point to help healthcare marketers make the case for social media in healthcare marketing and creating better connections with the healthcare community, hospitals and patients.

You can find more articles like this on TopRank: Online Marketing Blog (toprankblog.com).

Tell us what you think about social media and/or how it has impacted your business by leaving a comment on this article.

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