Basic Training: Home Health Edition Managing the Patient in the Home Setting March 26, 2013 Presented by: Cindy Campbell, RN, BSN, Associate Director of Operational Consulting Fazzi Associates, Inc. 243 King Street, Suite 246 Northampton, MA 01060 413-584-5300 Fax: 413-584-0220 www.fazzi.com
Fazzi Associates, Inc Continuing Educational Activity Required Disclosures to Participants Successful Completion of this Continuing Nursing Education Activity: In order to receive full contact hour credit for this CNE activity, you must: Listen to entire educational activity Complete the evaluation Conflicts of Interest A conflict of interest occurs when an individual has an opportunity to affect educational content about health care products or services of a commercial company with which she/he has a financial relationship. The planners and presenters of this CNE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity. Commercial Company Support There is no commercial company support for this CNE activity. Noncommercial Sponsor Support There is no noncommercial support for this CNE activity. Non-Endorsement of Products Fazzi Associates, Inc. s accredited provider status refers only to continuing nursing education activities and does not imply that there is real or implied endorsement of any product, service, or company referred to in this activity.
Instructions and Handouts for: Basic Training: Home Health Edition Managing the Patient in the Home Setting March 26, 2013 1:00pm - 2:15pm EST 11 12 10 9 8 7 6 1 5 2 3 4 Eastern Standard Time 1:00 PM to 2:15 PM 11 12 10 9 8 7 6 1 5 2 3 4 Central Standard Time 12:00 PM to 1:15 PM 11 12 10 9 8 7 6 1 5 2 3 4 Mountain Standard Time 11:00 AM to 12:15 AM 11 12 10 9 8 7 6 1 5 2 3 4 Pacific Standard Time 10:00 AM to 11:15 AM It is very important that you have these materials printed and ready to use prior to the start of the training. In order to participate in this training you will need to do the following: 1. Dial +1 (702) 489-0008 at least 10 minutes prior to the start of the tele-training. 2. When prompted, enter Conference ID Passcode: 255-135-174 3. You can also participate using your microphone and speakers. To do so select Mic & Speakers in the control panel. Please ensure your speaker volume is turned on. 4. To view the presentation online, you must click on the link sent to you from GoToWebinar. * Note: Please do not forward your own webinar login information as each one is email specific. Once you are logged in to the webinar anyone else that tries to use your information will not be allowed in.
Objective for this session 1. Identify the components of patient management in home care. Presenter Bio Cindy Campbell, RN, BS is a nationally recognized leader in the home health industry, an executive and industry change agent, and the Associate Director of Operational Consulting at Fazzi Associates. Campbell provides organizational re-design, operational process engineering, leadership mentoring and clinical modeling for home health, hospice and private duty agencies across the country. A passionate advocate of technology integration, Campbell is an Advisory Board Member of Healthcare Unbound, the Center for Business Innovation. Cindy was the first author of the Philips National Study on the Future of Technology and Telehealth in Home Care, co-sponsored by the National Association for Homecare and Hospice (NAHC) and Fazzi Associates, Inc. She has held membership on the NAHC Board of Directors, the Executive Committee of the American Telemedicine Association s Home Health and Remote Monitoring Special Interest Group and has chaired the Pediatric Homecare and Hospice Association of America. Campbell holds a BSN from Simmons College in Boston and lives in La Jolla, California. Directions on how to Receive Contact Hours This continuing nursing education activity was approved for 1.25 Contact Hours. Fazzi Associates is an approved provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. 1. Each participant must complete an electronic evaluation in order to receive contact hours. 2. Click on the following link in order to access the online evaluation form: https://www.research.net/s/hdfwq89
ORIENTATION SERIES MANAGING THE PATIENT IN THE HOME SETTING PRESENTED BY: Cindy Campbell, RN,BSN Associate Director of Operational Consulting Fazzi Associates, Inc. DISCLOSURES Successful Completion of Education Activity Listen to entire program Complete evaluation Disclosures No conflict of interest for presenters & planners No commercial company support No noncommercial company support No endorsement of any products, services, or company 1
Objective: Identify the components of patient management in home care. HEALTHCARE REALITIES Context is Critical: Payments in most parts of the country are sector specific. Under the A win for one sector is often a loss for another sector, i.e. early discharge (hospital win) while inability to serve high risk patient (home care loss). Sectors fight (lobby) to get the maximum for their sector. Bigger, richer sectors win. Poorer (less powerful) sectors lose even if they are better and more cost effective. This culture is destined to shift; the Affordable Care Act has started its movement. HEALTHCARE IN CRISIS U.S. healthcare represents at least one-seventh of the economy with spending totaling more than $2 trillion annually. By 2017, projects $4 trillion to be spent on health care: 21% of the GDP.* Not sustainable! Medicare Part A Hospital Insurance Trust Fund had been projected to go bankrupt between 2016 and 2019. Source: https://www.cms.gov/nationalhealthexpenddata/25_nhe_fact_sheet.asp 2
DRIVING THE SPEND 19% of hospitalizations resulted in readmission within 30 days (2008) 2/3 of Medicare, medical DC s are re-hospitalized or dead within a year 19% Medicare Hospital DC s followed by adverse event within 30 days 2/3 drug events, most often judged preventable MedPAC: 75% readmits avoidable (cost-$12b) 25% of re-hospitalizations had 6 or more chronic conditions: common home health cohort Source: http://www.dartmouth-hitchcock.org/dhmc-internet-upload/file_collection/jencks_handout.pdf SHIFTING RISK IN HEALTHCARE REFORM Degree of population risk transferred to provider by payment system Low High Fee For Service Pay for Coordination Pay for Performance Episodic Payments Shared Savings Capitation Paid for each unit of service w/o constraint on spending Additional per capita payment based on ability to manage care Payments tied to objective measures of performance Reform VBP/HAI Readmit Policy Payment based on delivery of services within given timeframe Reform Bundled Payment Shared savings from better care coordination and disease management Reform ACO s Providers share savings from better care coordination and disease management Source: Engelberg Center for Healthcare Reform at Brookings/The Dartmouth Institute THE FUTURE VIEW SCIENCE-BASED, MARKET-DRIVEN SOLUTIONS BRING CARE HOME Precision Medicine: The digitized human Genomic deep dive Mobile Health Cloud computing and interoperability Empowered, person-centered care We will start with the basics; keep an eye toward the future 3
VALUE BASED PURCHASING Shift from payment for quantity to quality. Currently payment reduced if OASIS data is not submitted. 10+ years of OASIS data already provided to CMS. Outcome Measures and Process Measures. PER VISIT VERSES EPISODIC Unlimited payment vs. episodic payment. Discipline centered care vs. patient focused care. Patient dependence vs. self management. WHO DRIVES THE PLAN? Physician? Admitting Nurse? Therapy? Interdisciplinary Team? Payer Source? 4
THE PATIENT FACILITY-BASED CARE 24/7 in person coverage of patient needs. Employee leaves patient in skilled hands. Other team members are accessible. Environment is externally controlled. HOME-BASED CARE 24/7 responsibility for the patient. Employee leaves patient in unskilled hands. Other team members are not as accessible. Environment is controlled by the patient / caregiver. Never under-estimate the power of motivation and the caregiver network, community. Crowd-sourcing on the rise. 5
FOCUS OF THE TEAM Multidisciplinary Interdisciplinary CASE MANAGEMENT Responsible for: Assessing patient needs; establishing realistic goals as well as the patient s goal for care (motivational). Developing a plan of care. Coordinating care delivery in an efficient and cost effective manner. Practices according to professional standards, agency policy, Medicare regulations, state laws, accreditation guidelines and other applicable home care regulations. COP 484.12 COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS The HHA and staff must: Operate and furnish services in compliance with all applicable Federal, State, and local laws and regulations. Comply with accepted professional standards and principles that apply to professionals furnishing services in the HHA. Remember that the regulations serve the needs of vulnerable and sick folks in need. 6
COP 484.18 PLAN OF CARE/485 Developed in consultation with agency staff. Pertinent diagnoses. Mental status. Types of services and equipment required. Frequency of visits. Prognosis. Rehabilitation potential. Functional limitations. Activities permitted. Nutritional requirements. COP 484.18 PLAN OF CARE/485 Medications and treatments. Safety measures. Instructions for timely discharge or referral. Any additional items the agency or physician choose to include. Therapy services include specific procedures and modalities to be used and the amount, frequency and duration. SPECIFICITY OF ORDERS Type of service. Professional who will provide Nature of the service and frequency of service Frequency and duration of visits. Ranges may be used (in some states) PRN services require description of medical signs and symptoms for visit and specific limit on the number 7
PLAN OF CARE Effective for 60 days. Completed prior to RAP Signed and dated by physician prior to billing Changes require new/modified orders from the physician for any aspect of the original POC. Verbal/oral orders may be accepted and put into writing by personnel authorized to do so Signed and dated with date of receipt Countersigned and dated by the physician prior to billing COP 484.30 DUTIES OF THE REGISTERED NURSE Makes initial evaluation visit. Regularly reevaluates the patient s nursing needs. Initiates the plan of care and revisions. Furnishes those services requiring substantial and specialized nursing skill. Initiates appropriate preventative and rehabilitative nursing procedures. COP 484.30 DUTIES OF THE REGISTERED NURSE Prepares clinical and progress notes. Coordinates services. Informs physician and other personnel of changes in the patient s condition and needs. Counsels the patient and family. Participates in in-service programs. Supervises and teaches other nursing personnel. 8
DUTIES OF THE LPN Furnishes services according to agency policies. Prepares clinical and progress notes. Assists the physician and RN in performing specialized procedures. Prepares equipment and materials for treatments observing aseptic technique as required. Assists patient in learning appropriate self-care techniques. COP 484.32 THERAPY SERVICES Given in accordance with the plan of care by a qualified therapist or by a qualified therapy assistant under the supervision of a qualified therapist. A PTA or OTA performs services planned, delegated, and supervised by the therapist. Assists in preparing clinical notes and progress reports Participates in educating the family and in in-service programs QUALIFIED THERAPIST Assists the physician in evaluating level of function. Helps develop the plan of care (revising as necessary). Prepares clinical and progress notes. Advises and consults with the family and other agency personnel. Participates in in-service programs. 9
COP 484.34 MEDICAL SOCIAL SERVICES Given in accordance with the plan of care by a qualified social worker or by a qualified social work assistant under the supervision of a qualified social worker. MEDICAL SOCIAL WORKER Assists the physician and other team members in understanding the significant social and emotional factors related to the health problems. Participates in the development of the plan of care. Prepares clinical and progress notes. Works with the family. Uses appropriate community resources. Participates in discharge planning and inservice programs. Acts as a consultant to other agency personnel. COP 484.36 HOME HEALTH AIDE SERVICES Duties assigned with written patient care instructions prepared by the RN or therapist responsible for the supervision of the home health aide. Reason for visits: Provide hands-on personal care Services needed to maintain the patient s health or to facilitate treatment of the patient s illness or injury 10
HOME HEALTH AIDE SERVICES Services are ordered by the physician and as permitted by State law. Duties include hands on personal care. Performance of simple procedures as an extension of nursing or therapy services Bathing dressing, grooming, foot care, etc. Assistance with elimination Feeding Assistance in ambulation, exercises or transfers HOME HEALTH AIDE SERVICES Assistance in administering medications ordinarily self administered. Simple dressing changes. Assistance with activities which are directly supportive of skilled therapy services. Incidental services when health related services are provided. Light cleaning, shopping, preparing a meal, etc. HOME HEALTH AIDE SERVICES Supervision made with an on-site visit to the patient s home by the supervising professional no less than every 2 weeks to ensure the overall quality of care provided. 11
EPISODE PRODUCTIVITY Get to the optimal outcome within the most efficient and effective use of resources: COLLABORATE and SERVE! Fazzi Associates, Inc. 243 King Street, Suite 246 Northampton, MA 01060 (800) 379-0361 www.fazzi.com Questions: training@fazzi.com Evaluation link: https://www.research.net/s/hdfwq89 12