COMMUNITY BASED HOME HEALTH SERVICES

1. COMMUNITY BASED HOME HEALTH SERVICES Denise Looker, LSW, MHSM Director of Operations Visiting Nurse Assn. of Arkansas

2. GOAL: INCREASE AWARENESS of the AVAILABILITY OF HOME HEALTH CARE IN THE COMMUNITY FOR THE ELDERLY

3. OBJECTIVES • Verbalize one guideline for qualification for Medicare reimbursed home care • Verbalize a benefit of using home health care

6. ARKANSAS DEMOGRAPHICS • 170 Medicare Certified Agencies in Arkansas • 44 Hospital Affiliated • 13 Free Standing private AR ownership • 27 National Companies • 72 Ark. Dept of Health • 14 Area Agency on Aging

7. REGULATING BODIES • Health Service Permit Agency • Centers for Medicare and Medicaid • Arkansas Department of Health

8. ACCREDITATIONS • The Joint Commission • CHAP • Not all Medicare certified agencies are accredited

9. HOME HEALTH REFERRAL SOURCES • Hospitals • Physicians • Other Medical Providers (DME, Infusion, Insurance Case Managers) • Community agencies • Family or patient

11. QUALIFICATIONS FOR MEDICARE REIMBURSED HOME CARE • Medical Necessity determined by Physician • Face to Face visit with certifying physician 90 days prior or 30 days after home health admission • Skilled criteria as defined by Medicare • Homebound status

12. QUALIFICATIONS FOR MEDICARE REIMBURSED HOME CARE • Medical Necessity: • Skilled Nursing • Physical Therapy • Speech Therapy • Must provide services that must be provided by a licensed clinician

13. QUALIFICATIONS FOR MEDICARE REIMBURSED HOME CARE • Face to Face Encounter • By certifying physician OR APN • Certifying physician must date and sign • By hospitalist if communicated to certifying physician • Home Health Agency CANNOT complete the form

14. QUALIFICATIONS FOR MEDICARE REIMBURSED HOME CARE • Skilled Criteria • Skilled Nursing • Skilled Treatment (Wound care, Infusion, Injections) • Teaching & Training (Disease process, Medication side effects) • Skilled Observation and Assessment (Response to Treatment, Changes in condition) • Management & Evaluation (short term) • Physical Therapy • Speech Therapy

15. QUALIFICATIONS FOR MEDICARE REIMBURSED HOME CARE • Homebound: • Leaving home takes considerable & taxing effort • Absences from home must be infrequent • Absences for medical, psychosocial, or therapeutic treatments are exempt • Absences to attend adult day care for medical treatments are exempt

16. QUALIFICATIONS FOR MEDICARE REIMBURSED HOME CARE • Homebound examples allowed: • Attending religious services • Family reunion, graduation, wedding, funeral • Barber/Beauty shop • Walk around the block with assistance • Family outing • Restrictions have been lightened in recent years-

17. PATIENTS WHO BENEFIT FROM HOME HEALTH: • Patients with chronic disease (especially after hospitalization) • Multiple co-morbidities • Multiple medications • Diet teaching • Tube feedings, TPN, IVs, catheter changes/management, dressing changes • Debility/falls/lengthy hospitalizations • PT,OT,SLP, SN needed to assure safe transition from hospital or SNF

18. Common Transition Problems • Medication lists do not match • Complex discharge instructions • Lack of knowledge regarding disease red flags • Poor connections/understanding of care post discharge

19. WHY USE HOME HEALTH??? • Patients recover more quickly in the home • Decreases risk of re-hospitalization • Better informed patients • Increases likelihood of patients’ learning to self-manage their disease • Cost effective • Home Health is the lowest cost provider

20. The Result of Poor Transitions Med PAC report to Congress – 20 percent of Medicare hospital admissions result in readmissions within 30 days12 $31 B spent on readmissions 75% preventable 50% saw no MD prior to readmission $1.7 B post-hospital savings due to early use of home health 2005-2006

21. WHY USE HOME HEALTH??? • Most Home Health Agencies are trained in chronic disease management • Most are trained in Transitions of Care techniques • Many have technology available for patient engagement • Telehealth • PTINR units • Electronic documentation

22. Home Telehealth

24. Our Patients’ Health Care Experience: • Often OVERwhelming!

25. WHY USE HOME HEALTH??? • HOME HEALTH CAN HELP!!!! • Valuable member of the health care team • Publicly reported clinical outcomes as well as patient satisfaction: • www.medicare.gov/homehealthcompare

26. CONTACT: • gdlooker@stvincenthealth.com