COMMUNITY BASED HOME HEALTH SERVICES

Denise Looker, LSW, MHSM

Director of Operations

Visiting Nurse Assn. of Arkansas

GOAL: INCREASE AWARENESS of the

AVAILABILITY OF HOME HEALTH CARE IN THE COMMUNITY FOR THE

ELDERLY

OBJECTIVES

• Verbalize one guideline for qualification for Medicare reimbursed home care

• Verbalize a benefit of using home health care

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

REGULATING BODIES

• Health Service Permit Agency

• Centers for Medicare and Medicaid

• Arkansas Department of Health

ACCREDITATIONS

• The Joint Commission

• CHAP

• Not all Medicare certified agencies are accredited

HOME HEALTH REFERRAL SOURCES

• Hospitals

• Physicians

• Other Medical Providers (DME, Infusion, Insurance Case Managers)

• Community agencies

• Family or patient

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

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

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

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

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

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-

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

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

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

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

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

Home Telehealth

Our Patients’ Healthcare Experience

Our Patients’ Health Care Experience:

Often OVERwhelming!

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

CONTACT:

• gdlooker@stvincenthealth.com