Remington - Medline · The Remington Report does not assume any liability for the contents of any ... patient with our intake department rather than the pharmacy or 911

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September/October 2014www.remingtonreport.com

Creative Ways To ImproveHome Health Models

President’s LetterThe changes happening in today’s health care environment are requiring creative andinnovative ways to improve Home Health business models – status quo will no longer do.This opens up the opportunity to develop new relationships with vendors that can offersmart solutions to many of the business challenges you face every day – solutions that canimprove your clinical, operational and financial outcomes. Surviving in a very regulatedenvironment while doing the best you can for patients is a common goal that has neverbeen more evident for agencies and vendors alike.

In last year’s Remington Supplement, Medline introduced you to an innovative newprogram called SmartCare™, which was developed to help reduce hospital readmissionsand support your patients and families with a concierge approach to care and compassion.Since then, hundreds of agencies nationwide have signed on to this program and reporteda significant reduction in avoidable readmissions, saving healthcare systems millions ofdollars. SmartCare has helped these agencies raise patient satisfaction levels anddifferentiate themselves with their referral sources. This year’s issue again highlights anagency’s success with the SmartCare program, hopefully inspiring you to take a secondlook at a new approach to changing the status quo.

Although your business tools are important assets that need to be continually evaluatedand improved, perhaps your most important asset is your staff. This year’s supplementdedicates ample space to articles devoted to your staff, champions of your business andfrontline caregivers to your patients. So, read on to:

• Discover how a Director of Clinical Services resolved the daily challenge of providingthe highest quality of care at her hospice agency while also producing positive patientoutcomes in the most cost effective manner and driving continual staff, family andpatient satisfaction.

• Learn about a unique approach to wound assessment and receive a free CE credit justfor reading an article written by Patricia Turner, a board certified CWOCN and CertifiedWound Specialist. You’ll be able to print a certificate after taking the assessment testonline at MedlineUniversity.com.

• Enjoy a tribute to all the nurses who have a fierce sense of commitment andcompassion for their patients through the voice of one nurse interviewed for Medline’sBlog Series, “Caring for America,” which was launched during National Nurses Week.

• Read about Medline’s partnership with the National Breast Cancer Foundation alongwith a reminder to you and your staff to be proactive about breast care. By visitingMedline.com and taking a pledge to get a mammogram, your staff can participate in thiscampaign and receive a free sample box of Medline’s famous pink gloves to share theircommitment with everyone they work with.

On behalf of all of us at Medline, thank you for the opportunity to be more than just amedical supplier, but also a partner of choice to over 8,000 home health and hospiceagencies nationwide. We look forward to hearing from you if there is anything we can doto improve our service and your business.

Sincerely,

Michael Lee, President, Home Care847-643-4042, Email: [email protected]

Disclaimer: The content of this article, abstract or report is for general informational purposes only. Thecontent is not intended to be, and should not be, interpreted as medical advice and should not be used tosubstitute professional medical advice, diagnosis or treatment. Any diagnostic or therapeutic procedures ortreatments that may be mentioned in this article, abstract or report are neither endorsed nor recommendedby The Remington Report. Any opinions expressed are the opinions of the authors and are not the opinionsof The Remington Report. The Remington Report does not assume any liability for the contents of anymaterial contained in this article, abstract or report.

2 © The Remington Report® September/October 2014

A Smart Way To Avoid ReadmissionsAnd Deliver Better CareAuthor: Jennifer Gullison RN, MSN, COS-C,Clinical Director and Certified Chronic CareSpecialist-Trainer, Cornerstone VNA

Cornerstone VNA, a 101 year old organization, shares

the challenges of providing additional services

(beyond clinical) to patients and their families during

regular hours of operation and after hours. An

innovative program “SmartCare™ finds the right

solutions to produce high-level results. Page 3

Apples To Ulcers: Tips For StagingPressure UlcersBy: Patricia Turner, BSN, RN, CWOCN, CWS

Pressure ulcer staging became particularly important

with the passing of the Deficit Reduction Act (DRA).

The concept of “hospital-acquired” and “present on

admission” brought to the forefront the importance of

accurate assessment and staging. Discussed is a way

for your staff to identify pressure ulcer staging using

“apple” images. Readers can earn CE credits. Page 7

Enhancing Patient And ClinicianSatisfaction In HospiceAuthor: Brenda A. Young, MA, BSN, RN, CHPN,Director of Clinical Services, Hospice of New York

A leading Hospice in the New York metro region faced

challenges in clinician and patient satisfaction related

to service and quality in medical supply. After a

conversion to the leading manufacturer and direct

provider in the Hospice industry, the Hospice of New

York improved quality, decreased labor, and enhanced

their employee morale. Page 10

Caring For AmericaHosted by: Martie Moore, Chief Nursing Officer,Medline

Caring For America, a Medline blog series, explores the

career path of a dedicated nurse executive and her

thoughts on the future. Page 12

A World Without Breast Cancer Is InOur Hands®

Medline’s partnership with the National Breast Cancer

Foundation has made significant strides in helping to

improve the lives of so many people. Learn more

about this campaign and how your staff can

participate. Page 14

Content

Who we are:

Cornerstone VNA, based in Rochester, NH, has been a non-profit home healthcare agency since 1913 serving Strafford,Belknap, Carroll and Rockingham Counties in New Hampshireand has recently expanded within communities in York County,Maine.

The team at the VNA uses the latest technology to providethe most highly skilled nursing, rehabilitative therapies, socialwork and support services in their service area. Specialtyprograms include Certified Wound & Ostomy care, DiabetesManagement & Education, Mental Health Nursing, IntravenousTherapy and a Maternal Wellness Program, including alactation consultant.

Other specialties include a telehealth program, a Life CareProgram with private duty services, and a hospice programwith a team of specialists providing pain and symptommanagement along with emotional and spiritual support tothe patient and their families 24 hours a day.

Our Challenge:

We currently have 24-hour on call nursing service and maintaina very skilled clinical staff. We also have a telehealth in-homemonitoring system to monitor our patients’ vital signs such asblood pressure, weight, oxygen level and pulse rate.

Despite our excellent care, we had two main challenges tosolve regarding enhancing our patient services. The first wasto provide additional services (beyond clinical) to our patientsand their families during regular hours of operation and afterhours. We recognized our patients needed assistance in theirdaily lives, so our goal was to be a comprehensive solutionfor patients and their families for clinical, emotional and othercare services.

The second challenge was to reduce our patients’preventable hospital readmissions. Reducing hospitalreadmissions is a major initiative for the entire continuum ofcare and that includes homecare where much is done toimprove patient care services and reduce unnecessaryreadmissions.

A Smart Way To Avoid ReadmissionsAnd Deliver Better CareAuthor: Jennifer Gullison RN, MSN, COS-C, Clinical Director andCertified Chronic Care Specialist-Trainer, Cornerstone VNA

September/October 2014 © the Remington Report® 3

The Solution

Back in December 2013, our Medline representative, knowingour immediate challenges, introduced us to SmartCare™, apatient monitoring system that goes beyond clinical monitoring.While SmartCare provides basic in-home monitoring of apatient’s vital signs, we had that area covered with anothersystem. Our requirements centered on the patients and familymembers’ emotional and general assistance needs, which ourcurrent system did not provide – and that’s where this newsystem came in.

The easiest way to describe SmartCare is that it’s likehaving a staff of personal care assistants and trained socialworkers all in one. The system’s communication equipment isinstalled in the patient’s home with a base plugged into a walloutlet and a simple wireless device that is slipped on topatient’s wrist or is clipped to their shirt, that requires just atouch of a button to contact the service representative. On theother end, the representative answers “Cornerstone Connect,”as if the patient is talking directly with our agency. This avoidsconfusion with the patient as to whom they are contacting,which makes for a smooth transition from the hospital, rehabcenter or whatever health facility they were coming from.

Each patient starts with a 60-day free trial period afterwhich they have the choice to stay on the service for a fee.Recently, SmartCare introduced a mobile device, which iswonderful for patients who are ambulatory enough that theydon’t have to be tied to their homes.

A Personal Care Assistant

Depending on the need of the patient or family member,SmartCare provides immediate access to emergent care, accessto our nursing staff for any clinical needs, or they can just talkto one of their certified social workers for emotional support.

The system also acts as a personal care assistant providingour patients with literally just about anything they need. Theycan help with making a doctor’s appointment, fill aprescription, order groceries, provide transportation, and evenorder dinner or book a flight. What this means is that ourpatient’s needs are met and our staff’s time is freed up to focuson patient visits and other crucial clinical needs.

In a recent real-life example, a patient advised the servicethat making and getting to her doctor appointment was verystressful and that she recently cancelled an appointmentbecause she could not obtain transportation. She requestedsupport from the Cornerstone Connect team. The service calledthe doctor’s office and scheduled the appointment on thepatient’s behalf. The representative then found transportationthat would get the patient to the appointment, which was one

and a half hours away. Finally, the representative also madesure the transportation was covered by the patient’s primaryinsurance provider.

The chart below shows that of all the calls to CornerstoneConnect, almost half – 48 percent – required the representativeto intervene on behalf of the patient, such as contacting apersonal physician, pharmacist, family member or other partyoutside of our agency. Only one percent of all calls required anintervention by our on-call clinician.

When we started with this program we met withSmartCare’s staff to set up protocols on how they were tomanage all questions and requests by the patients and theirfamily. The service had a template for the most commonquestions, but we also customized the protocols based on ourspecific agency requirements. For example, if a patient calledabout their medication, the service is scripted to connect thepatient with our intake department rather than the pharmacyor 911.

Resolution/Outcome Occurrence (%)

Intervention with Patient’s Care Network* 48%

Intervention with Patient 32%

Social Reassurance** 11%

Resolution/Outcome Occurrence (%)

Intervention Clinical On-Call*** 1%

EMS Dispatched with Transport 0.4%

First Responders Dispatched 0.4%without Transport

Notes

*Patient’s Care Network includes stakeholders such as PCP,Pharmacist, DME, Family Members, MCO, and other parties.

**Social Reassurance is characterized as general non-emergentcall interactions with the Care Center (e.g. patient looking simplytalk to someone)

***Program has not increased call volume to home health nurses.

Most Common Outcomes

Least Common Outcomes

Outcomes Data

4 © the Remington Report® September/October 2014

Reducing Readmissions

Without this program many of our patients would go to theemergency room if they had medication issues or some otherconcerns. Now we have a way to reduce our patient’sconcerns and anxieties – and ultimately prevent readmissions –by having them contact us first through Cornerstone Connectwhere we can provide real-time solutions.

The results so far are impressive. Through the first six monthsof using the program, Cornerstone had 135 patients enrolledon the service and avoided 44 readmissions at a considerablecost savings. See chart below.

Another very important service SmartCare provides tohelp reduce preventable readmissions is to respond to ourpatients like a physician office care coordinator. The servicehelps our patients stay on their medication schedules, ensurethey make and keep their doctor follow up visits and provideother helpful reminders. Since our nurses and many familymembers can’t be with our patients 24 hours a day, ournurses can give the service instructions to contact their patientswith specific reminders such as when to take their medication,make a doctor’s appointment or to check up with a patient inthe evening if the patient is not feeling well.

Recently one of our nurses used the reminder service witha patient who had low blood sugar. The service made anoutbound call to remind the patient to take his medication andthe nurse visited the patient at home the next day to administercare. Without this intervention, odds are this patient wouldhave probably been admitted to the hospital.

The service also immediately notifies us of any patient whoactivates the emergency response and is transported to thehospital. It also gives us the reason why the patient was takento the hospital. We can then follow up with hospital staff, senda nurse to the hospital if needed and make sure the patient getsa visit to their home if they were not admitted. Without theprogram, the patient would not be connected to our agencyand we may not have been notified they were ever taken tothe hospital.

The service has received very high patient satisfactionscores. The service makes on average three outgoing wellnesscalls during the 60-day free trial period. During the calls therepresentatives ask the patients how satisfied they are with theservice and 91 percent have indicated they are satisfied orvery satisfied. The representatives also remind the patientsabout their follow up doctor appointment or, in some cases,they even assist the patient with making the appointment.

Once the 60-day trial is complete, 56 percent of thepatients choose to stay on the service for a fee. The majoritydiscontinuing the service cited affordability as the issue, notsatisfaction.

Total Patients Enrolled 135

Total Unique Avoided Readmissions 44

Total Avoided Emergent Care/ED $174,240.00Expenses (2 Days)*

Total Avoided Emergent Care/ED $609,840.00Expenses (7 Days)**

Total Avoided Ambulance Transport $22,000.00Expenses***

Total Avoided Expenses (2 Days) $196,240.00

Total Avoided Expenses (7 Days) $631,840.00

Cost to Payer (SmartCare fees)**** $5,393.25

Total Healthcare Cost Savings (2 Days) $190,846.75

Total Healthcare Cost Savings (7 Days) $626,446.75

Notes

*Data pulled from New Hampshire statistics for cost based oncensus.gov information.

**Data pulled from New Hampshire statistics for cost based oncensus.gov information.

***Data pulled from national statistic of $500.

****Cost based on rate of $39.95 being applied to all patients.

Cumulative ROI Snapshot

Healthcare Dollar Savings

Outcomes Data


SmartCare has been a great resource for our patientsbecause it enables them to reach our agency, their doctors, orhelps them with their other care or emotional needs at the touchof a button, which puts them in the best position possible toimprove their health and keep them out of the hospital.

About the Author

Jennifer Gullison RN, MSN, COS-C, is clinical director andcertified chronic care specialist-trainer at Cornerstone VNA inRochester, NH. Her goal is to research, develop and implementbest practice models to keep clinicians trained as experts in allaspects of care needed to keep patients safely in their homesand to collaborate with other health care leaders in thecommunity to improve transitions of care for patients acrosshealth care settings.

“The system also acts as a personal care assistant providing our patients with literally just about anything

they need. They can help with making a doctor’s appointment, fill a prescription, order groceries, provide

transportation, and even order dinner or book a flight. What this means is that our patient’s needs are met

and our staff’s time is freed up to focus on patient visits and other crucial clinical needs.”

Key Data Points Percentage

Patients Very Satisfied or Satisfied with Service 91%

Doctor’s Appointment Reminder Generated* 79%

Doctor’s Appointment Made on Wellness Call** 8%

Notes

*Care Center provides PCP appointment reminders to driveadherence.

**Care Center w.ill assist patient with making appointment in realtime if needed. Most notably follow-ups post discharge.

Outbound Calls & Patient Outreach

Patients Retaining Service Beyond 60 Day Trial 56%

Patients Canceling at the end of 60 Day Trial * 44%

Notes

*Roughly 68% of patients cancel due to the inability to affordservice. This stat illustrates the importance of future MCO supportof SmartCare as covered benefit.

Retention Rate

ROI Data

Retention Data


© 2014 Medline Industries, Inc. All rights reserved.Medline is a registered trademark of Medline Industries, Inc. SmartCare is a trademark.



Summary

A leading Hospice in the New York metro region facedchallenges in clinician and patient satisfaction related to serviceand quality in medical supply. After a conversion to the leadingmanufacturer and direct provider in the Hospice industry, theHospice of New York improved quality, decreased labor, andenhanced their employee morale. The true silver lining wasdiscovered with increased patient and caregiver satisfactionscores compared to what was a true concern in late 2013.A supply savings of 41% was secondary and a nice additionto a great success story.

Background

The Hospice of New York was experiencing some increasedcomplaints from patients, caregivers, and clinicians about thequality of some important product categories such asincontinence and skin care. Additionally, it seemed to be achallenge to manage costs without more in-depth analyticalreports. Accurate data is only as good as the resources thathelp interpret it. The process of ordering was a bit inefficient aswell, and more time than needed was spent tracking orders.The labor costs related to supply management was not meetingexpectations. Like many within the hospice industry, this hospice

Enhancing Patient And ClinicianSatisfaction In HospiceAuthor: Brenda A. Young, MA, BSN, RN, CHPN, Director of Clinical Services, Hospice of New York


organization is continuously being challenged within acompetitive market, as well as feeling the headwinds ofregulatory and compliance tasks, Part D requirements and theHIS data set. Being proactive, there had to be a solution sothat resources could be directed to other top priorities.

This issue overall was problematic for a number of reasons:first and foremost, our organization has a median length of stayof 9 days, and an average length of stay of 42 days to “get itright.” The families are often in crisis dealing with anticipatorygrief, assisting their loved one with settling affairs and copingwith the medical conditions and care of a dying familymember. The last thing they need is numerous deliveries andthe wrong and inferior supplies being delivered, whichescalates their stress levels and becomes overwhelming; hence,the hospice is failing the patient-family centered experience.Hospice of New York’s motto is “to comfort always” and thispractice was not in alignment with our mission.

At first the initial goal was to improve overall productquality. Medline, a leading brand in wound care, was anobvious choice for us to review. After further considerationand quality review of important product categories such ascontinence care, skin care, and gloves, Hospice of New Yorkwas amazed to realize that Medline is the leading brand asboth the manufacturer and distributor in over 75% of the typicalHospice spend. Suddenly this became a serious opportunity tonot only improve quality, but to significantly reduce annualspend. As evidenced in Table 1 below, cost control in Hospicewill continue to be a focus in the industry.

Table 1

Results

After our clinical team realized the exceptional quality andconsultative reporting that was available, a smoothimplementation in January, 2014 occurred. Service, asexpected, was solid and our staff responded with confidenceto the new patient specific model of delivering supplies to theend user.

Our first collaborative business review revealed informationwe never may have expected could impact our overall costs,even beyond supply spend. The clinicians have experiencedsuccess with the toll-free WOCN hotline offered. We anticipategreat future results with the comprehensive suite of clinicalsolutions offered to us that have not been engaged yet.

Table 2

The change to Medline came about somewhat unexpectedlyas the Hospice of New York was first interested in improvingwound care practice. In the end, the initial idea evolved intoa transformation for our hospice in that we found a true partnerthat will help us manage our business. From overseeingutilization, contrasting benchmarks to other hospices, providingextensive clinical resources, and having the opportunity to meetother referral sources all lead to what the Hospice of New Yorkhas come to expect in being a leader. As the industry movestoward a palliative model with population health in theforefront, hospices will expect great resources from theirpartners. It will be paramount for survival and success.

Hospice of New York was founded in 1997 by Michaeland Vada Rosen and two managing partners. Hospice of NewYork serves 300 patients within Nassau County, Queens,Brooklyn, Manhattan and the Bronx. We are contracted with64 facilities with patients in their own homes, ALFs, SNFs orin one of seven IPUs.

© 2014 Medline Industries, Inc. All rights reserved.Medline is a registered trademark of Medline Industries, Inc. SmartCare is a trademark.

Rate Cut Amount Timeline

Budget Neutrality Adjustment -4.2% overall 2011-2016Factor

Accountable Care Act -11.8% overall 2013-2022Productivity AdjustmentFactor

Sequestration -2% per year 2013-2022

Medicaid -2% July 2014

Cumulative Rate Cuts Affecting Hospice

Medline Previous Supplier Savings

1/1/14 – 3/31/14 8/13(multiplied by 3 months)

$58,615 $101,703 41%

Total Supply Spend By Hospice of New York

“Our first collaborative business review revealed information we never may have expected could impact our

overall costs, even beyond supply spend.”


The emotional and professional demands on nurses are

greater than most of us can imagine. Patient population on

the rise. Staffing shortages. Compassion fatigue. Despite these

factors, nurses find a way to stay passionate, energized and

dedicated. As part of Medline’s Caring for America blog series,

Holly in Massachusetts talks about making a difference in

the lives of some of the most vulnerable patients through

home care.

Martie: Tell me, Holly, what’s been your journeyas a nurse?

Holly: Back in high school, I wanted to be a teacher, butthe market was flooded. My dad encouraged me to go intonursing and I later attended New York’s Skidmore College.During the four year program, two years involved training inManhattan hospitals. We worked everywhere from RooseveltHospital’s ER, home care in Chinatown, pediatrics at New YorkHospital, Med-Surg and even psych at Bellevue. It was atremendous foundation.

Martie: You really had an incredible experience.

Holly: I can’t praise the college enough because theeducation was truly superior. I always wanted to be a pediatricnurse. Thanks to my education, a Bronx hospital hired meimmediately. There were lots of kidney transplants and childrenwith GI/GU problems in the pediatric tertiary care unit. I lovedworking with children and their families.

A few years later, we relocated to Connecticut where Iworked in the ICU. Life brought me two sets of twins and itbecame too difficult to care for really sick children and my ownfour babies. That’s when I entered home care.

I was asked to work with babies on ventilators because itrequired complex care, a completely different skill set and theemotional strength to deal with babies dying at home. I becamea certified hospice nurse and took care of those babies on theweekends. Years later, I became a weekend nurse for VNAand cared for about a dozen patients daily. I worked 16 hour

days. Then, I took on clinical director roles which led to anumber of administrative roles. After living through manyacquisitions, I decided to get back to hands-on nursing.

An opportunity opened up at UCONN Medical Center’sbone marrow transplant unit. I was out of the hands-on clinicalsetting for about eight years. I loved working with patients andfelt so good because I never lost my skills. I became theassistant head nurse and absolutely loved working there.

“This is a career focused on caring for people and their families. You have to be so present to patients. And,

if you’re approaching it as a job, you can’t meet that human moment.”

Caring For America Hosted by: Martie Moore, Chief Nursing Officer, Medline


Martie: So how’d you land where you are today?

Holly: After the medical center, I worked at an adult daycenter for eight years then opened my own private casemanagement practice. While there, I found out about a privatepay leadership position followed by a VNA leadershipposition. Although I wasn’t looking for a job, I went on theinterview and was named a VNA executive director. They tooka closer look at my experiences and eventually named meCEO.

Martie: You have a fantastic story. I love how nursesare adaptive and brilliant. What would you tellnurses coming into the field?

Holly: This isn’t a job, it’s a career. And if you’re lookingfor a job, please don’t become a nurse. You need to have apassion in this business and must be adaptable. Nursing isreally a career, not something you should go into lightly. Youreally have to love people and be willing to invest part ofyourself into this profession. I’m finding for a number of people,it’s only a job. And you can’t turn it on and off. It really bothersme a lot. This is a career focused on caring for people andtheir families. You have to be so present to patients. And, ifyou’re approaching it as a job, you can’t meet that humanmoment.

Martie: Let’s talk about home care. What do youlove about it?

Holly: I love helping people … especially those mostvulnerable or in need. In home care, you can help people bestby connecting them to resources. Home care isn’t just aboutthe patient … it’s about the family, and the extension of thefamily. It’s about the 90-year old woman who lives alone thatneeds a caregiver that we can provide for them. What I loveabout home care is the opportunity to keep patients at homeand families together. As home care professionals, we can getpatients back to a greater level of functioning and assist themto be as independent as possible.

Martie: What would you change?

Holly: The reimbursement system doesn’t cover our coststhe way it needs to and it’s very challenging to care for peoplewith the existing regulations. When it comes to pay, homehealth aides, homemakers and companions are underpaid.They do the hardest work and are paid the least. Thereimbursement system doesn’t allow you to pay them more tocover your cost and I’d like to see them get paid what they’redue. They are valuable employees.

Martie: Where do you think nursing is going to bein 5-10 years?

Holly: I see NPs having independent practices and the roleof the nurse changing to be more administrative, perhapssimilar to that of a geriatric care manager. I think they’ll alsodo everything from finding financial resources to providingcomplex clinical care in the home. I also see nurse aideshaving more extensive training and responsibilities.

Martie: We’re moving care back to communities yetthe degree of illness and patient complexity is fargreater than what we’ve seen in the past. And, weneed to be supportive of our care providers.

Holly: I applaud those nurses that have stuck with nursingas a career and not a job. I have an appreciation and respectfor the passion they deliver to patients every day no matterwhat.

Martie: It’s been a personal blessing to hear your story andpersonal insight. You are my hero for what you’re doing andI’m so appreciative of the work you do.

Medline is paying tribute to the three

million nurses who face caregiving

challenges each day by giving them a

voice in a new blog series called Caring

for America. Visit Medline.com to read

more of these inspiring stories.

Martie Moore


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Your mission is Medline’s mission.

HOME HEALTH EXCELLENCE.

To learn more, contact your Medline representative, visit us at medline.com, or call 1-800-MEDLINE.

Medline is so much more than medical supplies. Our products, services and people help agencies like yours achieve the clinical and business outcomes you work to achieve every day. Let Medline help you to earn profits, build productivity, gain referrals, improve outcomes and manage supplies.

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