community based home health services
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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COMMUNITY BASED HOME HEALTH SERVICES
Denise Looker, LSW, MHSM
Director of Operations
Visiting Nurse Assn. of Arkansas
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GOAL: INCREASE AWARENESS of the
AVAILABILITY OF HOME HEALTH CARE IN THE COMMUNITY FOR THE
ELDERLY
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OBJECTIVES
• Verbalize one guideline for qualification for Medicare reimbursed home care
• Verbalize a benefit of using home health care
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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
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REGULATING BODIES
• Health Service Permit Agency
• Centers for Medicare and Medicaid
• Arkansas Department of Health
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ACCREDITATIONS
• The Joint Commission
• CHAP
• Not all Medicare certified agencies are accredited
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HOME HEALTH REFERRAL SOURCES
• Hospitals
• Physicians
• Other Medical Providers (DME, Infusion, Insurance Case Managers)
• Community agencies
• Family or patient
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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
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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
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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
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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
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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
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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-
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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
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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
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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
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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
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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
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Home Telehealth
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Our Patients’ Healthcare Experience
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Our Patients’ Health Care Experience:
Often OVERwhelming!
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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