Home Care Medical

Respiratory Care Clinical Outcomes

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Over 40 Years of Experience Home Care Medical (HCM) is committed to our mission of enhancing the quality of life of those we serve. In our continual pursuit of excellence, we monitor several performance measures – including our Respiratory Care Clinical Outcomes. The results of our Clinical Outcomes enable us to modify our policies and procedures to ensure we continue to provide superior care, products and services that our customers have come to know and trust.

Home Care Medical has been a leading provider of PAP, Oxygen, and Ventilator Care Therapy for the past 40+ years. Accredited by the Joint Commission and an active member of WAMES, The MedGroup and AAHomecare, Home Care Medical is proud of our results. If you have any questions regarding the following Clinical Outcomes, please feel free to contact Donna Smith, Home Care Medical Director of Respiratory at 262.786.9870 ext. 522 or via e-mail at donna.smith@hcmedical.com.

Did You Know? – 17.6% of Medicare beneficiaries were readmitted within 30 days of discharge resulting

in $15 billion in annual spending.

– Between 10 and 50% of readmissions are considered to be potentially avoidable.

– All data confirms that readmissions occur disproportionately closer to the day of discharge.

– 30 day timeframe captures the largest share of readmissions.

– First 30 days is the critical interval and represents the greatest opportunity for improvement.

– Highest rates of rehospitalization and most frequent reasons for rehospitalization are heart failure, pneumonia, Chronic Obstructive Pulmonary Disease (COPD), psychosis and GI problems.

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PAP Clinical Compliance 2016 Home Care Medical PAP Compliance

30 Compliance Percentage

Quarter 1 72%Quarter 2 72% Quarter 3 78%Quarter 4 72%

Home Care Medical’s current PAP user compliance rate average is 74%. According to Medicare, a data report from the PAP device which documents use of the PAP device for at least four hours per night on 70% of the nights for a 30 consecutive day period during the trial. Our goal is for our PAP users to be at 70% compliance within 30 days of therapy. We utilize cutting edge technology that allows us to monitor full time, 24 hours a day. This helps us to identify compliance or equipment malfunction in real time. When non-compliance is found, immediate troubleshooting and coaching is done – the same day.

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Mask problems are evaluated and appointments are scheduled for mask re-fits. If there are ques-tions regarding equipment function or if patients need retraining on the PAP machine, our staff is available to assist them.

Compliance Monitoring Staff

Our Respiratory Support Staff is here to follow-up with our patients on PAP compliance monitoring and to answer any questions that our patients may have. They also act as a liaison between the patient and the primary physician, nurse and/or the pulmonologist. Our Staff is available to trouble-shoot the PAP machines, along with any facial mask or supply issue that may arise.

Another important aspect of our best+fit PAP program is managing the compliance data from the ResMed Air View patient management system. This allows our staff to help maximize patient compliance, monitor the detailed reports on patient performance, and provide additional coaching that will help our patients with their compliance. Our program utilizes staff with a strong clinical background in Sleep Medicine.

Before the set-up: verify the script; have the patient watch an instructional video on what to expect from CPAP therapy; develop and understand from the patient their knowledge level of CPAP by asking them – have you ever been on CPAP, do you know anyone on CPAP, have you ever heard about CPAP. Per one of our respiratory therapist “these simple questions give me an understanding of the client’s attitude and likelihood of compliance.”

During the set-up: Follow a consistent, well defined procedure; PAP education; fitting the mask and trial demonstration; reordering supplies and travel information; questions and answers; summary, paperwork, reminder for follow-up physician appointments; and final return demonstration.

After the set-up: structured detailed follow-up process utilizing Air View patient management system; a dedicated individual with sleep experience whom you can trust; reports as often as you need them; and information communicated as it happens.

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Oxygen Clinical Outcomes2016 Home Care Medical Oxygen Patient Rehospitalization Clinical Outcomes Chart

< 30 Day Return to Hospital # of HCM Patients Total Patients Percentage

Quarter 1 4 142 2.7%Quarter 2 7 117 6.0%Quarter 3 4 146 2.7%Quarter 4 4 202 2.0%

Our Home Care Medical Oxygen Patient Rehospitalization Clinical Outcomes average for 2016 is 3.4%. The reasons for rehospitalization include shortness of breath, pneumonia, breathing problems, respiratory and internal bleeding and Chronic Obstructive Pulmonary Disease (COPD). According to a 2010 Dartmouth Institute for Health Policy and Clinical Practice atlas report, the percentage of Southeastern Wisconsin patients readmitted within 30 days of medical discharge is 15.4 to 15.9%.

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The following questions are asked to Home Care Medical oxygen patients related to the following three categories:

1. Education and Trainingp Are you following your physician orders for your prescribed oxygen therapy? p Has there been a change in your prescribed liter flow? p Do you have a scheduled follow-up physician appointment with positive discharge

from the hospital?

2. Service and Equipment Failure p Do you or your caregiver know how to operate your oxygen equipment? p Do you feel that you received proper instructions on how to operate and maintain

the oxygen equipment?

3. Medication Management p Are you taking your medication as prescribed according to your physician’s orders? p Have your respiratory medications changed within the last 30 days? p Did you have an emergency room or unplanned physician visit within the last 30 days? p If yes, reason for emergency room or unplanned physician visit. p If yes, how long were you hospitalized? p Were you discharged from the hospital with a prescription for medication?

Program Overview

Help patients become compliant and use oxygen as prescribed. To ensure patient compliance and to monitor the therapeutic benefits of their oxygen therapy, our Respiratory team will contact our patients on a regular basis:

• New oxygen patients receive a phone follow-up within 7 days of set-up and again at 30 days post set-up (excluding hospice, exchanges and current patients).

• After the initial 7 day follow-up call that has been made, we began to focus on those patients at the 30 day post set-up for rehospitalization. If they have been hospitalized, Home Care Medical documents the reason why and assists with action plans to prevent further or additional hospital-izations.

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Ventilator Care Clinical Outcomes2016 Home Care Medical Ventilator Hospitalization Clinical Outcomes Chart for Respiratory Infections:

< 30 Day Return to Hospital # of HCM Patients # of Respiratory Infections Percentage

Quarter 1 90 7 7.7%Quarter 2 90 3 3.3%Quarter 3 90 4 4.4%Quarter 4 93 9 9.6%

Ventilator clients hospitalized for respiratory related infections for 2016 is 6.25% (average). The primary diagnosis for hospitalization was pneumonia and shortness of breath. According to Predictors of hospital readmission, the overall mean readmission rate was 27% (1991) with a significant difference based on patient diagnosis.

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Our goal is to make the process of living at home or an alternate site on a ventilator more personal and comfortable. Studies have shown that patients residing at home prior to hospitalization had a significantly better quality of life, better physical functional status and better psychosocial function compared to ventilator patients residing in nursing homes or rehabilitation facilities. These patients also demonstrated better ambulation, mobility and overall better body care. We assist the caregivers to achieve this by providing in-depth education on ventilator management, constant and frequent com-munications and building a personal relationship with the patient, caregivers and family members.

Our best+fit approach to decreasing hospital readmissions is to provide the following services to our Ventilator patients, referrals and family members:

1. Strong Interdisciplinary Teamp Respiratory intakep Insurance verification specialist IV/enteral nursesp Ventilator management coordinatorp Respiratory therapist – assigned to the case

2. Smooth transition Homep Home environment assessment (prior to discharge)p Meeting patient and caregivers at home upon dischargep Management of all equipment and suppliesp Ongoing training as neededp Detailed monitoring and documentation of hospital readmissionsp Ventilator training to caregivers and nurses

3. Continuation of Carep Clinical and environmental patient assessment as neededp Equipment review and managementp Ongoing competency observations and review with caregivers and nursing staff p Respiratory Therapist 24/7 on-call p Hospital admission screening

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Our best+fit TeamHome Care Medical’s product selection is expansive. Our staff is highly qualified and our service is unparalleled. Our team of Respiratory Therapists, Respiratory Specialists, Emergency Medical Technicians, Home Care Technicians and support staff have over 160 years of combined respira-tory care experience. Primary duties of the respiratory team are delineated as follows:

– Respiratory Therapists: Teach utilization of equipment to users and family members and provide patient care for people needing ventilators, apnea monitors, oxygen, PAP and phototherapy therapy.

– Respiratory Specialists/Emergency Medical Technicians: Follow-up on patients new to oxy-gen. They evaluate patients for the most appropriate oxygen delivery system, which could be LOX, Concentrator, Oxygen Conserving Device or a self-filling oxygen system. They also review the home safety aspects of having oxygen in the home – including oxygen outcomes and compliance monitoring.

– Respiratory Clinical Support Staff: Coordinate discharge and set-ups for new oxygen patients. They are our lead in handling customer questions and concerns.

– Respiratory Support Coordinators: Help with scheduling, coordinating compliance, and work closely with Respiratory Intake Specialists to meet the needs of our customers.

– Respiratory Intake Specialists: Process calls from clients and referrals that are placing initial and ongoing orders for respiratory products and services.

– Home Care Technicians: Are trained to deliver, set-up and educate patients on oxygen therapy equipment. They teach clients the safe and effective use of the equipment.

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We are Here to Serve You!To learn more about our home medical equipment and supplies, please feel free to visit one of our retail stores and product showrooms at:

– Home Care Medical | Milwaukee Retail Store 4818 South 76th Street, Milwaukee, Wisconsin 53220 | Ph 414.423.8800

– Home Care Medical | Sheboygan Retail Store 2922 South Business Drive, Sheboygan, Wisconsin 53081 | Ph 920.458.5768

– Home Care Medical | West Bend Retail Store 1709 South 18th Avenue, West Bend, Wisconsin 53095 | Ph 262.957.5501

Plus, we are proud to now offer Home Care Medical’s Shop Online store where you can easily purchase all your Durable Medical Equipment (DME). Simple, fast and easy-to-use, it will change the way you shop online for our products.

– Home Care Medical | Shop Online 24/7 www.HomeCareMedicalShopOnline.com

We are proud of our broad selection of high quality PAP, Oxygen and Ventilator Care therapy products and services, award-winning team of health care professionals, and acknowledged commitment to quality. We look forward to providing the best+fit for your patients.

Home Care Medical . . . helping you and your family get on with life!

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We make the world a better placeBabies breathe on our Ventilators.

Toddlers improve therapy with our Nebulizer Solutions.Moms stay active with our Afflovest.

Dads sleep better with our PAP Therapy. And, Grandmas visit friends with our Traveling Oxygen.

We touch so many lives . . . everyday. How may we help you?

Respiratory Care 5665 South Westridge Drive New Berlin, Wisconsin 53151Ph 262.786.9870 ext. 208homecaremedical.com facebook.com/homecaremedical

April 2017