NAHC notes: what’s happening in home health?

ABILITY was well-represented at the National Association for Home Care & Hospice (NAHC) annual conference in Orlando in late October. ABILITY senior director of product management, Christine Lang, MBA, returned from the event with these observations.

What was the buzz this year? What’s everyone talking about?

Christine: Pre-claim review (PCR) for home health was the hottest topic this year. People remain nervous about managing the demands of PCR, while appreciating that CMS has delayed rollout in order to approve the program. While this is similar in ways to preauthorization requirements in other segments of healthcare, the scope of paperwork and timing in the home health PCR program requires agencies to really shift their current processes and workflow.

We heard about a lot of different approaches that agencies are taking both in Illinois, and in the other states targeted for the pilot. Some in Illinois are rigorously building programs to effectively comply without changing anything around care delivery practices. Some are not engaging at all. Others are evaluating major operational changes, like delaying the start of patient care until the face-to-face documentation is complete. Outside of Illinois, a handful of agencies are already preparing diligently, so that PCR will not be a disruption when it comes to their doorstep. Many are taking a wait-and-see approach.

Do you think the promise of home health is being recognized for its cost-saving potential?

Christine: We aren’t there yet! There’s still too little awareness about the services and value that home health promises and delivers. Cases are pretty evenly split in terms of being post-acute or community referrals, and you wonder how often the physician just doesn’t think to refer patients who would benefit from home healthcare. On the provider side, many in the industry still think of themselves in the “Medicare box,” but there are agencies starting to work more with the untapped markets beyond Medicare. Big payers often still don’t cover home health services, or greatly limit their use, when really, they could keep admissions and readmissions down and help with population health goals. Home is certainly the setting of care preferred by patients.

You had the opportunity to talk with some NAHC attendees about their key focus areas for quality improvement. What would you say are the top three measures most HHA’s are targeting?

Christine: That’s not an easy question, because every agency is unique and has different market demands, patient populations and organizational priorities. That said, certainly the hospitalization and readmission rates are important. Other providers, payers and policy-makers are focused on it for good reason: a preventable admission is expensive, exposes the patient to risk and isn’t fun for the patients or their families. It has a widespread impact on quality of life. Managing this event depends so much on patient need – you have everything from stroke recovery, to hip replacement, to chronic disease management – and these things really influence the patient’s risk and the care and services needed.

I think the management of oral medications is also a critical issue. It actually reflects on the agency’s quality in three ways: a process measure, an outcome measure and in HHCAHPS scores. All are publicly reported on Home Health Compare, included in star ratings and/or value-based purchasing. In addition, medication issues can lead to other health problems and negative outcomes.

Finally, timely initiation of care is a really important measure for two primary reasons. First, it is the only process measure that is statistically associated with higher outcomes and patient experience scores, which suggests that improving timely initiation of care might improve other performance measures. Second, there is more variability in this process measure than in others, and being able to get to the patient quickly is often very important to referral sources. So this can be an effective way to stand out in a competitive market.

ABILITY can help

ABILITY simplifies administrative and clinical complexities for home health and hospice providers. In early December, ABILITY will release updates to our ABILITY | OPTIMIZE™ OASIS and Analytics applications that will support the OASIS C-2 changes. To ease the transition, ABILITY will support both versions of the OASIS form. Stay tuned!