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