The 2025 proposed rule brings additional cuts that may further strain the industry’s ability to serve all patients. That was already a challenge before the pandemic, when only 77% of those needing care in 2018 received it. Six years later, that number is down to 65%.

“It’s a critical opportunity for us as an industry to make sure that the leaders at CMS, and the leaders in Congress, are recognizing the value of home health services within the continuum of care and within the entire health care ecosystem,” says John Gochnour, President and COO of The Pennant Group. “The home health proposed rule doesn’t do that.”

Here are three insights home health providers must know about the new rule and how they can successfully navigate it.

Not all providers are affected equally

The proposed rule includes a payment decrease in the aggregate of 1.7%, translating to about $280 million in lost revenue. Yet the impacts vary widely based on geography and patient case mix. Some factors, such as wage index, have seen erratic changes year after year.

“Turnover and wage costs are not changing abruptly. You’re not all of a sudden paying more one year and then less the next year,” says Scott Pattillo, Chief Strategy Officer, Homecare Homebase. “So it’s really important that you know — based on your geographic mix, your patient mix, your patient types and your acuity types — how it’s going to impact your agencies.”

The industry’s financial pressures are mounting — and the new rule doesn’t always account for that

Running a home health business is challenging enough on its own. It gets even trickier when CMS views the industry substantially differently than providers do.

“CMS is of the opinion that there are very high margins in Medicare,” Pattillo says. “They believe there’s a 17% margin on Medicare claims.”

Pattillo notes that CMS’s response to last year’s provider comment letters was that: “In a 17%-margin environment, we just don’t understand how a 1% to 2% decrease can impact anything materially. Taking 1% to 2% of that 17% margin does not make sense to us that it would destabilize the industry.”

But CMS’ view that providers see a 17% margin on Medicare claims does not account for multiple important factors, including:

• Wage increases and the inflationary environment
• The high number of Medicare Advantage patients that providers care for
• The high number of MA plans with reimbursement rates under the cost of care

Those last two are the big ones. Providers may have a 17% margin if they only took Medicare patients, but when half of their patients are under MA plans, their margins come out to more like 1-5%. In short, home health agency margins are much slimmer than CMS implies.

“The individual elements of cost of care are absolutely not going down,” Pattillo says. “There is nothing that has gotten cheaper about caring for patients, and we know the acuity of those patients is rising in terms of the way that they’re coming into your home health agencies.”

Adjusting to the new rule starts with turning to HCHB

When a new rule proposal is released, care providers turn to the HCHB Analytics Impact Model to review the rule’s potential impact and figure out what changes they need to make.

“The first thing that we do after the proposed rule is released is look to the Homecare Homebase model,” Gochnour says. “We then work from that to refine and understand, because we operate in 14 states across the country, so we have a lot of variability in how a proposed rule is going to impact each individual operation.”

The HCHB dashboard allows companies to see where they fit in the new rule. Benefits include insight into:

• The variability in CMS’s methodology
• How that variability your branches in different states
• How your agency will be affected by case mix changes
• The potential effect you will see to your revenue
• The ability to understand when and how to add new service lines

“We use this model to really estimate that impact and immediately provide our local operators with some insight into what the impact is going to be for them, so that they can begin honing in on what changes they may need to make,” Gochnour says.

This article is based on a recent HHCN-HCHB webinar featuring Scott Pattillo and John Gochnour. HCHB delivers powerful new tools and intuitive software that’s easy to learn and use. From scheduling, routing, documentation and reporting to intake, billing, and compliance we give you everything you need to boost productivity and profits while empowering exceptional patient care. To learn more, visit hchb.com.

The post 3 Insights Home-Based Care Providers Must Know About the Proposed Home Health Rule appeared first on Home Health Care News.

As Vice President Health Information Systems at AccentCare, Riemer adapts the organization’s technology to meet regulatory and compliance changes that impact assessments at the Start of Care. With addition after addition to the process, the Start of Care loses its core efficiencies.

“I think what’s changed over the last several years, in part as a direct relation to the COVID pandemic, is that things are getting a lot tighter,” Riemer says. “Over the years of all of the regulatory changes, what has happened is what I refer to as the Frankenstein Effect: we continuously add, but we never go back and review and look at how to gain efficiencies, how to increase patient care and quality and, most importantly, how to increase clinician satisfaction.”

Here is a look at how this effect comes to pass, and three tips on how to optimize Start of Care in the face of changing processes.

How to prevent the industry’s tricky changes from tripping you up

For the proposed payment rule for 2025, CMS is looking to collect four new pieces of data related to the social determinants of health (SDOH) category and looking to modify one other item. The four items proposed for collection are: one living situation item, two food items and one utilities item. CMS is also proposing a modification to the current transportation item.

If this all seems rather inside-baseball, you’re not alone. These proposed changes from CMS are just part of the many changing elements that home-based care providers have to account for at the Start of a Care plan. The result can be much more time spent entering data and checking forms and less time with patients.

“One of the downsides to our industry and the home health post-acute arena is that a lot of times, clinicians will see all of their patients during the day then they spend hours at home catching up on everything,” Riemer says. “I don’t think clinicians can ever 100% get away from their documentation, so our focus has been, where can we make it more effective?”

Over the past 12 to 18 months, AccentCare has focused on helping clinicians Start of Care assessments on the right track.

“I have an informaticist on my team who is an RN by trade — a board-certified informaticist — and she’s done ride-alongs in field studies and spent hours and days and weeks trying to take what is often muscle memory for an RN or an OT or PT and match it to the assessment itself to enhance the overall experience both for the clinician and the patient,” he says.

3 tips for optimizing Start of Care

In light of these challenges, Riemer recommends that providers take three steps to regain control of their Start of Care processes and their care assessments.

1. Create a clinical council

A care assessment is not a tech project, Riemer says. It’s a clinical initiative. Providers should identify volunteers among their field staff who know the technology used in home care while also knowing what the Start of Care process entails. Find foundational principles that staff can follow even in a rapidly evolving landscape.

“Set up some work groups,” Riemer says. “You don’t have to have an informaticist on staff. You just have to know somebody understands the technology — both what can be done and what can’t. A lot of times clinicians ask for things that just can’t be done in the system. So that person needs to know how to step back and help the team collaborate amongst themselves on what makes the most sense for how they do their daily visits.”

2. Approach care assessments like a project

In light of all of these constant changes, providers must approach changes to the care assessment processes like a project, with project leaders who drive the change forward. Don’t make the mistake of trying to govern by committee. Designate someone to manage the project and ensure you have leaders who are invested in the project’s success and have the authority to make a final judgement call when a decision needs to be made.

“Whether you go waterfall, agile, scrum — whatever fancy term everybody wants to use, there will still be a need to gather the requirements to document it from a business analyst perspective,” Riemer says.

3. Lastly, treat this as an iterative process

The more things change, the more they remain constant. Like any process of continuous improvement, getting the most out of a Start of Care plan requires agility and flexibility around all sorts of external changes.

“This one is just the nature of the beast — in an iterative process, you always have to reevaluate what worked in the last initiative and assess whether it will work this time around,” Riemer says.

For Riemer, that iterative process has long included technology solutions from Homecare Homebase.

“Homecare Homebase is the core that represents all of our home health, hospice and palliative service lines, and affect the majority of our patients,” he says. “My first implementation with HCHB was around 2011. I’ve been a Homebase Homecare client ever since.”

HCHB delivers powerful new tools and intuitive software that’s easy to learn and use. From scheduling, routing, patient notes and reporting to intake, approvals, billing, compliance and payment, we give you everything you need to boost productivity and profits while empowering exceptional patient care. To learn more, visit hchb.com.

The post Inside Today’s Changing Care Assessment Landscape — And How to Stay One Step Ahead appeared first on Home Health Care News.

After bringing on HCHB’s Revenue Cycle and Authorization Services, VNHS — an Atlanta-based non-profit provider of home-based care services — agreed to partner with HCHB to outsource their intake process as well.

“The cost associated with outsourcing is expected to be even further offset as we continue to scale,” says Jacqueline Ralph-Blair, Chief Innovation Officer of VNHS. “Remember, we’re a moderate-sized organization, we want to be positioned for scale.”

In short, it’s important to ask: “How do we offset those administrative costs and pressures?”

VNHS worked with HCHB to centralize its intake process. The results have been dynamic. Here is a look at three powerful stats that show the ROI of combining outsourcing with new technology — as well as three tips for success.

12.5% cost savings within the first year of centralizing intake

Ralph-Blair wasn’t just looking to the next few quarters when she decided to outsource intake services. She was looking at the next three quarters of a century.

“For our 2024 strategic plan, we had to focus on how to be sustainable and have a sustainable foundation to be here for the next 75 years,” she says. VNHS has experienced all of the pressures facing the home-based care industry, from increased labor costs to staffing constraints to the high cost of turnover and its impact on care quality.

VNHS offsets those constraints by recruiting and retaining top talent while also embracing third-party services.

“This meant being extremely tactical in who we were choosing to be our external partners,” she says. “Homecare Homebase has been that invaluable partner with Visiting Nurse Health System. They really hear our pain points and create solutions to address our concerns in trailblazing ways. We consider the Homecare Homebase team an active ally.”

In the first year with their new ally, VNHS saw a savings of 12.5%.

HCHB handles VNHS’ non-admissions for consistency and standardizations, meaning they now have great trackability for those non-admits to better utilize data to examine other opportunities. Centralization gives the team the flexibility needed to be more innovative and more bullish with their risks, Ralph-Blair says.

“We’ve been open now to trying new things like HCHB Smart Scheduling, which really helps us avoid those missed visits and late-day scheduling problems for our clinicians,” she says. “We were able to launch that this year — with a really solid implementation in our intake department.”

By streamlining their intake process and using Smart Scheduling, VNHS has freed up their clinical managers, giving them more time to focus on their clinicians, which in turn helps clinicians do what they do best: deliver care.

87% of VNHS clinicians felt that they were supported

For home-based care providers, the mental health and emotional wellbeing of their caregivers plays a major factor in the organization’s ability to deliver care. A recent study from Weill Cornell Medicine researchers showed that home-based care aides struggle with stress and depressive symptoms due to their work, and that caring for patients who need services outside the agency’s plan of care added to that stress.

In short, at a time when burnout is driving staffing shortages, clinician satisfaction is a game-changer.

“After adopting Smart Scheduling, we were able to see some really favorable results: 87% of our clinicians felt that they were supported and that they had the tools needed for success in our post-implementation survey,” Ralph-Blair says.

8% decline in nursing turnover

VNHS is now seeing a decline in nursing turnover after establishing efficient intake processes and implementing HCHB Smart Scheduling. This is critical in home health care today; the 2024 Home Health Care News Home-Based Care Outlook Survey and Report showed a massive industry focus on staff consistency, as 53% of respondents said that recruitment and retention was their greatest staffing-related challenge entering 2024.

Providers like VNHS who control that challenge are seeing better care outcomes.

“We were able to develop a streamlined process where we work directly with the VNHS sales team as if we were part of their staff,” says Joyce Osborne, Director of Clinical Operations at HCHB. “We receive their referrals. If the referrals are complete, our goal is to get them processed and on to the HCHB Authorization services team — within an hour from the time that referral was received.”

Efficient intake and authorization processes mean referrals are processed and ready to be scheduled quicker and scheduling automation takes the pressure off schedulers and nurses.

3 tips for operator success in outsourcing

For operators getting started in their outsourcing journey, Ralph-Blair offers three tips for success.

1. Take a phased approach. “Know your organization,” she says. “Don’t bite off more than you can chew. We rolled it out in phases, and we did stop-checks to make sure that we were cementing those concepts before we moved forward.”

2. Communicate often. “There is no limit to communication,” she says. “We communicate often, whether structured or unstructured. Find that appropriate cadence.”

3. Treat your technology partner as part of your team. Like Osborne noted, HCHB works with VNHS as if they were part of their staff. It’s a feeling that is reciprocated.

“We absolutely treat each other as one company,” Ralph-Blair says. “Homecare Homebase, for us, is a part of our team, a part of our family, and there is extensive transparency—so much so that everyone across the board is vested. Who you outsource with is just as important as what service you choose to outsource. There is just so much tech enablement out there that requires due diligence. Equal due diligence should be vested in those external organizations as well. We’ve just really found a collaborative, true partner with Homecare Homebase.”

HCHB delivers powerful new tools and intuitive software that’s easy to learn and use. From scheduling, routing, patient notes and reporting to intake, approvals, billing, compliance and payment, we give you everything you need to boost productivity and profits while empowering exceptional patient care. To learn more, visit hchb.com.

The post How One Home-Based Care Provider Saved 12.5% on Intake appeared first on Home Health Care News.

In business and health care, the term “solution” has become a stand-in for any piece of tech that business owners can use to solve problems. It’s so ubiquitous that it’s easy to forget the reason for the name: it quite literally is a solution to a problem. As the Vice President of Care Management at Enhabit Home Health & Hospice, Baker knew that success in a value-based landscape required an efficient operation that empowers caregivers to get the most out of their team members.

She also knew that in a 24-hour business, providing high-quality care to patients whenever they are in need is the difference between success and failure. Managing your entire patient population, responding quickly to patient needs and doing so without overburdening clinicians is critical, especially in a value-based landscape.

“Enhabit continuously evaluates new platforms and technologies that could help our organization with efficiency and quality of care,” Baker says. “With the evolution of health care and the increasing ability of our patients to adopt new technologies, we made the strategic decision to adopt a virtual engagement platform to better support patient care which we believe will help us better manage complex patients in an environment of limited clinical resources.”

Here is a look at how Enhabit made that move, and what it’s doing for patients.

The connection between patient engagement and nurse triage

Every home-based care provider knows how the phone call goes. Reacting to incoming calls from patients, whether urgent or non-urgent, places a significant burden on clinical staff. Proactively addressing patient needs before they or their caregivers have to call can alleviate this burden and improve the patient experience. Enhabit identified proactive patient engagement as a strategy to increase clinician capacity and meet patient needs preemptively.

“Value-based care boils down to two things really: keeping patients safely at home — out of the hospital and the emergency room — and creating an excellent patient experience,” Baker says. “Significantly better engagement creates opportunities for both.”

For a cost-effective patient engagement platform, Enhabit turned to care coordination technology partner CareXM. Their solution gives providers exactly what they need most in today’s value-based landscape: more clinical capacity and flexibility to care for patients in a timely, effective manner and proactively meet patient needs.

“There’s some immediately obvious value that adopting a virtual health strategy provides: lower overall cost, increased capacity for your staff and better staff satisfaction,” says Ellen Kuebrich, CareXM Chief Growth Officer. All of that adds up to better patient communication.

That’s what patient engagement means: patients get high touch interaction with their provider, leading to improved adherence in their care plan.

“We call that high-tech, high-touch patient engagement,” Kuebrich says.

Since implementing the solution in August 2022, Enhabit has used these lower-cost encounters to create more touchpoints with patients. For an organization providing care annually to 228,000 patients, “tools like this have to help us move the needle on reducing unnecessary in-person visits, emergent care and hospitalizations,” Baker says. “Doing so will continue to position us as the provider of choice for value-based agreements.”

It also gives Enhabit an increase in clinician capacity, because adding virtual visits to their organizational capability creates more hands-on time with patients.

“Our clinicians appreciate the benefit of having an additional resource on their care team to help patients reach their goals,” Baker says. “Additionally, the majority of our patients have expressed a positive experience with the virtual interventions and found great value in this type of interaction.”

Patient engagement means family engagement

With a high-tech, high-touch patient engagement and virtual visit platform, and a centralized virtual clinical team, Enhabit meets a patient’s needs and promptly delivers what they call A Better Way to Care® through a variety of ways.

“In home health and hospice, there can sometimes be a lot of foot traffic in and out of a patient’s home. This can be stressful and overwhelming to some patients,” Baker says. “With a virtual engagement platform, we can connect with our patients via video calls, high-risk text assessments and direct messaging, giving them another opportunity to check in and receive an additional layer of comfort about their health care journey.

Success with CareXM comes down to two keys, she says. First, a provider must have organizational leadership support, from the local clinical supervisors to the executive level. Second, the education and communication lines have to be clear and open. Because virtual interventions are somewhat new, there is a lot of unknown and even some skepticism from the clinicians. To drive success, it is critical to ensure they know the resource and its value and can communicate that with patients.

After that, the positive outcomes roll in.

“The home health and hospice agencies that are going to win in value-based care are actively adopting proactive triage and patient engagement strategies now,” Kuebrich says.

With customizable and automated care pathways, on-the-go surveys, and various modes of communication, patient engagement can reduce readmissions while offloading staff.

“Winning strategies for home health and hospice reduce nurse burden and achieve what everyone seeks: lower cost of care with better patient outcomes,” she says. “The key ingredient to this strategy is fast, flexible, on-demand reactive triage support combined with proactive patient engagement. This engagement is personalized for patients yet automated for your staff.”

With the success of Enhabit’s virtual health program, they will expand to include CareXM’s on-demand nurse triage service for faster response times and to bring further peace of mind to staffing.

“The greatest benefit of our limited deployment has been the ability to customize the correct type and number of encounters to each patient to help them meet their specific health care goals,” Baker adds. Enhabit uses a predictive analytics tool called Medalogix Pulse to better clinically manage their patients. As the partnership with CareXM expands, Enhabit will have even more actionable insights through call coding and know when and why patients are calling in.

“An engagement platform such as CareXM has allowed us to reach our patients through audio, video and written communication via secure text messaging,” she says. “Our aging population has become more and more tech-savvy over the last several years, opening up greater opportunities to utilize these technologies successfully to make a greater impact on patient care.”

CareXM is a leading telehealth provider, partnering with seven of the top ten home health and hospice agencies to deliver innovative solutions that extend the capabilities of care teams through proactive and reactive triage strategies. Its patient engagement and virtual visit platform and 24/7 on-demand triage service is a game-changing solution that reduces nurse burden, drives down costs, and improves patient satisfaction. To learn more, visit www.carexm.com.

The post Building a Value-Based Future with Patient Engagement & Virtual Visits appeared first on Home Health Care News.

The benefits came quickly.

“We saw an increase in clinician capacity, allowing us to do more with less,” says Vice President of Care Management Shelley Baker of Enhabit, which provides care annually to 228,000 patients. “Completing visits virtually, when appropriate, has freed up our clinicians to better manage their schedules so they can be with patients who need hands-on care.”

With over 360 health care locations nationwide, Enhabit has seen benefits from enhancing care techniques and entering the new world of virtual care — and for other operators looking to get there, here are four keys to success.

1. Obsess over workflow

Fewer staff members and more patients mean more patients per clinician, less time for staff rest, and increased burnout. Solving this requires a new focus on processes.

“The most important key is to always obsess in reaching a deep understanding of your current state workflow,” says Si Luo, Chief Executive Officer of care coordination partner CareXM.

2. Invest in a process partner and take advantage of their expertise

With new technology comes a new process, and the challenge of gaining staff buy-in. Getting staff trained and working is even trickier. Operators must invest in a process partner that can provide stage-by-stage, data-driven feedback on how the staff is adapting to the new process and new systems.

Finding a partner like CareXM alleviates a number of initial sticking points for staff members.

“Take advantage of our expertise,” says Ellen Kuebrich, Chief Growth Officer of Care XM. “This platform was built by home health and hospice nurses for home health and hospice nurses. We live and breathe telehealth every day — whether in fast, responsive triage or for proactive patient engagement programs.”

3. Fuel staff members by sharing the ROI

Home-based care providers have a lot on their plate. Giving them new technology systems to learn can backfire.

What helps is explaining to them “the why”: show them the ROI of implementing the tech and how it will make their jobs easier and more fulfilling. Luo sees two main benefits:

• Hard dollar benefits. The savings from multiple areas of change, including systems and disparate point solutions consolidation, and labor/staffing optimization, meaning you always know the right level of staff for the right time windows.
• Quality benefits. In home health, providers work with customers to measure both utilization and clinical outcomes impact, such as pain management, skin integrity, and other OASIS components that customers care about.

“When we make it easier to do the ‘right things right,’ clinical staff members get to hunt, gather and chase a lot less to instead synthesize the right amount of context,” Luo says. “They can then hand off to the right next step of care efficiently and accurately.”

4. Tailor patient engagement to your staff and patients

Patient engagement technology changes. Patient health complexity does too. But the foundation of a patient’s needs remains the same.

“The vitals aren’t changing. You need blood pressure, you need pulse ox, you need heart rate, that type of thing,” Kuebrich says. “It shouldn’t be that weird to have one set of tools that everybody’s going to use.”

What CareXM has learned is that telehealth cannot be one-size-fits-all. The aging demographics and increased prevalence of chronic conditions have driven this new era of patient engagement. CareXM allows Enhabit to reach patients through audio, video and written communication via secure text messaging. These technology tools bring care providers directly into patient homes, even if only virtually, granting them a clean look at each patient’s social determinants of health (SDOH).

As head of Enhabit’s Care Management Division for the past three years, Baker has seen this up close and personal.

“Our aging population has become more and more tech-savvy over the last several years, opening up greater opportunities to utilize these technologies successfully to make a greater impact on patient care,” Baker says. “Enhabit has chosen to utilize a centralized team that uses the engagement platform and supports branch locations.”

Staff members are happier. Patients are too.

“In the branches that currently have access to this resource, we have received positive feedback from the clinicians,” Baker says. “They have expressed their appreciation of the centralized support and the ability to have an additional resource in their toolbox to treat patients and help deliver high-quality, compassionate care.”

CareXM is a leading telehealth provider, partnering with seven of the top ten home health and hospice agencies to deliver innovative solutions that extend the capabilities of care teams through proactive and reactive triage strategies. Its patient engagement and virtual visit platform and 24/7 on-demand triage service is a game-changing solution that reduces nurse burden, drives down costs, and improves patient satisfaction. To learn more, visit www.carexm.com.

The post Inside the New World of Telehealth: 4 Keys to Success appeared first on Home Health Care News.

Typically, when clinicians’ receive orientation and education, it takes place in a classroom. When that portion of the onboarding process is complete, the newly trained clinicians are released into the field. The HOP into Homecare! app aids in the process by taking onboarding beyond the classroom, says founder Dr. Monika Virk.

“For an agency that is onboarding nurses and therapists, it helps them become field ready, and it predicts field readiness,” Virk says.

The grant funding will be earmarked for the company’s Remote Educator program, which provides home-based care agencies with a dedicated educator who will utilize the content and dashboards included in the HOP into Homecare! app to track and train new clinicians during their onboarding process.

The Inspiration Behind the HOP into Homecare! App

The HOP into Homecare! app was born out of the home-based care market’s need for a streamlined and effective onboarding process, one that can in turn improve patient outcomes through well-trained clinicians.

As the former Director of Quality Education and Program Development for hospital system-based VNA in Northern Virginia, Virk noticed agencies having the same problems when it comes to onboarding.

Virk conducted a study that found clinicians who are trained using a standardized approach perform 8% better on their OASIS assessment, compared with the existing clinicians.

Her background, as well as knowing what works and what doesn’t, motivated her to seek a standardized approach, and would eventually lead to the creation of HOP into Homecare!

Features and Functionality

As an app, HOP into Homecare! has a host of unique features and functionalities, allowing for what Virk refers to as “micro-education.”

“It’s very easy to use, because it’s in an app format,” she says. “Clinicians aren’t sitting in a classroom, getting hours and hours of content, and maybe absorbing it or maybe not. With the app, clinicians aren’t being fed too much information at a time. Then providers can integrate that with the field training.”

The app has three components: content, competencies and field visits. The content component focuses on the clinicians’ specific discipline. The field visits component focuses on tasks that clinicians must learn before entering the field, and competencies are agency specific requirements.

The Benefits for Home Care Agencies

At a time when demand for home-based care services remains at an all-time high, having highly-trained clinicians who are competent in the field is what will set an agency apart from its competitors.

Having a strong training and onboarding process also aids agencies with their retention efforts, as clinicians are more likely to remain at an organization that makes this a priority.

During the height of the pandemic, home-based care lost some of its most experienced industry veterans — nurses in particular — due to either burnout or retirement. One value-add of HOP into Homecare! is its ability to help agencies leverage the experience of these clinicians to assist industry newcomers.

“Home health is losing a lot of nurses,” Virk says. “They are getting burned out and they are changing fields. With the remote educator role, we can harness that experiential knowledge and use that to train the next generation of home health nurses.”

The Future of Onboarding in Home Health Care

As home-based care agencies look to simplify and standardize the onboarding and training process, particularly the clinical side, Apps like HOP into Homecare! will become more prevalent.

As for HOP into Homecare!, the long-term plan is to continuously improve the platform by adding functionalities and leveraging machine learning techniques on the platform user data to generate automated education plans for frontline clinicians and predictive analysis to enhance field readiness.

This article is sponsored by the HOP into Homecare! app. To discover more about how it is revolutionizing home health clinician onboarding, visit www.hqcpro.com.

The post The Next Stage of Onboarding in Home Health Care appeared first on Home Health Care News.

Yet while home-based care providers certainly have many excellent, technical questions, one sits above all others:

How will the expansion of HHVBP affect their reimbursement?

The good news: the answer lies more with providers than perhaps they realize.

Since CMS standardized it in 2018, Quality Assurance and Performance Improvement program, or QAPI, has served as a guiding light for home-based care providers. The program is the process by which a home-based care provider measures its quality metrics. If a provider knows they need to focus on reducing acute-care hospitalizations, for instance, QAPI can help them do so.

“That tells you what performance improvement measures you need to try in order to improve your hospitalization rate,” says J’non Griffin (HCS-D, COS-C, HCS-H, HCS-C), Principal of SVP Coding and OASIS at industry-leading post-acute care technology provider SimiTree. “I think a lot of agencies have kind of slacked off of their QAPI program. So it’s important to get that back into place and make an actually meaningful tool rather than just a requirement.”

Here is a look at three steps providers can take to improve their QAPI approach, fix their VBP scores and boost their Medicare payments.

1. Identify your VBP fixes

With the new Interim Performance Reports (IPR) out as of the last week of July, providers have a much better look into where exactly they need to make improvements to shore up performance under VBP. Providers can use the reports, available for download from the Internet Quality Improvement and Evaluation System (iQIES), to measure themselves in the first half of 2023 against the second half of 2022, as well as against other home health agencies nationwide.

“With the IPRs, we’ll be able to tell where an agency is deficient,” Griffin says. “If they’re below the national standard, obviously we cannot work at everything at one time, so what is the lowest hanging fruit? Where are you closest to getting to the benchmark to have enough points to avoid a reduction in pay?”

That pay will be for 2025, based on 2023 performance.

“That seems like a little bit of delayed gratification or delayed penalty, but it just is,” Griffin says. “What we are doing today will affect the 2025 payment.”

2. Put QAPI at the center of your fix process…

In addition to using QAPI to improve VBP scores, home health organizations can also use it to improve patient safety, reduce costs, and improve the overall quality of care. But how will they do it? Quite simply with the right expertise and programs in place.

Because CMS is comparing an agency’s 2023 performance metrics in certain key areas to national averages and benchmarks from the baseline year 2022 to create an overall VBP performance score, the score will impact Medicare payments with as much as a 5% increase or a 5% decrease. Tighter margins at agencies make that a significant amount.

To prepare, smart agencies are using QAPI to evaluate systems and processes, identify vulnerabilities and develop targeted strategies for improving performance in important areas. By using QAPI for this purpose, agencies ensure compliance with this important CoPs-mandated program and drive quality at the same time.

This makes it a highly effective approach.

“Every agency should be doing some form of performance improvement, some form of QAPI,” Griffin says. “What we’re suggesting is to concentrate on those areas that will get you to that next level in your IPR reports. So it could be dyspnea. It could be oral medications. It could be any of those things. But then you’ve identified it and you’re going to put a team together from your QAPI plan to focus on that outcome.”

3. …and put your frontline workers at the forefront of your QAPI team

Frontline workers are essential to the success of any QAPI program. They have the most direct contact with patients and can provide valuable insights into how to improve care.

Griffin notes that the QAPI team should not just include the QAPI director and clinical manager, but also the people actually on the ground delivering care. Nurses, home health aides, therapists — even schedulers. They all have valuable insights to share about how to improve the care process in a given area.

The key to success with QAPI is to have a well-designed and implemented program that is supported by the entire organization.

“You kind of have to think outside of the box of making a visit, making a visit, making a visit, and instead making meaningful contact with the patient to try to prevent the problem,” she says. “You may have a triage team to make calls. It’s really going to depend on the size of the agency and what kind of capacity you have.”

For agencies that lack that capacity, outsourcing is another option.

“If you don’t have that manpower, you can outsource that piece — making the phone calls to the patient to ask about their shortness of breath,” she says. “QAPI outsourcing makes it even easier to realize the benefits of quality improvements without placing any additional burden on staff to conduct necessary monitoring and reporting.”

Striving to create a culture of quality is an important goal for home health organizations. An effective QAPI program can help create and maintain a quality-focused culture that reduces mistakes, improves patient care and drives better outcomes. QAPI can also help improve an agency’s star ratings, drive better referrals, help with retention efforts via higher staff satisfaction and provide a multitude of additional benefits.

The key, Griffin says, is that no matter your capacity, you push forward.

“You don’t give up on it,” she says. “You don’t just say, ‘I throw my hands up, we can’t fix this.’ You pivot to something else and then you monitor that. You have to trend it. You can’t just hope that it happens. Somebody has to trend it and that’s usually your QAPI team.”

This article is sponsored by SimiTree, which helps home health organizations understand how to improve performance scores under VBP, and can help agencies realize the benefits of quality improvements without placing any additional burden on staff to conduct necessary monitoring and reporting. To learn more about effectively using QAPI to address VBP, visit simitreehc.com.

The post How to Improve Your VBP Scores and Boost Medicare Payments appeared first on Home Health Care News.

What it highlighted was not just the people receiving care, but also those providing it.

“I think the pandemic really shined a light on the importance of the clinician experience and satisfaction, and also the critical role that the clinician plays in the delivery system within the home,” says Brandy Sparkman-Beierle, chief clinical officer for home-based care technology platform Homecare Homebase.

Indeed, the home health clinician has always been at the core of patient care, but never before has this role been as important as it is today in a post-pandemic world. Results from the 2023 Home-Based Care Outlook Survey from Homecare Homebase and Home Health Care News revealed a striking focus on staffing in the year ahead:

• 67% of survey respondents cited staffing as the greatest challenge to the industry in 2023
• 42% of respondents believe their company can achieve the greatest business efficiencies in staffing utilization in 2023

How the home health clinician experience has changed

It’s easy and appropriate to use the pandemic as health care’s dividing line between “then” and “now.” But changes in the industry were starting even before 2020. Sparkman-Beierle sees three big changes to the home health clinician experience and all of them started before COVID.

Patients are asking to be taken care of in the home and many are more acutely ill than they were five years ago,” she says. “Clinician satisfaction and what I call ‘caregiver fatigue’ are at the center of that, and we don’t have the clinician pipeline that we had five years ago. The workforce has aged and is leaving the bedside at a higher rate today than they were five years ago. The pipeline isn’t robust enough as it relates to home care, to continue to place high-quality, compassionate, caring clinicians in the home at a speed that we need to.”

For clinicians, questions about work-life balance were top of mind even before COVID. Those have only grown since then, along with pandemic-specific challenges around everything from documentation to infection control. Organizations can optimize their EHR to help clinicians succeed and give them more time to provide care.

“I talk all the time inside Homecare Homebase about making sure that our technology is leveraged in a delightful, intuitive way,” Sparkman-Beierle says. “That means that the clinician is not completing— or concerned—with redundant tasks within the technology. That way, they can operate at the top of their license, do meaningful work, look into the eyes of the patient that they’re taking care of and deliver that care, versus looking down at a screen and click, click, clicking away.”

5 ways agencies can improve the clinician experience

Sparkman-Beierle sees five key ways that agencies can help their clinicians build a more satisfying work experience.

1. Create a culture of empowerment and active listening. “You need to ask thoughtful questions. “That means opening the dialogue and asking thoughtful, probing questions about what is important to them as clinicians. Where do they think they can get time back into their day? What are the redundant tasks that the agency leadership should focus on removing so that clinicians can focus on meaningful work? I think starting the conversation with the clinician is number one.”
2. Leverage data to engage with clinicians. Your agency’s data also contains information that can help you facilitate meaningful conversations around job satisfaction with your clinicians. For example, Homecare Homebase identified eight key factors that contribute to clinical satisfaction and created a dashboard in HCHB Analytics that provides a scorecard that leaders can use to gauge clinician satisfaction on an individual, branch or company-wide level. It provides insight into metrics like, daily documentation hours, drive time, caseload and schedule balance from the satisfaction perspective rather than focusing solely on productivity.
3. Ride-alongs. By definition, home-based care is a decentralized job. Sparkman-Beierle wants to see more agency leaders rolling up their sleeves and jumping into the front lines. “I think that agency leaders need to get in the car and ride out with their clinicians and just watch them,” she says. “How do they spend their time and how can leaders work with clinicians to create efficiencies within their day? This builds rapport with them as well.”
4. Build out a shared governance structure. Clinicians are on the ground level, but that doesn’t mean they should be left out of the agency-wide discussions. “We have to bring them to the table,” Sparkman-Beierle says. “They have to be a part of the decision-making. You have to create shared governance structures, and they have to understand the ‘why.’” She notes that to help clinicians understand the ‘why,’ agencies should keep them in the loop on any major agency changes. “They’re the subject matter experts,” she says. “They’re the ones out on the road every day knocking on doors and looking in patients’ eyes, so they should be a part of the critical conversations about how to improve their experience.”
5. Appropriate resource assignments. Lastly, Sparkman-Beierle notes the importance of assigning “appropriate work to the right clinicians” and always evaluating people, processes and technology, with the clinician and the patient as the north star. “Clinicians become experts in many different ways, and we need to make sure that we’re assigning the most meaningful work to the appropriate resource,” she says.

Home health agencies have been tasked with caring for both patients and clinicians. The path forward isn’t always easy, but with the right staff, the right approach to hiring and retaining that staff and the right technology tools, success is around the corner.

This article is sponsored by Homecare Homebase. Homecare Homebase is a software leader offering hosted, cloud-based solutions to streamline operations, simplify compliance and boost clinical and financial outcomes for home-based care agencies. Our customized mobile solutions enable real-time, wireless data exchange and communication between field clinicians, physicians and office staff for better care, more accurate reporting and improved revenue cycle management. To learn more, visit hchb.com.

The post 5 Ways to Improve the Clinician Experience in Home Health appeared first on Home Health Care News.

That’s the essence of how home-based care providers are finding success under OASIS-E, which took effect January 1, 2023. Patient documentation requirements have changed in lockstep with the industry’s continued shift toward value-based care, with greater focus on each patient’s mental state as well as their social determinants of health (SDOH).

In a time when total dementia numbers are on the rise due to the boomer population, the new OASIS-E helps providers meet the moment, bringing the potential for improved care outcomes and a boosted bottom line.

Smart use of OASIS-E can also help providers stave off staffing churn. Staffing was a problem before the pandemic and has become a bigger one since. For reasons tied to both staff satisfaction and a healthy balance sheet, providers that get OASIS-E right will likely have a leg-up on staffing challenges.

“Everyone’s competing for caregivers,” says Jon Erik Higginbotham (RN, BSN), Vice President of Business Development and Clinical Analyst for Homecare Homebase, “and it’s even more cutthroat than it was before.”

For home-based care providers, the path to successful care outcomes, full reimbursement and staffing satisfaction all begins with OASIS data collection. That new focus on data raises the stakes on staffing turnover and training and brings more pressure to the daily work of home-based care nursing staff.

One of the largest concerns with the implementation of OASIS E was the potential to disrupt nursing staff by adding significant documentation time to start of care visits. “Before OASIS-E came to effect, most of the consulting groups were saying, ‘This is going to be significantly impactful,’” he says. The anticipation was potential four-hour starts of care and at least 45 minutes added on to OASIS-E visits.

“Because Homecare Homebase has a really robust and objective data set, it’s just not the case. On average, we’re seeing an increase of 1.2 minutes total documentation time,” he says. “That’s in-home and out-of-home documentation time for OASIS start-of-cares. The clinicians’ lives haven’t changed that much from documenting in OASIS-D to OASIS-E. That’s really exciting from our perspective.”

OASIS-E does not have to be the tedious, time-consuming process many predicted. Here are three best practices that home-health providers can take to succeed under OASIS-E.

Recognize that a nurse’s career has changed

While OASIS-E does not have to be unduly time-consuming, it is still complex, and it is integrated into nurses’ daily lives. That means that success starts with the nurses. And that means operators need to start by recognizing that nursing careers have changed.

“In the old world of nursing, you used to go to the hospital, work there for 30 years and retire. It’s not really working like that anymore,” Higginbotham says. “Now everyone is moving between different roles in nursing and therapy.”

As a result, providers have to work a bit harder to attract and retain great nurses. Reducing the time they have to spend on their OASIS data collection can be a key differentiator.

“I think OASIS education is the fundamental difference that can really impact a clinician’s daily life and operations as well as an organization’s efficiency and success with value-based purchasing,” he says. “All of that really centers around OASIS education.”

Technology is critical here. Homecare Homebase prompts nurses to complete documentation. While nurses might initially view this as a loss of control, the benefits far outweigh the downside.

“Operationally, it creates a culture of compliance, and it creates a culture of completion which is really important,” Higginbotham says. “We’re going to build in (compliance and validation) so that clinicians can’t send back these assessments that really don’t make sense holistically and are going to cause us to get OASIS rejections.”

Second, Homecare Homebase’s suite of tools helps home-based care providers paint the best possible picture of patients. “We have a tool called Disease State Management, where if a patient has a diagnosis of CHF, let’s say, I can guide my clinician to do certain things to ensure the patient’s safety.”

Deliver on work-life balance

Gathering data under OASIS-E is one of the challenges facing home-based care nurses today. But in a post-pandemic world, it’s far from the only one. The aforementioned ongoing battle for staff, Higginbotham says, is one, while another is the industry’s loss of a “psychological safety net” that held clinicians in place, working in home-based care.

Since the pandemic, providers need to focus more on their clinicians’ wellbeing.

“Mental health for our clinicians comes into play even more here because clinicians have a lot more opportunities to move and make more money in other arenas,” Higginbotham says.

By helping nursing staff with OASIS data collection, a home-based care provider checks two boxes: better care outcomes and happier staff members. That’s because the time they save their nurses is time those nurses can put back into other areas of their days.

“Employees are looking for more flexibility in their schedule and more flexibility in their personal life,” he says. “People are coming to home health and hospice for a little bit more flexibility because they are realizing that work-life balance is important.”

Understand the intent of PHQ questions

From the moment it was announced, OASIS-E was set to capture additional data that should give CMS a clearer picture of patient conditions and outcomes. The shift toward more attentive data collection is in keeping with other industry initiatives that are running in parallel to OASIS-E. The expansion of the Home Health Value-Based Purchasing Model is also highly dependent on careful data collection.

Higginbotham views the revised Patient Health Questionnaire (PHQ) assessment and its increased focus on SDOH as the top two changes of OASIS-E.

“Most payers will not reimburse the provider if they don’t ask those SDOH questions,” Higginbotham says. “What OASIS-E really did was force organizations at a high level to educate a little more intensely on OASIS so that nurses aren’t getting down these rabbit holes, which can really increase documentation time with the PHQ and social determinants of health.”

In short, OASIS is about giving CMS a clear view of each patient. Questions that assess a person’s ability to function mentally, not just physically are critical to that view. By being more precise in patient questions, and increasing focus on SDOH, providers will gather more accurate data, which will help them craft a more extensive and thorough plan of care. That improvement should, in theory, drive better outcomes and potentially greater payments.

“I’m really excited for the ability to start using the data sets that the acute care and ambulatory side have had for a long time with social determinants of health to model outcomes,” Higginbotham says. “As frustrating as I know it is as a clinician, I think eventually it’s going to improve outcomes for all of our patients that are being taken care of in the home.”

This article is sponsored by Homecare Homebase. Homecare Homebase is a software leader offering hosted, cloud-based solutions to streamline operations, simplify compliance and boost clinical and financial outcomes for home-based care agencies. Our customized mobile solutions enable real-time, wireless data exchange and communication between field clinicians, physicians and office staff for better care, more accurate reporting and improved revenue cycle management. For more information, visit hchb.com.

The post What’s Next in Home Health: 3 Best Practices for Home-Based Care Providers Under OASIS-E appeared first on Home Health Care News.

The home health care industry was already on a growth fast track before the pandemic, and COVID made more and more people want health care services from the safety of their homes. The need for home health care skyrocketed, along with the need for clinicians who specialized in these types of services. These factors hiked wages and shrank the candidate pool.

The demographic pressures — the greater demand for home-based care services mixed with the need for clinicians who have specialized skills — are leading to continued wage growth in the market. This upward trend is likely to continue, says Eric Scharber, managing principal for SimiTree, a company that provides industry-leading, tech-enabled specialty revenue cycle management (RCM), coding, professional services, and talent management resources for post-acute and behavioral health organizations.

“Until the demographic piece changes, which is decades away, I don’t see a lot of relief,” Scharber says.

For home health and hospice providers, the key to temporarily solving the problem is, itself, temporary: interim leadership.

“A candidate-driven market” — staffing questions entering 2023

Home health is a candidate-driven market, with more jobs than candidates to fill them. As Scharber notes, that means wages will continue to increase.

“It’s leveled off a bit, but it’s not going to come back down because it’s still a candidate-driven market,” he says.

This sustained wage growth is leading home-based care leadership to lean on new strategies for talent acquisition and retention. This is taking place at a time when leadership is already tasked with an uncertain economic climate.

Interim leadership: gig workers in leadership roles

But clinical positions aren’t the only roles home-based care executives are struggling to fill. When someone leaves a management role, it can leave gaps that can potentially put the quality of patient care at risk.

In those situations, interim leadership can help.

By leveraging assistance from external management experts who are experienced in home-based care operations, including staffing, these leaders can maintain focus on their day-to-day operations while filling their open management positions. SimiTree offers interim leadership among its services, and it can be a boon to existing leadership teams during times of turnover.

“Interim leadership is temporary management staffing,” Scharber says. “We’ve got a bench of professionals who have worked with SimiTree for years and years doing this gig work. It’s what they like to do. It’s what they are good at.”

Interim leadership helps home-based care leaders in three key ways. With interim leadership, agency leaders can:

• Avoid stressing existing team members with the extra workload during the transition to a new hire
• Provide support to their team in real time, for as little as a few weeks
• Fill any role in the executive suite including financial, operations, clinical, compliance and other roles
• Fill any management role throughout the middle level of the organization
• Remain focused on executing their business initiatives, while a permanent hire can be recruited (which SimiTree can assist with as well)

“This person comes with all the experience,” Scharber says. “There’s no ramp up. They hit the ground running and they could continue to execute on your initiatives.”

The road ahead in 2023

While many home-based care organizations are eager to overcome today’s staffing challenges, the underlying demographic pressures are unlikely to subside in the near term. The health care staffing crisis will continue to require leaders to attract and retain talent to fill the gaps — a process that revolves around relationships, Scharber says.

“Build the relationships, whether it’s with SimiTree or other firms that can help you get access to the largest population of professionals in this space,” he says. “You’ve got to use every resource possible to try and fill the gap. This isn’t going to change for a very long time to come.”

This article is sponsored by SimiTree. SimiTree is a tech-enabled revenue cycle, coding, professional services and talent management resource for post-acute and behavioral health organizations. To learn more about how to achieve stronger financial performance, call 800.949.0388 or visit SimiTreeHC.com.

The Views Series is a sponsored content program featuring leading companies’ news, views, case studies and announcements pertinent to their organization and the industry at large. For more information on Views, please contact sales@agingmedia.com.

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