Issue link: https://emsworld.epubxp.com/i/336320
12 HOME HEALTHCARE Unlike the years of working in separate silos, healthcare in the new model requires extensive communication and coordination among all providers. That means real changes in how home healthcare operates. Clinical accuracy, staff control and care insight are crucial. Cisneros notes that home health can develop strategies to improve its value to ACOs. "Find savings and efficiencies," he says. "Clinical care elements do not equal time elements. Don't grade those out. That's a step you can take today." Other strategies include: ■ Intake management —Data must be timely and accurate. "Nobody thinks it's OK to wait two or three days," Cisneros says. "It's important that care starts within 24 hours or less." The problem, he says, is that often the home health clinicians are concerned about offending the patient. He rec- ommends scripting the start of care control. "We Integrated Healthcare Delivery July 2014 www.ihdelivery.com The noncompliant patient —An oft-heard complaint from home health clinicians is that they cannot complete their assignment because the patient is noncompliant. The SNIFs and hos- pitals know how to deal with noncompliant pa- tients, says Cisneros: They discharge them. "Find ways to make them compliant. Demonstrate compliance on the first visit," he says. If they do not comply, discharge them. "In the ACO world, they are not going to tolerate noncompliant pa- tients," he says. Documentation —"We all hate documenta- tion. Noted. Now let's do it correctly," Cisneros says. Incorrect documentation can lead to poor patient outcomes, scheduling issues and reim- bursement challenges. Nonproductive clinicians —"There are not going to be the margins to tolerate nonproduc- tive clinicians," he says. "Take patients away from clinicians who won't [follow rules] and give them to clinicians who will. That's a shot to the heart of a healthcare clinician, but don't hospitals do that?" He recommends removing obstacles for things they are expected to do and putting ob- stacles in the way of things they should avoid. He estimates a home healthcare business may lose up to 15% of its clinicians this way but notes, "Are these really the clinicians who will be missed?" If you want to keep them, help them understand these changes are about improving patient care. "Ask them, 'How does it help the patient?'" he says. Missed visits —This is a huge productivity problem, says Cisneros. To obtain patient buy-in, Cisneros recommends clinicians review goals with patients early on. Tell them how this works. Pro- viding a script for the start-care approach is helpful. Clinicians can make it difficult to miss visits. Instead of calling patients the day of a visit, call the day before. Track reasons why visits were missed. He also recommends avoiding over- scheduling. "Eight to 10 visits a day is bad care," he says. It shouldn't take 10 visits to get seven. LUPAs (low-utilization payment adjustments) —"Stop worrying about LUPAs!" Cisneros says. "Do OASIS correctly, deal with it, then move on." LUPAs are an issue for home health because they're not considered full epi- sodes and are reimbursed significantly below the standard episode rate. The Roadblocks Ahead To obtain patient buy-in, Cisneros recommends clinicians review goals with patients early on. IHD_10-13_NewWorld0714.indd 12 6/13/14 11:22 AM