Issue link: https://emsworld.epubxp.com/i/336320
13 www.ihdelivery.com July 2014 Integrated Healthcare Delivery HOME HEALTHCARE are not going to let the patient dictate their care program. [Home healthcare] is not a buffet for the patient," he says. Hospitals don't operate that way, and neither should home health. ■ OASIS accuracy —"Clinical case accuracy is paramount. Case management is everything," he says. "The F-score relates to our S-score, and that affects our reimbursement." He suggests doing OASIS training with just the case-mix questions. "Stop thinking of it as a 22-page questionnaire and start thinking of it as a 20-question question- naire," he says. ■ Plan of care development —For some home health clinicians, patient contacts have become little more than social visits with vitals. "Nobody is going to be paying for that," Cisneros says. Clinicians must stop thinking in terms of visits and start thinking about delivering care programs. With a defined schedule, patients will feel more in control and have an incentive to stay home instead of being sent to an SNIF (skilled nursing inpatient facility). The duration and frequency of a care plan must be considered. Typically, home healthcare plans are for 60 days. "We take 60 days because we had 60 days. Some patients may only need 30 days," Cisneros says. Rather than giving all patients seven visits, clinicians must determine the appropriate frequency. Some patients will need four visits, while others need 12. The plan of care should fit the patient's clinical care, rather than a specific time element. "Patients improve on their own timetable," he says. Cisneros estimates the costs of unfocused care at approximately $1,000 per case. "We are not going to be able to waste that money anymore," he says. The added bonus is that once a plan of care and frequency have been determined, supervisors can staff more appropriately. He recommends supervisors work more closely with those in the field. "Clinicians can't do it on their own," he says. "What's really happened in home healthcare is that it is clinician-driven. The era when the front-line clinician can determine the frequency of care is over." He assures supervisors that clinicians will eventually come to appreciate the assistance. "The care burden is relieved when they stop manipulating it for their own benefit," he says. ■ Safety-based care content —Patients in danger of readmission must be identified early and given additional attention. "If you can't eliminate the setbacks, the ACO will find someone who can," Cisneros warns. It means clinicians must initiate care in a timely fashion and eliminate setbacks by identifying potential issues (falls, etc.) and con- ducting medication reconciliation. ■ Productivity —Cisneros says missed visits are crippling home healthcare and changes must be made to improve scheduling. He admits those changes will not be easy, especially for clinicians used to working independently. Everyone else in the healthcare system tells clinicians what to do and how often; "Why are home healthcare clini- cians any different?" Cisneros asks. Expect pushback. "Pushback is a phase," he says. "It lasts 2–3 weeks. You have to outlive them. Eventually their care and competency kicks in, and they are on board. If you can hold the line, they will adapt." The first step is to establish clearly defined goals. For Cisneros, it comes down to a simple question: "Ask yourself what you would do if the patient were your aunt and you weren't getting paid [to care for her]. Then do that," he says. ■ Episodic care delivery —The key is to focus on the primary diagnosis. In the cases where a comorbidity affects the post-acute diagnosis, the care plan may have to be adjusted. Summary Cisneros believes the evolution of home health- care a good thing. The payoff is great for patients, clinicians and businesses. "You win the cost race by a mile, but you have to prove your value," he says. In order to compete in the brave new world of healthcare, home health must learn to manage patient care more effectively and efficiently. He believes it can. "We are going to become the heroes of the healthcare system again," he adds. Teresa McCallion, EMT-B, is associate editor for Integrated Healthcare Delivery. IHD_10-13_NewWorld0714.indd 13 6/13/14 11:22 AM