January 22nd, 2010 by Carol Anderson
To obtain a state license in the following states, a potential provider requires a Certificate of Public Need (CON):
Alabama
Alaska,
Arkansas
Georgia
Hawaii
Kentucky
Maryland
Mississippi
Montana
New Jersey
New York
North Carolina
South Carolina
Tennessee
Vermont
West Virginia
District of Columbia
This process can be a little different from state-to-state. The long and short of it is that you have to demonstrate that the area that you want to open an agency is underserved by existing home health providers.
The CON process usually requires a feasability study of the area and completion of an application (state specific) The process can consume a lot of resources and take up to two years to get approved (or rejected).
An alternative for some potential providers is to purchase an existing home health provider number from an existing organization. If this is the direction you choose, a due diligence survey would be prudent. Unfortunately, it is not uncommon that an agency is purchased and is already under a record review by the fiscal intermediary. Meaning that some of the claims that have already been paid are subject to being returned to CMS. Other unfortunate buying decisions include buying an agency with an existing census only to discover that a large percentage of the census is not eligible for Medicare payment.
The only way to reduce your exposure to risk is to analyze not only the financial health of the organization, but the level of compliance as well.
Contact Anderson & Tuttle for assistance with either the CON process, including a feasibility study or for a due diligence assessment of an agency you are interested in acquiring.
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November 2nd, 2009 by Carol Anderson
Now is the Time to Send the Senate a Message… – The National Hospice and Palliative Care Organization.
There’s a letter from Senator Wyden going around asking for protection for hospice from rate cuts. Use this link to contact your senator to sign the letter!! Just put in your zip code and the letter is written!
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October 17th, 2009 by Carol Anderson
Anderson & Tuttle are taking on a huge challenge in the home health and hospice industry: selecting software. Watch for our new blog on this site dedicated soley to technology. We will be posting software reviews, describing what to look for and ask about during a sales demo.
For instance, everybody wants web-based, right? What does that mean? Is there ANY home health software that isn’t web-based on the market today? In layman’s terms, for our purposes it means it can be accessed via an Internet connection. It seems that the difference you look for in this category is where is the server? and who is responsible for purchasing it? maintaining it? backing it up in the event of theft or disaster?
So, when you are asking about web hosting versus web based, consider what you are asking for and use the terms you are familiar with: Can my clinicians access the application even when there is no internet access? Do I need to select and purchase a server?
These are the little things that we are talking to the software community about. We’ve talked to folks and picked their brains and watched their demos and hope to develop a tool with which to compare the functions and features and make educated decisions about selection.
Stay posted for the Software Review Blog coming soon to AndersonTuttle.com
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October 7th, 2009 by Carol Anderson
Nurse Productivity: Usually defined as the number of visits in a given time (day, or week) is a valuable metric to monitor for any Home Health agency. Unfortunately, however, this metric does not necessarily translate into financial health. For instance, since 1999 home health is not paid by the visit anymore. We are paid by the unit, or “episode”. A more relevant metric would be the cost of the episode versus the reimbursement of the episode.
It takes a little time, thought, and a lot of coding and OASIS knowledge to maximized the reimbursement per unit. It requires even more skill and knowledge to manage the episode with the appropriate amount of resources. The number of visits that a nurse does in a day does not account for how “productive” an agency is in mastering that formula.
Unfortunately, other decisions hinge on this metric. It is a myth to believe that the value of software and point-of-care solutions lies in the ability to improve “nurse productivity”. Some agencies have even decided against point-of-care realizing that it doesn’t translate into improved visits-per-day. What they are missing however, is the opportunity to improve the financial and clinical outcomes for the episode by utilizing the technology.
Measuring “nursing produdctivity” to determine the financial health of a home health agency is equal to checking the oil gauge to calculate how much gas is in the tank. Both are metrics, both are important dashboard icons, but fixing one does not fix the other.
Tags: electonic medical record, Home Health, nursing productivity, point-of-care
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October 5th, 2009 by Carol Anderson
We are developing a study to determine just how much of the industry has embraced technology (and to what extent) as well as who has completely avoided it and what its going to take to get them on the road to EHR. See this article about the study and let us know if you would like to participate in developing questions for the questionnaire, or particpate in the survey as a home based provider.
http://www.homecareautomationreport.com/article.php?id=950
Tags: electronic health record, Home Health, hospice, research, software
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September 26th, 2009 by Carol Anderson
Medicare Conditions of Participation 484.55 or G TAG 337 states:
“The comprehensive assessment must include a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.”
CHAP standards HH II.7a takes it a step further and adds “effectiveness of pain medication”
It is common that on admission, a home health patient pulls out a box of pill bottles, along with discharge instructions from the hospital, rarely are they reconciled. Further, examination of the bottles reveal multiple pharmacies and multiple doctors. Therefore, the ONLY person who can review the medication as mandated by Medicare is the home health professional sitting at the table with the patient.
It is a basic function of the home health assessment that ensures patient safety. It is so important that the description of a medication review is written into the Federal Register. There were no assumptions that professionals would perform this task consistently and unfortunately, that is for good reason.
There are some medication profile forms that include the language of the CMS Condition; for instance the Med-Pass medication review tool has a place to document the review on admission and anytime there is a new or changed medication. The use of the form would require a process to include documentation on the profile of review and the date.
Most point-of-care systems document drug-to-drug interactions and a medication assessment in the admission note that satisfies the condition. However, many systems require some additional documentation when the med profile is changed. This can be done in the visit note or on the medication profile depending on the software.
Most software vendors will work with agencies to meet the requirements of the Medicare Conditions of Participation.
Medication Review is a documentation process, it is also a nursing process and once an agency identifies a method to document the review, the staff should be educated to actually conduct the review as described and to reinforce that they are the patient’s last line of defense against medication error.
Tags: CHAP, G337, Home Health, Medicare, medication errors, medication review
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