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Posts Tagged ‘Home Health’
Coding Education by PPS Plus
Saturday, June 26th, 2010
Nurse Productivity: Relevant in Home Health?
Wednesday, October 7th, 2009Nurse 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.
Electronic Health Record in Home Based Care?
Monday, October 5th, 2009We 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
Medication Review: The last line of defense
Saturday, September 26th, 2009Medicare 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.
