The bottom line for home healthcare agencies
Working as a registered nurse for 22 years within the school health system, Waiver programs with OPWDD, home healthcare as a field RN, and now serving as Director of Patient Services for Edison Home Healthcare in New York City, I have seen and experienced the health care business from both a nursing perspective and administrative perspective, in terms of how healthcare companies strive to grow their bottom lines while maintaining quality home health services for their clients. As with all industries, there are elements beyond our control and no shortage of bureaucracy to navigate.
Value-Based Payments are payments that are earned when an LHCSA licensed home care service agency performs well-meeting quality measures. The MLTC’s keep score on certain events that are monitored. They measure client falls, vaccinations, hospitalizations, and declining health status. They also look at uncovered or missed shifts where an Aide was not replaced for a call-out.
Below are some stumbling blocks that can impact a Home Health Care Agency’s bottom line:
Flu ShotsLHCSA (Licensed Home Care Service Agency) RNs conduct in-home visits bi-annually for LHCSA clients to create and establish a plan of care based on individual needs. The plan of care is then discussed with the assigned Home Healthcare Aide and specifically outlines the care needs of the client. When an RN is conducting the home visit, information regarding flu vaccination prior to and during flu season, is gathered. Clients who refuse to be vaccinated are counseled and encouraged to obtain a flu shot. However, flu vaccinations are not mandatory, and it is the clients’ choice whether or not to vaccinate. The LHCSA RN is not the only RN who is making this recommendation for the annual flu shot, the MLTC’s (Managed Long-Term Care Agency’s) Case Manager RN, who is also assigned to this client makes recommendations to the client regarding flu shots.
In addition, the UAS Assessment RN has an opportunity to make this recommendation to the client. With this said, based on value-based payments, only the LHCSA will be penalized for a client’s failure to get a flu shot through a decrease in their reimbursement rates if the flu vaccine is not completed with the contracted client. It is difficult to enforce flu vaccinations with clients since they are not mandated to comply with this request. Quarterly scores are given to the contracted LHCSA by MLTCs (Managed Long-term Care companies), and these scores determine the home healthcare company’s reimbursement rates.
Client HospitalizationsClient hospitalizations and ER visits are another issue that affects the bottom line of LHCSAs. If a client has had a change in status, the Aide must notify the LHCSA and most often the recommendation is to call 911. Many of these clients are elderly and health conditions can escalate quickly. Early intervention is best, but subtle changes can go unnoticed. An Aide may not pick up on an early status change in his or her client. If there isn’t family support to assist with the client’s health monitoring, these clients may need to use the emergency room more often when their health declines. Only a doctor or nurse practitioner can provide medical care to the client when they become ill. LHCSA policy requires that 911 be called when a client becomes ill if there is no family member to take responsibility. Frequent trips to the ER and hospital admissions adversely affect the Quality Measure score in this category and decrease the reimbursement rate to the LHCSA.
Client FallsLHCSA policy dictates that if a client has a fall while receiving Aide services, the Aide is not allowed to help the client up or assist with the fall and must call 911. Picking up a client who has had a fall can have severe consequences for the client.
There may be unknown injuries that cannot be visualized, both internally and externally. Moving a person who has had a fall without having the training or expertise in this field can create catastrophic consequences for the client’s health and wellbeing. A client must be evaluated and moved by paramedics who will determine if the injury requires further evaluation and treatment at the hospital. ER visits and hospital admissions are Quality Measures which can negatively affect reimbursement rates. A reputable LHCSA would never discourage calling 911 or taking the client to the emergency room. A client may refuse to go to the hospital and, when called, an EMT may clear someone medically and determine that the client is not in immediate harm and does not need to go to the hospital. The LHCSA is responsible for falls while on service and of service by the MLTC’s.
OvertimeIn addition to the Quality Measures affecting an LHCSA’s bottom line, paying overtime to Aides also decreases a company’s profit margin. Overtime will eat right into the LHCSA’s bottom line. It is very important that there are Aides available to cover shifts when there are call-outs or when there is suddenly more demand for Home Healthcare Aides and your company is being called upon to provide more Aides to fill this need. Lack of effective communication practices with a company’s Aides can exacerbate the need for companies to pay overtime.
Can Home Healthcare Agencies Keep a Healthy Bottom Line While Not Compromising Services?Policies that exist within the home care and long-term care industries are necessary and should never be compromised. However, there are effective methods that can be employed to improve profits while maintaining and striving to improve client care. If we look very closely at each client regarding health status, family support system or lack of family support, their level of dependence for ADL’s, food preparation, medication reminders, social isolation, fall risks as well as skin integrity among other factors, the Plan of Care will appropriately and effectively meet their comprehensive needs. The steps that will take us to a higher, more comprehensive level of care includes:
By improving our clients’ health with early intervention and better communication, Licensed Home Care Service Agencies will produce a positive effect on their bottom line.
Transitional care services ‘preferred’ over standard care after HF discharge
Among older patients hospitalized with heart failure, transitional care services, particularly nurse home visits, improved health outcomes and appeared to be more cost effective than standard care, according to research published in the Annals of Internal Medicine.
The findings demonstrate that postdischarge transitional care services are “preferred to standard care” in this patient population, Manuel R. Blum, MD, MSc, of the Stanford University School of Medicine and Bern University Hospital and University of Bern, Switzerland, and colleagues wrote.
“Patients with HF requiring inpatient admission are a vulnerable population and have a poor long-term prognosis, with a 2-year readmission-free survival rate as low as 17%,” they wrote. “Risks for death and rehospitalization are accentuated immediately after inpatient discharge, with much of the economic burden in HF resulting from costly hospital readmissions.”
Blum and colleagues created a decision analytic microsimulation model to determine whether patients with HF aged 75 years or older should receive standard care after hospital discharge or follow-up transitional care. They used data from randomized controlled trials, clinical registries, cohort studies, CDC tables, CMS data and information from the National Inpatient Sample.
Among older patients hospitalized with heart failure, transitional care services, particularly nurse home visits, improved health outcomes and appeared to be more cost effective than standard care, according to research published in the Annals of Internal Medicine.
Source: Adobe Stock
The model compared three interventions to standard care for patients with HF discharged from the hospital — nurse home visits, which consisted of a nurse visiting patients’ homes for clinical assessments and education; nurse case management, a nurse-led multifaceted disease management program that provided self-care education, telephone support and occasionally nurse home visits; and disease management clinics, where patients went to follow-up visits at clinics for team-based, multidisciplinary HF management.
The model showed that all three transitional care interventions were more costly and more effective compared with standard care. However, nurse home visits were the most costly and effective of the three.
Compared with standard care, nurse home visits increased QALYs by approximately 0.24 (2.49 vs. 2.25), survival by approximately 4 months and lifetime health care costs by $4,622 ($81,327 vs. $76,705). Cost increases were primarily attributed to longer periods of care for HF stemming from increased life expectancy. The incremental cost-effectiveness ratio was $19,570 per QALY gained.
Results were mostly insensitive to variations in in-hospital mortality, patient age at baseline or rehospitalization costs.
A probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care for 99.8% of 10,000 samples with willingness-to-pay thresholds over $50,000 or more per QALY.
Blum and colleagues noted that as the relative differences between the three services identified in the study were small, “one of the transitional care services in this analysis should become part of standard care for post-discharge management of patients with HF, but the best implementation choice among [nurse home visits, nurse case management, and disease management clinics] may depend on setting-specic features.”
Leora I. Horwitz, MD, MHS, associate professor in the departments of population health and medicine at the New York University Grossman School of Medicine, made a few suggestions for incorporating these services into standard care, in an editorial accompanying the study.
“Standardized program protocols and training materials might help increase intervention delity and effectiveness,” she explained. “Explicit insurance coverage or incentives for dedicated transitions programs — perhaps after certication or training based on a recognized standard — would also spur uptake.” – by Erin Michael
Disclosures: The study authors report no relevant financial disclosures. Horwitz reports receiving royalties from UpToDate outside the submitted work and previously working under contract to CMS to develop readmission measures for public reporting, including the hospital-wide readmission measure and excess days in acute care measures.
Among older patients hospitalized with heart failure, transitional care services, particularly nurse home visits, improved health outcomes and appeared to be more cost effective than standard care, according to research published in the Annals of Internal Medicine.
The findings demonstrate that postdischarge transitional care services are “preferred to standard care” in this patient population, Manuel R. Blum, MD, MSc, of the Stanford University School of Medicine and Bern University Hospital and University of Bern, Switzerland, and colleagues wrote.
“Patients with HF requiring inpatient admission are a vulnerable population and have a poor long-term prognosis, with a 2-year readmission-free survival rate as low as 17%,” they wrote. “Risks for death and rehospitalization are accentuated immediately after inpatient discharge, with much of the economic burden in HF resulting from costly hospital readmissions.”
Blum and colleagues created a decision analytic microsimulation model to determine whether patients with HF aged 75 years or older should receive standard care after hospital discharge or follow-up transitional care. They used data from randomized controlled trials, clinical registries, cohort studies, CDC tables, CMS data and information from the National Inpatient Sample.
Among older patients hospitalized with heart failure, transitional care services, particularly nurse home visits, improved health outcomes and appeared to be more cost effective than standard care, according to research published in the Annals of Internal Medicine.
Source: Adobe Stock
The model compared three interventions to standard care for patients with HF discharged from the hospital — nurse home visits, which consisted of a nurse visiting patients’ homes for clinical assessments and education; nurse case management, a nurse-led multifaceted disease management program that provided self-care education, telephone support and occasionally nurse home visits; and disease management clinics, where patients went to follow-up visits at clinics for team-based, multidisciplinary HF management.
The model showed that all three transitional care interventions were more costly and more effective compared with standard care. However, nurse home visits were the most costly and effective of the three.
Compared with standard care, nurse home visits increased QALYs by approximately 0.24 (2.49 vs. 2.25), survival by approximately 4 months and lifetime health care costs by $4,622 ($81,327 vs. $76,705). Cost increases were primarily attributed to longer periods of care for HF stemming from increased life expectancy. The incremental cost-effectiveness ratio was $19,570 per QALY gained.
Results were mostly insensitive to variations in in-hospital mortality, patient age at baseline or rehospitalization costs.
A probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care for 99.8% of 10,000 samples with willingness-to-pay thresholds over $50,000 or more per QALY.
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Blum and colleagues noted that as the relative differences between the three services identified in the study were small, “one of the transitional care services in this analysis should become part of standard care for post-discharge management of patients with HF, but the best implementation choice among [nurse home visits, nurse case management, and disease management clinics] may depend on setting-specic features.”
Leora I. Horwitz, MD, MHS, associate professor in the departments of population health and medicine at the New York University Grossman School of Medicine, made a few suggestions for incorporating these services into standard care, in an editorial accompanying the study.
“Standardized program protocols and training materials might help increase intervention delity and effectiveness,” she explained. “Explicit insurance coverage or incentives for dedicated transitions programs — perhaps after certication or training based on a recognized standard — would also spur uptake.” – by Erin Michael
Disclosures: The study authors report no relevant financial disclosures. Horwitz reports receiving royalties from UpToDate outside the submitted work and previously working under contract to CMS to develop readmission measures for public reporting, including the hospital-wide readmission measure and excess days in acute care measures.
Global Home Health Hub Market Analysis, Trends, and Forecasts 2019-2027 - ResearchAndMarkets.com
DUBLIN--(BUSINESS WIRE)--The "Home Health Hub - Market Analysis, Trends, and Forecasts" report has been added to ResearchAndMarkets.com's offering.
The global market for Home Health Hub is projected to reach US$1.1 billion by 2025, driven by the growing focus of governments worldwide on reducing the burden on primary care systems by encouraging lower-cost alternate care sites (ACSs).
ACSs are informal care providers who come in several forms such as assisted living and housing communities, continuing care retirement communities, palliative/hospice care, nursing homes, transitional care, and physician clinics, among others. ACSs offer solution to two of the major challenges faced by current healthcare system i.e. high cost and affordability; and timely access to healthcare services. Non-hospital based alternate care sites are emerging as the next frontier in reducing costs of patient care. Digital technology in this regard is playing a key role in enhancing the reliability of ACSs, creating meaningful point-of-care guidance, and providing an alternative to the conventional labor-intensive model of primary care.
ACSs also play a pivotal role in continuity and coordination of care in pursuit of the ultimate goal to achieve integrated people-centered health services. Growing healthcare burden and the resulting surge in demand for medical services is overwhelming the healthcare system resulting in inefficient delivery of care globally. The scenario is driving the importance of ACSs. Also, the ongoing reforms towards a more sustainable value based pay-for-performance healthcare model are helping widen the role of ACSs, given their ability to offer an alternative to expensive hospital services. As digital transformation continues to snowball through the healthcare industry, ACSs will continue to acquire increased importance and significance in providing comprehensive care and also collaborative planning of care and shared clinical decision-making with primary care givers.
Home Health Hub is the revolutionary step forward in supporting continuity and care coordination between ACSs and primary healthcare systems. The technology is geared to support remote patient monitoring, tele-health, tele-medicine, and virtual healthcare delivery. Home Health Hub is defined as a combination of hardware and software systems that allow the creation of a medical hub for monitoring, acquiring, and transmitting patient data from point-of-care facility to healthcare professionals in the primary care sector. Home care agencies, nursing homes and assisted living facilities utilize a wide range of home healthcare technologies and represent 'hubs' for collecting and transmitting patient data. They therefore are major end-users of home health hub products and services. However, rapid proliferation of digital health technologies are bringing healthcare even closer to the patient, making the patient's home the point-of-care facility. Smart homes are helping drive the trend towards connected home-based self-care.
A smart home hitherto valued for its unrivalled convenience and comfort is now gaining popularity for its potential to enhance the home healthcare experience. They will play an increasingly important role in the evolution of digital, remote, connected and virtual care systems. Consumer-oriented smart homes with technologies targeted for home infotainment and security will now act as portals for healthcare delivery. While medical wearables and smartphones enable remote patient monitoring and telemedicine services targeted at disease management, smart homes can help expand the functionality of digital health services from just disease management to health management. In other words, IoHT and smart homes when combined with cloud will revolutionize digital health and will expand the role of digital health beyond elderly care and health monitoring to other areas of wellness, nutrition, exercise, sleep, medication monitoring, mental, social wellbeing, managing pregnancy and prenatal health, among others. The United States and Europe represent large markets worldwide with a combined share of 73.7% of the market. China ranks as the fastest growing market with a CAGR of 34.8% over the analysis period supported by the fact that the country leads the world in adoption of digital health technologies by healthcare professionals as well as patients. The blistering pace of adoption of self-monitoring has result in the country becoming the world's largest and most lucrative wearables market.
Key Topics Covered:
I. INTRODUCTION, METHODOLOGY & REPORT SCOPE
II. EXECUTIVE SUMMARY
1. MARKET OVERVIEW
2. FOCUS ON SELECT PLAYERS
3. MARKET TRENDS & DRIVERS
4. GLOBAL MARKET PERSPECTIVE
III. MARKET ANALYSIS
GEOGRAPHIC MARKET ANALYSIS
UNITED STATES
IV. COMPETITION
For more information about this report visit https://www.researchandmarkets.com/r/4j1lli
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