Utilization trends in home health

Rebecca Byrd, RNTechota

Goals

Explain how home health care can reduce rehospitalizations

Discriminate between home health agencies based on publicly reported outcome measures

Summarize outcome measurements using OASIS

The problem of rehospitaliation

Anywhere from 10-25% of inpatient discharges will be readmitted

Medicare patients have a higher readmission rate

More than half of Medicare readmissions related to circulatory diseases (Jiang and Wier, 2010)

Financial penalties for high readmission rates start 10/1/12 thank you ACA!

Hospital Readmissions Reduction Program

Outside the scope of this presentation

Probably something you're already familiar with

If not, exhaustive details are at the CMS website

http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html/

How does home health come into play?

IHI (Institute for Healthcare Improvement) found that the single biggest problem with readmissions was lack of post-acute care

Home health provides nursing assessment, health teaching, and clinical interventions following hospitalization

Medication reconcilliation and drug monitoring are required components of home health care under federal regulations

Selecting a home health agency

To find the best home health care agencies, do not rely on the agency's marketing strategy!

Do your own homework on Home Health Compare

http://medicare.gov/homehealthcompare/

Lets you compare both process measures and outcomes measures from up to 3 different agencies (at a time) vs. state and national trends

A brief word about OASIS...

The Outcome and Asessment Information Set

Long list of questions that are incorporated into the admission and discharge assessments

Keyed into a computer and uploaded to a CMS database

Compares each patient's admission vs. discharge scores to determine outcomes

Also tracks when patients come in and out of the hospital

Types of Process Measures that matter most

Management of heart failure symptoms

Diabetic foot care

Drug education

Fall risk assessment

Types of Outcomes Measures that matter most

Acute care hospitalizations

Emergency department use

Improvement in oral medications

Improvement in dyspnea

Improvement in ambulation

An example of what the results look like...

(this is not an endorsement of any particular home health care agency)

THANK YOU!!!

Please email any questions to rbyrd@rubic.com

References

Jiang, H.J., and Wier, L.M. (2010). All-cause hospital readmissions among non-elderly Medicaid patients 2007. AHRQ Statistical Brief #89. Accessed at www.hcup-us.ahrq.gov/reports/statbriefs/sb90.jsp