March #HomeHealthChat: Interdisciplinary Teams

The March #HomeHealthChat was co-hosted by the ElderCare Workforce Alliance (@ElderCareTeam). The ElderCare Workforce Alliance is a group of 31 national organizations, joined together to address the immediate and future workforce crisis in caring for an aging America.

The #HomeHealthChat focused on Interdisciplinary Teams.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director of Communications and Events Jen Schiller here.

Below are some of the highlights from the chat:

Low 30-Day Readmissions from Home Health Signal Positive Results for CJR Model

Current research on major joint replacement points to successful uses of home health care as the post-acute care setting for patients. Merits of home-based care include reduced cost, improved clinical outcomes, and increased patient satisfaction. Now, with the recently introduced Centers for Medicare and Medicaid Services Comprehensive Care for Joint Replacement (CJR) Model, which will begin on April 1 of this year, home health sits at the forefront of providing cost-effective and high-quality patient care for patients following hip and knee replacements.

The low rates of 30-day readmission for patients with MS-DRG-470 (major joint replacement) (the 30-day readmission rate nationally is 3.54% from home health, compared with 6.83% from skilled nursing facilities), make the benefit of home health, especially after hip and knee replacement, crystal clear and should help CMS and those participating in the CJR Model to better understand the best means of treating patients.

Knee replacements are one of the most common surgeries performed on Medicare beneficiaries, underscoring the need to develop models that improve patient care delivery, including enhanced efficiencies and reduced costs. Nationally, nearly 10 percent of total home health Medicare Part A home health claims are for patients receiving care after a major joint replacement or reattachment of lower extremity without major complications of comorbidities. Among home health claims, major joint replacement is over three times more common as an MS-DRG than the next most common MS-DRG. In 2013, almost 200,000 home health Part A claims were filed nationally for patients after hip and knee replacements, signaling a need for high quality, safe, and cost-effective models of care after such orthopedic procedures. According to the Clinically Appropriate and Cost-Effective Placement report from 2012, when home health agencies are the first setting of care, Medicare sees an average of over $5,000 in cost savings for each MS-DRG 470 patient’s episode (defined as inpatient hospitalization and the 60 days post-discharge).

In addition to the clinical and cost savings benefits above, recovery and therapy in the home setting allow clinicians to address the unique needs of individual patients, make families feel more comfortable in assisting with care, and assists patients to more quickly resume activities of daily living, such as bathing and dressing. The Cleveland Clinic Model for Home Care After Knee Replacement, profiled in the Cleveland Clinic Journal of Medicine supplement article, “In-home care following total knee replacement,” provides an excellent example for the future success of the CJR Model.

The article outlines The Cleveland Clinic Total Knee Care Path, an integrated care approach, emphasizing home health care in discharge planning and care transitions. Patient and family education is critical and should begin early and remain consistent. The following goals are emphasized in the Cleveland Clinic program:

  • Shared decision-making
  • A home care environment that includes support of family and friends
  • Patient and family education to enhance shared decision-making
  • Return to the home environment as soon as it is deemed safe
  • Elimination of unnecessary or duplicative treatments, tests, or interventions
  • Acceptance of multiple plans or paths in response to changing clinical conditions

In the 10 years since the Cleveland Clinic has integrated home health care into recovery from a total knee replacement, results have been very positive, including a reduction in the average acute care hospital length of stay, increased discharge to home rates, reduced readmission rates, and lower costs to the overall system. In fact, patients discharged to home use fewer resources and cost the system one third as much as patients who receive inpatient post-acute care. Discharge to home rates rose from 32 percent to 74 percent, and hospital stay length decreased by an average of almost one full day, saving money by limiting longer facility stays.

The CJR Model represents a step forward in promoting quality care for patients, as the home is, when clinically appropriate, an ideal setting for patients after an acute care stay when coupled with skilled home health care services. By looking at the readmissions and cost data, along with the successful CCJM Model, we can get a clearer picture of the ways of home health can be utilized to maximize outcomes, reduce cost, and improve patient experience.

January #HomeHealthChat: Home Health and Mental Illness

The January #HomeHealthChat was co-hosted by the Visiting Nurse Association of Ohio (@VNAOhio). Visiting Nurse Association of Ohio is a not-for-profit home healthcare and hospice organization.

The #HomeHealthChat focused on Home Health and Mental Illness.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director of Communications and Events Jen Schiller here.

Below are some of the highlights from the chat:

The Home Health and Hospice ICD-10 Transition Workgroup Closing the Coding Guidance Gap

October 1, 2015 came and went. The sky didn’t fall, but many agencies did stumble as they grappled with software glitches, struggled with insufficient documentation from referral partners and from their own clinicians, and as internal coding-knowledge gaps surfaced. Agencies also continue to receive conflicting and/or inapplicable guidance from the American Hospital Association’s (AHA) Coding Clinic, CMS’ designee for official ICD coding guidance and clarifications. These inconsistencies can lead to payment delays or claim denials.

Confusion over the use of ‘A’ as the seventh character indicating initial encounter by home health agencies brought the problem to light. In light of the issue, the Home Health and Hospice ICD-10 Transition Workgroup (the “ICD-10 Transition Workgroup”), of which the Alliance is a member, worked with CMS to ensure that the January 1, 2016 release of the home health Grouper reflected the AHA Coding Clinic’s guidance around use of the seventh character A. But this instance is by no means the only time when new guidance has caused confusion for the industry.

Numerous instances of guidance issued by the AHA Coding Clinic are not easily interpreted by or adapted to home health or hospice. The ICD-10 Transition Workgroup is working closely with the AHA Coding Clinic to address this concern. We have crafted a solution that we believe will ensure that guidance issued by the AHA Coding Clinic does not unintentionally lead to improper coding or create barriers to payment for home health or hospice.

Working on behalf of industry, the ICD-10 Transition Workgroup has developed an agreement with the AHA Coding Clinic. The AHA Coding Clinic has agreed to accept industry queries from the board of the Association of Home Care Coding & Compliance (AHCC) and the board of its credentialing body, the Board of Medical Specialty Coding & Compliance (BMSC), on behalf of the industry. As the BMSC board is comprised of eight of the nation’s leading home health and hospice coding experts, the AHA Coding Clinic has further agreed to accept with those queries a recommended response and the rationale for that response. The AHA Coding Clinic Editorial Advisory Board will consider the query as well as the recommended response before issuing guidance.

Coding questions should be submitted to AHCC using the following email: AHCCVoice@decisionhealth.com. BMSC board members will review the questions submitted to determine if there already is an answer to the question or if there is a need for clarification or additional guidance from the AHA Coding Clinic. If there is an answer, the board will point you to where that answer can be found. If the board believes guidance or clarification is needed, the query will be forwarded to the AHA Coding Clinic with the board members’ recommended response and rationale. Subsequent guidance issued by the Coding Clinic’s EAB will be distributed to the industry through a communique from your association.

By funneling all home health and hospice industry coding questions through one channel and disseminating resulting guidance or clarification throughout the industry at one time, we will be able to accomplish several significant goals:

  • Identify and resolve widespread coding issues affecting all agencies
  • Receive from the AHA Coding Clinic one response that applies to all agencies
  • Identify industry-wide knowledge gaps
  • Ensure correct and compliant coding based on first-hand knowledge of changing guidance

To our knowledge, the AHA Coding Clinic Editorial Advisory Board never has considered provider setting when issuing coding guidance. Now they will. This is an important step in ensuring that home health and hospice have the tools they need to correctly and compliantly code and submit claims.

About AHCC

AHCC is the community for professionals dedicated to providing quality care in post-acute care settings and establishing, meeting, and maintaining standards of excellence in their area of expertise.

AHCC’s credentialing arm, the Board of Medical Specialty Coding & Compliance (BMSC), offers professional credentials, including the only nationally accredited home health coding credential that tests coding skills exclusively, the Home Care Coding Specialist—Diagnosis (HCS-D), and the nationally accredited Home Care Clinical Specialist – OASIS (HCS-O).

BMSC has been credentialing home health coders since 2003. More than 63% of agencies require coders to have earned the HCS-D credential as a condition of employment. The credentials are overseen by an independent board of home health and OASIS experts nationally recognized as leading authorities. Each board member has more than 25 years of experience in home health and hospice, and all are in-demand home health and hospice coding educators.

*Home Health and Hospice ICD-10 Transition Workgroup

Alliance for Home Health Quality & Innovation

Teresa Lee, Executive Director

 

Association of Home Care Coding & Compliance

Corinne Kuypers-Denlinger, Executive Director; VP, Post-Acute Care Product Group, DecisionHealth

Tricia A. Twombly, CEO, BMCS; Senior Director, DecisionHealth

 

Centers for Medicare & Medicaid Services

Dr. William Rogers, ICD-10 Ombudsman

 

National Association for Home Care & Hospice

Mark K. Carr, VP, Regulatory Affairs

Theresa Forrester, VP, Hospice Policy & Programs

 

National Hospice & Palliative Care Organization

Jennifer Kennedy, Director, Regulatory & Compliance

 

Visiting Nurses Association of America

Liza Greenberg, VP, Quality (Interim)

December #HomeHealthChat: Home and Community-Based Services

The December #HomeHealthChat was co-hosted by National Quality Forum (@NatQualityForum). The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement.

The #HomeHealthChat focused on Home and Community-Based Services.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director of Communications and Events Jen Schiller here.

Below are some of the highlights from the chat:

Alliance Partnering with VNAA to Improve Home Health Care for the Future

The Alliance is excited to announce a new collaborative partnership with the Visiting Nurse Associations of America (VNAA) focusing on aligning key quality improvement, education and research efforts in an effort to better support our members and the home health community writ large. Through better collaboration, the Alliance and VNAA will be able to focus collective efforts and resources on opportunities to improve care for patients and the health care system by appropriately optimizing home health care.

Both organizations’ staffs are looking forward to working together on a number of exciting events and initiatives in 2016 and beyond.

Below is additional information about the partnership, and some of the benefits for both organizations and the home health care community.

Who are the partners in this announcement?

The Alliance for Home Health Quality and Innovation (the Alliance) is a nonprofit, national consortium of nonprofit and proprietary home health care providers and organizations. The Alliance invests in research and education about home health care and its ability to deliver quality, cost-effective, patient-centered care across the care continuum. The Alliance is committed to conducting and sponsoring research and initiatives that demonstrate and enhance the value proposition that home health care has to offer patients and the entire U.S. health care system.

Visiting Nurse Associations of America (VNAA) is a nonprofit, national industry organization that supports, promotes, and advances mission-driven providers of community-based health care including home health, hospice, palliative care and health promotion services to ensure quality care within their communities. VNAA leads innovation and transformation for home-based care providers to ensure success in new health care delivery and payment models.

 

What is the purpose of this alignment?

The Alliance and VNAA seek to reduce fragmentation of industry leadership and resources to achieve long-term affiliation and alignment of programs and services for the benefit of the home-based care industry, the respective members of each organization, and for the public good.

 

Why is this alignment important for the home-based care industry?

The alignment of the Alliance and VNAA will significantly strengthen the voice of home based care providers in Washington and across the country. Aligning forces for purposes of research and education will strengthen the voice of home-based care providers, and allow for more efficient and more effective initiatives. This alignment will also allow VNAA and the Alliance to streamline resource allocations and strategic agendas to reduce duplication of efforts.

 

Why is this alignment important to policy makers?

Policymakers in Washington, DC have expressed concern about the fragmented voice of the home-based care industry. This alignment brings together two highly regarded home-based care member organizations to strengthen that voice and leadership for the industry. Collectively, VNAA and the Alliance represent a significant portion of the home-based care provided in the United States.

 

How is this alignment important to patients and family caregivers?

Strengthening the voice of home-based care providers will help ensure continued access to high quality home-based care services. Ensuring access to services will allow patients to stay in their homes and provide important support and education for family caregivers.

 

What impact will this alignment have on current members of VNAA and the Alliance?

Existing VNAA and Alliance member organizations will benefit from enhanced and expanded research agendas and materials, co-located meetings and symposia, as well as member-level access and pricing to both organizations’ events and materials. These enhanced benefits will be in addition to current member benefits provided by each organization.

 

What is the timeframe for this alignment?

The Alliance and VNAA have begun to work collaboratively on important initiatives, and will continue to identify new operational and programmatic opportunities in the coming months.

 

What types of projects are the Alliance and VNAA already working on?

VNAA and the Alliance have launched a collaboration to identify and promulgate best practices for home-based care services. Specifically, VNAA and the Alliance have invited leaders with appropriate expertise from each organization to participate in the workgroup on hip and knee joint replacement best practices in response to the Centers for Medicare and Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CCJR) demonstration program. This program will increase demand for high value hip and knee home care programs, and presents a significant opportunity for home-based care providers. The collaborative results will support and expand VNAA’s industry-leading best practice resource, The VNAA Blueprint for Excellence. The VNAA Blueprint tool and website includes evidence-based best practice information, along with training information, evaluation metrics, and additional resources.

 

What types of collaborative projects do the Alliance and VNAA anticipate in the future?

VNAA and Alliance members may consider research into the impact of interventions supported by best practices such as VNAA’s Blueprint for Excellence. Such research projects would align with VNAA’s research database initiative. In addition, where feasible, the Alliance and VNAA will plan joint meetings to align projects, press briefings, conferences and symposia to advance research and educational efforts on the value of home-based care in new health care delivery and payment models.

 

Will the Alliance and VNAA continue to operate as separate organizations?

VNAA and the Alliance will continue to operate as separate organizations. The leaders of both organizations will continue to seek further areas for collaboration and partnership.

October #HomeHealthChat: Home Health and Caregiver Technology ​

The October #HomeHealthChat was co-hosted by Honor (@honor). The #HomeHealthChat focused on home health and caregiver technology.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Special Assistant to the Executive Director Jennifer Schiller here.

Below are some of the highlights from the chat:

December #HomeHealthChat: State of the Home Health Industry

On Tuesday, December 17th, the Alliance hosted the final #homehealthchat of 2014 on Twitter.

The chat focused on the state of the home health industry.

The co-host was Steve Landers, M.D, M.P.H. (@SteveLandersMD). Dr. Landers is the president and CEO of VNA Health Group, and also the president and chairman of the Alliance for Home Health Quality and Innovation.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Special Assistant to the Executive Director Jennifer Schiller here.

Below are some of the highlights from the chat:

September #HomeHealthChat: Falls Prevention

On Tuesday, September 24th, the Alliance hosted its #homehealthchat on Twitter. The topic of the chat was falls prevention, featuring co-host the Visiting Nurse Service of New York, a not-for-profit organization that provides in-home nursing care, therapy and hospice and palliative services to New Yorkers of all ages and backgrounds.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please email Jennifer Schiller at jschiller@ahhqi.org.

Below are some of the highlights from the chat: