May #HomeHealthChat: The Importance of Advance Care Planning

The May #HomeHealthChat was co-hosted by Lee Goldberg (@lmgoldberg). Lee Goldberg is the Project Director for The Pew Charitable Trusts’ Improving End of Life Care Project.

The #HomeHealthChat focused on the Importance of Advance Care Planning.

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:

Prioritizing Care From Hospital to Home

Last week, the Washington Post published the heartbreaking story of Joyce Oyler, a home health patient who passed away after receiving the wrong medication; an error which failed to be caught at all levels, including home health. Ms. Oyler’s story is a terrible reminder of the critical nature of care transitions from setting to setting.

Care transitions are a central area of both focus and improvement for the home health care community. Recognizing the importance of quality and safety issues in the transition from hospital to home, the Alliance developed the Home Health Model of Care Transitions. The model lays out an evidenced-based approach to successfully complete a transition and prevent rehospitalization. The model specifically emphasizes medication management as a core component of an effective care transition, and specifies that a home health agency identify the name of each drug prescribed, what it’s used for, dosage, and when and how often the patient should take each medication. Medication allergies and pharmacy name and phone number should also be listed.

Other organizations are also dedicated to putting care transitions at the forefront of emphasis. For instance, the Visiting Nurse Associations of America (VNAA) compiled the Blueprint for Excellence, which features a module of patient safety including medication reconciliation. The Blueprint defines medication reconciliation and adherence, outlines the impact it has one patient outcomes and safety, and identifies best practices for medication reconciliation and adherence in the home. You can access the VNAA Blueprint for Excellence guidelines and resources on medication reconciliation here.

Federal initiatives are further driving quality improvement and patient safety in home health. Just recently, the Centers for Medicare and Medicaid Services (CMS) began assigning Home Health Star Ratings for quality and patient experience, on top of the existing publicly reported quality measures on Home Health Compare.

Star ratings are one mechanism to help consumers access better quality and patient preferred outcomes in home health care, however a number of additional models are currently being implemented to drive home the idea of value over volume in care. The Home Health Value Based Purchasing Model is tying payment to performance, while bundled payment arrangements and accountable care organizations are using payment models that seek to incentivize efficiency.

At the end of the day, policymakers, home health agencies, hospitals, and patient advocates must work collaboratively on ways to best tackle gaps in care from hospital to home.

Preventing tragic deaths, such as Ms. Oyler’s, is so critically important. We simply need to do better for patients and their families. Federal policy initiatives are paving the way, and the work of the Alliance, VNAA, and others are helping by addressing, compiling, and disseminating evidence-based practices and tools.

Together we as an industry and community can work to prevent critical medication errors, hospital readmissions, and most importantly, unnecessary patient deaths.