Inaugural #HomeHealthChat: Cost-Effective Home Health Care

On Tuesday, July 23rd, the Alliance hosted its inaugural #homehealthchat on Twitter. The Twitter chat focused on the cost-effectiveness of skilled home health care and featured the Partnership for Quality Home Healthcare (@PQHH) as the Alliance’s co-host.

The hour-long conversation covered topics ranging from the benefits of coordinated care to the consequences of reinstituting a copayment on home health care episodes. Chat attendees discussed and provided examples of home health care as a cost-saving and patient preferred alternative to other forms of post-acute care.

The following questions were posed during the chat:

Q1: What makes home healthcare a cost-effective alternative to other settings?
Q2: Who benefits most from cost-effective home healthcare?
Q3: How would a co-pay affect patients who want to receive care at home?
Q4: What types of clinical and medical care can home health professionals offer patients with their homes?
Q5: What role can coordinated care play in improving the patient experience and quality of care?

The Alliance will host future home health-focused Twitter chats on the fourth Tuesday of every month at 2pm ET. Be sure to check here for updates on topics and questions! If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please email C. Grace Whiting, the Alliance’s Director of Strategic Initiatives & Communications, at gwhiting@ahhqi.org.

Below are some of the highlights from the first chat:


How Accountable Care Organizations Are Thinking About Home Care

Guest Author, Rodney Hornbake, M.D.

I practice medicine in a quiet corner of Connecticut half way between New York and Boston.  But despite my location, I am in close proximity to two Accountable Care Organizations (ACOs).  There are now four in our state approved by CMS and in operation.  Several more are expected to be approved to begin operation January 1, 2013 and one of these will cover the entire state.  Elsewhere, physician organizations and hospital systems are beginning to act as if they were already accountable for the quality and value of the services they provide.

I have taken part in the planning for one of these ACOs, by leading the development and implementation of clinical strategies designed to make the ACO successful. The vehicle for the ACO is a large Independent Practice Association (IPA) known as Medical Professional Services (MPS).  The IPA includes more than 400 physicians in central Connecticut.   The purpose of this blog is to share the deliberations and planning as they relate to home care and to explore how others outside Connecticut are addressing the same issue.

During 2011, MPS explored multiple opportunities that were available as a result of the Affordable Care Act.  The CMS initiatives and health care delivery reform approaches that MPS considered were:

1. The Bundled Payments for Care Improvement Initiative;
2. Independence at Home; and
3. Accountable Care Organizations.

As part of our deliberations in regard to the Bundled Payments initiative, MPS convened a meeting with the leadership of five local home health organizations.  These included not for profit agencies, a hospital-owned agency and a for-profit agency.  In a short time, the group identified strategies to:

  1. Shift appropriate patients from facility based post-acute care to lower cost home based care;
  2. Improve operations of primary care practices to provide optimal support to home care;
  3. Improve operations of home care agencies to provide optimal support to primary care physicians; and
  4. Focus care on patient-centered goals.  This last strategy relates directly to the desire of many patients to avoid hospitalization and to focus instead on palliative care or hospice care.

These strategies in turn were accompanied by specific tactics.

  1. Share information.  This specifically means sharing discharge summaries and other key clinical documents with the home care agency.  (While the ACO anticipates health information exchange, a web portal or other high tech solutions, most agencies currently rely on faxes.)
  2. Support functional teams.  Every home care nurse would share his or her cell phone number with the physician who in turn would provide his or her cell phone number to the home care nurse.  Other providers will be added to the nurse-physician team as needed.
  3. Rapid cycle performance improvement.  MPS would host a weekly conference call to discuss every readmission from home care as well as every “near miss.”

In the end, MPS elected to become an Accountable Care Organization (CMS prohibits organizations from sharing in savings for more than one innovation project).  All the strategies and tactics developed to address bundled payments were adopted by the ACO when it began operation on July 1, 2012.

Other ACOs are also working to optimize post-acute care.  Detroit Medical Center includes eight acute care hospitals, multiple out-patient facilities and one post-acute care facility.  The health system has formed a virtual network of partnering post-acute providers and established a joint operating committee to oversee its operations.[1]  The focus is on improving clinical outcomes and efficiencies through collaboration on mutual goals.

HealthEast Care System in St. Paul, Minnesota is also relying on formalizing collaboration with selected post-acute providers to align the continuum of care to the maximum benefit of patients.[2]

Thus, while details vary from market to market, certain themes are emerging.  The most important one is collaboration among high performance organizations to achieve mutual goals.  Home health care organizations that understand this dynamic can strategically position their organizations in a rapidly evolving market place.


[1] Lauren Phillips, “Continuing Care Networks: Affiliating with Post-Acute Providers,” Health Care Financial Management Newsletter, (May 30, 2012), available online at http://www.hfma.org/publications/newsletters/strategic-financial-planning/archives/2012/summer/continuing-care-networks–affiliating-with-post-acute-providers/.

[2] Ibid.

New Data on Hospital Readmissions: CACEP Working Paper #4

The Alliance today released Working Paper #4 of the Clinically Advanced and Cost-Effective Placement (CACEP) research project, which examines hospital readmission and admission frequency and associated Medicare episode payments across three episode types: post-acute, pre-acute, and non-post-acute (community-based) care. Hospital readmissions and admissions were analyzed within the context of patients’ chronic conditions and demographic characteristics.

Key Findings

  • Hospital readmissions increased Medicare episode payments by at least 100 percent.
  • Patients with more severe primary chronic conditions tend to have more readmissions.
  • 22.4% of post-acute care episodes have at least one readmission.
  • Medicare post-acute care payments more than double when an episode contains at least one readmission, from an average payment of $15,335 without a readmission to $33,926 with a readmission.

Additional Working Paper #4 Resources

Full Report 
Study Highlights
Executive Summary
Webinar
Presentation Slides

Home Health Implications

CACEP Working Paper #4 data suggest that better management of chronic disease across all three episode types through home health intervention could enable more patients to remain out of the hospital following an initial admission, or prevent avoidable hospitalizations all together.  Clinically appropriate and cost effective care ultimately can improve the quality of patient care and reduce the cost for the Medicare program and taxpayers.  Home health care combines the right mix of care management, prevention training and close observation to significantly reduce hospital admissions.

As lawmakers look into ways to reduce spending from hospital admissions and readmissions, how can home health be part of the conversation? Please comment below to submit your ideas. 

Stay tuned for the release of the final paper of the Clinically Advanced and Cost-Effective Placement (CACEP) project this fall. Details coming soon!

Home Health News Roundup: Week of July 2 – July 6

Nursing home costs grow as home health costs stay flat, survey shows

A new study by Genworth focused on the change in elder care costs in 2011. While nursing facilities saw costs increase between 1.2 and 4.2 percent, home health costs saw no increase at all.

 

New Numbers on Elder Care

With the addition of elder care to the American Time Use Survey, the Bureau of Labor Statistics can now identify the segment of the population providing care to the elderly, as well as the types and frequency of care provided.

 

Study: Frequent Hospice Visits Can Help People Remain Home at End of Life

According to a new report highlighting the importance of hospice programs, patients who prefer to remain home at end of life are more likely to be able to do so if they get frequent visits from nurses and doctors.

 

New elderly care program controls health costs

A new type of elderly care program is saving money by allowing patients to live at home while receiving care and company at a day care center.

 

Use of electronic health records by post-acute providers improves care transitions, experts say

Experts believe the use of electronic health records by post-acute care providers can improve and ease transitions for patients during the recovery process.

 

CMS Wants to Cut Home Health Agency Payments by $20 Million in 2013

On Friday the Centers for Medicare and Medicaid Services (CMS) announced the new home health prospective payment system (HH PPS) rule to cut payment rates to home health agencies by $20 million in 2013. The proposed rule is expected to encourage efficiency and payment accuracy among providers.