We field clinicians, home health owners, nursing directors, office staff, clinical supervisors, administrators et al...strive for clinical excellence every day by performing thorough assessments, implementing excellent patient teaching plans, using superior remote monitoring systems and fantastic electronic medical record (EMR) systems and writing remarkable careplans to help us serve patients better.
What Defines Success in Home Health Care?
Clinical stability, recall of prevention.
We all know that...right? Get the patient to a stable status and teach them how to prevent the return of symptom(s).
And that is a tall order!
Expecting the patient, the one who is suffering, to learn all the symptoms that require monitoring, then learn all the prevention that must be practiced...is very challenging!
The patient's caregiver is your formidable ally in making sure this all gets done.
Why is the Caregiver your Secret to Success?
Achieving discharge-ready status is the goal for all patients.
Once its been determined that the physician's careplan is working, the next requirement is to make sure the patient can recall 1) when to call the doctor and 2) the prevention to be practiced to control symptoms. Because the patient already has a lot to handle - i.e.staying healthy - the patient's caregiver is THE KEY to achieving these goals.
Competent Caregivers Help Achieve Discharge in LESS VISITS
Excessive Patient Visits May Indicate Inefficiency. Excessive patient visits are costly to the HHA and may indicate inefficiency in patient care. If the physician's careplan requires changes extra visits are warranted, of course. But this is not the norm. With most patients, there should be a clear path to discharge once clinical stability is achieved.
State Laws Require a Competent Caregiver
Although CMS does not have a specific standard or CoP requiring an emergency contact, most state laws governing HHA licensure have this requirement. In addition to providing care in case the home health professional can not make a visit, this policy will help you to make less visits and achieve timely discharges.
Competent Caregivers are Good for Business
Under PDGM, the average number of visits is 20% less than the number of visits made under PPS. For example, a patient needing intensive wound care should receive 12 to 19 visits SN visits over 6 to 8 weeks, the national average utilization for acute clinical HHRGs. Given the average national utilization, your Regional Intermediary (RI) will expect you to maximize the patient’s resources and include family and other supportive assistance in teaching and discharge planning. If you submit a Final Claim with visits that are significantly under or over the average utilization, your RI will start auditing patient records with ADRs.
What You Should Do
Identification of a teachable caregiver must be a top priority of the admitting clinician. Even better - when you receive a referral and schedule the admission visit, ask that the emergency contact (of record) be present for home care visits. This person should be included in teaching, administration of treatments, and discharge planning.