As of the beginning of this month (October 1, 2012), hospitals that receive funds from Medicare have a whole new set of very serious rules. There is a lot of discussion of these new rules in the health care literature, including from Kaiser Health News.
As Kaiser Health News indicated, back in August of this year,
With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.
Basically, as part of health care reform, Medicare is saying, “enough is enough.”
Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills.
Frankly, while there is certainly some abuse out there, some hospitals who are too focused on the financial rewards, rather than excellent care, at Support For Home In-Home Care, we do not believe that is the real issue. We work with many great discharge planners and case managers and doctors and nurses who are all about the care of their patients. The larger problem, as we see it, has been the lack of a strong network of care among all the health and service providers that need to be involved in supporting the health and well-being of seniors.
The problem facing hospital case managers and discharge planners is that their reach has not extended beyond the walls of the hospital. Once a non-compliant diabetic senior is discharged, the hospital loses control of her diet. When someone whose medication is not well controlled at home leaves the hospital, the case manager is in a difficult place.
While home health agencies help in these circumstances, we are only talking about a couple of visits per week. That does not cover fall prevention or diet management or medication monitoring and reminders on an on-going basis for that critical 30-day post-discharge period.
So, if we are going to change the statistics – and save the financial status of many hospitals, we need a new model. Often referred to as Transitions in Care, the model calls for much better communication and cooperation among all providers – hospitals, home health, rehab and skilled nursing facilities, DMEs, non-clinical home care agencies, …
Dr. Steve Fox, Medical Director of Wellspring Personal Care in Chicago, talks about care for the medically complex senior in terms of geriatric syndromes. The model below is adapted from his work.
This model has important implications for non-clinical home care companies, including our own. In some ways, we are better positioned to truly participate in this new model than a lot of other companies, but this is the way we see the future for non-clinical home care:
- Agencies need to staff primarily with state Certified Nurse Assistants (CNAs) and Certified Home Health Aides (HHAs). They are better trained and better able to communicate with clinical health care workers than most caregivers.
- While some home care agencies have a gerontologist and some have an RN, we believe the need is for a balance of gerontology and geriatrics and have staffed our management team to achieve that balance.
- Home Care Aides provide support for Activities of Daily Living (ADLs), but they need to be trained to look beyond ADLs to help identify issues facing the medically complex seniors.
- Communication with clinical partners in care needs to be regular and structured, to ensure the the needs of the medically complex senior are address in a timely manner.
- Home care agencies need to answer their phones and be available for intake 24 hours per day. Answering services just do not cut it when a case manager at a hospital needs help.
- Home care programs need to focus on the issues that cause hospital readmissions – fall risk management, dietary management, medication compliance, infection control and so forth – whether it is an hour per day or 24×7.
Having a good heart and good intentions is not enough if we are going to help our clients / patients deal with the geriatric syndromes they face – and help the hospitals face a brand new and scary financial future due to penalties from unnecessary hospital readmissions.
Best wishes. Bert