M Y H O M E C A R E B I Z

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2 IT S COMPETITIVE OUT THERE Do you want more business? You need an edge Also Medicare will be providing financial bonuses to HHAs for good care

3 IT S COMPETITIVE OUT THERE MAINE In Maine 25,000 Medicare Home Health patients in certified HHAs 714 patients per agency

4 IT S COMPETITIVE OUT THERE ILLINOIS In Michigan 147,000 Medicare Home Health patients in certified HHAs 202 patients per agency

5 MEDICARE IS IN ON IT Has put in place ways to measure quality of patient care Has starting paying hospitals this way Get more value for taxpayer dollars Value-Based Purchasing, Affordable Care Act

6 AFFORDABLE CARE ACT The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare, and signed into law in 2010 includes reforms aimed at improving healthcare outcomes and streamlining the delivery of health care.

7 BACKGROUND

8 VBP FOR HOSPITALS The hospital-based VBP system went into effect January For hospitals, 70% of scores are based on clinical outcomes such as how well the facility controlled heart surgery patients' blood sugar levels. The other 30 percent is determined by patient satisfaction.

9 VBP FOR HOME HEALTH Efforts were already underway 15 years ago to develop a valuedriven healthcare system OASIS! OASIS was developed for home health care as part of this effort. One purpose of OASIS is to compare patient outcomes between admission and discharge. Certified HHAs started using OASIS in July CAHPS implemented in 2010 for patient satisfaction portion.

10 HOME HEALTH COMPARE Medicare started publishing OASIS outcomes in newspapers around the country in Currently Medicare continues to publish outcomes on its website to help consumers make informed choices when selecting an HHA (Home Health COMPARE). Discharge planners & insurance companies monitor Home Health COMPARE.

11 CAHPS The Consumer Assessment of Healthcare Providers and Systems (CAHPS ) Home Health Care Survey One goal of CAHPS: public reporting of survey results will create incentives for agencies to improve their quality of care.

12 WHAT VBP MEANS TO YOU Soon, your HHA will receive financial bonuses from Medicare for good outcomes, and penalties for poor outcomes. Outcomes will most likely include those from both OASIS and CAHPS - like hospitals. How Home Health COMPARE affects you now Commercial insurers and hospital discharge planners currently use Home Health COMPARE to identify and refer/contract to HHAs with low re-hospitalization rates.

13 THE BOTTOM LINE These outcomes will determine if you get bonuses or penalties from Medicare. Medicare is doing this to get the best quality for the tax payer. You need to develop a sales & marketing strategy that is in-line with VBP. MyHomecareBiz is designed to help you promise and deliver superior clinical and patient satisfaction outcomes.

14 TWO STEPS TO BUILDING RELATIONSHIPS WITH REFERRAL SOURCES First, convince them to refer to you by promising them exceptional service. Second, delivering on your promise.

15 WHO ARE YOUR REFERRAL SOURCES? Community-based Physicians Discharge planners Each are marketed differently.

16 UNDERSTAND WHAT MOTIVATES REFERRAL SOURCES

17 COMMUNITY-BASED REFERRAL SOURCES Family, self-referral, community organizations What about home health care - is important to a family member or social service agency? Competency Experience Word of Mouth Loving & caring, yet professional Market Patient Satisfaction.

18 CONVINCING THEM TO REFER TO YOU Sample brochure

19 DELIVERING ON YOUR PROMISE CAHPS data is over 1 year old! Can t use old data! Use MyHomecareBiz to monitor patient satisfaction in DAILY IN REAL TIME with automated telephone surveys

20 DELIVERING ON YOUR PROMISE Monitor employee performance daily Correct issues before the final CAHPS survey You ll improve your overall CAHPS scores

21 PUBLISHING PATIENT SATISFACTION RESULTS Sample newsletter Regular newsletters with patient success stories, testimonials.

22 PHYSICIANS What about a home health agency - is important to a physician? Makes her/his job easier Competency - ability to stabilize the patient Ability to keep patient out of the hospital Level II outcomes

23 CONVINCING THEM TO REFER TO YOU Sample brochure

24 DELIVERING ON YOUR PROMISE Home Health COMPARE Level I Level II

25 THE OUTCOMES Level I - 13 Yes or No OASIS Start of Care and Discharge Questions Level II - 7 OASIS Questions where answers are compared between Start of Care and Discharge

26 LEVEL I OUTCOMES OVERVIEW These are Yes or No questions on the Start of Care and Transfer/Discharge Assessments. Compliance should be 100% or close. After training, testing ~ 100% compliance should be achieved within 2 4 weeks.

27 LEVEL I OUTCOMES QUESTIONS How often the home health team began care in a timely manner. (M0102) Start of Care determined whether the patient received a flu-shot for the current flu season. (M1040) Transfer/Discharge determined whether the patient received a pneumococcal vaccine. (M1050) Transfer/Discharge checked the patient for pain. (M1240) Start of Care checked the patient for the risk of developing pressure ulcer (M1300) Start of Care if the patient had heart failure, treated heart failure (weakening of the heart) symptoms (M1500) Transfer/Discharge checked the patient for depression. (M1730) Start of Care

28 LEVEL I OUTCOMES QUESTIONS CONTINUED How often the home health team: checked the patient s risk of falling. (M1910) Start of Care taught patient (or their family caregiver) about their drugs. (M2010) Start of Care for patients with diabetes, got doctor orders, gave foot care, and taught patient about foot care. (M2250b) Start of Care treated patients for pain. (M2250e) Start of Care included treatment to prevent pressure ulcers the plan of care. (M2250f) Start of Care took doctor-ordered action to prevent pressure ulcers (M2250g) Start of Care

29 IMPROVE LEVEL I OUTCOMES Establish Best Practice P&P & procedures - Evidence- Based Best Practices Train, test staff Best Practices Track compliance with Best Practices Add to, change practices to achieve compliance

30 ESTABLISH BEST PRACTICE P&P Policy: M0102 Begin care in a timely manner. (M0102) Ideas?

31 ESTABLISH BEST PRACTICE P&P CONT Policy: All patients are assessed for the following: (M1240) pain (M1300) risk of developing pressure ulcer (M1730) depression (M1910) risk of falling Clinician never answers no, always answers yes or N/A

32 ESTABLISH BEST PRACTICE P&P CONT.. Always Yes or NA (M2010) taught patient (or their family caregiver) about their drugs. (M2250b) for patients with diabetes, got doctor orders, gave foot care, and taught patient about foot care. (M2250e) treated patients for pain. (M2250f) included treatment to prevent pressure ulcers the plan of care. (M2250g) took doctor-ordered action to prevent pressure ulcers

33 ESTABLISH BEST PRACTICE P&P CONT Transfer/Discharge Questions (M1040) determined whether the patient received a flu-shot for the current flu season. (M1050) determined whether the patient received a pneumococcal vaccine. Get supervisor, DON or other office person to monitor this. Before nurse/therapist completes OASIS the information is communicated to them.

34 ESTABLISH BEST PRACTICE P&P Full set of Policies & Procedures in MyHomecareBiz Evidence Based Best Practices for Home Health Care Write your own policies

35 TRACK COMPLIANCE Are you improving your outcomes? How you can do it on MHCB Ideas for non-mhcb users

36 LEVEL II OUTCOMES OVERVIEW 7 OASIS Questions Did the patient improve between Start of Care and Transfer/Discharge? Daily monitoring of the patient s status is required. After training, improvement in statistics should be achieved within 6-8 weeks. Data used in sales & marketing for discharge planners and physicians

37 LEVEL II OUTCOMES How often the patient improved in Pain (M1242) Surgical wound (M1342) Breathing (M1400) Bathing (M1830) Transferring (M1850) Ambulation (M1860) Oral medication management (M2020)

38 WHAT PREVENTS IMPROVEMENT? Non-compliance Patient is not teachable Treatment doesn t work

39 ENSURING IMPROVEMENT Establish Best Practice P&P & procedures (P&P) Patient/caregiver non-compliance Competent contingency plan Interventions & goals for the 7 measures Train, test staff on P&P Track compliance with P&P Add, change P&P to achieve compliance

40 DYSPNEA Best Practices 1. Teach patient "pursed lip" breathing and "diaphramatic" breathing. 2. Teach patient to avoid very cold air and make sure no one smokes in the home. Reduce air pollution by eliminating fireplace smoke and other irritants. 3. Tell patient to talk to her/his doctor about pulmonary rehabilitation. 4. Medication teaching

41 MEDICATION MANAGEMENT Best Practices Require repeat demonstrations or explanations about medications that will be taken at home. Have the patient repeat back the information provided or show that they have mastered drug administration techniques such as measuring liquid medications every visit.

42 AMBULATION Best Practices Balance exercises sitting, standing Gait training Transfer techniques Upper and lower body muscle strengthening exercises

43 DELIVERING ON YOUR PROMISE Patient Outcomes Reports

44 DISCHARGE PLANNERS What s about a home health agency is important to a discharge planner? Ability to keep patient out of the hospital

45 CONVINCING THEM TO REFER TO YOU Sample brochure

46 DELIVER ON YOUR PROMISE

47 LEVEL III OUTCOMES How often home health patient had to be admitted to the hospital. (M2410)

48 LEVEL III OUTCOMES Re-hospitalization rate: did the patient require acute care under your watch? Most powerful indicator of home care quality Hospitals are penalized for re-admissions Discharge planners refer most to HHAs with the lowest readmission rates Commercial insurance companies contract with HHAs with the lowest re-admission rates Data used in sales & marketing for discharge planners and physicians

49 PREVENTING HOSPITALIZATION Establish Best Practice P&P & procedures (P&P) Risk management for known re-hospitalization factors Live after-hours contact no answering machines Patient teaching on managing exacerbations for 16 conditions Train, test staff on P&P Track compliance with P&P Add, change P&P to achieve compliance

50 WHAT CAUSES RE-HOSPITALIZATION? Patient/caregiver doesn t know how to manage exacerbations goes to ER

51 IDENTIFYING RE-HOSPITALIZATION RISK Project BOOST Re-hospitalization Risk - The 8 P s problem medications psychological issues principal diagnoses poly-pharmacy poor literacy patient support prior hospitalizations palliative care

52 ESTABLISH P&P PROBLEM MEDICATIONS Patient teaching regarding high-risk medications Digoxin Coumadin Plavix & aspirin Insulin Stat orders related to high-risk medications

53 ESTABLISH P&P PSYCHOLOGICAL Depression & confusion contribute to rehospitalization Track this with each visit

54 ESTABLISH P&P DEPRESSION SCREENING Patient teaching regarding high-risk medications Stat orders related to high-risk medications

55 ESTABLISH P&P PRINCIPAL DIAGNOSES Certain diagnoses contribute to rehospitalization risk Cancer Stroke Diabetes COPD CHF Track the status of these at each visit

56 ESTABLISH P&P POLY-PHARMACY 5 or more medications contribute to rehospitalization risk Track the status of medication management at each visit

57 ESTABLISH P&P POOR LITERACY Limited teachability contributes to rehospitalization risk Make sure there is a competent caregiver

58 ESTABLISH P&P PATIENT SUPPORT Limited support contributes to rehospitalization risk Make sure the patient has a competent caregiver

59 ESTABLISH P&P PALLIATIVE CARE Un-managed/uncontrolled pain contributes to re-hospitalization risk Track the status of pain at each visit

60 TRAIN, TEST STAFF ON P&P MyHomecareBiz Evidence Based Best Practices for Home Health Care Clinician Edition

61 TRACK COMPLIANCE This is your biggest challenge How you can do it on MHCB Ideas for non-mhcb users

62 EXAMPLE OF MODIFYING POLICY Your policy on Patient Support: all patients admitted have a competent contingency plan Compliance rate is 45% after training/testing Reason: patients admitted with contingency plans Re-evaluate how to manage patients without support systems

63 DELIVER ON YOUR PROMISE Sample discharge report

64 DAZZLE YOUR REFERRAL SOURCES Give them a reason not to refer to anyone else!

65 SALES STRATEGIES Get your OASIS and CAHPS scores in the top 5% of your State. Offer specialized services board-certified: Diabetes; pain management, cardiac rehabilitation, post-cva etc Provide real-time monitoring to physicians: MHCB Physician Portal displays comparisons between admission & most recent visit

66 TRADITIONAL MEDIA Showcase your Superior Care Newsletter Brochure Website Sales & Marketing staff

67 WEBSITE Biggest bang for your buck Showcase your latest statistics Focus on one outcome at a time; discuss your Best Practices, i.e. Best Practices for Pain Management Get patient testimonials Get employee testimonials

68 NEWSLETTER CONTINUED Mail newsletter monthly, bimonthly or quarterly MyHomecareBiz designs and develops stunning newsletters. Just get us patient testimonials we ll do the rest.

69 BROCHURES Have a mission statement List services, locations Identify specialty areas Biographies of Agency leaders Training protocols for Agency Staff Mention Clinical Best Practice System

70 WEBSITE Change content so it matches newsletter Change content no less than every 3 months

71 IN-PERSON MARKETERS Owner/administrator is best marketer Understands and communicates effectively HHA s Best Practice system Is knowledgeable about HHA s COMPARE & CAHPS scores Has ability to show referral sources real-time monitoring