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Future challenges: Scrutiny, more complex patients
Look at trends in other states to prepare for changes
Managers don't normally keep a crystal ball in their supply closet, but the ability to predict, or at least guess, at the future of health care as our country faces economic and political changes could be helpful.
Because no one has a reliable way to predict the future, Marcia P. Reissig, RN, MS, CHCE, CEO of Sutter VNA and Hospice in San Francisco, suggests that all managers, "Stay on top of what is happening so nothing takes you by surprise," she advises. Reading, staying in touch with state and national associations, and networking with colleagues in the industry can keep you up to date.
Although the economy has received the headlines during recent months, a slowing economy is not completely negative for hospice care, points out Reissig. "It will probably be easier to retain experienced staff members, because people are less likely to job-hop during tough economic times," she says. When employees stay in place to retain seniority and reduce the likelihood of being laid off, the managers spend less time hiring and training new employees, she points out. "We may also see nurses return to home health after leaving to work in other businesses," Reissig adds.
Private duty care to suffer?
One area that probably will feel the negative effect of the economy is private duty care, says Reissig. "I anticipate that some families who are now using private duty nurses will have changes in their financial situations, so that they can't afford private duty care," she says. Families that have used private duty providers to offer respite care, supplement family care, or provide care in addition to Medicare might choose to have family members take on more of the caregiver responsibilities, she says.
Palliative care is a growing area, but managers face reimbursement issues, Reissig says. "There are people who qualify for palliative care as home care patients, and people who qualify as hospice patients whose care can be reimbursed, but there are people that get caught between the two services with no care," she says. "I'd like to see more effort to blend the two payment systems of home health and hospice so that the 'in-between' group of patients can be served."
Florida may indicate regulatory trends
"From a legal and regulatory point of view, I don't see the economy or the new administration changing the issues faced by home health managers in 2009," says Elizabeth E. Hogue, Esq., a Washington DC-based attorney.
Managers should pay attention to what happened in Florida in July 2008, she says. State regulations now prevent home health agencies from providing anything of value to discharge planners to promote the use of their agency, she explains. Notepads, lunches, pens, and educational sessions that offer free continuing education credits are all banned, she adds. "This is a trend that is showing up in all areas of health care," she says.
Florida also can be used as an example of increased scrutiny of claims, says Beth Carpenter, MBA, president of Beth Carpenter and Associates, a Chicago-based health care consulting firm. "There is increased monitoring of claims to see what types of services are provided," Carpenter says. This use of claims data to look at drugs, treatments, and patterns of care is a change, she says.
"State surveyors used to be the main face of compliance, but now Florida and other states want home health agencies to use accreditation organizations to handle licensure and compliance surveys," she explains. "The state is focusing on monitoring home health services through claims made."
Auditors do their job
Audits to detect fraud also will continue to increase, says Hogue. Even if you cross your "T's" and dot your "I's" be prepared for auditors to find something, she warns. "An auditor's job is to find stuff, so they will scrutinize the little details in every document," she points out. Budget control has been a high-priority issue for the Centers for Medicare & Medicaid Services over the past four years, and one way to recoup money is to find evidence of fraud, she explains. "Home health agencies will face more retrospective audits in the coming year," she adds.
While regulatory and economic issues will continue to challenge home health, Carpenter believes that the overall aging of the U.S. population has more effect on the home care industry. "As the population ages, we see more patients with one or more chronic disease states in addition to the reason for their admission to home care," she says. Not only do the multiple conditions mean an increased need for nursing resources, but they also mean that agencies must change how they provide care, Carpenter adds. "Although patients need more care, we are facing increased scrutiny from regulatory organizations that monitor claims, so we must find ways to provide care needed in the most efficient way possible," she says.
Technology boosts safety
Technology, such as telemonitoring, can be used to enhance patient care without increasing visits, and motion sensors or fall monitors can improve patient safety, says Carpenter. "Some home care agencies have been slow to adopt technology," she admits. Although the initial and ongoing costs of implementing a telemonitoring program cannot be reimbursed, the improved outcomes and increased efficiency of staff time offset the costs, she says.
Perhaps the biggest challenge that managers face is the fact that the industry will continue to change, says Reissig. "This is the time that leadership and execution are critical," she says. "Don't just have a plan to handle change; be prepared to implement the plan, hold people accountable for their responsibilities.
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