By Elaine Christie, Author


Six months after the implementation of a pilot program using preprogrammed phones to encourage patients to call or text their home care provider or visiting nurse at the onset of worsening conditions, readmission rates at Accessible Home Health Care decreased significantly.

• The number of missed visits decreased by 50%.

• The company’s CMS rating increased 20% to 4.5 stars.

When patients are hospitalized, they rely on the dependable nurse call button. But once home, that familiar helper is gone. And while effective communication between the nurse and patient before and during discharge is critical, what percentage of 30-day readmissions could be avoided — and how many thousands of dollars could be saved — if patient symptoms were addressed immediately post-discharge?

Reducing unplanned hospital readmissions is obviously a high priority for hospital case managers as Medicare penalties grow each year. The problem is that no two patients are alike. Often, one patient may require more than one type of service — and the more complicated the case, the more challenging it can be to coordinate post-discharge care.

But now, discharge planners can include preprogrammed phones for calls and texting options for patients at high risk of readmission. If patients communicate with their home care provider or visiting nurses at the onset of symptoms or complications, readmissions could be avoided by prompt in-home treatment.

The problem is that some patients are less likely to be technologically savvy, explains Randy Paramore, chief executive officer of Accessible Home Health Care in Houston.

That’s one reason he took part in a pilot program to test preprogrammed phones that encourage patients to call or text their home health providers before they involve EMS dispatches and EDs.

Six months after the implementation of the pilot program, Paramore says the number of missed visits plunged by 50% while their CMS rating increased 20% to 4.5 stars. This improvement put them in the top 5% of home healthcare agencies in Texas and the top 10% in the nation. Readmission rates are significantly lower, and patient satisfaction has improved dramatically.

“By far, the biggest operational challenge is communication and missed visits. Too often, clients wouldn’t answer their phones when clinicians called to confirm appointments, even 15 minutes before the scheduled time,” says Paramore.

The May 2018 issue of Hospital Case Management shared a different program that saw an 80% participation rate in post-discharge phone calls to patients. In that case, when the phone rang, the caller ID cited the healthcare facility as the source of the call. Inpatient case managers worked with participating patients to expect the automated phone calls, explaining why it’s important to participate and how the nurses would be following them to make sure they are doing well. (The article is available at:

Now, it’s about educating patients to be proactive and reach out about any worsening symptoms or worries.

Paramore says the device also played a role in how his team members communicate with each other as well as with patients. Staff can call into the device, allowing direct contact to patients without giving out nurse cellphone numbers.

Accessible Home Health Care professionals can easily reach patients to confirm appointments, which is the biggest contributor to lowering missed visit rates. Certified nursing assistants visiting patients use the device to speak directly with their supervising RNs. The staff are able to communicate potential issues as indicated by changes in vital signs or other indicators, often mitigating the potential for immediate readmission.

Paramore wanted a solution that would improve the three most critical metrics he tracks:

• communication between Accessible Home Health Care staff, clients, and their families;

• the agency’s CMS star rating;

• unnecessary hospital readmissions.

Paramore estimates his home health agency has wasted more than 300 personnel hours per year due to missed appointments caused by miscommunication among team members and patients. His home health agency serves the entire Houston metropolitan area and employs 30 clinicians in a variety of disciplines, including registered nurses, certified nurse assistants, social workers, and physical, occupational, and speech therapists.

Not only did this take a toll on the agency’s costs of doing business, but it also frustrated staff and patients.

While the average CMS rating for agencies like Accessible Home Health Care is 3.0, Paramore wanted his team to deliver better-than-average quality care. "Our CMS star rating moved from 3.5 at the start of the pilot program to 4.5 in January 2018," he says.