Increased scrutiny, more complex patients top list of 2009 challenges

Look at trends in other states to prepare for changes

Home health 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 home health 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, chief executive officer of Sutter VNA and Hospice in San Francisco, suggests that all home health managers, "Stay on top of what is happening so nothing takes you by surprise." Reading, staying in touch with state and national home health 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 home 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," she adds.

One area of home health that will probably 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 home health to offer respite care, supplement family care, or provide care in addition to Medicare home health may choose to have family members take on more of the caregiver responsibilities, she says.

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. "I do think that home health 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, president of Beth Carpenter and Associates, a Chicago-based healthcare consulting firm. "There is increased monitoring of claims to see what types of services are provided," she 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," she adds.

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 United States' 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, she 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, 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.

The acuity and complexity of home care patient conditions also will give home care a great opportunity as chronic disease management programs become more important, says Reissig. As more states evaluate and pass legislation supporting the concept of the "medical home," home health agencies can use their expertise in coordinating patient care in a home to take a lead, she says.

Perhaps the biggest challenge that home health managers face is the fact that things in 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, and be ready to adapt."


For more information about changes and predictions for home health, contact:

• Beth Carpenter, President, Beth Carpenter and Associates, Chicago, IL. Telephone: (847) 382-1035. E-mail: Website:

• Elizabeth E. Hogue, Esq., Attorney, Washington D.C. Telephone: (877) 871-4062. Fax: (877) 871-9739. E-mail:

• Marcia P. Reissig, RN, MS, CHCE, Chief Executive Officer, Sutter VNA and Hospice, 1900 Powell St., Suite 300, Emeryville, CA 94608. Telephone: (800) 698-1273 or (510) 450-8525. E-mail: