Survival tips from experts

Health care reform presents opportunities and challenges

Reduction in reimbursement is the bottom line when it comes to home health and health care reform. Although no one wants to paid less, there is time to adjust and be prepared for cuts that will come, because they don't all come at one time, points out Andy Carter, MPP, president and chief executive officer of Visiting Nurse Associations of America (VNAA) in Washington, D.C.

Become more productive

One of the cuts that poses a real challenge to home health agencies is the productivity cut, says Carter. Because home health does not operate in the same manner as other health care providers, with staff and patients located in the same building, there are some productivity challenges that cannot be overcome, he says. "A nurse still has to drive to a patient's home to see one patient, and that won't change," he says. "However, there is room for productivity improvement in all areas of our economy, including home health," he says.

"How can we help nurses care for more patients is a key question," says Marcia P. Reissig, RN, MS, chief executive officer of Sutter VNA and Hospice in Emeryville, CA. Telemonitoring and telephone calls can supplement and possibly reduce the number of personal visits for some patients, she suggests. "Finding a way to keep home health care affordable, not only for Medicare patients, but also for private-pay patients is the key to success in the future," she says.

"Every agency manager should be reviewing all processes within the agency," recommends Reissig. "Look at all of the back-office activities and see if you need as many staff members as you have," she says. Cross-training and technology can be two solutions to improve efficiency and productivity in your billing and claims departments, she adds.

Technology is an important part of preparing for the next years, says Reissig. "From point-of-care documentation to back-office systems, every agency needs a system that ties all agency activities together," she says. "Another critical component of a good computer system is ease of use," she points out. No agency should invest in a system that requires lengthy training sessions for employees, she says. "One or two days should be the maximum for clinical personnel," she suggests.

Although technology can be expensive, it doesn't have to be prohibitive, says Reissig. "We just implemented a new system that we pay for on per-visit basis," she points out. "We had no capital investment, but it integrates everything we need."

Develop programs for chronic care

Chronic care management is an area that all home health agencies should evaluate, says Reissig. "It's not enough to provide care for heart failure, when the same patient may also have diabetes, chronic obstructive pulmonary disease, and renal failure," she points out. "A good chronic care management program will require a high level of clinical competence," she points out. Nurses will need to be able to think critically when caring for a patient with multiple chronic conditions," she says. As more home health agencies develop chronic care programs to meet the increasing need, there will be more competition for highly qualified staff, she adds.

The Independence at Home Act sets up a 3-year demonstration project that promotes multidisciplinary care, including primary care physicians, nurses, social workers and therapists, for Medicare patients with complex, chronic care needs in their homes, says Carter. "The project will begin no later than January 2012," he says. "Sophisticated home health agencies that are capable of assuming a wider range of responsibilities should evaluate this as a service to develop," he recommends.

Diversify to survive

Expanding the number of payer sources and patient audiences that your agency relies upon is another way to survive, but you need to develop programs that meet the needs of these different audiences.

Diversification may include development of a private duty program, says Reissig. "As more people purchase long-term care insurance, we'll see a greater demand for home care," she says. Although long-term care insurance usually provides reimbursement for both home care and nursing home care, the affordability of home care and the desire to stay in the home will create more opportunities for home care agencies, she says. "We need to make sure our services are affordable for patients who are not Medicare patients," she points out.

Affordability and easy access are important aspects of home care, points out Reissig. "Throughout the health care reform debate, we saw more people realize that home care plays an important part in cost-effective patient care. Now, we have to make sure we can provide the services that patients need at a rate they can afford."