PPS update: Education key to productivity

Staff learning curve must be shortened quickly

[Editor’s note: In future issues, Homecare Quality Management details the step-by-step processes that a quality manager at an agency participating in the prospective payment system (PPS) demonstration project used to educate staff, monitor quality of care, streamline the additional paperwork caused by the PPS system, and provide outcomes-based quality improvement updates during the study.]

Even with "enormous amounts of inservice," the increased paperwork caused by Phase II of the Health Care Financing Administration’s (HCFA) Medicare Home Health Prospective Payment Demonstration pilot project affected productivity in participating agencies.

"We saw a decrease in productivity until the staff became accustomed to the new documentation," says Diane Mintz, RN, BSN, nurse manager, Visiting Nurse and Health Services in Greenfield, MA. "It’s coming back up now that the staff has become used to it, but there is a lot of paperwork that draws on clinical staff time. The tools they gave us to measure between point A [intake] and point B [discharge] are very detailed and very long."

Each time a patient is admitted, a thorough assessment tool must be completed. A similar form must be completed when a patient is discharged, either from the agency or from the prospective pay plan, in addition to numerous other forms. For example, two forms are required each time a patient is transferred to an inpatient facility, but only if transferred for more than 48 hours.

"This is a very complicated system," notes Eleanor Littman, RN, MSN, director of home health, Prime Health at Home in Watsonville, CA. "The cost and complexity of the billing, the accounting, the information needed to support it, and the financial tracking and clinical tracking is tremendous."

Participation in the program required extensive up-front training for staff. Mintz notes that her agency provided extensive inservices for its staff, but only after she and her agency’s quality assurance coordinator went to an inservice. The two then had to design inservices for its staff.

They also brought in outside help. "We had workshops put on by Abt Associates [a Cambridge, MA, consulting firm assisting HCFA with the project] and our intermediary," says Marna Mucha, RN, MSN, manager for community health services at Mary Lane Hospital Home Health Department in Ware, MA.