From the CEO’s desk

A hospital administrator talks about home care

When it comes to maintaining your agency’s hospital-affiliated status, nothing beats support from the top. While agency directors have more than a few ideas of how to garner it, perhaps no one has greater insight on how to accomplish this than "the top" itself.

As president and CEO of Tupelo-based North Mississippi Medical Center, Jeff Barber, PhD, is solidly behind his hospital’s home care agency. For those home health agency directors who find themselves in a the less-than-enviable position of having to convince their CEOs of home care’s merits, he offers a bit of advice.

Barber explains that the success or failure in maintaining a positive relationship between the hospital and the home health agency rests with the management of both entities.

"It really boils down to how strong a relationship the home health agency director has with the counterpart directors of their institution," he says. "The importance of that relationship is that for the continuum of care to be effective and get patients into the home health care environment, there need to be clear, concise communication channels and procedures, and a process to make it all work."

If that works effectively, says Barber, the home health agency can benefit the hospital and itself by floating staff into areas of the hospital which are experiencing unusually high bed occupancies or staffing needs, while keeping its own overtime costs to a minimum. But, as Barber points out, such seamless cooperation is rare. "For all this to happen it takes really good communication," he says, "and where most facilities fall down is on the adequacy of communication channels."

Barber finds hospitals that try to manage both home health agencies and clinics "do both equally badly because hospital and department administrators haven’t been trained in how to manage clinics or home health care." Barber concedes this is a generalization but says his hospital has avoided the trap of taking someone from the hospital and putting that person in charge of the home health agency.

"We took someone from the outside who had experience in running home health. She meets weekly with hospital directors and established the processes to evaluate what the agency is doing and to maintain open channels of communication," he explains.

A tool for better community relations

As Barber sees it, home health agency directors would be well-served to point out home care’s many benefits — not just to the hospital’s bottom line, but also as a community relations tool. He notes home health care benefits hospitals in the following ways:

o Providing an opportunity for the hospital to cut the length of stay and save on Medicare DRG reimbursement. "The point of managing care through the hospital," he notes, "is getting patients out in an appropriate time to another appropriate setting. It’s very important. We haven’t always, but we’re now doing it effectively and that has helped us become better at what we do."

o Acting as a referral source for additional patient hospitalization. Says Barber, "[If] patients already have a relationship with the home health nurse and then require further hospitalization, they may think of us first."

o Reducing patient costs in the long run and improving a community’s overall quality of health. "Community-owned hospitals have a better sense of what’s right for the community, and a home health agency is the right thing," he says. "These agencies provide a better health care environment for the types of patients they treat and at less cost to the patient, so it actually improves the health status of the population. Without [the agencies], people would be getting sicker."

Barber encourages hospital administrators to look at the big picture in assessing the value of home care. "When you look at it as a piece of the continuum that if you don’t have it, you’ll have increased costs over the long haul." The agency may not be a money-maker, but it does reduce the amount that otherwise would be lost on long-term care if patients remained in the hospital.

o Acting as an placement option for hospital employees laid off as a result of downsizing. Barber suggests that home health agency administrators consider hiring employees downsized by the hospital as agency aides and nurses. "The home health agency should look at the employee pool from the hospital . . . as an opportunity to create a flex pool," Barber explains. "Here is an opportunity to take good employees. [Agency directors] know they’re reliable and committed. It’s better to have a flex pool from hospital employees than from an outside agency."