Home therapy adds a piece of rehab continuum

Payers push for low-cost options

The staff at the Rehabilitation Hospital of Indiana (RHI) took about a year and a half for feasibility studies and planning of their home-based rehab service.

A resource team of managers from each discipline developed the plan, taking into account Health Care Financing Administration and RHI licensure requirements, says Melissa Dill, MS, OT, outpatient program manager for the Indianapolis provider.

The team began by doing a feasibility study looking at nine months of the hospital’s inpatient discharges to see if there was a need for the service and to determine if it would be feasible from a business perspective, Dill says.

The team projected the potential volume for home health services by looking at the number of patients being discharged with home health services and the geographical areas in which they lived. Their feasibility study was based on the potential volume, Medicare’s regional limits for home health reimbursement, and anticipated costs, such as staff salaries, supplies, and overhead.

From there the team developed the policies and procedures and put them into place.

James C. Summerfelt, MS, PT, uses a jigsaw puzzle as an analogy to explain how a home health service is structured.

"When you get the pieces out of the box, it’s total chaos. You complete the borders first and fill in the center," says Summerfelt, who is director of home health and rehabilitation planning operations for the Rehabilitation Institute of Chicago (RIC).

In home health, the four borders are clinical competency of staff, clinical protocols, outcomes, and patient satisfaction.

Summerfelt advises rehab providers to make sure the four borders are in place before they start a home health program.

Here are some other tips for setting up home therapy services at your facility:

• Be very familiar with your state licensure guidelines and HCFA conditions of participation. You must comply with these before you see your first patient.

• Join your state home care association. Dill has found Indiana’s home care association to be helpful in providing continuing education and in getting tips from other agencies.

• If you choose to align with existing home health agencies, choose your partners carefully. Make sure they have the same standards for quality and outcomes that you do.

• Don’t rush into a partnership without considering all aspects, Summerfelt warns. For instance, RIC is negotiating to preserve ownership of their proprietary products, such as their continuous quality improvement system, outcomes reporting tools, and clinical pathways.