CNO demonstration extended for one year
CNO demonstration extended for one year
Nurses praise home health application
News that the Health Care Financing Admini stration (HCFA) extended the Community Nursing Organization (CNO) demonstration another year delighted directors at the four test sites, who are convinced of the project’s positive impact on patients.
Originally scheduled to end Dec. 31, 1996, the project was continued until Dec. 31, 1997, so more outcomes data could be collected.
"All the sites are pleased about the extension," says CNO on-site director Ruth Mitchell, RN, MS, of the Visiting Nurse Service of New York (VNS-NY). "We feel as though it’s a valuable model. Although we don’t have the hard data yet, anecdotally we know we’ve made a huge difference in people’s lives." (See related story, p. 21.)
Other test sites are Carle Clinic Associates of Mahomet, IL, one of the largest multispecialty physician group practices in the United States; Carondelet Health Care of Tuscon, AZ, a group of three hospitals, a family center, and 17 community health centers; and Living at Home/ Block Nurse Program, a grass-roots volunteer network in Minnesota that assists communities in providing local nursing support for the elderly.
"Each site is different with its implementation," says Mitchell, who heads the CNO project’s only home care test site, "but one thing we all have in common is a core [competency] of nursing care. Our enrollees can access nursing care."
Future looks promising
Access is important, says Mitchell, because "you don’t get a nurse under Medicare unless you’re in the hospital. Under Medicare home health [provisions] you lose nursing services when you get better. Under the CNO, you don’t lose it. Patients can access nurses, and nurses can come to them."
Mitchell is excited about the future of home care nursing under the CNO model. She hopes it will make "community-based nursing more accessible to the Medicare population, and that Medicare will look more carefully at what nursing has to offer."
Home health organizations like VNS-NY derive benefits from the CNO model they otherwise would not have under regular Medicare. Mitchell says the CNO "focus is on a need for nursing as opposed to focusing on homebound status. Not needing a 485 streamlines things. It’s simply a process of setting up home health care."
Getting away from cookie-cutter approach’
Without the 485, says Mitchell, "we’re not hassling the doctors, and we’re decreasing tracking expenses. We can individualize home health care, rather than use a cookie-cutter approach. Care can be short and intensive or more protracted and less intensive."
The CNO demonstration began operating in 1994 to test the operational feasibility of the CNO, and to examine whether capitation and nurse case management would promote appropriate use of nursing and ambulatory care services in the community while reducing the use of more costly acute care services. HCFA provides payments to CNOs on a prepaid, capitated basis for enrollees.
Using nurses as case managers, with each assigned to a group of CNO enrollees, the program emphasizes risk-level appraisals, prevention, health habit promotion, education, and coordination of treatments and therapy. Nurses supervise all care provided through the CNOs, as well as monitoring and assessing outcomes.
CNO lets nurses focus on patient needs
Another CNO advantage, says Mitchell, "is managing under capitation lets nurses do what nurses do well focus on services and the patient’s needs."
The extension was needed to enable CNO sites to enroll more patients and track outcomes, says Melissa Hulbert, HCFA research analyst. HCFA’s goal was to enroll 7,000 patients the first year. But when the interim report was published after the first 15 months, the CNOs only had enrolled about 4,900 people.
"With a capitated model you have to have a certain population enrollment," Hulbert says. "The CNO has a lot of preventive aspects, and it takes longer to get results. These are not quick outcomes."
CNO sites provide a service package that includes the following mandatory benefits:
• part-time or intermittent nursing care furnished by or under the supervision of registered professional nurses;
• physical, occupational, or speech therapy;
• social and related services supportive of a plan of ambulatory care;
• part-time or intermittent services of a home health aide;
• medical supplies (other than drugs or biologicals) and durable medical equipment while under a plan of care;
• medical and other health services authorized in paragraphs (2)(H)(ii) and (5) through (9) of section 1861 of the Social Security Act;
• rural health clinic services as described in section 1861(a)(1)(C) of the Social Security Act;
• certain section 1915(c)(4)(B) services.
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