When it comes to IPS, denial just won't work
When it comes to IPS, denial just won't work
Creative in spreading the BBA word
Denial, our friends in 12-step programs tell us, is not a river in Egypt. Neither is denial a safe approach for your staff to take when facing the consequences caused by the Balanced Budget Act of 1997.
Recognizing that her field staff have the most frequent contact with Lehigh Valley's patients, acting director Cynthia M. Runner-Heidt, RN, MSN, wanted to let her employees know not only what was happening to home care, but why. Through her conversations with directors of other hospital-based agencies, Heidt had become convinced that many home care and hospital administrators "had their heads in the sand" over the Balanced Budget Act's (BBA) consequences. Fearing that such denial could harm both staff and patients, she decided to act swiftly.
Enlisting the desktop publishing skills of administrative assistant Stephanie Mascavage, Heidt produced a clever memo in the form of four-page brochure, containing a glossary of all the terms relevant to the BBA. (See Lehigh Valley Home Care BBA memo, inserted in this issue.) "I wanted to do something different than just your standard, dull memo they would ignore," Heidt explains.
Memo got staff's attention
Her intent was to introduce staff to the problems facing home care today and tomorrow and to induce them to attend inservices on the Interim Payment System (IPS), OASIS, surety bonds and other pieces of the BBA puzzle.
Designed on standard letter-size paper, the brochure was printed on the office photocopier in two pages, assembled back-to-back and folded in half to a 5 X 8 inch brochure.
On the cover of the memo, a cartoon sets the tone. It is a picture of a woman reading a newspaper filled with headlines about all the changes in home care. "Maybe I missed something. . . but I thought home care was about taking care of people," she laments.
Inside, under the heading of "Home Health Vocabulary of the Future" are definitions of such terms as ORT (Operation Restore Trust); MSN (Medicare Summary Notice); Surety Bonds; OASIS; Part B Shift; IPS; Per Beneficiary Cap; Unduplicated Census; and MSA (Metropolitan Statistical Area code). The MSA caused considerable consternation among staff who didn't know Medicare pays more for visits in urban areas than in rural areas where most of Lehigh Valley's clients live, Heidt says.
"The staff was shocked about the MSA," she says. "They didn't understand the rural vs. urban issue. And I wanted them to know we are committed to our rural area."
Heidt, who still serves as director of patient care while filling the vacant director's position, supervises about 100 employees. The medium-sized, full-service home care operation, with nine offices serving most of eastern rural Pennsylvania, is part of Lehigh Valley Hospital and Health Network based in Allentown, PA, once a booming steel town.
Lehigh Valley Home Care already has felt the pinch of the BBA. It recently closed one of its branch offices because of Medicare reimbursement cuts, Heidt says, which means that some people lost their jobs, although Heidt declined to comment further.
So it was clearly in their best interest that employees and their supervisors, who will undergo more intense training in the months ahead, learn all they could about changes affecting their lives. The memo opened their eyes, Heidt says. "The staff's reaction was surprise. They knew there were changes coming, for example, OASIS, but they didn't realize how directly it will impact the RN staff.
"You wonder what your staff hear. Then they talk to other home care nurses and the story changes. I didn't want someone's personal interpretation of what was happening, so I sent the memo. The staff has gotten a lot of communication recently from our entire system about belt-tightening and being more cost efficient, but it doesn't hit home unless they see how hit affects their individual practice.
Staff received an eye-opening education
Enter the memo. It explains how OASIS, for example, will "increase the time needed to perform initial assessment, recertifications, and discharges," and informs staff that it will require specially trained RN's to do all admissions.
Other descriptions include the following:
· IPS. "Beginning July 1, 1998, a new Medicare reimbursement system is being introduced to home health which will dramatically reshape and reduce reimbursement to home health nationwide."
· Surety Bonds. "Insurance. It is a promise to be responsible for debt default or failure - a new cost of doing business."
· Per Beneficiary Cap. "Each agency will have a per beneficiary annual limit applied to the agency's unduplicated count of Medicare patients. . . . Home care's previous approach of maximizing visits (more visits, more money) is outdated and will jeopardize the 'balance.'"
A major concern among her staff was their long-term patients. "They asked 'what are we going to do with a particular patient, when we've taken care of her for years,'" Heidt says. "Then I talk about balancing between short-term patients and long-term patients."
Heidt predicts that RNs will have to become more "generalists" in practice because of lower reimbursement. "Do they really need to refer a patient to a therapist? Can the RN staff teach the family how to teach the patient to use a walker, for example. The RN role may be more multifaceted, the way it used to be," she says.
More family involvement was a solution thought up by staff, Heidt explains, when they are asked to find ways to work more efficiently.
Heidt believes her agency's mission, which includes hospice, will "serve us well under IPS, as part of the hospital's acute care continuum - it's easier. It's tougher for visiting nurse associations that are not part of a system. That's long-term care. Wenever identified ourselves as long-term. We're more used to having high-intensity, short-term cases."
IPS will affect the home care-hospice relationship, too, Heidt predicts. With fewer dollars available from Medicare, it will be to the home care agency's advantage to move patients who need it into hospice. The responsibility of explaining hospice's benefits to the home care patient and family will fall to the RN, Heidt explains.
Once the staff education is complete, Heidt will start on management. "We will get down to the real nitty-gritty," she says. "I'll be meeting with our business manager, then our clinical management team and discuss how we are going to manage it. We are developing a plan for managing IPS. We are seeking corporate suggestions; we have to be more attuned to things. We will look at our information system to see if changes need to be made."
Heidt says her management training program is still in the planning stages, "but we are going to look at all disciplines involved, our visit patterns, our recertifications, family participation in care, and decide what's necessary." She says that community agencies, such as the Area on Aging, will be called on to provide more services.
"We're all awaiting the revolution in home care," Heidt says. "But providers want to put it off, just like Congress [which doesn't want to overhaul Medicare.] Providers don't want to face it."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.