Case study shows impact of Medicare cuts
Case study shows impact of Medicare cuts
Greater Medford (MA) Visiting Nursing Association used a recent case study in an inservice on home care finances to demonstrate how the agency’s focus has shifted toward reducing utilization.
One of the agency’s goals in the following case was to keep the patient out of the hospital. "He had frequent hospitalizations for congestive heart failure [CHF] previously, and the plan of care has helped to keep him out of the hospital for a year and a half," says Lisa L. O’Loughlin, BS, RN, executive director of Greater Medford VNA.
The case study is as follows:
An 84-year-old male is diagnosed with CHF and multiple sclerosis. He is receiving the following services:
• nursing one to two times per week for cardiopulmonary assessment for early signs and symptoms of CHF;
• physical therapy one to two times per week for exercise program;
• a home health aide visits seven times per week for transfers with a Hoyer lift. The family is able to transfer the patient back in the afternoon.
With the above plan, the agency would exceed its cap under Medicare’s interim payment system in about 10 weeks.
The plan of care was reviewed during a case conference. After the review, a family meeting was held. The family agreed to transfer the patient in the morning and afternoon on the weekends, therefore decreasing the home health aide visits to five days per week.
A physical therapist taught the home health aide the exercise plan and will supervise the plan every two weeks, therefore decreasing the physical therapist’s visits to every two weeks. Nursing decreased to one time per week for cardiopulmonary assessment.
This revised plan of care extended the cap over a longer period of time with the hope that the year-end aggregate would balance expected losses on this patient. The plan of care also decreased the patient’s risk of hospital admission, which would have increased health care costs.
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