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Technology has made commonplace what seemed impossible only 10 years ago, and while we now take it for granted that someone can make an overseas phone call while standing in the middle of an isolated field in Nebraska, you should not take for granted the rules and policies your agency decides to implement in regards to technology.
Like mall-bound teenagers whose pagers and wireless phones allow parents to keep track of their whereabouts, home health care professionals can benefit from a bit of techno-savvy.
In both instances, safety is a chief concern. As a matter of course, health care professionals can find themselves facing emergency situations involving their patients, themselves, or both. Keeping in mind that Medicare does not currently reimburse agencies for cell phone expenses, how can a home care agency justify their usage and expense, and just as importantly, should they?
That was the question posed by Chris Scofield, RN, vice president of operations for VNS & Hospice of West Michigan in Grand Rapids, whose agency is looking into the possibility of purchasing cell phones for its clinical staff.
Her question went beyond the simple matter of whether to provide staff with them, and extended into the issue of "whether we should discontinue pagers for the staff; whether we should purchase [phones] or have the staff purchase them; and what specific policies were involved with monthly service fees, limiting the number of calls an employee makes, and so on."
Clearly, the first issue that must be tackled is whether to implement the use of wireless phones at all, no matter who purchases them or how they are reimbursed. Certainly, there are some clear benefits and strong rationales to providing home care staff with phones.
Efficiency is one reason behind the push for wireless phones in the home care environment. "We have cells with voice mail for all staff, including home health aides. [Staff] then retrieve many of their doctors’ orders and such directly without needing to go through the supervisors in the office," says Kathy Kieke, RN, MSN, care center director at St. Cloud (MN) Hospital Home Care and Hospice.
But even such expediency doesn’t preclude some basic cell phone etiquette, she notes. "We expect [home health aides] to leave them turned off during patient care unless expecting phone calls related to that patient."
As Kim Stout, RN, BSN, home health director at McAlester (OK) Regional Health Center Home Health notes, "I like the fact that [home care staff] have access to a phone in all situations, for example, if they have car trouble or are facing an unsafe home environment."
Another serious point to consider, especially for those home care agencies servicing low-income patients, is made by Stephanie Mello-Gaskell, MS, RN, vice president of clinical services at VNA of Southeastern Massachusetts in Fall River, who says her staff have faced instances where "we have a patient who doesn’t have a phone or won’t allow the employee use of his or her home phone. In those cases, we have to use the cell phone."
Employee safety aside, the issue of Medicare reimbursement — or lack thereof — cannot be overlooked. No matter how you slice it, cellular and digital phones cost money.
Even so, Bobby E. Dusek, CPA, a home care consultant in Abilene, TX, contends that the real issue involved in the phone debate is not reimbursement-related but "whether the agency should provide cell phones, pay for staff members’ business use of their own cell phones, or only use pagers. The answer to these questions will vary from agency to agency, and there is no right answer," he says.
"Our industry has become so conditioned to thinking about Medicare allowability that we have forgotten how a regular business works. In the case of cell phones, you should be thinking about whether the cost is justified by additional staff productivity or safety, not just whether Medicare will reimburse for the cost. Under PPS [the prospective payment system], you receive revenue Medicare payments based on services that you provide patients, not the cost of providing those services."
However, Dusek still reminds those agencies thinking of going wireless that "the cost of providing phones will come out of agency profits, so there has to be a firm benefit to providing the phones. And yes, nonprofits also have to think about profits even though we may refer to them as excess of revenues over expenses.’ Any agency that continually operates at a loss will ultimately fail."
For those agencies who do opt to go wireless, there is of course, the matter of reimbursement. This can mean either the employee or the agency is getting paid, but whomever it is, the policy needs to be made clear from the start.
Mello-Gaskell, for example, says her agency has helped limit cell phone expenses through the use of "limited reimbursement from the agency to the employee." As she explains, "We have not set a maximum level of reimbursement because our thinking was that doing so would provide an incentive to employees to use the phone as long as they didn’t go over the max."
Has the policy worked? Well, says Mello-Gaskell, "we have about 80 regular employees and reimburse around five to six staff members a month."
Stout’s agency has taken still another approach to keeping phone usage in line: "A policy was written regarding appropriate usage — for business use only — and care and cleaning. If personal calls are made or received, the employee is then responsible for reimbursing the agency. I, as director for the unit, receive the bill for each phone and review it for appropriate usage, then approve the bill for payment."
St. Cloud Hospital Home Care is even saving a little bit of money thanks to its use of wireless phones. "They’ve been working well for us and cost about the same as we were paying for beepers; less, really, when you add in the cost of the calling cards the staff all had," notes Kieke.
As many people know, wireless phone companies and service providers are in a stiff competition for your business. Every ad seems to promise more minutes and a lower fare than the next guy’s, and in some cases, people have cancelled their home service and moved all their calls to their cell phones because it’s cheaper.
Considering some plans allow 1,500 minutes for around $40 a month, how can you make sure your agency isn’t paying for a host of personal calls as well?
David Chilcote II, ACSW, administrative director of Naples, FL-based Community Home Services Inc., says that he is familiar with that and explains his agency’s reimbursement policy.
"Personal cell phones can be used for business, and we will reimburse the associate up to their full month’s service charges for all business-related calls, but we do not exceed the total bill due in reimbursement," he notes, and adds that "some employees have plans that give them tons of free minutes. With plans like those, business calls can be priced out’ and actually be more than the total month’s charges.
"Some of my staff feel it is too much of a hassle to mark and turn in their phone bill for reimbursement, although we encourage them to do so. Some use their cell phones as a tax advantage at the end of the year and never turn in their bills to the agency for reimbursement," Chilcote says.
Despite the rush to go cellular, there are still some agencies for which phones aren’t the only or even the best answer. As Stout notes, "Our agency provides cell phones to all home care staff making visits. They seem to work much better than beepers; however, there are instances in our rural part of the world when they are out of range."
Chilcote’s agency, while it does reimburse staff for business use of their personal phones, furnishes alphanumeric pagers rather than phones, "although [phones] might be an excellent means of attracting and retaining nursing staff, who are quite in demand, as we all know."
Alphanumeric pagers allow staff to check in with the agency office, as well as receive messages and, as an added bonus, pagers may be less susceptible to outside interference.
Mello-Gaskell says she has experienced firsthand one of the risks posed by using cell phones. "We have had experiences where conversations about patients or with patients have been clearly overheard. For example, a nurse was in an elderly high-rise and had a conversation with a doctor about the patient she was visiting, and for some reason, people on cordless phones in the same building were able to hear the details of the conversation.
"We found out this had happened when the nurse left the apartment and the neighbor was waiting in the elevator and told the nurse. We have had scenarios like this occur a couple of times," Mello-Gaskell adds.
"We remind staff frequently about limiting the use of cell phones for communication of patient information. However, if it is an absolute must, [staff] are to be aware of the information they are providing, i.e., diagnosis information. We have never really gotten away from pagers," she says.
"What we did do was upgrade to alpha pager so that a message can be typed in. We continue to use alpha pagers for most of the communication with field staff," Mello-Gaskell explains. "Often a nurse manager will leave a message in the nurse’s voice mailbox and then have the staff paged to the mailbox for the message."
[For more information, contact:
• David Chilcote II, ACSW, Administrative Director, Community Home Services, Inc., 851 Fifth Ave. N., Suite 301, Naples, FL 34102. Telephone: (941) 403-6430.
• Bobby E. Dusek, CPA, President, Bobby E. Dusek CPA, 4400 Buffalo Gap Road, Suite 5900, Abilene, TX 79606. Telephone: (915) 691-5656.
• Stephanie Mello-Gaskell, MS, RN, Vice President of Clinical Services, VNA of Southeastern Massachusetts, 502 Bedford St., Fall River, MA 02720. Telephone: (508) 676-8251.
• Kathy Kieke, RN, MSN, Care Center Director, St. Cloud Hospital Home Care and Hospice, 48 29th Ave. N., Suite 15, St. Cloud, MN 56303. Telephone: (320) 240-3265.
• Chris Scofield, RN, Vice President of Operations, VNS & Hospice of West Michigan, 1401 Cedar Drive N.E., Grand Rapids, MI 49503. Telephone: (616) 774-2702.
• Kim Stout, RN, BSN, Home Health Director, McAlester Regional Health Center Home Health, 1 Clark Bass Blvd., McAlester, OK 74501. Telephone: (918) 421-8019.]