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Agencies share strategies for coping with PPS
Some agencies aren’t waiting to see what happens with supply costs under PPS. They’ve already taken steps to acquire new vendors and ensure greater oversight of supply use.
The goal: Keep overall costs down as much as possible, while still providing the best care. Sometimes, that doesn’t necessarily mean cheaper supplies.
In fact, says Jimmie Galbreath, RN, MSN, director of Home Health Group-Decatur (AL), his agency has often turned to more expensive wound care supplies that can save the agency in the long run by requiring fewer visits to change dressings.
"It’s cheaper for the agency to use a more expensive supply and go less frequently than it is to go daily and use a less-expensive supply," Galbreath says. "Before, it was normal saline, [gauze], and tape, and you’d do it daily. Well, that’s OK; but if you use Duoderm and it’s changed twice a week, is it as effective — or even more effective? It just depends on the wound."
Home Health Group also shopped around for a cheaper vendor before PPS was implemented.
At the Visiting Nurse Association of Boston, a system was instituted to give more oversight to supply orders. H. Kenneth McNulty, vice president of finance, says a supply committee of clinicians created a new formulary for the agency, showing supplies that should be used for different types of cases. The list was distributed to district offices.
On each clinical team, one person was given responsibility for ordering all supplies. A nurse now submits an order to the district office, where it’s reviewed to make sure it’s appropriate for the diagnosis and the quantities needed are correct.
Total supply costs for each patient also are reviewed, and a unit supervisor must sign off on any order that exceeds a certain amount. McNulty says that while some patients will inevitably exceed that amount, the overall average should stay within a certain range.
"It’s perfectly acceptable for the cost to be more than [the limit]; if in fact, the clinical diagnosis required those supplies," he says. "But you’ve got to justify that."
Doesn’t this create more paperwork for the staff? "It is a pain," McNulty says. "And it’s tough on the folks in the unit. But once they get used it to it, it just becomes one more thing in their day and they just do it.
"It’s also true that the nurses knew they could have been doing a better job reducing costs without a whole lot of effort."
Galbreath says that Home Health Group is now considering a new arrangement for delivering supplies — contracting with a supplier that can deliver them directly to patients. This saves clinicians time spent delivering supplies themselves, an important step when the goal is to improve efficiency.
Combined with a proposal to issue nurses laptop computers, it could mean much less time spent in the office and more time spent with patients.
"We want staff under PPS to be delivering care and providing care," Galbreath says. "We don’t want staff to be coming in and out of the office to get what they need in order to provide the service to the community. We’re paid by the services we deliver, not what it costs us to operate."
He says direct delivery of supplies wouldn’t be appropriate for all patients, including some who live in high-crime areas or those whose home environments can’t support hygienic storage.