Hospitals penalized for excessive readmissions - 2,597
2017 Medicare payment penalties - $528 million dollars (yes, that's a half a billion dollars)
Number of hospital discharges with an adverse event within 30 days of discharge - 1 in 5
If your agency exists within the private duty industry, you may have taken only a passing interest, or worse yet, a hands off approach to readmission reduction. Half a billion dollars (and counting) says you need to rethink that position. Skilled home health can only do so much. With an average of 3 visits per week (all disciplines) with maybe an hour per visit...that totals 3 of the 168 hours that exist in a 7 day week. That leaves 165 hours where a patient might be unattended, have an exacerbation, or fall off of their plan of care.
Private duty can (and should) be the solution to many of these problems. While it would be ideal if a caregiver could be in every home all day and night, of an unattended patient, that's usually not necessary. Simply having someone spend a few hours to attend to personal needs, do med reminders, and make sure the environment is safe can go a long way toward helping the 1 in 5 that might wind up back in the ER...or in a full hospital readmission.
Sure, patients have to pay privately for private duty (or have LTC insurance, or some other state, community, or VA program to pay for it)...but with the stakes so high, don't you believe that may families would?
If so, why is the hospital referral rate to private duty so abysmally low?
We call it "Referral Apathy". That is, the discharge planner refers all of the "must have" services that are generally covered by insurance and leaves the private pay "up to the patient". Without professional guidance and prompting (in the form of a bona fide referral) most patients are not going to willingly open their checkbook to hire a caregiver. That fault then lies with the discharge planner....but heck, it's my fault (and yours too). We didn't make them see the importance of making all necessary referrals....so we are as much to blame as they are.
Private duty agencies should be seeking high level meetings within health plans and hospital systems. You should be tracking your own readmission rates and use those to show your competency in helping your local hospital avoid a slice of the half billion dollar pie. Simply calling directly on the case managers won't likely change much.....this is a conversation that happens much higher up the food chain. If you meet with indifference at one C suite, seek out another one. Keep working until you find the ear that understands the value of true, professional referrals made to at risk patients during discharge. If nothing else, it's an insurance policy for the hospital that they clearly instructed the patient in their needs. You might (and some have) found systems and health plans that are willing to pay for such care because the cost of providing it is less than the penalty of not.
Hey...home healthcare agencies...you need to be in on this too. It's crystal clear to me that your nurses and therapists have a unique insight into your patient's home lives. It's also clear that most home healthcare agencies also under refer to private duty when they see a need (including agencies that have their own PD division!). You'll need to train (and retrain) your clinical staff on the appropriateness of making these referrals. You'll need to build a network of PD providers that show and prove low readmit rates, and you'll need to to reinforce to your entire staff that every appropriate referral needs to be made....whether we believe the patient can afford the care or not.
The healthcare world is changing around us.....by the day....heck, by the minute. ACOs and post acute bundled payment providers are coming to snatch up as many lives and dollars as they can. Only the strongest agencies will thrive and survive in this new era of outcome based reimbursement. If you're not one of them, become one of them. If you are one, it's time to take your sales efforts up a notch to position yourself as the go to provider in your service area.
Some will win, many will lose.....it's time to get on the winning side.....for the betterment and benefit of those many, many patients in need. No one wants to go back to the hospital after discharge.....let's make sure that they don't have to.