Categories: healthcare reform, home health, readmission rates, chronic care
Keeping patients away from avoidable, costly visits to the hospital is something everyone agrees is important. Yet as many as 20 percent of Medicare patients admitted to a hospital in 2009 were readmitted within 30 days. Health care providers are facing the challenge of finding a solution that works for patients and their families as well as hospitals and managed care providers.
HealthLeaders Magazine recently published Strategic Solutions for the Readmission Challenge, a report in which Amedisys and other health care leaders discuss how to decrease return visits to the hospital. Two of the keys they focused on was collaboration and education. Often, patients are sent home with instructions that require significant life changes. It’s clear that expecting them to manage their condition, medications and care plan with just a packet of information isn’t working. That’s why coordinating care during the transition from hospital to home is so important. It helps empower patients to be responsible for their health, while making it more likely that any behavioral and socioeconomic complications are addressed before they require another trip to the hospital. For example, in the Amedisys care transitions program, our care transition coordinators (CTCs) become the patient’s “touch point” for any issues between the time of discharge and the time when our nurse visits the patient’s home.
For patients, not returning to the hospital unnecessarily has obvious benefits. But, hospitals and managed care providers see a value too. Beginning this October, Medicare will penalize hospitals with high readmission rates for patients with heart failure, acute myocardial infarction or pneumonia. The HealthLeaders report includes several case studies from leading hospital systems that are using care transitions to keep their patients from coming back. One of the benefits to implementing a care transitions program is it doesn’t have to drastically change the way a hospital operates. Educating patients and their families, using technology such as telemedicine, and coordinating with home health, nursing homes and other post-acute providers to provide consistent education to patients and families can help both hospitals and their patients improve results.
The bottom line is that 10,000 baby boomers turn 65 every day - and 75 percent of them have multiple chronic conditions. If we don’t change the way we care for them, our health care system will not be able to meet their growing needs. But, if we commit to understanding the way people manage their health and provide community-based solutions that work with a patient’s needs to establish a plan of care, we can help seniors to live healthier, more independent lives.
Categories: chronic care, independence at home, primary care, caregiving
One of the most important relationship decisions you’ll ever make is selecting your primary care physician (PCP). Ideally, you’ll be involved with your PCP for a long time, so it’s important to find one who you trust.
PCPs are your home base for health care. You’ll see them for most of your non-emergency needs including preventive care, routine check-ups, and most illnesses. If you need a specialist for a condition or illness, PCPs will refer you to someone appropriate.
As important as they are, choosing a PCP takes a little bit of research. The first step is asking around. Ask your friends, neighbors and relatives who they see and if they are happy with their provider. You can also check with your insurance provider for directories that can help you make the right choice.
Once you’ve narrowed it down, schedule a preliminary meeting with your top choices to get a feel for care style. The Mayo Clinic recommends you choose a provider who:
- Makes you feel comfortable discussing health topics
- Answers your questions
- Communicates well, speaking in terms you can understand
- Doesn’t make you feel rushed
- Suggests ways to improve your health
- Recommends screenings and exams appropriate for your age and sex
- Treats common illnesses and injuries
- Involves you as a partner in your care—asks what you think, listens to your concerns and expects you to follow through with action when required
- Explains the options when you need treatment
- Offers referrals to highly qualified specialists when necessary
- Has a convenient location from your work or home
- Offers convenient hours and appointments without long waits
The information on this page is provided for informational purposes only; Amedisys does not endorse any particular provider. Please carefully evaluate whether any provider or supplier is able to meet your needs.
Categories: chronic care, home health, readmission rates, research, AHHCQI
Practicing medicine for 30 years as a family physician, I saw firsthand the difference quality health care at home can make in both outcomes and quality of life for someone who has chronic illness. That’s why it was no surprise to me when the latest study from the Alliance for Home Health Care Quality and Innovation showed that home health care is not only cost effective, but also helps prevent avoidable readmissions to the hospital.
The data from the Alliance stresses the importance of strongly coordinated care efforts between physicians and home health care providers. When patients are discharged from the hospital and receive home health care, they are likely to stay out of the hospital, helping the nation’s health care system run more effectively and more efficiently.
This study defines a “pathway” as the kind of care a patient receives. According to the findings:
- The average cost of the most common pathway (home health to community-based care) is $5,273
- The average cost of the 10 most common pathways is $9,096
- The average cost of all other non-post-acute care pathways is $32,617
Though home health has proven to be one of the most cost-effective pathways, payments for home health care, skilled nursing facilities, inpatient rehab facilities, and long-term care hospitals make up only 2.3 percent of all pre-acute care Medicare episode payments. Hospital and physician services make up 92 percent. With the findings showing the benefits of home health care in both quality of care and cost, there is a lot of opportunity for Amedisys and other home health care providers to become an even more important partner in a strong and effective health care system.
If you’re interested in reading more about the study, I recommend the working paper, Baseline Statistics of Patient Pathways, part of the Alliance’s Clinically Appropriate and Cost-Effective Placement (CACEP) Project. They are doing some great work toward determining how the Medicare home health benefit can improve the quality and efficiency of care for patients.
The next installment of the CACEP Project, discussing the future of the Medicare payment system, will be released in September. I look forward to sharing my thoughts here.
About the Author
Michael Fleming, MD, FAAFP is the Chief Medical Officer for Amedisys, and Past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors. He serves as an assistant clinical professor in the Department of Family Medicine at the LSU Health Science Center and in the Department of Family and Community Medicine at Tulane University Medical School.
Categories: home health, palliative care, patient goals of care, hospice, chronic care
Guest post by Dr. Bernard Hammes, director of the Gundersen Health System’s Respecting Choices and Medical Humanities Program
There is a movement afoot. We are transforming from an impulsive attempt to “cure at all costs” to one that is patient and family centered and focuses on informed choices and quality of life for those with advanced illness.
Patient and family-centered care for those with advanced illnesses are a necessity – our humanity and nation depend upon it.
Why force patients into weeks and sometimes months of acute-care hospitalizations when what they want is pain relief, symptom management and their loved ones around them – in the comfort of their own home?
Why continue with a “cure at all costs” philosophy, when respecting informed, patient treatment wishes ensures higher quality care and may save $25 billion in annual health-care costs for the nation’s health system?
These are the questions we explore in our book, Having Your Own Say… Working with some of the most prominent medical professionals in the U.S. and Australia, we explore innovative and proven models for patient centric end-of-life healthcare options.
Our goal in highlighting the various healthcare models in this book is to ensure that patients receive the treatment they desire for themselves based on truly informed decisions to avoid both over - or under - treatment. To me, it’s about giving patients the quality of end-of-life care as defined by each individual and, for their families, it’s about making sure their loved ones’ wishes are known and followed.
One colleague, Dr. Michael Fleming, chief medical officer for Amedisys, is another passionate advocate for patient-centered care. That’s why I asked him to author one of the chapters for Having Your Own Say…In chapter 10, he wrote about “Focusing on the Patient’s Needs and Desires: Care at Home.” He cited an AARP poll that tells us 89% of individuals age 50 years and older want to remain in their homes as they age, including receiving treatment there.
Health care at home allows clinicians to identify in-home safety hazards, medication discrepancies, and social challenges not always visible in a clinical setting. So, home is not only where people want to be, but the comforts of home have also been proven to promote healing, reduce health risks, and is more cost-effective to other post-acute care settings.
Dr. Fleming and I both adhere to the Institute of Medicine’s philosophy that all care should, “deliver the right care, for the right person, at the right time.” In order to achieve this goal, we must evolve.
Can we (the legacy health system) evolve to a patient-centered care model?
Will people with advanced illness become empowered and informed decision-makers regarding their care before it’s too late?
We’d love to hear your thoughts. Please email us with your comments to RespectingChoices@gundluth.org.
And may all of us have the support, courage and knowledge to see death as “…a continuation of life, and a friend to be prepared for,” as Joseph Cardinal Bernadin wrote in his memoir about facing death during his battle with cancer.
For more information about the book: http://www.havingyourownsay.org/
Dr. Bernard Hammes is the director of Medical Humanities and Respecting Choices® for Gundersen Health System headquartered in La Crosse, Wis. In this position, he provides educational programs for house staff, medical students, nursing students and physician assistant students. Dr. Hammes’ work has been primarily focused on improving care for patients with serious illness. He has developed institutional policies and practices, staff education and patient/community education with a special focus on advance care planning. This work has resulted in two nationally recognized programs on advance care planning: If I Only Knew... and Respecting Choices. He served as editor for the book Having Your Own Say: Getting the Right Care When It Matters Most.
Categories: healthcare reform, home health, PECOS, CMS
The Patient Protection and Affordable Care Act requires all physicians who order or refer Medicare-covered home health services and supplies to enroll in the CMS Provider Enrollment, Chain and Ownership System (PECOS). Physicians are required to enroll in PECOS by May 1, 2013, to order, refer, or receive payment for Medicare-covered home health services.
How to Enroll in PECOS
Get your National Plan and Provider Enumeration System (NPPES) user 10 and password. If you don't have a NPPES login, or need help changing your password, contact the NPI Enumerator at: 1.800.465.3203 or firstname.lastname@example.org.
Gather the necessary items for enrollment. Review the "Before You Enroll" checklist.
Complete and submit the enrollment application at: https://pecos.cms.hhs.gov.
Print, sign, and date the two-page Certification Statement. (Available at the end of the online application.)
Mail the signed Certification Statement, along with supporting documentation, to your designated Medicare contractor within seven days of the electronic submission.
Download the Guide
To help you navigate this CMS requirement, we’ve created 5 Steps to PECOS Enrollment, a one-page guide detailing:
- the steps to enrolling
- information to gather before enrolling
- where to contact for help with PECOS or Medicare enrollment