Archive for 'Did You Know?'

How Does Your HHA’s Patient Satisfaction Measure Up?

Posted on 04. Nov, 2009 by .


Can you guess the area where home care patients are least satisfied?

Home care aides are working overtime to improve quality and increase patient satisfaction — and their efforts are paying off.

A survey of more than 105,000 patients treated by nearly 900 agencies across the country found homecare patients’ are highly satisfied with the care they’re receiving, according to the 2009 Home Care Pulse Report: Patient Perspectives on American Health Care released on Oct. 9 by improvement solutions provider Press Ganey Associates.

The survey also found that:

  • Occupational therapists received the highest rates of patient satisfaction.
  • Satisfaction levels peak in the first few months of care.
  • Satisfaction levels bottom out after twelve months of care.
  • Medicaid and private pay patients were less satisfied than Medicare patients.
  • Patients are more satisfied if they receive care in the morning than they are in afternoon.

Downside: The report wasn’t all good news. Patients gave lower ratings for administrative procedures, the survey showed. These ratings could come back to haunt agencies, notes Press Ganey VP of home care Lisa Cone-Swartz.

Agencies must “focus on continuous improvement in light of proposed health care reform that may include home care and hospice in pay-for-performance, also known as value-based purchasing,” Cone-Swartz says.

© Home Care Week


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Why Some Advanced Dementia Patients Don’t Get Hospice Care

Posted on 27. Oct, 2009 by .


This step could ease pain among advanced dementia patients who are dying, researchers say.

Add advanced dementia patients to the long list of terminally-ill patients for whom the hospice benefit is underutilized, says a study recently published in the New England Journal of Medicine.

“Dementia is a leading cause of death in the UnitedStates but is underrecognized as a terminal illness,” researchers explain in their abstract. As a result, some advanced dementia patients suffer painful and “burdensome interventions” when a better choice is palliative care. ”People with advanced dementia are often given dialysis and put on ventilators; they may even get preventive care that cannot possibly help them, like colonoscopies and drugs forosteoporosis or high cholesterol,” explains Tara Parker Pope in The New York Times.

Why don’t some advanced dementia patients get the palliative and hospice care they need? “Patients with health care proxieswho have an understanding of the prognosis and clinical courseare likely to receive less aggressive care near the end of life,” concludes the NEJM abstract. That’s researcher-speak for: The more patients’ families understand that advanced dementia is a terminal disease, the more likely they are to choose hospice for their loved ones at the end of life.

The researchers followed 323 SNF residents with advanced dementia in 22 different nursing homes — and their families — for 18 months.

Available on CD or MP3: 5 ways to boost your hospice’s conversion rate.

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Researchers Find Connection Between Home Care Worker Needlestick Injuries & Stressful Working Conditions

Posted on 20. Oct, 2009 by .


Should OSHA, Joint Commission Regulate Home Health More?

Working with home care patients can be stressful, and the more stresses there are, the more risk for needlestick injuries among nurses, say researchers at Columbia University’s Mailman School of Public Health.


There are 10,000 needlestick injuries among home care nurses each each, about 7.6 per 100 nurses, reports a study published in the American Journal of Infection Control. The study involved 700 home care RNs in New York State.

Needlesticks are a concern because “they can result in infection with bloodborne pathogens, such as hepatitis and HIV,” said lead study author Robyn Gershon, DrPH.

Statistical Correlation to Note: Nurses reporting household stressors, such as cigarette smoke, unsanitary conditions, air pollution, and vermin, were nearly twice as likely to report needlestick injuries,” says a Columbia University release. “Most significant was the fact that home healthcare nurses exposed to violence in their patients’ households were nearly three and a half times more likely to also report needlestick injuries.” (Editor’s note: ‘Vermin?’ Yikes!)

“These results indicate that household hazards in general, and home care violence in particular, needs addressing,” said Dr. Gershon. Certain OSHA regs don’t apply in home care settings, but that there are certain infection control standards from the Joint Commission … [More]

Available on CD or MP3: 40 Wage-and-Hour Mistakes That Most Health Care Providers Make — And How You Can Avoid Them. With attorney John Gilliland.

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Here’s How To Reduce Walking-Aid-Related Patient Falls

Posted on 14. Oct, 2009 by .


Are you teaching patients to avoid this dangerous practice?

Making sure patients know how to use a walking aid can save them a trip to the emergency department once they go home. A new study published this summer in the Journal of the American Geriatric Society shows that the over-65 population has a frequent number of hospital admissions and injuries stemming from walking aid-related falls.

About one-third of the injured required hospitalization.

“An estimated 47,312 older adult falls injuries associated with walking aids were treated annually in U.S. emergency departments: 87.3 percent with walkers, 12.3 percent with canes, and 0.4 percent with both,” the study reports.

Help fall-proof elderly patients by properly fitting walking aids and teaching them how to use them. For example, “the walker or cane should be the height of your wrists when your arms are at their sides,” according to a tip sheet provided by the American Physical Therapy Association. Other tips: (more…)

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Home Health Coding Challenge: History of Pressure Ulcers

Posted on 07. Oct, 2009 by .


If you’re thinking V67.x, think again.

Question: Should we use V67.x (Follow-up examination following surgery) rather than a condition code for a healed stage 2 ulcer that we are following for observation due to newly healed status but are recertifying for observation? Should we use the follow-up code in lieu of the actual condition that now is resolved?

Answer: A V67.x code for following surgery would be inappropriate in this case, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principle of Selman-Holman & Associates in Denton, Texas.

Why: The patient did not have surgery for the stage 2 ulcer. The only code from that category that you might consider using is V67.09. That is a very non-specific code. You cannot code the stage 2 ulcer once it is resolved.

The next issue you have is whether the care you are providing (observation and assessment) would be covered, Selman-Holman says. Consider the span of time from healing to the end of the previous episode.

Is there a potential fluctuation in the patient’s condition? Has the patient had repeated skin integrity problemsor changes in caregivers that make you think that the patient is at increased risk of developing more ulcers? What other diagnoses does the patient have that indicate an increased risk for skin breakdown? Your answers to these questions must support the need for skilled care.

Code V13.3 (Personal history of diseases of skin and subcutaneous tissue) is the appropriate history code for a patient who has a history of ulcers.

© Home Health ICD-9 Alert.

Wound Care Coding Secrets for Home Health, an audio presented Tricia Twombly.

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Is Home Care the Best Option for 1 Million CHF Patients Per Year?

Posted on 30. Sep, 2009 by .


Here’s your scoop on a potential new patient pool?

New research is pointing to a viable home care alternative for a heart condition that lands 1 million Americans in the hospital each year, says a recent study published in the Archives of Internal Medicine.

Five million Americans have chronic heart failure, “a progressive and disabling syndrome,” according to the Archives study. Each year, the condition triggers 1 million hospital admissions, with a 50 percent risk of rehospitalization within 6 months after discharge. Until now, hospitals have been the place where these heart patients are treated, but such hospitalizations put them at risk for other nasty things such as treatment complications.

During the one-year study, Italian patients over 75 who had chronic heart failure were randomly assigned to be treated either in the hospital or a “physician-led hospital-at-home service.”

Mortality rates between the two groups were about equal, but the patients cared for at home fared better. “Only the Geriatric Home Hospitalization Service patients experienced improvements in depression, nutritional status, and quality-of-life scores,” the study authors write. The at-home patients also enjoyed longer periods before subsequent hospitalization, in comparison to the patients treated in the hospital the first time.


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A Rough & Tumble HHA Industry in the Lone Star State

Posted on 23. Sep, 2009 by .


Once again, there’s HHA trouble a-brewing in Texas. HEAT has focused much of its fraud-fighting efforts on Texas home care agencies and durable medical equipment suppliers, and a recent article in the Dallas Morning News targets home care fraud straight on.

Certainly, there are many honest providers in Texas, but the state has attracted some rough characters as well. There are several reasons for the high-dollar HHA fraud in Texas, suggests the Dallas Morning News, including:

  • “Texas has more home health agencies billing Medicare and more Medicare home health patients than any other state. It also ranks near the bottom in Medicare home health quality ratings and near the top in suspected waste and fraud,” the article reports.
  • Texas is one of 33 states that doesn’t require a certificate of need to open an HHA. (Since 1987, there hasn’t been a federal law requiring states to regulate the opening of new health care facilities by requiring such certs.)
  • There are some legitimate reasons that Texas needs more HHAs than other states. For example, it has more rural areas than other states, and home health often is the most practical health care delivery method in such settings. But even so, there is lots of home health fraud in Texas, industry experts acknowledge … More from the Dallas Morning News.

AUDIO: Medicaid fraud enforcement is on the rise for home care. Are you prepared? With attorney Bob Markette.

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Home Health Reimbursement: Heads Up On a New Supplies Edit

Posted on 16. Sep, 2009 by .


You may be erroneously upcoding your NRS payment.

Don’t use a fifth digit swap as an unofficial significant change in condition adjustment, or your claims will fall victim to the new supply edit.

CMS is putting a new claims edit into place starting Oct. 5 for prospective payment system episodes dated Jan. 1, 2008 or later, according to Transmittal No. 6393 (CR 1714). Under the edit, the Medicare claims system will allow home health agencies to change the fifth digit of the Health Insurance Prospective Payment System (HIPPS) code, which represents the NRS level, only from a number to its corresponding-NRS-level  letter or vice versa.

When PPS refinements instituting NRS payments took effect in January 2008, CMS lifted the requirement that the HIPPS code’s  fifth digit match on the request for anticipated payment (RAP) and final claim. That’s so agencies could record that they provided no supplies when they first said on the RAP they would, or vice versa.

NRS Confusion Can Look Like Fraud

Background: PPS pays agencies the same whether they actually furnish the supplies or not. The OASIS assessment sets the NRS payment level, then agencies indicate whether they furnished supplies with a series of letters (S-X) in the fifth position of the HIPPS code, or did not furnish supplies with a series of numbers (1-6). Rather than switching from an NRS number to its matching letter or vice versa, “it has come to CMS’ attention that, in some cases, home health agencies are instead inappropriately billing a different NRS severity level on the final claim,” the transmittal explains. The new edit will allow only fifth-digit switches in the same category. (more…)

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What Health Care Pollsters Don’t Know About Your HHA Patients

Posted on 09. Sep, 2009 by .


Caution: Next time you hear about a poll telling you what your elderly patients may think or feel, find out more about the survey sample before you draw your own conclusions.

Amidst all the kerfluffle about health care reform, we often hear about what the ‘elderly’ have told pollsters about Medicare reform, end-of-life issues, and more, writes Jane Gross in The New York Times.

The problem: Many surveys use old standards to define ‘old,’ and often lump all people over age 65 into the same big (and diverse) group. Differences between people in their 60s and 70s and folks in their 80s or 90s are huge, as anyone knows who works with this 40-odd year age span.

To complicate matters, it’s hard for pollsters to know what the ‘old-old’ think. Such 85-plus folks often live where pollsters don’t go or call, and some have communication or dementia issues, Gross points out.

“The contention that old people are worried about being deprived of all-but-limitless access to health care may not be supported by the oldest of the old, the ones who are suffering most from excessive intervention and the sometimes unwelcome care that is breaking the bank. At the very least, before we declare what they think, we owe it to them to ask,” Gross concludes. Read her full op ed piece here.

AUDIO: Make sense of all the noise about health care reform to chart a future for your HHA.

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Newt Stands Up For Home Care

Posted on 02. Sep, 2009 by .


Sometimes wisdom comes from unlikely places. Case in point: Newt Gingrich has some smart things to say about home care in an op ed piece published in The Atlanta Constitution this week.

The article points out what most home care providers already know — that much of the health care reform brewing in Washington proposes cuts to home care, the very thing that saves Medicare and other insurers lots of money they’d otherwise spend on costly hospitalizations. Don’t cut home care, Gingrich and co-author Nancy Desmond argue. Simply stop ”paying crooks, such as men earning maternity; pizza parlors being paid as HIV transfusion centers; and dead patients earning federal health care benefits.”

“We’re not talking about inadvertent billing errors here,” the article continues. “We’re talking about outright fraud going on in the Medicare and Medicaid systems that is not being addressed.”

What’s striking about the op ed piece is not what it says, but where it comes from, points out Home Health Law Blog, which alerted us to the editorial. Whatever you think of Newt (blogger Robert Markette admits he’s a fan), it’s striking that it’s not someone from the home care industry making these points. Rather, they’re coming from The Center for Health Transformation, a ‘think tank’ Gingrich founded, which receives support from companies inside and outside the health industry, according to Sourcewatch.

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