“Value-based purchasing is coming and and we need to reinvent how we do private duty,” says Guy Tommasi, a successful home care owner and industry expert.
Value-based purchasing is increasingly becoming the new normal in health care, and private duty agencies need to demonstrate their own value in order to remain relevant to referral sources.
LIFETIME Care at Home in Guilford, Conn., grew its revenue by 5% in one year by earning a seat at the value-based purchasing table. “Value-based purchasing is coming and we need to reinvent how we do private duty,” says Guy Tommasi, Jr., executive director for LIFETIME Care at Home.
Hospitals, physicians and some Medicare-certified home health agencies compete in value-based purchasing programs. Under value-based models, providers are paid based on patient outcomes and quality of care. For instance, top-performing home health agencies in the value-based purchasing pilot receive bonus payments, while agencies that perform poorly receive payment penalties.
While value-based purchasing doesn’t directly impact how private duty agencies are reimbursed, agencies need to pay attention to how it drives potential provider partners and referral sources.
“If we want to be part of the whole post-acute care world we need to be like them, not the other way around,” Tommasi says.
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Track client hospitalizations
Hospital readmission rates are among the things providers are measured by under value-based purchasing. And some settings are measured on whether or not a patient is hospitalized within 30 days of discharge.
In the area of preventing hospital readmissions, private duty agencies are well positioned to join the ranks of supportive partners.
“One key driver behind the hospital readmission revolving door is a lack of coordination of care after discharge,” Tommasi says.
Private duty agencies help clients stay out of the hospital but providing in-home support for clients who are fall risks, have trouble with taking medications, have difficulty ambulating or need transportation to doctor appointments. And it makes sense for private duty agencies to work together with other providers to keep clients safe and out of the hospital.
“What’s great about [private duty] is that we are the lowest cost setting that can, possibly, have the highest impact,” says Mary Alice Mirek, home care director and senior manager of Well Care Home Care in Wilmington, N.C.
But it’s not enough to simply believe this is the case. Agencies must be able to support the claim.
“Value has to be supported by data. Data tells the story. Meaningful data sells the story,” Tommasi says.
With this aim in mind, Tommasi created a tool for his agency’s caregivers to use when assessing clients. Responses are collected and tracked in the office.
Based on information collected with the tool, LIFETIME Care at Home is able to provide data that shows an 11% hospital readmission rate for its clients.
While there is no existing benchmark for private duty agencies’ hospitalization rates, Medicare-skilled home health agencies nationwide had a 30-day rehospitalization rate of 15.8%, according to the January 2019 refresh of Home Health Compare.
The agency makes the case to hospitals, doctors’ offices and home health agencies that LIFETIME Care at Home can help providers protect their payment based on a proven track record of keeping patients out of the hospital.
Develop a system for tracking. This can be done manually with Excel spreadsheets. These spreadsheets should at least include when the client was admitted to care and when the client was discharged and why. Note if the client improved and no longer needed care or if the client went back to the hospital, and keep careful account of that percentage. Some agencies may track this information within their scheduling software. This approach is particularly helpful if the software allows for specific, user definable fields to document and track if/when a client returns to the hospital.
Assess clients for hospitalization risk. Well Care Home Care uses the LACE tool to assess the risk for rehospitalization. The LACE tool evaluates the length of stay in the hospital, acuity of the admission, comorbidities and emergency department visits. “If [the patient] scored high, they are high risk for hitting the hospital again. Our goal is to prevent that readmission,” Mirek says. If the tool indicates a client is high risk, put strategies or interventions in place to do what you can to keep that client from returning to the hospital. You could do additional wellness checks, facilitate doctor’s appointments or make medication reminders a priority.
Demonstrate value through additional outcomes. The LIFETIME Care at Home tool also tracks client satisfaction, care team satisfaction and the level of assistance the client requires. The agency uses the tool at the beginning of care and again during 30-, 60- and 90-day reviews. This allows the agency to demonstrate how the client improved in areas such as the ability to dress and prepare meals, as well as rehospitalization rates.
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Consider tracking common diagnoses. Keeping track of clients with diagnoses that commonly lead to rehospitalization can add another layer of useful data for agencies looking to demonstrate valuable outcomes.
Under the hospital readmission reduction program, hospitals with readmission rates above the national average are penalized by a reduction in payments. Tracking the same conditions — heart attack and heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), elective hip or knee replacement, and coronary artery bypass graft (CABG) — can make the data more valuable to hospitals.
Agencies should track how many clients with these diagnoses are readmitted within 30 days in order to provide more valuable outcomes data to hospital referral sources.
Use the same language as the referral source. While you don’t need to take a deep dive into the rules and terminology relevant to each provider setting, it does make sense to get a general overview, Tommasi says.
He recommends learning the meaning of terms such as the OASIS, triple aim, MACRA, PDGM, HHCAHPS, MedPAC, star ratings, downside risk, ADL and IADL. A basic understanding of concepts helps demonstrate your agency is paying attention to the same things as its potential partners.
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