Increasing Awareness

Home care is an integral part of our nation’s health care system. The Medicare Payment Advisory Commission, or MedPAC, the independent federal body established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program reported that:

• In 2004, 99% of all Medicare beneficiaries lived in an area that was served by at least one home health agency, while 97% of beneficiaries lived in an area that was served by more than one agency; most beneficiaries, thus, had a choice among providers.
• Nearly 90% of the beneficiaries who responded to the Consumer Assessment of Health Plans Survey (CAHPS) about their home health experiences in 2003 reported that they had little or no difficulty accessing home health services when they sought them.

So in essence, people have access to home care services, they have a choice among providers, and consumers are happy with their home health experience. The range of those interested in home care is vast. While these stakeholders may have similar interests, they are not always the same, for example:

Why Technology is Important

Increased pressures on home care and hospice staff are forcing changes in work and practice patterns for many caregivers. The ever-increasing pressures of improving efficiencies, reducing costs, and meeting stricter legal and regulatory requirements while simultaneously providing high quality, evidenced- and performance-based care are challenging our caregivers to rely on technology to achieve these goals.

The technology most conducive to home care falls into four major categories: Point of Care, Office Automation, Telehealth and Telephony.

Point of Care Solutions

Technology, such as laptops, tablets, personal digital assistants (PDAs) or other web-based portals used while the caregiver is seeing a patient, increases efficiencies and increases data accuracy.

• Improves efficiency of clinical processes by making it easier to access and communicate vital information.
• Provides real time information maximizing the caregiver’s time and reducing the need for lab tests by centralizing medical records.
• Enhances patient outcomes by using electronic protocols for assessments, certification, diagnoses, orders, medications, allergies and advanced directives.
• Allows caregivers to capture information in real time improving the accuracy of the information for electronic validation of OASIS assessments and eliminates data re-entry.
• Allows caregivers to spend more time with patients and less time documenting the visit afterwards.
• Allows staff to make corrections to medical and billing records, upload that data from a home computer, and reduce the cycle time for billing.
• Improves coordination of care and communication between all disciplines for a more cohesive treatment plan and improved patient outcomes.
• Enhances consistency and compliance by providing easy access to follow-up notes, incomplete documents, schedules and medication profile.
• Increases accuracy by automatically calculating Low Utilization Payment Adjustments (LUPA), Partial Episode Payments (PEP) and outliers.

Office Automation or Back Office Solutions

Back Office software for home care agencies tracks and manages information beginning with the client intake process to workforce management and back office accounting.

Benefits of Office Automation

• Improves efficiency of scheduling of staff and clients by using intelligent scheduling support.
• Matches staff with clients based on client preferences, staff availability, geographic location, skills required, previous schedule history, and profitability.
• Improves human resources management by automating certification and overtime tracking, which eliminates scheduling workers with expired licenses; alerts staff and management regarding overtime and double-booking at the point of scheduling.
• Improves general and administrative management through better reporting and financial management, e.g., verifies schedules, automatically generates private pay invoices, and assesses and calculates claims.
• Automates the documentation of OASIS data and provide validation prior to submission.
• Manages clinical information quickly and easily.
• Streamlines physician order tracking process by confirming orders are signed and received by the agency prior to billing and allows physicians to electronically sign their orders, thus, decreasing the billing cycle time.
• Enables agencies to designate trained case managers to manage care for certain diagnoses; streamlining patient care activities helps maintain a consistent quality of care, while simultaneously managing costs.
• Tracks patient care so that adverse events are quickly communicated to the entire care team.

Telehealth

Telehealth technologies include two-way video conferencing, which is particularly useful for consultations, remote vital sign collection and transmission and education in the home. Telehealth allows agencies to provide health care more effectively to meet the patient’s needs, while more effectively using staff to deliver that care.

Benefits of Telehealth

• Documenting vital signs and symptoms from the home without the intervention of a clinician, empowers patients to better controls contributing factors which can exacerbate their health conditions, such as diet, exercise, alcohol, insulin and medication use, and stress levels, translating into higher patient satisfaction.
• Using two-way interactive video improves communications between patients and caregivers, giving the caregivers and patients data in real-time, thus, enhancing the overall diagnosis.
• Monitoring patients remotely improves patient care by collecting vital patient information on a daily basis from the patient’s home without the need for a clinician or caregiver to be present, thus eliminating gaps in patient monitoring.

Studies show that implementation of a telehealth system can dramatically improve the overall health and outcomes of patients using the system.
In a telehealth study of the Veterans Administration (VA), the Community Care Coordination Service deployed telehealth to 791 high-risk, elderly veterans with hypertension, heart failure, diabetes, or chronic obstructive pulmonary disease (COPD) – five of the most costly conditions.

After one year, the VA found:

• 40% reduction in emergency room visits,
• 63% reduction in hospital admissions,
• 64% reduction in nursing home visits, and
• Significant improvement in patients’ perception of quality of life.

See “Virtually healthy: Chronic disease management in the home.” Meyer, Kobb, & Ryan. (2004).

“‘The study showed that home telehealth makes health care more effective because it improves patients´ access to care and is easy to use,' said Secretary of Veterans Affairs Dr. James B. Peake. ‘A real plus is that this approach to care can be sustained because it's so cost-effective and more veteran-centric. Patients in rural areas are increasingly finding that telehealth improves their access to health care and promotes their ongoing relationship with our health care system.' “The study found a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations for patients using home telehealth. The data also show that for some patients the cost of telehealth services in their homes averaged $1,600 a year - much lower than in-home clinician care costs. “The authors of the study in the current issue (2009) of the journal Telemedicine and e-Health are VA national telehealth staff members. The study looked at health outcomes from 17,025 VA home telehealth patients.” http://www1.va.gov/opa/pressrel/docs/telehealth.doc Telephony Solutions

Telephonic IVR (Interactive Voice Response), or telephony, electronically captures and processes information, such as timecards entered daily via the telephone and automatic schedule verification, streamlining billing and payroll processes, and helps to manage the tasks of a mobile workforce.

Benefits of Telephony

Telephony technology improves communications via a voice messaging system through specialized dissemination to a category of caregivers or broadcast to the entire workforce.

• Reduces the potential for fraud and abuse by automatically verifying the location of where the call originated and automatically reporting discrepancies, and improving an agencies’ ability to manage by exception.
• Collects activity codes, supplies, and/or mileage helping to ensure that information is accurately captured.
• Reduces the overall cost of services by minimizing the staff required to edit and process timecards, billing and payroll information.
• Eliminates paper time cards and ensures accuracy of payroll information.
• Improves scheduling and manages no-shows and cancellations in real-time.