Home health agencies can help hospitals reduce readmissions and control overall healthcare costs, according to a new study by the University of Pennsylvania School of Nursing, but how effective these agencies are in meeting such goals largely depends on the quality of organizational support given to healthcare field workers.
Frequently, home care nurses are so overburdened with non-care responsibilities that they are unable to provide patients and their families with the level of healthcare services they need, said Olga Jarrin, a registered nurse and lead author of the report, “Home Health Agency Work Environments and Hospitalizations,” was published in the October issue of the scientific journal Medical Care.
And the reduced reimbursement from Medicare only adds to the burden of home health agencies, the report noted. The home health industry continues to absorb Medicare payment cuts of 14 percent from 2014 through 2017 (3.5 percent for each year). The Center for Medicare & Medicaid (CMS) estimates the cuts will leave 40 percent of home health providers operating in the red by 2017. Reduced reimbursment puts pressure on agencies' budgets, which may limit them from hiring enough staff to keep employees from being overworked, for example, the report said.
“These kinds of blunt, across-the-board cuts make it harder for high-performing home health agencies to continue their success,” said Steven Landers, MD, president and CEO of the Visiting Nurses Association Health Group.
Being aware of the work environment pressures home health agencies may be under and how those pressures may impact their ability to be an effective partner will help hospitals determine which agencies to work with.
To be an effective partner with hospitals, home health agencies should focus first and foremost on getting the basics right, Landers said. For example, not letting medication issues fall through the cracks when patients transition from a hospital to home. “Confusion, omissions and errors around medicine care are responsible for a lot of readmissions,” he said.
Medication management is especially crucial in a home care situation because most patients are elderly. “They may have 10 or 15 medicines to take, and sometimes there are memory issues,” Landers said.
Home health service providers also can help control costs around readmissions and long-term institutional care by ensuring patients get appropriate medical follow-up, Landers added.
“It’s not uncommon for someone to go into a hospital and be seen by multiple physicians and have a number of outstanding medical issues when they leave the hospital requiring physician follow-up,” he said. “We view our job in home health as playing a care coordination role, making sure those appointments and follow-ups happen.”
To play an effective care coordination role and hold down healthcare costs, interoperability of electronic health information systems is critical, said Jarrin.
“This includes tracking of patients and communication attempts to ensure follow-up appointments are made and kept, that all providers are aware of hospitalization and discharge, and that medication issues are reconciled,” she said. Through electronic health information systems, the home health agency and its partnered hospitals can track patients, including their follow-up appointments, reconcile medication issues and ensure communication among all the caregivers and providers so that problems are seen and addressed “before things become so bad that rehospitalization is unavoidable,” she said.