Given the existing setting of home health care, it is not devoid of challenges and all care agencies should have a proper plan in place to deal with these challenges. These challenges involve:
- Determining the type care service to provide to a given patient
- The quality of care to provide to the beneficiaries and
- The regulations of the health care system on the whole.
With a plan in place they will be able to sustain and face the future which by itself is highly demanding with the constant changes going within it and the markets.
Challenges with financing mechanisms
The challenges that home care agencies face today can be broadly categorized into several specific groups of which the financing mechanisms seem to be the most significant hindrance. As per the current scenario of home health Prospective Payment System or PPS, the average 60 day episode payment for all supplies and services include:
- All different skilled nursing services
- Medical supplies apart from durable medical equipment and
- Therapies provided.
However, the Fee For Service or FFS payment system in home health care Philadelphia does not reimburse the cost for specific services that may be vital for incorporating patient care. This may be the cost for:
- HIT or Health Information Technology capabilities
- Tele-health services
- Staffing for coordination of care and
- Support for care transition.
In addition to that, several home health providers also suggest that better communication and coordination is required across the entire spectrum to provide better service. This communication will bring different machinery of health care systems such as:
- The referring hospitals
- The physicians and
- All other medical as well as nonmedical providers.
These providers together form the mechanism that improves the health care system but as of now establishing such communication is done without any extra reimbursement from Medicare.
Need for reconsideration
The experts think that it is high time that CMS acknowledges these matters so that they take these things up in their recent rulemaking efforts.
Ideally, in these modern times it is essential that health IT tools and health information exchange are adopted. This will reduce the cost of health care and improve its quality as well.
All home health care agencies just like all PAC or Post-Acute Care providers are now ineligible for Medicare EHR or Electronic Health Records to get any incentive programs that will offset the costs of acquiring such capabilities.
However, recently CMS has announced some reforms that will enable the home care agencies to receive Medicaid for incentive payments but it is still not clear as to whether or not these incentives will provide support to investments made in HIT and HER.
The regulatory constraints
There are also a few specific regulatory barriers within the health care service structure as far as benefits that impede operative care are considered. These provisions prevent the level of integration necessary for establishing a proper coordination with the other health care service providers.
There are several thought leaders who opine that:
- Medicare requires the beneficiary to be homebound and
- Include all beneficiaries that have limited capabilities and really need such services in their home.
As far as the homebound requirement is considered, a few also recommended that the determining factors for eligibility of such benefits must be based on whether or not the beneficiary has had any definite number of chronic conditions and ADLs. It must also consider the use of Hierarchical Condition Categories scores that is similar to the Medicare Advantage. However, there is no consensus on the best method for establishing such eligibility.
As far as the APMs are concerned, accountability for the overarching costs must be considered in a bundled payment as well as a shared savings construct. They suggest that there should be a selective waiver of homebound requirement so as to increase accessibility of the patients to home health care services in case of real needs.
Program integrity and fraud
One of the most significant challenges that the home care agencies face is in addressing fraud, abuse and program integrity. As the demand of home health care rises significantly in a very short period of time, the chances and instances of fraud and abuse also rise at an equal rate in the health space.
This is another issue that needs to be addressed soon ensuring at the same time that the patients who really need such services can avail it easily. CMS on its web site lists a variety of actions the home care agencies must take to help in detecting fraud and abuse. These efforts include:
- Timely licensure
- Proper accreditation
- Transparency in practice and policy and
- Auditing and monitoring the performance.
All these efforts are crucial to eliminate the fraudulent actors as well as ensure that the patients have easy access to home health services of high quality. This will not place any undue burden on the home care agencies and also not prevent the patients from accessing such services.
Metrics to measure performance
The home care agencies in most of the times are unaware of the metrics to use to measure their performance. Most of them resort to patient experience and quality which is done in an improper way in most of the times. CMS and others however have come up with a list of metrics that the home care agencies should use for precise measurement of their performance. This list of metrics includes:
- Value based purchasing
- Quality ratings and
- Specific forms of reporting.
This will help the agencies to look into the areas that need improvement and at the same time the performance report will link payment to it. The most significant change brought in by CMS is the need to provide public reporting.
CMS and IOM however suggests that the main consideration for the home care agencies should be in identifying the core measures and align them with the health care system so that they can achieve the Triple Aim.
Therefore, challenges in work and workforce limitations, clinical and operational capabilities for long term care can easily be handled with a little bit of effort by the home care agencies.