Doing More For Less: Home Health Agencies & The Challenge Of Outcomes Measurement

Home health agencies increasingly deal with an alphabet soup of requirements with acronyms like HH-VBP, STAR, and PCR. These new requirements share a common goal: increasing transparency and efficiency by gathering data to measure patient outcomes. It's a tall order, and definitely easier said than done.

Benefits of Outcomes-Based Medicine & Measurement

The goal of outcomes measurement is better care for patients, fewer hospital readmissions, and quality metrics that help medical professionals evaluate alternatives and provide the best treatment possible. More specific benefits include:

  • Patient involvement in care decisions and monitoring. Outcomes measurement requires patient involvement and feedback. Instead of a top-down model of "do what the doctor/nurse says," outcomes-based medicine needs a caregiver/patient partnership to succeed. Remember: patient satisfaction data will be included in the Home Health Value-based Purchasing (HH-VBP) scoring system. Satisfied patients are good for your bottom line.
  • Better care for patients. Strong patient-centered, collaborative care initiatives have reduced emergency room visits by 60% or more in some studies.
  • Identify success and react to failure. Outcomes measurement shows which processes and treatments are working and which are not. Data metrics help highlight problems in treatment and procedures.

Data is the key to improvement because it provides the facts to back up conclusions and initiate change. People cling to the familiar, no matter what the industry or situation. "We've always done it this way, and it worked fine," isn't an answer in this new environment. Data can show how it wasn't "working fine" and provide the impetus to nudge organizations and caregivers to adopt more effective care protocols.

HHAs Face Staffing & Financial Challenges

The challenge that worries HHAs the most is financial. The bumpy rollout of pre-claim review (PCR) in Illinois last year rattled agencies in other states as they watched Illinois HHAs struggled with staffing, paperwork, and a high number of non-affirmations. At a time when payment levels are stable or falling, the new requirements seem overwhelming.

Since outcomes measurement is based on reporting, HHAs are modifying their organizational structure and reassigning some roles. There's cost involved. For instance, if you have to move nurses from patient care into reporting functions, that's a personnel change that may affect patient care and finances.

Home care nurses may also face increased workloads and job stress. In 2014, the journal Medical Care noted that the combination of CMS cost-savings plans combined with new quality initiatives may negatively affect the home health work environment:

Additional productivity requirements adding to nurse workload, combined with other cost-saving measures implemented by home health agencies, may increase turnover of experienced nurses, and lead to lower home health care quality. The primary findings of this study were that home health agencies with good environments have lower rates of nurse burnout and acute care hospitalizations, and higher rates of discharges to community living.

It may seem like an insurmountable task to cut costs, provide excellent care, keep up with paperwork, and have a happy, satisfied staff, but that's what you have to do.

Fortunately, this is one rare case where the problem - data collection - is also the solution. 

Use Data to React to the Present & Prepare for the Future

Data integrity is a critical component of any HHA's success right now. Inaccurate reporting has real financial consequences with reduced payments, lower quality ratings, and non-affirmations that delay the start of care. So much depends on successful patient outcomes, and documenting your success means gathering, organizing, and reporting massive amounts of data. Uncertainty adds to providers' unease. "A and B data sets are needed now, but what's around the corner? Will we have to report everything from C to Z next year?"

The amount of data that must be collected and reported is just too time-intensive maintain with clipboards and spreadsheets, so many HHAs are turning to health care software providers for help and advice. It's important to choose software that offers the functionality you need, is easy to use, and offers upgrades that match current rules and regulations. 

That's a tall order, particularly for small agencies with limited IT experience. In a 2015 interview with Medical Economics, Jonathan French, director of health information systems quality for the Health Information Management Systems Society, noted that some providers (and vendors) don't have the necessary expertise to define a system, and some vendors "will give them what they ask for, even if it's not necessarily what they really need."

HHAs need data solutions that are robust enough to handle current requirements as well as respond to future demands. Successful outcomes measurement will benefit all stakeholders.

This 2013 column in the Harvard Business Review makes that point elegantly and succinctly:

As health care reform kicks into high gear, providers are facing a difficult challenge: being paid less to produce better outcomes. We must view this as an opportunity, not a burden. After all, the providers who make the transition early will be rewarded with more satisfied patients, lower expenses, and pride in a job well done.

Contact Homecare Homebase to learn how our advanced software solutions can help you deliver a higher level of care with less paperwork and more consistent profits.