A Gerontological Society of America study stated that “home health patients are at greatest risk of hospitalizations within the first weeks of home health. Over 25% of hospitalization occurred in the first 6 days and over 50% occurred in the first 2 weeks.” Another study based on 1.4 million Medicare cases from the Centers for Medicare and Medicaid (CMS) indicated that physical and occupational therapy yields positive results in post-acute care like reduced readmissions.
Under Home Health Value-Based Purchasing (HHVBP), the claims-based measures comprised of Acute Care Hospitalization (ACH) and Emergency Department Use (ED Use) account for 35% of the Quality Measure Weighting. This proves that multidisciplinary care could make a difference in re-hospitalization and ED Use when implemented early in the episode of care.
All About the Bigger Picture
In preparation for HHVBP, agencies are gearing up on staff education on scoring the items that make up the OASIS-based Quality Measures in HHVBP. Most often than not, agencies are too focused on the data that they forget there is a real patient behind it who might have underlying needs.
Value management is definitely more than scoring the OASIS assessment. While clinicians responsible for OASIS completion should have a working knowledge of how to score all OASIS items, they should also be knowledgeable about what to do with this information. In developing the plan of care, clinicians should look beyond the skilled nursing needs and consider other potential needs of the patient.
For instance, the Total Normalized Composite Change in Mobility (TNC Mobility) and Total Normalized Composite Change in Self-Care (TNC Self-care) are both crucial OASIS-based Quality Measures in HHVBP and are key indicators for physical or occupational therapy needs of a patient. Moreover, both make up 50% of the total OASIS scoring impact on the Total Performance Score (TPS).
Clinicians play a crucial role in assessing the patient’s physical limitations, as well as their environmental, behavioral, and cognitive challenges. They prescribe necessary therapy interventions to improve the patient’s safety and allow them to stay in the comfort of their home after being discharged from home health. For instance, if a patient shows a high risk for functional limitations in achieving tasks or exhibits cognitive decline of any sort, physical and occupational therapy, and speech and language pathology should be considered respectively as these challenges could potentially lead to a hospital visit.
Overall, agencies must ensure a patient-focused plan of care that keeps individual patient goals in mind. Ways to decrease rehospitalization rates or ED use must be identified. Agencies should also determine where they stand when it comes to patient satisfaction.
Win-Win for Agencies and Patients
Since therapists work with the patient, their family, and caregivers by providing education and support for patient safety at home, therapy disciplines definitely play a vital role in their ability to safely remain in the OASIS M242O D/C Community and out of the hospital.
Any improvement in any of the OASIS-Based Measures, along with lesser risk for rehospitalization and a comprehensive plan of care, is a win for both the agency and the patient. The latter’s wins are remaining in their home, satisfaction with the care provided, and their inclination to recommend the agency to others. The former’s win is the improvement of scores between discharge and the start of care.
Make sure your clinicians are able to anticipate and identify the needs of patients in order to provide holistic care that is right for each patient’s unique needs. Additionally, your QA team or provider should be able to help your clinicians recognize key areas that describe patient needs based on assessments in the documentation.