There is so much change in current regulations that it’s easy to see how the home care industry’s strategic direction gets lost to the “tyranny of the urgent.” The new Home Health Conditions of Participation will place increased emphasis on quality improvement,
The new conditions of participation for value-based purchasing will go into effect in January, and they will emphasize the need for strong clinical processes and data-driven quality improvement.
However, agencies’ long-term success with value-based purchasing is not just dependent on their ability to improve quality. What will win in the end are care delivery systems that provide better outcomes for less money.
While information technology will play a key role in achieving the shift to value, it is only part of solution for organizations delivering healthcare services in the home.
While the industry has not been told when value-based purchasing will be applied to home health agencies outside of the pilot states, most all agree that providing better quality at less cost is what needs to happen. That requires restructuring care processes, and restructuring care processes takes time.
While the value-based purchasing pilot is scheduled to continue for five more years, CMS is not required to wait until then to implement a general rollout. Successful organizations will be those that begin re-shaping their care processes today to achieve better results for less.
Here are three things that organizations should keep in mind to be prepared to achieve success in the value-based purchasing model.
It’s not all about the technology
Many have believed that IT used to deliver home care would help providers focus on process-based automation and performance metrics, thus revolutionizing the industry.
Unfortunately, that goal has not been achieved. That’s because about the technology. It’s about the people needed to achieve extraordinary performance.
The aviation industry went through a similar awakening 40 years ago, when a decision was made to start making people the top priority when discussing quality, because it became clear that meeting the industry’s safety goal was dependent on people working closely together. A core concept that came out of the initiative was Crew Resource Management, or CRM.
Another technology challenge that must be overcome is placing too much focus on the actual performance metrics themselves. While these metrics are an absolutely essential piece of the solution, they are the performance indicators, not the process needed to achieve them.
Indicators often cause providers to focus intently on creating a process to achieve better scores on an outcome measure without really focusing on the process needed to truly achieve that outcome. Providers must strive to understand the performance metric and infuse that understanding into processes of care to truly achieve the desired end.
Technology has a key role in performance improvement, but the technology is ultimately a tool. Organizations that really shine are the ones that get the people part right and enable those people to use the tools available to them to maximize their results.
Time is everything
As it turns out, the way to decrease turnaround time is not by working harder and faster, but by removing waste from processes, which also increases quality.
Lean Education Academic Network (LEAN) methodology emphasizes finding what customers value and figuring out how to create or adapt processes that eliminate waste.
Using the LEAN methodology when it comes to documenting visit notes is a perfect example of eliminating waste while increasing speed and quality. Any nurse in home care will tell you that the longer a nurse waits to do visit notes, the more is likely to be forgotten about the visit. And studies confirm that documentation accuracy decreases because of those delays.
Providing inaccurate clinical details can cause all sorts of problems. For instance, incorrectly answering any of the more than 100 OASIS admission questions could result in erroneous outcomes, and that could lead a provider’s performance improvement initiative on a proverbial ghost chase. They could be identifying outcomes to focus on that in actuality they are doing well on, or worse yet missing serious issues that should be addressed. This, of course, can become a major patient safety issue.
The industry can promote performance improvement while increasing quality and speed by eliminating waste—in this case, wasted time. As it turns out, here’s where a process-based software shines, because it literally shines a light on where processes are failing or underperforming.
Data show that notes completed on the day of a home care visit take 30 percent less time to complete than those that get done later. For a regular nursing visit note, that’s approximately 10 minutes per visit of time saved if notes are completed on the same day as the visit. Spread out over a course of a typical day, which usually includes between five to six visits, that could represent saving an hour’s worth of work per home care staff.
The devil is in the details
LEAN methodology also makes sense in the context of a clinical process, particularly in home health. The key strategy of LEAN is to find out what the customer defines as value (for example, what would they pay for) and to create the most efficient process possible to achieve it.
In home health, the Centers for Medicare & Medicaid Services has defined very clearly one set of what it would pay for in terms of value-based purchasing outcomes. One approach for achieving those outcomes consistently involves close study of the process-based quality improvement (PBQI) measures.
To do well with these measures, providers must be focused on specific details and really understand the objective of the outcome of interest and how it is evaluated. Once that is understood, providers must craft processes so that it’s clear to clinicians what they need to do and make it easy for them to do it. After that, it’s easy to evaluate if it’s really being done.
These details are crucial for providers that will need technology best practices and tools to help ensure that assessments, planning and interventions are accomplished in a timely and effective way.
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