Overview:

A large hospital-affiliated home care agency in the Midwest requested assistance preparing clinical and office systems for prospective payment.

Objectives

• Restructure clinical care delivery system to maximize coordination of patient care and reduce visits per patient while maintaining high quality standards
• Assist in designing marketing program for agency customers
• Identify strategies to reduce cost of care delivery
• Educate agency staff at all levels regarding impact of PPS

What we did

• Implemented geographic based interdisciplinary case management model
• Designed and implemented gatekeeper/utilization manager position
• Implemented pre-hospital discharge SWOT assessment to identify patient needs and manage customer expectations of home care under PPS
• Established system for outlier and high cost HHRG resource tracking
• Implemented pathway documentation for leading diagnostic categories
• Created formulary for medical supplies and oversight management of supply costs
• Conducted in-depth PPS training including : ICD-9 Coding, OASIS training and competency testing, PPS billing completion and PPS fundamentals for clinical and business staff
• Implemented home telemedicine program for wound and skin care patients

Results