downhill slide

hoolahan, ASN, RN · Nov 1, 2001

I haven't heard that Medicare would rather have pt's in the hospital, can you explain why? (Not being sarcastic, but what is the benefit to them?)

Sorry to hear that your experience has been so bad. Oasis is ridiculous for all those readmits, esp for frequent flyers. I have decided all I will answer on recerts is the MO### questions, you know those are all you are mandated to answer, right? Now, as to your agency's policy, well that's a diff story.

My agency also pays me by the hour, so I make out OK, I would always choose hourly vs visit rate if I had a choice personally.

I suspect the reason your #'s are down is b/c your agency has become more selective in the admits they will accept. My former agency refused to accept daily wounds if there was not a willing caregiver in the home to teach. We absolutely would not take any BID anything, and we didn't take back known difficult or non-compliant pt's. Your agency is probably being more selective, and so less referrals are coming their way.

AS for 5-7W1 or W2, just for teaching, that is interesting. I have never worked in an agency that would endorse that. No wonder you're feeling so bad. Hard to go from that kind of teaching luxury to just a few visits. But think of it this way, you are still providing a valuable service. How many times have you called to setup a new pt appointment and they have said ,"We're so glad you're coming, I need to ask you....." You will learn how to select the most improtant things a pt should know for visit one, etc. Carepath's can help you with this.

I hope you hang in there, try to find an agency that pays hourly in your area, maybe its just your agency that is going down the toilet, while many nurses are/have left due to PPS/OASIS doodoo, many of us have weathered the storm, and we're doing OK. Best of luck to you, we need good HH nurses.

Home Health Columnist / Guide · Nov 1, 2001

Mommanurse:

Come to Philadelphia, PA to work------so much work in my area, other agenices can't see all the patients and were getting them!. Bet your agency is small 25-30 new clients a week or less. Cash flow is a problem if turn around time for Plan of TX signing and billing doesn't occur quickly with in 30 days.

We average 30 referrals a DAY , over 70 on fridays-- 700-800 NEW referrals a MONTH. We still do BID wound care as we have the staffing---some times for months. Have a mixure of Medicare and Managed care. Our MA HMO often covers BID for wound dehisence clients as cheaper than being in the hospital.

In 16 years of home care NEVER visited daily just for teaching except maybe new diabetics for first 3-5 days --only for wound care, then got CETN in quickly as possible to get to QOD visits. Feel your agency was way overutilizing. In the south, average Medicare home care visit per patient was 110 visits PRE OASIS.

In the Northeast, it was about 36-40 visits.

You were WAY over treating clients. Our sister agency which is much smaller, says its visits are now about 18-20 per patient. We have sicker, chronically ill urban, older patients trying to live alone and haven't changed our visiting as much. Do have a good basis of short term clients, post surgical: CES, Breast CA, Abd surgery with JP drains that we only see for 3-8 visits to balance us out.

Home care is thriving here, we are doing good with OASIS and want every Medicare patient we can lay our hands on unlike some for-profit companies. Paperwork is more of a hassle---will see OASIS change a lot next year as they now have a full year of data collected to do their comparisons--expect payment to be changed too. Home care has ALWAYS had paperwork: we have a lot for our cliincal pathways that is additional but our patient outcomes are good with lower than average rehospitalizations.