Will home health survive?

[alabamagrad]

The DON at my home health agency states that home health is about to be squeezed. She has warned us of up coming layoffs. Which scares me because I was the last one hired. She says that medicare will give a lump sum for a pt that the hospital, doctors, and home health will have to share. What do you all think. I think I need to go back for my masters.

[QueenNasus]

I have heard about the lump sum payments as well. Our agency is planning on making our visits more efficient and effective with faster turnaround time. that's the best way to go about it. When you start overworking your nurses you end up with poor care.

[prettymica, ASN, BSN, MSN, LPN, RN, APRN, NP]

I haven't heard.. when is the lump sum supposed to start?

[paradiseboundRN]

The process is called "bundling" of payments. It hasn't officially started, I think its still in the planning phase, but some agencies are part of the pilot program. Under the Bundled Payments initiative, CMS (Medicare) would link payments for multiple services patients receive during an episode of care. For example, instead of a surgical procedure generating multiple claims from multiple providers (hospital, surgeon, home care), the entire team is compensated with a “bundled” payment. The goal is to provide incentives to deliver health care services more efficiently while maintaining or improving quality of care. Providers will have flexibility to determine which episodes of care and which services would be bundled together. Medicare currently makes separate payments to providers for the services they furnish to patients for a single illness or course of treatment, which CMS believes leads to fragmented care with minimal coordination across providers and health care settings. Bundling will be for Medicare patients only.

Layoffs are unlikely, but if they do happen it will be in the small agencies. Bundling will require that agencies contract with, or establish joint ventures with, the other providers to split the payment. The hospital based or larger agencies are already partnered with, or are owned by the same hospital system. The smaller agency will need to find providers to partner with.

Home care is growing fast and there will be jobs. You may be making less visits but you'll be seeing more patients. Its still Medicare's best bet for keeping patients out of the hospital. And a hospital visits cost a lot more than home care does.

[AnnemRN]

Home health reimbursements changed in 2000 from pay per visit to bundled payments for the entire 60 day POC. I think we need to wait and see the results of the pilot program and how much the reimbursements will be.

I have never had a problem keeping a home health position even though there have been many changes in how the agencies were reimbursed over the years.

[AdkNurse]

My agency is also paid per episode for CHHA cases, in other words, bundling.

We have suffered major layoffs of clerical staff (which basically means more work for us nurses in the end) and have over the past few years not filled many nursing positions when nurses left due to retirement or for other jobs.

But, this is mostly due to the fact that I work for a government agency in the public health dept (which umbrellas the CHHA, LTHHCP and PCA programs as well as the mandated maternal/child health programs), and our county supervisors have over the past few years basically bankrupted our county, so the layoffs have not exactly been a result of our home care agency efficiency, but rather "across the board" layoffs in every department of the county (except for DMV and the snowplow drivers, but that's a whole 'nother story!)

The introduction of electronic charting has caused our visit times to be longer, and so we are seeing more patients, it's taking us more time to see those patients, and our reimbursement rates are less.

However, there are so very many changes happening in health care, I'm another one who is of the mindset that home care is eventually going to be playing a much bigger role in the overall industry, as it's clearly been proven that home care after hospital discharges reduces rehospitalization rates.

I think it's going to be a very bumpy ride and many smaller home care agencies and even governmental home care agencies may go under or be sold to private entities (two surrounding counties where I live have been sold to private agencies).

With good leadership and extreme proactiveness in adapting to changes and having fleets of home care nurses that are extremely educated and proficient in OASIS documentation (required by Medicare) will make or break an agency in the immediate future.

But the longer term future of home care is, again in my opinion, going to burst with need of nurses and programs.