A Needs Assessment of a Home Health Agency & Education Plan Madjil Clark, BSN, RN, Charity Ebert, BSN, RN, Andrea Englund, BSN, RN & Rita Million, BSN, RN

Introduction Home Health agencies are paid on a prospective payment system (PPS) Home Health agencies are paid on a prospective payment system (PPS) Payment is determined by completion of a data set Outcome Assessment and Information Set (OASIS) Payment is determined by completion of a data set Outcome Assessment and Information Set (OASIS) CMS mandated changes to the payment structure of Home Health Agencies effective January 1, 2008 CMS mandated changes to the payment structure of Home Health Agencies effective January 1, 2008

Introduction Changes are based on a retrospective review of Medicare claims that demonstrate a decrease in home health visits per episode while patient acuity (case mix) increased Changes are based on a retrospective review of Medicare claims that demonstrate a decrease in home health visits per episode while patient acuity (case mix) increased Translates into inaccurate reimbursement system Translates into inaccurate reimbursement system

PPS Regulatory Changes Two new OASIS questions Two new OASIS questions Expanded Home Health Resource Group (HHRG) similar to a DRG Expanded Home Health Resource Group (HHRG) similar to a DRG Change to a 3 tier therapy threshold Change to a 3 tier therapy threshold Non-Routine Supply (NRS) add on Non-Routine Supply (NRS) add on Addition of 2 more outcomes that will be publicly reported Addition of 2 more outcomes that will be publicly reported

Example of an OASIS question MO110 MO110 Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an “early” episode or a “later” episode in the patient’s current sequence of adjacent Medicare home health payment episodes? Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an “early” episode or a “later” episode in the patient’s current sequence of adjacent Medicare home health payment episodes? Early Early Late Late UK- Unknown UK- Unknown NA- Not Applicable: No Medicare case mix group to be defined by this assessment NA- Not Applicable: No Medicare case mix group to be defined by this assessment

Target Population of the Transformation Home Health Agency of a non-profit Medical Center Home Health Agency of a non-profit Medical Center Primary patient population >65years old Primary patient population >65years old Professional staff of RN, PT, OT, SLP who complete the OASIS assessment Professional staff of RN, PT, OT, SLP who complete the OASIS assessment Entire agency impacted Entire agency impacted

Needs Assessment- Focus Focus on Staff needs Focus on Staff needs Focus on Management needs Focus on Management needs Focus on Patient needs ???? Focus on Patient needs ????

Needs Assessment-Strategies SWOT analysis of the agency SWOT analysis of the agency Survey of the staff Survey of the staff Focus Groups Focus Groups Review of agency data Review of agency data

SWOT Analysis

Quality Measure Percentage BryanLGH State Average National Average Percentage of patients who get better at walking or moving around 33% 33% 42% 42% Percentage of patient who get better at getting in and out of bed 54% 54% 56% 56% 53% 53% Percentage of patients who have less pain when moving around 58% 58% 62% 62% 63% 63% Percentage of patients whose bladder control improves 57% 57% 48% 48% 50% 50% Percentage of patients who get better at bathing 61% 61% 64% 64% Percentage of patients who get better at taking their medicines correctly (By mouth) 30% 30% 37% 37% 42% 42% Percentage of patients who are short of breath less often 68% 68% 63% 63% 61% 61% Percentage of patients who stay at home after an episode of home health care ends 73% 73% 72% 72% 68% 68% Percentage of patients who had to be admitted to the hospital 22% 22% 24% 24% 29% 29% Percentage of patients who need urgent, unplanned medical care 18% 18% 21% 21%

Problem Statement Staff needs to be educated and have a thorough understanding of the OASIS assessment, changes to the OASIS questions, and strategies to assist with accurate documentation. An education plan needs to be developed and implemented to meet staff needs and achieve the desired outcomes.

Desired Outcome Staff will document accurate OASIS assessments Staff will document accurate OASIS assessments Staff will understand the importance of accurately documenting the OASIS as it relates to agency reimbursement and benchmarking clinical outcomes Staff will understand the importance of accurately documenting the OASIS as it relates to agency reimbursement and benchmarking clinical outcomes Staff will utilize the OASIS assessment to drive the development and focus of the plan of care Staff will utilize the OASIS assessment to drive the development and focus of the plan of care

Transformation Plan Learning styles of clinicians Learning styles of clinicians Content of the education plan Content of the education plan Learning strategies to support the transformation Learning strategies to support the transformation Timelines and sequencing of activities Timelines and sequencing of activities

Project Team Includes Management, IT staff, nursing and therapy staff- (Primary Stakeholders) Includes Management, IT staff, nursing and therapy staff- (Primary Stakeholders) Primary Responsibility: Facilitate the transformation of the agency through a needs assessment, develop and implement an education plan, and evaluate the project Primary Responsibility: Facilitate the transformation of the agency through a needs assessment, develop and implement an education plan, and evaluate the project

Staff Education Plan Learning Styles assessment for each clinician Learning Styles assessment for each clinician Web based education of the OASIS Web based education of the OASIS Participation in formal education training Participation in formal education training Lecture and video Lecture and video Application of knowledge through case study review Application of knowledge through case study review

Timeline Phase 1 Milestones (December 10, 2007) Phase 1 Milestones (December 10, 2007) Needs assessment Needs assessment All staff education activities All staff education activities Finalize testing of computer upgrade Finalize testing of computer upgrade Phase 2 (December 26, 2007) Phase 2 (December 26, 2007) Mandatory Staff meeting Mandatory Staff meeting Finalize agency process changes and communicate Finalize agency process changes and communicate

Timeline Phase 3 (December 27, 2007) Phase 3 (December 27, 2007)

Gantt Chart

Evaluation Framework for Program Evaluation Framework for Program Evaluation Rationale for Selection of Model Rationale for Selection of Model

CDC Framework for Program Evaluation

Significance of the Transformation Process to Staff The OASIS assessment drives reimbursement for the agency, supports the physician directed plan of care and generates the public reported outcomes The OASIS assessment drives reimbursement for the agency, supports the physician directed plan of care and generates the public reported outcomes Ability to project revenue and prevent down coding of claims Ability to project revenue and prevent down coding of claims Demonstration projects on pay for performance (P4P) currently going on in Home Health Demonstration projects on pay for performance (P4P) currently going on in Home Health

Conclusion Federally mandated changes Federally mandated changes Direct impact on staff, patients & finances Direct impact on staff, patients & finances Educational programs Educational programs Evaluation & feedback Evaluation & feedback

Questions

References