Improving Home Health Care Quality

March 23, 2007
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GRAND RAPIDS — Eight home health care companies in Grand Rapids, Holland and Muskegon are participating in a national effort to improve quality and standardization of patient care, with a goal of reducing hospitalizations by 5 percent in one year.

The program, founded by a group of national organizations involved in home health care and the Centers for Medicare & Medicaid Services, is offering educational tools, guidelines and best practices to participating home health companies.

Health care providers increasingly are focusing on the quality of patient care as a way to reduce costs in the long run, said Lody Zwarensteyn, president of Grand Rapids-based Alliance for Health.

“The whole movement nationwide is being focused on quality,” Zwarensteyn said. “Quality is less expensive. It’s been borne out time and time again. Nursing homes and home care are getting there.”

Some 130 home health agencies in Michigan are participating, said Joyce Simpson, home care project coordinator for the Michigan Peer Review Organization. She is organizing the program in Michigan.

“What’s new is the strategy,” said Harvey Zuckerberg, executive director of the Michigan Home Health Association, which includes more than 300 certified, private duty, hospice, home medical equipment and pharmacy/infusion companies.

“The focus on quality performance for Medicare health care providers always has been in place,” Zuckerberg said. “What we’re doing now is supplying resources, supplying home care providers with tools and materials to help them do their own assessment, to do internal training to make sure their practice is best practice.”

“It sounds like it’s pretty much going to be a fact that different health care providers are going to be paid (by Medicare) based on performance,” Simpson said, and for home health care companies, the outcome measure is likely to be the rate at which patients return to hospitals.

“A certain percentage is appropriate,” said Simpson. “But are there things we can do to be proactive to prevent that from happening?”

Under the 12-month program, home health care agencies will receive monthly packets of educational and assessment materials to share with the staff. The program also will provide the agencies information about how their re-hospitalization rates stack up against the rest of the state and country.

The national effort is focused on emergency care plans, fall prevention programs, telehealth, teletriage, risk assessments, medication management and physician communication.

Home health care companies have less control over the patient’s actions and environment than do hospitals, where quality initiatives are proliferating, noted Sheri Vree, director of Community Care Givers, a Grandville home health care agency. But home health workers have the ability to draw across health care disciplines to provide patients services in their homes. For example, a nurse could request in-home physical or occupational therapy services that might prevent falls, a leading cause of returning to the hospital for the company’s mostly elderly clients.

“We really are looking at wanting to make sure all of our patients, not only in this agency but throughout the city or state, all receive the basic standards of care,” Vree said. “Finding the time and resources and material to do that — it’s going to be real helpful that they’re going to have some of that ready to go.”

Vree said Medicare, which covers home health care for age 65 and older, is considering basing its payments on outcomes.

“That is something we definitely have to be working toward if that comes to be, and one of reasons we really have to do this,” Vree said.

Teresa Toland, executive director of Porter Hills Home Health Care, said her company saw re-hospitalization rates drop with participation in a statewide quality effort.

“This is one time when we want our scores to go down,” she said.

Re-admitting patients to the hospital is “a huge expense for Medicare,” Toland said. “Once we send them to the hospital, our pay is removed, too.”

“The goal is to keep people in their homes. It’s where they want to be and it’s a much less expensive form of health care,” Simpson said.    

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