Is your agency using our Assessment Comparison Report? This report is available for every follow-up OASIS assessment after a Start of Care (Recertification, ROC or other follow-up). The Assessment Comparison Report compares the current assessment to all of the previous assessments for a patient. You can see if your patients are improving in key areas at a glance as you are working toward discharge.
The report is color-coded so that you can quickly see if a patient has declined in status, remained the same or improved. When you load an OASIS assessment in Home Health Edition, you will find the Assessment Comparison Report under “Reports” (the same place where you find your OASIS Analysis Report).
]]>Recently an industry list serve had much discussion of an agency having to pay unemployment insurance benefits to a RN employee who was fired for falsifying the clinical notes. They reported that fact to their state employment office but were still charged for the unemployment claim.
We had a client who fired their contracted PT because she was having some of her visits done by her cousin who was a PT assistant and licensed in another state. The client did not bill Medicare for any of her visits.
In both of the above cases the agency properly fired the caregiver and did not bill for the services the caregiver had provided.
The agency should also check out the employee and the independent contractor on the Office of Inspector General exclusions list, http://exclusions.oig.hhs.gov/ .
“No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else.” (OIG)
The list is updated monthly and every provider should be checking all their employees and contractors upon hiring and on a regular basis thereafter. (See http://oig.hhs.gov/newsroom/video/2011/heat_modules.asp for 4 ½ minute video if wanting more information.)
Why stop there? I suggest that both parties should also:
1) Report the matter to the caregiver’s license board
2) Report the matter to CMS
3) Report the matter to Medicaid
4) Report the matter to the local authorities as criminal acts
The caregivers who were terminated will go to work for other health care providers. They likely will continue their illegal practices. Their practices may cause health problems or complications and even death for the patients they treat.
And If I was a successor employer and found myself sued for malpractice or investigated I would look back at the history of the caregiver and involve former employers to share the responsibility, the blame and the costs.
When engaged in house cleaning you don’t sweep the dirt under the rug (so my wife tells me).
©2011 Tom Boyd. All rights reserved.
About the Author:
Tom Boyd confesses to over 1/3 of a century with Medicare reimbursement starting with the dark side as a Medicare Auditor. Known as the “mad hatter” of cost reports he is an expert on cost reimbursement and other dinosaurs and may be the only person in the country to miss home health cost reimbursement.
He is the overworked chairperson of the NAHC/HHFMA task force committee on the HHA cost report and an often frustrated and beaten member of the U.S. Chess Federation. Mr. Boyd has spoken on home health financial and compliance issues before NAHC, NHPCO and more than twenty state and regional home health care associations.
Tom has a BA in management from Sonoma State University and a MBA from St. Mary’s College of California. A home health consultant since 1989 Tom’s goals are to keep at it until he gets it right. Visit www.boydandnicholas.com or contact Tom at tboyd@boydandnicholas.com
]]>A patient develops osteomyelitis and has to have her fingers amputated. Walk through this sample scenario to practice your coding skills.
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There are 16 general OASIS conventions. Watch this video blog to learn about conventions 13-16.
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Did you know that PPS Plus can calculate your costs to compare with your reimbursement so that you can see where you stand financially with an assessment at the outset of an episode of care?
When you load an assessment to look at your reports, you will have a navigation tree at the top left of your screen with three folders. Open the folder designated as “PPS Plus.” You will see a list of folders, one of which is “Ordered Services and Supplies”. Select this folder and you will be able to enter the projected number of visits for each discipline.
At the bottom right of your screen you will see your HHRG, HIPPS, case-mix wt. and reimbursement. Hover over your reimbursement with your cursor and you will then see your reimbursement amount, costs and a profit/loss for the episode.
Walk through this sample scenario to practice your coding skills.
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]]>There are 16 general OASIS conventions. Watch this video blog to learn about conventions 9-12.
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]]>In our continuing effort to provide our clients with reports that will assist them with monitoring the quality of their patient care, we have added a new report with the latest software update.
We have released the Emergent Care Report which you will find under the PBQI/OBQM/OBQI Reports section in Home Health Edition. It lists the reasons for emergent care and the transfers and discharges when they occur. The report also shows the patient’s name, type of assessment, hospital admission, clinician, and branch name.
]]>The week of November 13-19, 2011 has been designated as part of November Home Care and Hospice Month. This may be the perfect time to step back and reflect on these special team members.
There has been much discussion about the shortage of direct care workers and aides in the media and among caregivers seeking competent and qualified aides. There is a point at which we can long longer absorb the sheer numbers of aides that are projected to be needed as we all age. And age we will -and we all want these great aides to care for us!
This article seeks to help us question efforts related to retaining, educating and empowering the aides on our teams. It is not unusual for a family member to sometimes not remember the name of the nurse or the therapist -but sometimes -they can still remember the name of their aide! The best aides truly are our eyes and ears.
I believe that as the nursing continues we will look more and more to specialized aides to better care for those seeking to stay home. And that the best home care and hospice organizations will find, empower and retain these special aides.
What are the factors driving the need for more aides? Though there are many reasons, the following are the most important. They are 1) The Aging of the Population, including the two biggest cohorts -many of us -the baby boomers and the oldest old (those older than 85) 2) The Growth in Healthcare Spending, 3) Dramatic and Continuing Changes in the Family Structure -most adult children, especially daughters work outside the home 4) More people wish to remain at home for cost, comfort and safety reasons, when possible, and 5) Older adults need more care because of #1! In fact, PHI Fact Projections for the "Top Ten Fastest Growing Occupations through 2016 lists "personal and home care aides" as number 2, with a projected increase of 50.6% and "home health aides" as number 3, with a projected growth rate of 48.7%. So -two of the top three fastest growing occupations are what have been termed "the heart of home care". Sadly, there have been studies that show turnover rates as high as 60% on average and another that attributed almost 5 million dollars for aide turnover. One study found that hospices experienced a turnover average of 30%.
So what is a managers' role in this? It may to identify that it is time for a change. The goal may be to "reframe" thinking from "recruitment and retention" to "retention and recruitment". This change can frame the discussion from efforts of (continual or disruptive) turnover of aides to retaining (and valuing) competent and experienced aides. The goal of this R and R may be "the creation of an available, competent and caring team in a special culture" caring for your patients and their family members. The data is out there to improve the culture and retain aides. It does not cost anything to say "thank you!" for a job well done!
In honor of Aide Week I propose the following word to define the best of aide care with the word
H- Home care and hospice aides are the heart of care at home -and that setting is where ever the patient calls home - and those of us in home care know how variable that "home" can be -from a mansion on the water to a cardboard box behind a 7-11 store --
E- Efforts -Aides may or may not get thanked by patients and family members for their works and efforts. Sometimes patients can be challenging and do not want to do what is on the aide's plan of care-This may make it very hard for the aides and they are usually out at the patient's home and alone and caring for very ill or frail or confused patients -not an easy job! When you can -and especially and for no reason -maybe this week call and thanks aide team members for their efforts!
A- Accountable - Aides have a big job and are accountable for the patient's personal care, ADL assistance, sometimes meal preparation, light housekeeping, helping the patient remember/reminisce, sometimes bathing patients who do not wish to be bathed or like water, and on and on -as individualized as the plan of care. Do your aides feel they can call you and take 2-3 minutes and vent? Or get feedback and maybe they just want to hear that they did the best they could in a sad or difficult situation? I know sometimes we want to "fix" things but sometimes all an aide caregiver might need is an ear or a sounding board.
R- Retain -There are some interesting, innovative models out there related to retention. There are organizations that help aides who wish to become LPNs or RNs fulfill that dream. Others work to support and continually educate their aides who wish to remain aides and have different levels of expertise, specialty or competence. "Retention" is not one person's job or role -it is the entire organization's job and makes up a part of the culture. I know of an aide who came for an interview (and she had a specialized skill set the organization was seeking) who left after being chastised for being late (this was a city setting and no one told her where to park) and then the "greeter" behind the desk at this large agency was not friendly and was in fact rude. Sadly, she left before the interview and later told me she could tell "it was not where she wanted to work". Do you best to keep your best aides and have them bring in their aide friends -this may help create a culture where people/aides want to come to work!
T- Team -It has been said there is no "I" in team. Aides should be an integral part of the patient care team. Provide a clear understanding of the aide's role on the team and in patient care activities. This may mean care conferencing, attending team meetings, educational offerings, participating in quality or record reviews and more. Documentation is always an important component of the aide's role. Is there ongoing communication and education (not just counseling) about the need to document what is on the aide's checklist or other documentation tool? How are aide documentation-related challenges handled at your organization? It is how you would wish for a problem to be addressed? A lot is expected from our aide colleagues -We must show them they are a valued part of the home care and hospice team.
©2011 Tina Marrelli. All rights reserved.
About the Author:
Tina Marrelli is a health care consultant and the author of "Home Health Aide Guidelines for Care: Instructor Manual and "Home Health Aide: The Aide's Handbook" as well as the "Handbook of Home Health Standards: Quality, Documentation, and Reimbursement" (Mosby, 2012) and other books. Tina is also the Editor of the peer-reviewed, interdisciplinary Journal, "Home Healthcare Nurse" published by Lippincott and in its 29th year. Tina can be contacted at www.marrelli.com or by e-mail at news@marrelli.com or through www.IHCNO.org
]]>Walk through this sample scenario to practice your coding skills.
Click here to print this tip!
]]>