Planning can help home health agencies thrive in the era of P4P

November 1, 2006

Pay-for-Performance (P4P) provides home health agencies an opportunity to show their value and expertise to the healthcare industry. The primary goal of home health has always been to educate the client and family on how to proactively manage a chronic illness and avoid the reoccurrence of an acute illness. Home health nurses are the eyes and ears of the physician, often recommending modifications to the plan of care based on their knowledge of the patient's medical condition and home environment. With the advancement of healthcare technologies and pending P4P regulations, this knowledge becomes a more important basis for assessing patient and family compliance to care recommendations.

Pay-for-Performance (P4P) provides home health agencies an opportunity to show their value and expertise to the healthcare industry. The primary goal of home health has always been to educate the client and family on how to proactively manage a chronic illness and avoid the reoccurrence of an acute illness. Home health nurses are the eyes and ears of the physician, often recommending modifications to the plan of care based on their knowledge of the patient's medical condition and home environment. With the advancement of healthcare technologies and pending P4P regulations, this knowledge becomes a more important basis for assessing patient and family compliance to care recommendations.

Home health is the obvious leader in the move toward P4P. The availability of the Outcome and Assessment Information Set (OASIS) data over several years provides the proven, valid, and reliable clinical outcomes the federal government and other payers are seeking at all levels of the continuum of care. The major question that remains is: "What is the best way to prepare to thrive in this new performance-based culture?" Let's discuss some steps to success as you prepare your agencies to raise the bar for better patient care.

Step 1: Opportunity: See P4P as an opportunity to re-evaluate your business as a whole. Forced change is often frowned upon, resulting in agencies looking for ways to "fit" the change into their current way of conducting business. With P4P standards, this approach could easily result in lost revenue, staff turnover and even the need to close the doors.

Step 3: Implement: Plan for change using an approach you are familiar with, such as the Nursing Care Process-Assess, Plan, Implement and Evaluate.

Assess (Analyze) - Before P4P becomes a reality, it is critical that you assess and analyze your current business processes.

Plan - Position your agency, based on your assessment, to provide the best and most consistent clinical outcomes for the top 5 to 10 diagnoses seen by your staff.

Implement your plan. Begin re-educating your staff on key OASIS questions and strategies to identify more realistic responses.

Evaluate - Review your progress quarterly.

In addition to the strategic changes you make, the implementation of technology is critical to positioning your agency for P4P. Fully integrated technologies, including electronic medical records, telehealth and benchmarking software, will drive operations, increase service and allow for better patient care.

The clinical and administrative management of a successful home health agency know the clinical status of all of their patients, along with the financial standing of their agency at all times. Their referral sources and physicians know they are the best in the area for the disease management models they use, as well as other key diagnosis seen in this region. Patients and families choose them for home care because they have the best outcomes reported. Payers give them a financial bonus (P4P) because their outcomes meet and often exceed the national average.

CMS took the first steps toward initiating P4P with their July 2006 announcement of the calendar year (CY) 2007 reimbursement model. With advanced preparation, you won't be scrambling to make needed changes at the last minute.

Marilyn Ellicott, RN, CPHQ, is senior clinician for Misys Healthcare Systems, homecare business unit