Haydel Consulting Services LLC

It is hard to discharge patients. It is especially hard when we feel like the patient really needs us. It also decreases census. The undeniable truth is that each time we discharge a patient, we are decreasing our revenue. And so we don’t discharge as often as we should.

Pretend for a minute that you are commissioned by Medicare to find claims that don’t meet the medical necessity criteria. What would you do? Do you allow agencies to hold onto patients because they feel protective of a patient who no longer meets criteria? Do you understand that agencies need to keep their census up to make ends meet?

Me? I would look at billing histories of agencies. Those agencies who had an excessive length of stay would immediately grab my attention. Next, I would request charts of patients who had been on service longer than two or three episodes. And I would make a ton of money.

Look at the data that you send when you drop a claim. You send start of care dates, diagnosis codes, and utilization information. If any of these numbers ‘fall out’, you are subject to scrutiny. Notice you do not send goals, or even visit notes to determine if services are billable. Chances are very good that if your patient has been on service for six episodes, at least one of the last three is not billable.

So, when it comes time to make the tough decision to discharge patients, consider if you really like having a Medicare provider number that allows you to bill Medicare for services. And if your census begins to drop keep in mind that front end marketing is the solution to declining census. Also, since early episodes pay more than later ones, your average payment per episode will increase meaning that you can maintain your income with fewer patients.

One of my clients had briefly employed a marketer who was recently arrested for DME fraud along with 38 other individuals from the surrounding area. Home Health agencies, DME companies and physicians were all involved. Of all the juicy details there is only one that struck fear in me. The marketer that was arrested had one five minute interview with a federal agent several months prior to her arrest. That was it.

This tells us that by the time a regulatory body (with the exception of state and certification surveys) arrives at your office, it is really just a formality. You have already sent to them the information required to build a case against you.

So, go out and find some new blood. Invest in ethical marketing. Empower your field staff to be marketers while performing their daily duties by educating them. Volunteer in the community. Improve the quality of your care to impress new referral sources. And while the number of admissions in a given month is important, it is even more important to capture information about new referral sources. Lots of referral sources will give you a chance but when that referral source refers three of more patients, you then have a new referral source. And that will bring new blood into your agency so that you can responsibly discharge your patients who have met goals.

Looking at the tropical weather map this morning, it occurs to me that our friends on the North East coast may be experiencing some very unpleasant weather over the weekend. Because we have experience in hurricanes, I am going to list the things that I think are most important to weather the storm and I encourage all my Gulf Coast and Florida Readers to contribute anything that may help our friends that are visited by Earl over the weekend.

• Follow your emergency preparedness plan. I am assuming that all states require one. If you have never been involved in mass evacuations, you will learn that the plan is more than a regulatory exercise.
• Medicines. Medicines. Medicines. Patients need a complete, accurate list of medications. After Katrina, it was a nightmare trying to determine what displaced people took. When asked, patients will say they take a white pill for sugar or the purple pill. Yay Nexium for that marketing campaign.
• Medicines again. If possible, ensure that your patients have a two week supply of medications. Often the state will allow Medicaid patients to pick up medications early when a hurricane landfall is expectected.
• BACK UP YOUR DATA. TWICE.
• Keep track of patients. It is wonderful when a patient is going to weather the storm at a family member’s house. But after the storm, you need to locate your patients and will require contact information to get in touch with them.
• Contact the electric company to let them know the address of any patients who are dependent upon electricity for oxygen, IV pumps, etc.
• Call your state OASIS coordinator to determine how to deal with patients who go to hospitals for shelter. Otherwise, your hospitalization rate can skyrocket.

I am sure there is so much more. I am counting on all my Gulf Coast and Florida readers to add to the list.

Finally, if your agency is off the path of the storm in an area that is likely to receive evacuees, remember that natural disasters are NOT marketing events. If you are called upon to see a patient who has been temporarily evacuated, call the original agency and visit them under contractual arrangement. This will mean less paperwork for an agency overwhelmed by a storm and will clean up your karma.

Having experience with hurricanes, I am praying that our friends on the northeast coast are spared. If they are not, let’s do everything we can to help them.