Front Loading Visits

Everyone seems to be familiar with the concept of front loading visits and yet, during clinical record reviews at a variety of clients’ offices, I do not see it being used routinely. Too often, the same old tired weekly frequencies are ordered. And yet, we know that most hospitalizations occur within the first weeks of home health care. Patients coming out of the hospital are at higher risk for re-hospitalization during the first month post hospitalization.

Financial considerations may be seen as a barrier to some agencies and yet, when done with care consideration, it does not necessarily add to the overall episode costs. In fact, overall episode costs may be lowered while improving outcomes. Consider the following patient post hospitalization for congestive heart failure. A ‘generous’ schedule might be 18 visits which would be translated into 2W9.

What if we took those 18 visits and divided them as follows:

3W1 with two additional phone calls to verify weight and medication compliance

2W1 with three additional phone calls to verify weight and medication compliance

1W7 with 2 PRN visits for weight gain greater than three pounds AND twice weekly phone calls to monitor weight and medication compliance.

This comes to only 14 visits if the PRN visits are both used. Now, if the patient puts on five pounds and orders are obtained to increase diuretics, additional visits can be ordered in the interim to monitory symptoms.

And, if the patient does well, the agency saves the cost of 4 visits – roughly $400.00 – while at the same time delivering care of a higher quality to the patient.

That sounds like a plan to me.