Our Financial Future

Usually I am an eternal optimist but I have had a few setbacks as we are facing cuts to the Medicare Home Health Benefit. Even though home health is responsible for less than four percent of the Medicare budget, Congress voted to reduce home health payments by 13 percent (43 billion) over the next ten years. Their stated purpose is to reduce waste and inefficiency. The New York Times article can be found here.

Obviously my first thought is one of pure outrage. The politics of health care reform can be overwhelming and frightening for all of us who take care of patients or work to support those that do provide hands on care. And yet, in spite of my repeated pleas to Mr. Obama and being very frank about my opinions, it appears as though I have been largely ignored. Imagine that.

So what can we do? Do we stage a grass roots effort and hope that we can raise a few thousand dollars for a lobbyist that can never compete against the millions of dollars funneled into special funds in exchange for congressional votes? That is one option and it isn’t a bad one even though it may prove to be ineffective. But while we are writing letters, arguing loudly and doing everything we can to protect our industry, we must face the truth that home health care will likely take a hit in the near future. And if the false prophets of hope and denial are proven to be unsuccessful, we will be left with an enormous challenge.

But it’s a challenge we can meet! Every day I read in the newspapers about how bad the economy is and yet, the global numbers really don’t tell you the story of any one person’s finances. The same applies to the health care budget. Cuts will be hard but manageable if we begin to prepare now.

And the great thing about preparing for impending financial cuts is that the preparation involves all the same things we should be doing already to be efficient. Here are some steps you can take now.

1. If you are leaving money on the table, stop. It is not unusual to find an agency leaving between five and eight percent of money on the table due to inaccurate OASIS scoring. Those same agencies have the opportunity to reduce their cuts by bringing their baseline up to the ethical maximum. And agency currently leaving eight percent on the table will only suffer a five percent cut if they work on their OASIS scoring now. And who would mind an eight percent raise even if the cuts never happen?
2. If you haven’t already done so, look into converting to point of care computers. Although the investment of time and money is huge initially, the investment will pay off when you can reduce back office staff and all the quality of your data is impeccable. This will happen with or without cuts.
3. Look at staffing patterns. If your agency does not use LPNs, consider doing so for stable patients. Consider reducing or eliminating nursing visits in therapy only cases. Review every process that each person in your agency performs and see if it is really necessary or ‘if it is something we have always done’. If it falls in the latter category, consider eliminating it for a period. Try to reduce the use of PRN nurses so that your agency can provide more efficient care with staff who regularly see patients.
4. Take a really good look at the software you are currently using. If possible call for staff training. Many agencies are using software systems that have been in place long before most of the staff was hired. It is common to find that current software is able to provide tools and information that you were not aware of in the past.
5. Slowly develop disease management programs. I am not referring to the pathways of the past that provide nurses with a set recipe for care. I am referring to education, tools and resources for nurses to take care of diabetics, CHF patients, PVD, etc.
6. Invest in a wound care expert. This isn’t as dramatic as it seems. Find one or two nurses in your agency that excel in wound care and provide them all the education you can and try to have them see all patients with wounds at least once. Many wound care vendors provide wound care education at no cost to your agency.
7. Teach care planning and goal setting. Eliminate the ‘random’ visit where we go get a set of vital signs and aimlessly assess the patient. All visits should be planned to work towards a specific goal!

Finally, breathe. That’s all. I came into home health during IPS. If you don’t know what IPS is, drop to your knees and say a prayer of thanks. If you remember IPS, you know that we have been through worse in the past and we will make it through anything the future throws our way.

Don’t get me wrong. I don’t want the cuts any more than the next person. But if I want to survive as a nurse in home health, the only option I have is to preserve my integrity and help you get ready for the future. And if we get lucky and healthcare reform is put on hold until we retire and fruit flavored rain becomes the norm, we will still provide better care and make more money. Can’t beat that with a stick!

As always, I welcome your comments below or you can email us here.