2K10

This is the first week of 2K10 that we will spend at work. Most of us found OASIS-C questions awaiting us. By the end of the week, we will have our first experiences with using the dataset with patients. Please share your experiences with us.

With all the emphasis on OASIS-C, many projects, goals and other facets of running an agency have been all but forgotten. When we haven’t been dealing with OASIS-C, we have been focused on the politics surrounding health care. And we have RACs that are scheduled to begin this year. That’s a lot going on.

I have faith that we will get through this year and more to come. However, if I had to challenge agencies to do one thing, it would be to re-focus some of your energy and resources to reducing hospitalizations. The overall hospitalization rate for home health is essentially unchanged since 2006. This puts us in a weak position when we are vying for funding in Washington. One way that we can really show our worth to those politicians who don’t truly understand healthcare is to save the Medicare Trust Fund money by reducing hospitalizations.

On a more personal front, one of my coworkers has had a granddaughter in the hospital since early December. Megan, a newborn, is doing well and expected to be home next week. But meanwhile she has two brothers at home equally in need of  parents. I have been on the sidelines watching the enormously taxing effort it has been to maintain some semblance of normalcy in the household and be available to the hospital and doctors and hospitalized infant. In short, this is a huge disruption to their lives. It is costly even outside of insurance and it is exhausting. And there is no reason to believe that our patients experience hospitalizations any differently.

So taking a personal look at how hospitalizations affect the entire family, it occurs to me that now more than ever, I want to challenge you to reduce your hospitalization rates.

Some strategies that have been effective in my clients’ offices:

1. Know how many hospitalizations you had last month and try to come in under the number this month. Although this is hardly a statistically sound, risk adjusted calculation, it works and it is easy. CMS data is far too outdated to be of any use.
2. Review medications on each and every visit. Half of all patients who are hospitalized have a recent history of a medication error or omission.
3. Review each and every hospitalization. This is not to see if you did anything ‘wrong’ but if you could have done anything better. It is almost always possible to do better.
4. Implement phone encounters or contacts.
5. Falls precautions are about a whole lot more than removing throw rugs. Get your therapists involved!
6. Educate all staff about signs and symptoms of CHF and monitor all patients with a diagnosis of CHF carefully. This will also assist with OASIS-C documentation.
7. Invest in your nurses who are good with wound care. Wound care skills will make your agency money and reduce hospitalizations.

Albert Einstein defined insanity as doing the same thing over and over and expecting different results. Besides having great hair, Einstein is known for his wisdom. We have been monitoring and addressing hospitalization rates for years now without appreciable results. Maybe we can do something differently and really make a difference in patients’ lives while at the same time proving our worth to the guys who will be in charge of Medicare dollars in the years to come.

Your comments are always welcome but even more so this week as we begin OASIS-C. Your experiences with OASIS-C and any ideas you have to reduce hospitalizations can be left below in the comment section or emailed to us.