I have had a lot of questions this past week about lengths of stay for home health and what they should be. One large company in our area has begun mass discharging at several locations throughout the state causing my clients to worry that maybe the big company knows something that my smaller clients do not. Another client has a very short length of stay and wants to know if they should extend it.
If you want to know the facts as I understand them, the Zone contractors are looking at agencies with excessively long lengths of stay. The clients that I have had this year average around five episodes per admission. What’s more is that the Zone contractors look at total length of time on service regardless of the number of admissions. Many of the clinical records we review have multiple admissions and discharges. So, if you think by reducing you average length of stay by discharging and readmitting will fool anyone, you may be right but it won’t be the Zone you fool.
There are various published numbers about the average home health length of stay per state. The Southern states where both income and education are lower than the national average tend to have average lengths of stays of around 2.4 episodes per admission. Some of the Northeastern states where money and education are not in short supply have a much lower length of stay.
But, I really don’t care about what your average is. People hear that their length of stay is average or below and they breathe a sigh of relief and go on about their business. I had an agency where most patients were on service for about a year. However, a cardiovascular surgery group referred several patients a week to the agency who were only seen for three visits. Their average length of stay was quite acceptable. The reality is that most of their census consisted of patients who did not meet eligibility criteria.
To be sure, every agency has a patient that continues to come up with new ways to challenge the nursing staff. They are admitted with DM but right before discharge they fall and break their hip. After therapy gets them back on their feet, they have a small MI. Later it is a stroke, etc. As nurses, we cannot and should not look at an arbitrary number and discharge a patient because they have been on service for two years. And even one episode is too long for a patient who is not homebound.
As most of you know, I am an information junkie. I love the numbers and they tell me a lot about clients. But when it comes to taking care of patients our concern shouldn’t be length of stay. There should be no mass discharges to lower averages. The only questions that matter are:
- Is the patient under the care of a licensed physician operating within his scope of practice?
- Are the services required by the patient reasonable and necessary as defined in Chapter 7 of the Medicare Benefits manual?
- Is the assessment and the care plan of the patient accurate and sufficient to guide care?
- Can you provide the services?
- Can you document the services?
Oddly enough, it is question number five that most agencies get stumped on but I digress.
If you can satisfactorily answer all five of these questions upon admission and recertification, the patient should remain on service. Regardless of the length of stay, any patient discharged requiring home health care that is covered by the Medicare Home Health benefit is being shorted the benefits that they rightfully deserve.
Numbers give us a place to start looking. It would be rare indeed for an agency that only keeps eligible patients on service to have a length of stay of five episodes per admission. Upon investigation of a new client, I will certainly keep numbers in mind as I review clinical records. However, my recommendations to the agency are made based upon the patient’s needs and conditions.
Does following these guidelines mean that the Zone folks won’t come looking for you? Probably assuming the same guidelines were in effect for the past three years. In addition to Zone contractors, remember we have RAC’s, state surveys, accrediting organizations and numerous other regulatory bodies who are more than welcome to visit an agency at any time and look at your records. Be ready. All it takes is one disgruntled employee to file a complaint or a surveyor who didn’t get enough sleep the night before to make trouble for you. You have no control over that. What you can control is your ability to respond successfully to any sort of scrutiny.
Questions? Post below or email me.