Improve timely intake and address CMS concerns by strengthening relationships

Ensure clear communication with hospital discharge planners as patients prepare for home health by making sure the hospital knows the information your agency needs to start care timely.

 

This is a priority for CMS as it looks to add an acceptance to service CoP in the 2025 home health rule — to address concerns about delays in care when agencies aren’t prepared to begin visits when needed (HHL 07/22/24). And organizations that shorten the gap between hospital discharge and the initiation of home care can see improved patient outcomes that can impact future referrals and payments under Home Health Value-Based Purchasing (HHVBP).

 

Many hospital patients are discharged while they still have medical needs, says Angela Huff, senior managing consultant at Forvis Mazars in Springfield, Mo. To gain these referrals, agencies should establish trust with local hospitals, showing an understanding of any specialty programs and ensuring a swift changeover.

 

“Hospitals are busy and they need to be able to work with partners that can help them facilitate smoother transitions of care,” Huff says. “If agencies can understand how they can participate not only from a process perspective but also filling in a need that the hospital may have, that’ll help drive referrals and build that relationship.”

It’s important to work with both community and institutional admission sources, says Lisa McClammy, senior clinical education consultant with MAC Legacy in Denton, Texas. She adds that partnering with hospitals can also lead to increased payments as they take on patients who require more complex care.

 

Care must begin within 48 hours of a patient’s referral date, hospital discharge or physician-ordered start-of-care date, McClammy notes.

 

“A smooth transition of care is vital,” Huff says. “It’s incredibly important to ensure that the care plan continues and that things aren’t missed so that the patients don’t potentially backslide and have a negative outcome.”

 

Even as little as a two- or three-day delay can have adverse impacts on patient outcomes, Huff notes. She adds that the reason for a patient’s hospitalization prior to home health often requires lifestyle changes, which the patient may be ill-prepared to enact immediately after discharge.

 

For example, consider a patient who was given intravenous antibiotics for a urinary tract infection (UTI) during hospitalization. Physicians switched the patient to oral antibiotics three days before discharge and directed the patient to continue the treatment until the UTI was gone. If several days pass between hospital discharge and the start of in-home care, the patient may not take the necessary medication or even fill the prescription.

 

“Because that was missed, the patient’s UTI came back,” Huff says. “If you go out and are starting care the next day, you can catch those things.”

 

Delays in care can also cause confusion or inaction around wound care, dietary and activity changes and other ordered treatments.

 

Such issues can lead to diminished quality of care and heighten the risk of rehospitalization or emergency department use within the first week of in-home care, McClammy says. She notes that this can also increase the burden on staff down the line.

 

“Agencies need to assess the current intake process to identify any gaps or barriers to timely initiation of care,” McClammy says. “It is important to have a consistent and comprehensive intake process to ensure the agency has all of the information needed to begin care in a timely manner.”

 

She notes that agencies should review their intake process when they:

The following steps can help streamline the transition for hospital referrals:

 

Gather relevant information. Agencies must identify a community practitioner immediately
upon referral, McClammy says. She notes that the referral is invalid without a physician who has agreed to take point on the patient’s care and provide orders.

 

The intake team must also obtain all of the patient’s medical records and orders before care can begin, McClammy says. She adds that this should include hospital and medical records, medication lists, a discharge summary, face-to-face documentation and records of communication between the practitioner ordering home care and the community practitioner who will write orders moving forward.

 

Streamline payor selection. One of the costliest mistakes is selecting the wrong payor, Huff says. She notes that this may occur because a staff member is rushing to complete the intake process, or a payor is not set up correctly in the electronic medical record (EMR).

 

“When someone is in intake and they’re just trying to get a patient onboarded, they may select a payor that looks right or is close, and the downstream effect of that and the cost of correction is incredibly significant,” Huff says.

 

Agencies may never see reimbursement for incorrectly billed claims and could spend even more money trying to fix the mistake, Huff adds. She notes that some agencies may not catch this issue until after care is delivered. “If someone trips out of the gate, it is really difficult to recover from that from a financial perspective.”

 

Review denials. “Excellence in intake is vitally important, and you may have to look at the causes for denials,” Huff says. She notes that evaluating these denials can help providers identify bottlenecks in the intake process and understand why these issues reoccur.

 

It may not be obvious up front but it shows up in your accounts receivable, Huff says. She notes that reviewing quality assurance corrections can also bring intake issues to light.

“Make sure you have a consistent, solid approach to how you process referrals,” Huff says. “Once you’ve got that in place, then look at the people.”

 

Agencies must adopt a concise plan of action for intake staff to follow, she notes. With these steps in hand, employees can hopefully develop a clearer understanding of the process.

 

If a particular employee is consistently making mistakes, the organization’s administrator may need to provide additional training, Huff adds. She notes that implementing performance metrics and providing rewards for employees who exceed expectations can also help prevent providers from having to make costly or avoidable corrections.

 

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Rule comments due August 26

Stakeholders have until Aug. 26, 2024, to submit comments to the 2025 Home Health Prospective Payment System Rate Update proposed rule. See the rule and comment at https://tinyurl.com/m87b6nb8.