Re: Perspective payment system and home health

[Guest guest]

One of the most frustrating elements of home health historically has been

successfully integrating therapy into home health agencies that focus

primarily on nursing services. My 18 years of experience in home health has

seen this pattern fluctuate in severity of nursing focus. A key element is

the strength and perseverance of the therapy manager or key therapist to

educate nursing staff about therapy and it's integral role in delivering the

best comprehensive program to each patient it serves. But even more critical

is the receptiveness of the nursing hierarchy to listen to and hear the

message.

PPS has thrown many home health agencies challenges they are not yet prepared

to manage. Some are focusing on a financial formula that overly controls the

# of visits to insure profitability with each patient. The easiest way to

effect this method is to have a nurse open each case, set the visit freq/dur

for each discipline (if they are even allowed to see the patient), and

maximize reimbursement with the highest HHRG ranking with fewest services

utilized. Often a cookbook method of set frequencies will be used to control

utilization. The flexibility of these " pathways " is one indicator of whether

the financial formula method is being utilized or another.

A better methodolgy IMHO is to balance the financial constraints of PPS with

patient needs on an overall basis, which allows for flexibility while

managing utilization. This methodology will focus on the integration of the

appropriate discipline to meet patient needs in the most cost effective means

possible. Sometimes nursing will prevail, sometimes therapy or social work,

sometimes each. The difficulty with this approach is there needs to be an

underlying philosophy of mutual respect and recognition of value for each

discipline for each other. It is also more difficult to implement than a

cookbook approach. But the beauty is that each patient can be best served by

what services are integral for their recovery and utilization can still be

effectively managed to assure agency profitability.

Deciding which approach to follow is what home health agencies are struggling

with these days. Unfortunately, some patients are being short-changed since

October 1 PPS implementation. Reviewing agencies, and eventually the OIG,

will be on the outlook for visible signs of manipulation of the system.

Long-term I hope that those agencies that adopt a balanced approach and look

to effectively integrate therapy will prevail. In the meantime, it is

essential that therapists work diligently to effect change or know when it's

time to walk away.

W. , PT, MS

Therapeutics

2065 Van Antwerp Ave

Grosse Pointe Woods, MI

ph/fax

dperrypt@...

In a message dated 1/9/01 5:12:35 AM Eastern Standard Time,

tccdore@... writes:

> I am flabbergasted at how the nursing staff at the home health agency I

work

> for do not have any insight into integrating therapy services into the new

> home health PPS. They cut hours, treat at the threshold of each patient

> exactly. I fear for the next audit or even an OIG visit because of their

> practice and demands they are putting on the therapist. Any suggestions?

>

> T.Noor

> _____