Pay-for- Frustration in Small Home Health Agency

Problem: Too Many CMS Rules and Paperwork to Ensure “Quality”

Solution: Have CMS Bureaucrats Serve Time in Home Health Agencies as Part of Job Training

After I wrote a Healthleaders article on Pay-For-Performance possibly not being what it’s cracked up to be (see yesterday’s blog), I received this note.

Dr. Reece:

I applaud your common sense description of the P4P plight we all face. I’m the director for a Home Health agency in Ohio. We face the same problems in the Home Health environment with respect to poor patient compliance based on cultural and financial problems that patient care is frought with.

You were right on with the comment, politically incorrect or not, that "Patients are equally responsible for bad disease outcomes". Is it fair to punish physicians and agencies for poor choices?

And what about the nature of the human condition itself that lends to the inevitable outcome of the body "wearing out"?

And what of the patients who are non-compliant and are given notice by their physicians that they will no longer treat them? We all know the P4P quality measures will be negatively affected by these types of patients.

The same holds true in home health. There is already fear that we will avoid co-morbid patients because of predisposed potential for a downhill spiral prior to discharge from home care.

Chronic conditions such as COPD, diabetes, CHF, diabetic wounds among others are repeat offenders when it comes to re-hospitalization and emergent care.

This can't be helped and so I ask those that will rely on P4P as a payment guide to ask this question: What will become of agencies who care for these patients regardless of P4P percentages?

And what will become patients who are avoided because P4P threatens to remove these monies if the percentages fall below "their" idea of quality?

Ask these patients who depend on home care nurses and aides who help them cope with their medical problems. Not to mention physicians who rely on us as well to manage follow-up and change in treatment regimens so as to prevent emergency room visits.

I recommend that those who make these determinations should walk a mile in ALL our shoes!

Ellen Henderson, RN, Director
Twin City Home Health
Dennison, OH 44621
740-922-7450 Ext. 3901

I followed up by calling Ms. Henderson. She runs a small home health agency – 12 employees with about 40 home health patients. The agency is affiliated with a 25 bed rural hospital.

She says current CMS reporting requirements burden her staff. Federal rules may require 2 to 4 hours of paperwork to meet quality requirements. “That’s time we could better spend caring for patients.” What P4P might add to the red tape, she doesn’t know, but she fears the worse.

Many of her patients are non-compliant. Their behavior poses safety hazards beyond the control of her staff. One client insists on keeping kerosene cans next to his oxygen tank; another suffers a wound infection from a dog licking his wound.

Even though satisfaction surveys show a 99% approval rating among her agency’s home health clients, she notes “We look bad on quality surveys because we accept patients with chronic disease and multiple co-morbidities.”

Other agencies hesitate to accept these patients because they reflect badly on quality ratings, She said home health agencies across the land are resisting mandatory P4P participation “because it would put us out of business.”

She said home health agencies would like to see major changes in regulations that would not punish agencies who care for chronically-ill patients with poor prognoses.

I have a modest proposal: have fledging CMS bureaucrats spend a week in a home health agency filling out CMS forms, going on home calls, and observing how patients comply as part of their job training.

The moral is: Bureaucratic regulations have unforeseen complications: things don’t always look the same from the bottom-up as from the top-down.