April 25, 2011
There’s No Place Like Home…For Health Care
By Michael D. Shaw
In February, 2009, the Centers for Medicare & Medicaid Services (CMS) reported that there are 10,581 Medicare Certified Home Health Agencies in the United States. For those keeping score, Texas leads the way with 2,190 followed by Florida at 1,236.
If hospice care and facilities that are not certified by Medicare are also included, the National Association for Home Care & Hospice notes that:
Approximately 12 million individuals currently receive care from more than 33,000 providers (for causes including acute illness, long-term health conditions, permanent disability, or terminal illness). In 2009, annual expenditures for home health care were projected to be $72.2 billion.
Home care is a cost-effective service for individuals recuperating from a hospital stay and for those who, because of a functional or cognitive disability, are unable to take care of themselves.
As you might expect, there are a staggering number of regulations (federal, state, and local) that apply to home care providers. One benefit of the almost incomprehensible bureaucratization is that there are plenty of available resources for those who are contemplating home care.
A good place to start is the publication “There’s No Place Like Home—For Growing Old“, from the National Institute on Aging.
While cost-effectiveness is certainly not the only parameter to consider in patient care, it is a topic of great concern. Compiled government data compared hospital, skilled nursing facility, and home health Medicare (per day or per visit) charges for the period 2005-2009. In 2009, the figures were $6200, $622, and $135, respectively. Moreover, the increase in hospital charges over the time period was 24%, compared to only 8% for home care.
Arguably, when compared to other aspects of health care, the home providers are under the greatest scrutiny regarding matters of quality control and reporting of outcomes. Central to quality health care is diligent record-keeping—and this precept applies even more so to patients outside of conventional clinical settings.
Such record-keeping is essential for at least these reasons…
- It forms the basis for a full medical history
- It facilitates communication among providers
- It enables providers to anticipate future health problems
- It allows providers to quickly note deviations from what is normally expected
- Medicolegal implications
Among other requirements, CMS mandates that Medicare-certified home health agencies must collect information as specified by the so-called Outcome and Assessment Information Set, known affectionately as OASIS. (I wonder how much tax revenue is spent on creating acronyms?)
In light of OASIS, a survey run by the CDC in 2007 indicated that 41% of home health and hospice providers had electronic medical records, with an additional 15% planning to implement them the following year. Fortunately, there are number of companies supplying specialized software for OASIS compliance, including HealthWyse, HealthWare, and Strategic Healthcare Programs.
As to the realm of home health agencies that are not Medicare-certified, bear in mind that homebound clients are often in need of services that do not require a doctor, nurse, or related paraprofessional. Examples would include…
- Help with personal care
- Meal preparation
- Assistance with medications
- Aspects of money management
If the family of the homebound client cannot provide these services, a commercial non Medicare-certified home health agency is hired. Here again, record-keeping is essential, but in this space, it is still quite common for the in-home provider to keep paper records, usually in the form of a care journal. At best, this can be a time-consuming hassle, and often requires that these journals be collected by supervisory staff.
Even then, the supervisors—to say nothing of concerned relatives—lack real-time oversight of the care process. Getting rid of paper records, and taking full advantage of Internet and mobile technologies—at a reasonable price—would be an important step.
San Francisco based ClearCare is a new company that intends to do just that. Electronic care journals are archived on the Cloud, with in-home tasks automatically pushed to the point-of-care on a smart phone or tablet. Should a task not be completed, or if a caregiver has not checked in, supervisory staff is immediately alerted, via their Internet-powered management console. As an option, such monitoring capability can also be given to relatives of the homebound client.
Just one more example of how advanced technology can help cure our growing health care crisis.