A Needs Assessment of a A Needs Assessment of a Home Health Agency & Home Health Agency &
Education PlanEducation Plan
Madjil Clark, BSN, RN, Charity Ebert, BSN, Madjil Clark, BSN, RN, Charity Ebert, BSN, RN, RN,
Andrea Englund, BSN, RN & Rita Million, Andrea Englund, BSN, RN & Rita Million, BSN, RNBSN, RN
IntroductionIntroduction Home Health agencies are paid on a Home Health agencies are paid on a
prospective payment system (PPS)prospective payment system (PPS)
Payment is determined by Payment is determined by completion of a data set Outcome completion of a data set Outcome Assessment and Information Set Assessment and Information Set (OASIS) (OASIS)
CMS mandated changes to the CMS mandated changes to the payment structure of Home Health payment structure of Home Health Agencies effective January 1, 2008Agencies effective January 1, 2008
Introduction Introduction
Changes are based on a Changes are based on a retrospective review of Medicare retrospective review of Medicare claims that demonstrate a decrease claims that demonstrate a decrease in home health visits per episode in home health visits per episode while patient acuity (case mix) while patient acuity (case mix) increased increased
Translates into inaccurate Translates into inaccurate reimbursement system reimbursement system
PPS Regulatory Changes PPS Regulatory Changes
Two new OASIS questions Two new OASIS questions Expanded Home Health Resource Expanded Home Health Resource
Group (HHRG) similar to a DRG Group (HHRG) similar to a DRG Change to a 3 tier therapy threshold Change to a 3 tier therapy threshold Non-Routine Supply (NRS) add on Non-Routine Supply (NRS) add on Addition of 2 more outcomes that will Addition of 2 more outcomes that will
be publicly reported be publicly reported
Example of an OASIS Example of an OASIS question question
MO110MO110 Episode TimingEpisode Timing: : Is the Medicare home Is the Medicare home
health payment episode for which this health payment episode for which this assessment will define a case mix group an assessment will define a case mix group an “early” episode or a “later” episode in the “early” episode or a “later” episode in the patient’s current sequence of adjacent Medicare patient’s current sequence of adjacent Medicare home health payment episodes?home health payment episodes? Early Early LateLate UK- Unknown UK- Unknown NA- Not Applicable: No Medicare case mix group to be NA- Not Applicable: No Medicare case mix group to be
defined by this assessmentdefined by this assessment
Target Population of the Target Population of the Transformation Transformation
Home Health Agency of a non-profit Home Health Agency of a non-profit Medical CenterMedical Center
Primary patient population >65years old Primary patient population >65years old
Professional staff of RN, PT, OT, SLP who Professional staff of RN, PT, OT, SLP who complete the OASIS assessment complete the OASIS assessment
Entire agency impacted Entire agency impacted
Needs Assessment- Focus Needs Assessment- Focus
Focus on Staff needs Focus on Staff needs
Focus on Management needs Focus on Management needs
Focus on Patient needs ????Focus on Patient needs ????
Needs Assessment-Needs Assessment-Strategies Strategies
SWOT analysis of the agency SWOT analysis of the agency
Survey of the staff Survey of the staff
Focus Groups Focus Groups
Review of agency data Review of agency data
Threats
Opportunities
Weaknesses
Strengths
OrganizationalNeeds
Identified
SWOT Needs Assessment
SWOT Analysis SWOT Analysis
Average Case Mix Weight, by Month2006
1.377
1.58
1.396
1.517 1.538
1.465
1.607
1.511
1.352 1.375
1.574 1.56
1.2
1.3
1.4
1.5
1.6
1.7
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Avg
of
Csx
MxW
gt
Case MixWgt
Average Case Mix Weight, by Month2007
1.523 1.52 1.5581.432 1.471 1.507
0
0.5
1
1.5
2
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Avg
of
Csx
MxW
gt
Case MixWgt
Quality MeasureQuality Measure Percentage Percentage BryanLGHBryanLGH
State AverageState Average National Average National Average
Percentage of patients who get better at Percentage of patients who get better at walking or moving aroundwalking or moving around
33%33% 42%42% 42%42%
Percentage of patient who get better at getting Percentage of patient who get better at getting in and out of bed in and out of bed
54%54% 56%56% 53%53%
Percentage of patients who have less pain Percentage of patients who have less pain when moving around when moving around
58%58% 62%62% 63%63%
Percentage of patients whose bladder control Percentage of patients whose bladder control improves improves
57%57% 48%48% 50%50%
Percentage of patients who get better at Percentage of patients who get better at bathing bathing
61%61% 64%64% 64%64%
Percentage of patients who get better at taking Percentage of patients who get better at taking their medicines correctly (By mouth)their medicines correctly (By mouth)
30%30% 37%37% 42%42%
Percentage of patients who are short of breath Percentage of patients who are short of breath less often less often
68%68% 63%63% 61%61%
Percentage of patients who stay at home after Percentage of patients who stay at home after an episode of home health care ends an episode of home health care ends
73%73% 72%72% 68%68%
Percentage of patients who had to be admitted Percentage of patients who had to be admitted to the hospitalto the hospital
22%22% 24%24% 29%29%
Percentage of patients who need urgent, Percentage of patients who need urgent, unplanned medical care unplanned medical care
18%18% 18%18% 21%21%
Problem StatementProblem Statement
Staff needs to be educated and have a Staff needs to be educated and have a thorough understanding of the OASIS thorough understanding of the OASIS assessment, changes to the OASIS assessment, changes to the OASIS questions, and strategies to assist with questions, and strategies to assist with accurate documentation. An education accurate documentation. An education plan needs to be developed and plan needs to be developed and implemented to meet staff needs and implemented to meet staff needs and achieve the desired outcomes.achieve the desired outcomes.
Desired OutcomeDesired Outcome
Staff will document accurate OASIS Staff will document accurate OASIS assessmentsassessments
Staff will understand the importance of Staff will understand the importance of accurately documenting the OASIS as it relates accurately documenting the OASIS as it relates to agency reimbursement and benchmarking to agency reimbursement and benchmarking clinical outcomes clinical outcomes
Staff will utilize the OASIS assessment to drive Staff will utilize the OASIS assessment to drive the development and focus of the plan of care the development and focus of the plan of care
Transformation PlanTransformation Plan
Learning styles of cliniciansLearning styles of clinicians Content of the education plan Content of the education plan Learning strategies to support the Learning strategies to support the
transformation transformation Timelines and sequencing of Timelines and sequencing of
activities activities
Project TeamProject Team
Includes Management, IT staff, Includes Management, IT staff, nursing and therapy staff- (Primary nursing and therapy staff- (Primary Stakeholders)Stakeholders)
Primary Responsibility: Facilitate the Primary Responsibility: Facilitate the transformation of the agency through transformation of the agency through a needs assessment, develop and a needs assessment, develop and implement an education plan, and implement an education plan, and evaluate the project evaluate the project
Staff Education PlanStaff Education Plan
Learning Styles assessment for each Learning Styles assessment for each clinician clinician
Web based education of the OASIS Web based education of the OASIS Participation in formal education Participation in formal education
training training Lecture and video Lecture and video
Application of knowledge through Application of knowledge through case study review case study review
TimelineTimeline
Phase 1 Milestones (December 10, 2007) Phase 1 Milestones (December 10, 2007) Needs assessmentNeeds assessment All staff education activities All staff education activities Finalize testing of computer upgrade Finalize testing of computer upgrade
Phase 2 (December 26, 2007)Phase 2 (December 26, 2007) Mandatory Staff meeting Mandatory Staff meeting Finalize agency process changes and Finalize agency process changes and
communicate communicate
EvaluationEvaluation
Framework for Program EvaluationFramework for Program Evaluation Rationale for Selection of ModelRationale for Selection of Model
Significance of the Significance of the Transformation Process to Transformation Process to
StaffStaff The OASIS assessment drives The OASIS assessment drives
reimbursement for the agency, reimbursement for the agency, supports the physician directed plan of supports the physician directed plan of care and generates the public reported care and generates the public reported outcomes outcomes
Ability to project revenue and prevent Ability to project revenue and prevent down coding of claims down coding of claims
Demonstration projects on pay for Demonstration projects on pay for performance (P4P) currently going on in performance (P4P) currently going on in Home Health Home Health
ConclusionConclusion
Federally mandated changesFederally mandated changes
Direct impact on staff, patients & Direct impact on staff, patients & financesfinances
Educational programsEducational programs
Evaluation & feedbackEvaluation & feedback