Moving from home care to home-based services

It’s time to change what we call ourselves…move from thinking of the Colorado Visiting Nurse Association (VNA) as a “non-profit home health care agency” to a “non-profit organization that provides home-based services”. This may seem like a small distinction, but it there are three reasons we should make this change:
1) “Home health care” agencies are defined by outdated Medicare regulations specifically focused on controlling home care as a way to decrease fraud and abuse within a fee-for-service payment environment.
2) Second, there is very little government and/or insurance company reimbursement for para-based services focused on helping patients remain independent in the home.
3) Further, there is very little coordination of care across our various divisions because of the differing ways we are paid for care that we provide.

The Colorado Visiting Nurse Association has begun to think differently about the care we provide as healthcare transitions from a fee-for-service (FFS) payment system to one where healthcare organizations are paid for overall care and health outcomes.
Currently there are many differences between the care provided by each of our home-focused divisions; home health, paraprofessional home services and hospice/palliative. Care provided by our home health professionals is mostly regulated by Medicare and requires patients to be “home-bound” and have a documented needed for care provided by an RN, PT, LPN, etc.

By definition, paraprofessionals are workers who are not qualified or licensed to serve in particular professions but who handle tasks in support of qualified professionals in those fields. Paraprofessionals often work alongside fully qualified professionals, but they also sometimes work more independently, such as in the case of the health care paraprofessionals who provide home visits to the disabled, ill or elderly.

Care provide by paraprofessionals is more proactive in nature and is provided to help patients remain independent in the home, e.g., bathing, shopping, house-keeping, getting in and out of bed, etc. Hospice visits for appropriate patients are similar to home health visits in that hospice patients have to meet strict criteria for admission, i.e. patients must have a terminal diagnosis and patients must have a prognosis of having less than six months to live.

As one can see, there is a big barrier between the care provided by paraprofessionals and home health and hospice; the barrier has to do with the strict Medicare definitions put in place to help decrease overuse and abuse of skilled home health. Bottom line: the way home health services are reimbursed in our country is too focused on decreasing costs and abuse, rather than on improving care for patients.

The good news is that the old ways of paying for the care we provide are beginning to change as Medicare begins to move to paying for the value provided in the home, rather than just for an episode of care. Here is an excerpt taken from the recent U.S. Department of Health and Human Services Report to Congress: Plan to Implement a Medicare Home Health Agency Value-Based Purchasing Program. The report details a summary of Medicare’s view of the problem of fraud, as well as the limited connection between payments and quality of care.

“…the Medicare Payment Advisory Commission (MedPAC), the Office of the Inspector General, the General Accounting Office (GAO), and other stakeholders have raised significant concerns with fraud and abuse in the Medicare home health benefit. While the benefit is designed to encourage teams of skilled professionals to provide patient-focused care to homebound beneficiaries, there is growing concern that the existing payment system does not provide the necessary incentives to provide such high quality patient focused care.”

There is a lot that is changing in healthcare. Care provided in the home is fast becoming of vital importance to improving the health of populations of patients.

– Christopher Lee, Colorado VNA President & CEO, July 13, 2015