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  1. Macon, Jana BSIS
  2. Heislitz, Daneen BS

Article Content

With Medicare planning to cut its rates by $350 million next year (Dickson, 2015), many healthcare organizations are wondering how they'll continue providing quality care on leaner budgets. Home healthcare and hospice agencies in particular may experience significant reductions. With Medicare making up a substantial portion of their budgets-approximately 41% for home healthcare and 90% for hospice-it's no surprise that these financial cuts are cause for concern. However, there are proactive strategies that healthcare leaders can employ to turn these seemingly difficult changes into an opportunity for success. By taking the following key steps to reduce costs, improve workflow, and monitor compliance, home healthcare and hospice agencies can position themselves to thrive and stay competitive despite industry changes and challenges.


1. Be aware of what's coming


There's no doubt that healthcare is changing, and home healthcare and hospice leaders must come up with innovative strategies in order to thrive. Rather than ignoring these shifts, they should be mindful of applicable changes coming from the Centers for Medicare and Medicaid Services (CMS) as well as other state and local agencies. There are countless ways to stay current. For example, organizations may choose to participate in listservs and email groups, as well as state and national associations such as the National Association for Home Care & Hospice. Also, when new rules or regulations are proposed, providers should be vocal and express their opinions through designated channels, driving the appropriate modifications before final rules are released. Some ways to do this include reaching out to local or state Congressional leaders via emails, letters, or through associations such as the National Hospice and Palliative Care Organization and their Hospice Action Network.


2. Understand the potential impact of emerging requirements


Reimbursement rates and penalties will affect every home healthcare and hospice agency differently. With this in mind, organizations should first project the financial impact of these changes to their business and then proactively mitigate possible problems in order to sustain business and continue providing top-notch patient care. For instance, some hospice agencies might actually see a rise in their reimbursement structure from the Fiscal Year 2016 Hospice Final Rule depending on their payer mix and their patients' length of stay; however, these same organizations may also be susceptible to more penalties. For home healthcare agencies, they must stay on top of the requirements for the Outcome and Assessment Information Set (OASIS-C1) submissions in order to avoid costly penalties. By adjusting its patient mix and staying on top of regulatory requirements, an organization may be able to avoid penalties while retaining increased reimbursement. Understanding these implications and planning accordingly can help organizations actually come out ahead despite industry-wide reductions.


3. Improve workflow using consistent and repeatable processes


In light of cuts, home healthcare and hospice agencies should aim to use staff time as efficiently as possible. By developing thorough and reliable processes supported or even automated by technology, organizations can generate not only efficiencies and speed workflow, but provide better patient care while also promoting regulation compliance. For example, when a new clinical staff member visits a patient, the agency can ensure that the clinician fulfills documentation requirements and follows regulations by using technology-guided processes. This allows the clinician or staff member to spend more time with the patient and still remain compliant with CMS' conditions of participation or other policies.


4. Employ an innovative electronic medical record


If an organization hasn't already done so, adopting an electronic medical record (EMR) to streamline and automate workflow is a crucial step. This can eliminate paper-based methods that can be inconsistent and resource-intensive. For example, a few office staff might know about new CMS regulations, but then they must communicate that information to clinicians and rely on them to update and maintain hardcopy patient files. Unfortunately, systems like these are susceptible to error and can lead to noncompliance, in addition to operational and clinical issues. On the other hand, when an EMR intelligently guides processes, home healthcare and hospice agencies can sustain consistency, realize efficiencies, and remain compliant with less staff time spent on documentation outside of patient visits.


5. Partner with a progressive software vendor


When selecting an EMR, home healthcare and hospice agencies should look for a supportive and reliable partner, seeking a company that stays abreast of evolving regulations and provides resources to ensure staff are informed of and familiar with any adjustments. Additionally, the vendor should be able to roll out software changes quickly in response to new or revised regulations to minimize noncompliance risks. Overall, a vendor should be forward-looking, keeping one step ahead of all the regulatory changes in the industry.


Staying Competitive

When it comes down to it, physicians and hospitals want to do business with home healthcare and hospice agencies that put patients first, have high patient satisfaction, give visibility to patients within the home, and have successful outcomes. By being as efficient as possible and keeping up with CMS and other regulatory changes, organizations can react to and remain compliant with shifting requirements while still providing quality patient care and distinguishing themselves from competitors. By taking these key steps to reduce costs, improve workflow, and monitor compliance, home healthcare and hospice agencies can position themselves to thrive and stay competitive despite industry challenges.


AHRQ Stats: Causes of Death

Heart disease remained the leading cause of death in the United States, followed by cancer and chronic lower respiratory disease, in 2010. Cancer was the leading cause of death for adults age 45 to 64, whereas accidents were the leading cause of death for adults age 25 to 44.

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Dickson V. (2015, July 7). Home health agencies face $150 million Medicare cut. Modern Healthcare. Retrieved from http://www.modernhealthcare.com/article/20150707/NEWS/150709949[Context Link]