In order to distinguish your homecare patients with Type 2 Diabetes who are at increased risk of developing other chronic diseases – such as heart disease, kidney disease, etc. – identify patients with one or more of the following risk factors within a particular time period:

• more than one HbA1C that is greater than 7% and/or
• LDL-C greater than 100 mg/DL and/or
• blood pressure readings of greater than 140/90 and/or
• individuals who smoke tobacco

Once the patients are identified, the next step would be to define and implement a plan for patient and family education and intervention.  Read more...

Three main areas or systems will need to be addressed in order to support accountable care objectives; care transition, coordination of evidence-based care and consistent reporting and communication.

Care Transition and Coordination of Evidence-Based Care

As the patient transitions from one care setting to another, it is important to address those areas that are often a concern, such as summary of care provided by previous setting, medications, follow-up with primary care provider, and maintaining a comprehensive record.

There are several care transition models available in the public domain. Contact the Quality Improvement Organization in your State for guidance, or access the Institute for Health Improvement for information about the State Action on Avoidable Rehospitalizations (STAAR) initiative.  Read more...

Numerous quality measures for physicians are focused on disease processes such as diabetes mellitus, heart failure, and chronic kidney disease.  Screening or Prevention measures applicable to diabetes, mammograms, colorectal cancer screening, body mass index evaluation (a noted contributory factor to heart disease and diabetes) are also part of physician reporting.

For Medicare recipients receiving home care services between 1997 and 2009, diabetes and heart failure are the leading principle diagnoses for the patient population (Center for Medicare and Medicaid Services, 2010).  Coordination of evaluations and interventions between the home care provider and the physician(s) would allow for a repetitive and comprehensive approach to the care of the patient.

While home care has no reported outcomes regarding smoking cessation defined, both hospitals and physicians do. Smoking has been identified as a contributing factor to pneumonia, heart disease, cancers, etc. (National Cancer Institute) and would logically contribute to the hospitalization costs.

The Department of Health and Human Services published a Surgeon General’s report that indicates that counseling and pharmacologic treatments such as nicotine replacement therapies and bupropion are effective for smoking cessation (U.S. Department of Health and Human Services, 2010). Home care could support the smoking cessation efforts for hospitals and physicians by integrating appropriate interventions in the plans for the care of the patient. Reporting, though not public, could further strengthen marketing efforts for home care providers with referral sources.

An area of commonality between all the hospital, physician and home care outcomes is immunizations.  Two types of immunizations / vaccines are the focus:

1. Influenza
2. Pneumococcal

Immunizations are an integral part of avoiding hospitalization.  Nichol KL, Wuorenma J, and von Stemberg (as cited by the Center for Disease Control, August 6, 2010) report a ‘substantial reduction in hospitalization and deaths among persons aged 65 and greater with influenza immunization’.  Read more...

Perhaps the most publicized topic is hospital readmission rates.  In 2007, MedPAC reported that “17.6% of admissions result in readmissions within 30 days of discharge, accounting for $15 billion in spending.  Not all of the readmissions are avoidable, but some are” (MedPAC, June 2007, p. 103).

The majority of hospital readmission costs are associated with four distinct medical conditions, which lead to over $1.6 billion in spending on readmissions alone.  These conditions include heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and acute myocardial infarction (AMI) (MedPAC, June 2007, p.116).  Granted these numbers are based upon 2005 Medicare hospital discharges and they could be even higher in 2011.  Read more...

by Rhonda Chetney, MS, RN

As a former homecare director of an agency that offered skilled home health, hospice and private duty services, we seldom placed our focus for reducing readmissions on the private duty side of the business.  

As we continue to see constraints from Medicare for home health, such as Face-to-Face visits, more stringent Therapy rules and reimbursement cuts; private duty is emerging as the place where patient’s will receive increasing amounts of care in the home setting.   Read more...

by Joseph E. Fochler

The most expensive Go to Market Participant we can choose is using a direct Sales Force. While the least efficient choice we can make in terms of expense, often the use of a Sales Force can be our most effective choice of reaching our target market and producing the desired results.  Read more...

by Joseph E. Fochler

One in five Americans use social media websites as a source of healthcare information, according to National Research Corporation’s Ticker survey, which bills itself as the largest, most up-to-date poll on consumer healthcare opinions and behaviors.

The survey found that 94 percent of respondents have used Facebook to gather information on their healthcare, 32 percent used YouTube and 18 percent used Twitter.

The National Research survey did not ask specifically what social media presences the respondents checked out, what advice they were seeking or from whom. But there is plenty of evidence that social media users are following health-related feeds.  Read more...