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New Rules on Medicare Home Health Care

February 14, 2017 | Medicare Enrollment

On January 9, the Centers for Medicare & Medicaid Services (CMS) toughened the health and safety standards a home health agency must meet to be a Medicare or Medicaid approved provider. Approximately 12,600 home health agencies currently provide home health services to more than 5 million Medicare and Medicaid beneficiaries. Such agencies provide a broad range of services, including skilled nursing care, physical therapy visits and social work services for individuals in the comfort and privacy of their own homes. Since all services are supervised by physicians and performed by an array of properly credentialed professionals, you can expect greater care and safety. The new standards are based on research in patient education and medicine, so they have the potential to improve on the Medicare program in a number of ways.

Overhauled Agency Procedures

Good care begins with an efficiently run home health agency fully committed to improvement. As leadership has a major impact on the success of an organization, Medicare is increasing the qualifications for home health administrators and clinical managers. In terms of administration, the new standards also call for a simplified organizational structure. Although chain of command will likely be simplified with the new standards, such hierarchy won’t be eliminated entirely. The common structure of a parent agency that oversees branches will be retained. This kind of structure allows the overall business model to grow while catering to the needs of local markets. In turn, it helps consumers by making sure that Medicare as an agency understands individual needs, especially when it comes to home healthcare.

The CMS also wants to improve customer satisfaction by requiring individual agencies to implement ongoing evaluation to enhance patient care. Although quality assessment and performance improvement (QAPI) may be a new term to much of the general public, its basic premise is not. Home health agencies are expected to collect objective data on their own performance, reflect upon it and use it as the basis for improving patient care. CMS has, in fact, used QAPI to devise many of its new standards.

Increased Understanding

One aspect that’s seen great improvement via new standards is increasing understanding among healthcare professionals and patients. Without clear communication, true healthcare is not possible. To that end, CMS has instituted an integrated communication system that requires healthcare workers across disciplines to continually identify and respond to patient needs. Timely and detailed interaction among all professionals involved in home care that will lead to faster, more focused intervention.

Patients are also expected to directly benefit from this set of standards, as a key component of the new standards is providing each home care patient and their caregivers with written direction regarding:

  • Treatments
  • Medication administration
  • Daily care requirements
  • How to contact their home health agency clinical manager

Providing simple, written instructions will help patients more easily access the care system. It’s also more economical. Research in 2007 showed that patient costs were reduced by 33 percent within one month of providing clear discharge instructions to patients.

Better Care

In addition to increased patient satisfaction and participation within the healthcare system, improving communication also enhances patient care. The CMS issues mandates to make sure that patients get the care they need. One example is improved screenings in a patient’s overall well-being. While patients already receive fairly thorough physical and mental health assessments, more stringent requirements will allow home care consumers the chance to receive earlier treatment for conditions, like depression, that can easily be overlooked in elderly home care patients.

The new standards also give consumers and families the opportunity to take charge of their own healthcare. Requiring patients, families, and caregivers to be educated in standard infection control practices can reduce infection and hospitalization rates. Handwashing is one such practice since it’s easy to do and offers exceptional returns for preventing the spread of germs. These practices, of course, are only as good as how they’re implemented. But since increased supervision of all home healthcare workers is also an integral part of the new standards, quality of care and assessment measures should also improve with time.

The Bottom Line

The new CMS standards for home healthcare agencies are based on established research and standards of practice common to hospitals, clinics and other healthcare facilities. Streamlining agency structure will improve patient outcome, as will raising accountability and offering guidelines for best practices across the industry. The end result should be better patient care, more satisfied Medicare beneficiaries and more responsible use of the program’s resources.