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A Needs Assessment of a Home Health Agency & Education Plan. Madjil Clark, BSN, RN, Charity Ebert, BSN, RN, Andrea Englund, BSN, RN & Rita Million, BSN, RN. Introduction. Home Health agencies are paid on a prospective payment system (PPS)
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A Needs Assessment of a Home Health Agency & Education Plan Madjil Clark, BSN, RN, Charity Ebert, BSN, RN, Andrea Englund, BSN, RN & Rita Million, BSN, RN
Introduction • Home Health agencies are paid on a prospective payment system (PPS) • Payment is determined by completion of a data set Outcome Assessment and Information Set (OASIS) • CMS mandated changes to the payment structure of Home Health Agencies effective January 1, 2008
Introduction • Changes are based on a retrospective review of Medicare claims that demonstrate a decrease in home health visits per episode while patient acuity (case mix) increased • Translates into inaccurate reimbursement system
PPS Regulatory Changes • Two new OASIS questions • Expanded Home Health Resource Group (HHRG) similar to a DRG • Change to a 3 tier therapy threshold • Non-Routine Supply (NRS) add on • Addition of 2 more outcomes that will be publicly reported
Example of an OASIS question • MO110 • Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an “early” episode or a “later” episode in the patient’s current sequence of adjacent Medicare home health payment episodes? • Early • Late • UK- Unknown • NA- Not Applicable: No Medicare case mix group to be defined by this assessment
Target Population of the Transformation • Home Health Agency of a non-profit Medical Center • Primary patient population >65years old • Professional staff of RN, PT, OT, SLP who complete the OASIS assessment • Entire agency impacted
Needs Assessment- Focus • Focus on Staff needs • Focus on Management needs • Focus on Patient needs ????
Needs Assessment-Strategies • SWOT analysis of the agency • Survey of the staff • Focus Groups • Review of agency data
Problem Statement Staff needs to be educated and have a thorough understanding of the OASIS assessment, changes to the OASIS questions, and strategies to assist with accurate documentation. An education plan needs to be developed and implemented to meet staff needs and achieve the desired outcomes.
Desired Outcome • Staff will document accurate OASIS assessments • Staff will understand the importance of accurately documenting the OASIS as it relates to agency reimbursement and benchmarking clinical outcomes • Staff will utilize the OASIS assessment to drive the development and focus of the plan of care
Transformation Plan • Learning styles of clinicians • Content of the education plan • Learning strategies to support the transformation • Timelines and sequencing of activities
Project Team • Includes Management, IT staff, nursing and therapy staff- (Primary Stakeholders) • Primary Responsibility: Facilitate the transformation of the agency through a needs assessment, develop and implement an education plan, and evaluate the project
Staff Education Plan • Learning Styles assessment for each clinician • Web based education of the OASIS • Participation in formal education training • Lecture and video • Application of knowledge through case study review
Timeline • Phase 1 Milestones (December 10, 2007) • Needs assessment • All staff education activities • Finalize testing of computer upgrade • Phase 2 (December 26, 2007) • Mandatory Staff meeting • Finalize agency process changes and communicate
Timeline • Phase 3 (December 27, 2007)
Evaluation • Framework for Program Evaluation • Rationale for Selection of Model
Significance of the Transformation Process to Staff • The OASIS assessment drives reimbursement for the agency, supports the physician directed plan of care and generates the public reported outcomes • Ability to project revenue and prevent down coding of claims • Demonstration projects on pay for performance (P4P) currently going on in Home Health
Conclusion • Federally mandated changes • Direct impact on staff, patients & finances • Educational programs • Evaluation & feedback
