When the numbers came in last summer, they did not look good for New Jersey: 97% of the Garden State’s hospitals would see their Medicare payments reduced because of how many patients had been readmitted. That was the highest percentage of any state in the country.
Given that stat, it’s no wonder that a private duty agency based in that state is pushing hard on new initiatives to reduce hospital readmissions, believing that more home care providers are competing on this metric and that major referral streams are at stake.
“We recognized early on that as a private pay home care company, although we are on the periphery of the Affordable Care Act [programs], we do play a big part in it,” says Lenny Verkhoglaz, CEO of Executive Care, a Hackensack-based private duty provider that has franchises in New Jersey, Florida, and Texas.
The government does not directly control private pay revenues as it does Medicare and Medicaid reimbursements. But home care is affected by ACA programs that reduce Medicare payments to hospitals that readmit a high proportion of patients. These hospitals—and the physician practices, skilled nursing facilities, and other organizations that may be partnered with them—now have a strong incentive to work with home care agencies that can keep their patients from cycling back too frequently.
Executive Care has responded by developing staff training and protocols in the last nine months. The initiative is focused on specific conditions that are formally associated with Medicare readmission penalties or that place a patient at high risk of being rehospitalized. These include congestive heart failure, acute myocardial infarction, diabetes, and chronic pulmonary obstructive disorder (COPD).
“We’ve developed programs for our nurses and caregivers to understand what the disease or condition is, how to recognize it, how to not necessarily treat it but monitor it,” Verkhoglaz says. “If they see red flags go up, they alert the office, the social worker, whoever can take appropriate action.”
The training is done on an in-service basis, face-to-face, in a classroom with overhead projections and written materials. The low-tech approach may change, if Executive Care finds a technology solution that fits its needs, Verkhoglaz says. But a private duty agency does not need a big capital outlay on technology in order to make inroads on this front, he emphasizes.
However, skilled staff members are needed, as qualified nurses and trainable caregivers are the lynchpin of the effort, according to Verkhoglaz.
“These are serious cases,” he says of the diagnoses that are involved. “Obviously, you can’t assign just any caregiver to these cases, they have to be the cream of the crop, who can understand and react.”
So far, Executive Care has achieved the best results for conditions such as depression and diabetes. Diseases that are harder to control, such as congestive heart failure, are more challenging, Verkhoglaz says. Still, after starting this approach with one hospital, Executive Care now is rolling it out to others and is getting a good reception.
“We’ve created fliers touting our programs,” Verkhoglaz says. “We give them out to case managers and discharge planners to make them aware that this exists that we’re ready to take on their clients, what kind of training we provide to our caregivers. There seems to be very high interest … we’re getting good feedback.”
Executive Care is continuing to work hard, not only to keep improving its numbers but to remain competitive in the home care marketplace.
“Other companies are touting their programs,” Verkhoglaz says. “We’re not the only ones doing this.”
Written by Tim Mullaney