As the home care industry grapples with the transition to value-based purchasing and the impacts of Pre-Claim Review in certain states, referrals are more important than ever. But to have a successful referral program, simply implementing a strategy won’t cut it. Agencies must have a solid process to build upon, beginning with employees and intake staff.
The foundation of a referral program is the intake staff. Empowering and educating staff is vital to improving a home health referral process, Mary Ericson, director of nursing at Farmington, Illinois-based Spoon River Home Health, said during a panel at the Illinois Home Care and Hospice Council Annual Conference in Lombard, Illinois, last week.
“Agencies need to ask themselves if their intake staff is feeling empowered to say yes or no to referrals and if they are giving staff the proper tools to do so,” Ericson explained.
Helping intake staff feel confident to ask any questions they may have about a patient is one way to empower them and ensure the necessary information is getting passed along, Maria Ferraro, clinical manager of home health at Arlington Heights, Illinois-based Northwest Community Healthcare, said during the session.
“Questions surrounding homebound status, what kind of support patients are getting in their home and if the patient is even aware of what services he or she will be receiving are extremely important,” Ferraro said. “As we look at new CoPs [home health Conditions of Participation] , it’s going to be increasingly important to make sure referrals turn into successful outcomes.”
If questions are not asked upfront, agencies could unknowingly participate in abuse of the process, she added.
“If we unknowingly go out and give a patient service before evaluations and end up not billing for a certain service because they actually didn’t need it, we are placing resources that aren’t necessary on ourselves,” Ferraro explained.
The person calling in the referral also doesn’t always know everything about a patient’s situation and should be asked numerous questions regarding the patient’s health, Ericson added.
“Sometimes the person calling in the referral knows exactly what the patient’s situation is but other times they may not have even met the patient before,” she said. “That’s why it’s the responsibility of the intake staff to ask questions.”
Right to Refusal
An important part of a successful referral program includes refusing patients, if necessary, Ericson explained.
Once all the details are collected about a referred patient, having an open line of communication between liaisons and intake staff can be extremely beneficial when deciding if a patient should not be accepted into home care.
Though agencies may want to serve as many patients as possible, they should not forget how many patients they can take on at one time.
“A home assessment where a staff member would determine if home care services are even necessary should be a top priority,” Ericson said. “You need to know if the home environment is safe and conducive to care and if it’s the right transition destination for the patient if they are coming form the hospital or a skilled nursing facility.”
There is nothing wrong with refusing patients if an agency has the choice, Ferraro adds. But what agencies should keep in mind throughout the entire referral process is being a good referring partner.
“Being a good referring partner includes giving a response within 24 hours, offering in-house assessments, offering in-house meet and greets, making sure you have adequate staffing and understanding your capacity,” Ferraro said. “Even if you need to refuse a patient for a legitimate reason, if you are consistent in handling referral partners, there’s more of chance your agency will be chosen again down the road.”
Written by Alana Stramowski