Wildfires, COVID-19 and PDGM: Growing a Home Health Business During Moments of Crisis

Home health agencies are used to operating during moments of crisis. That’s especially true for California-based Medical Home Care Professionals, which has had to overcome several over the past few years.

In 2018, for example, Medical Home Care Professionals operated during the historic Carr Fire that devastated nearly 230,000 acres across California’s Shasta and Trinity counties. This year, the agency has experienced the indirect consequences of more wildfires and the direct impact of the COVID-19 virus — all while transitioning to the Patient-Driven Groupings Model (PDGM).

To find out what it takes to stay afloat during such turmoil, Home Health Care News recently caught up with Elaine Flores, the COO of Medical Home Care Professionals, for its latest episode of Disrupt. Highlights from the conversation are below, edited for length and clarity.

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HHCN: Before talking about the 2020 wildfires and operating during moments of crisis, can you provide some background on your agency?

Flores: Medical Home Care Professionals is a locally owned and operated home health agency in Redding, California. We also do custodial-type care. Our owner, Kathy McKillop, founded the company in 1985. We’re celebrating our 36th anniversary this October. Kathy was — and still is — a licensed vocational nurse. She had a patient at one of the local hospitals who wanted to go home. She felt that she could make that happen, so she took him home and started caring for him, providing 24-hour services. That was just what our community needed.

We’re now serving over 300 patients, with about 120 employees. We’re a Medicare-certified home health agency as well as a state-licensed home health agency for California. We work heavily with the MediCal program. We service all age demographics, from infants to geriatrics. We even do end-of-life work.

Your agency has had to walk a rocky road over the past few years, jumping from crisis to crisis. You operated through forest fires in 2018, then a historic blizzard after that. Now, you’re facing more forest fires and the COVID-19 virus. What has that been like?

In July 2018, our community had a fire called the Carr Fire. It started at our beloved Whiskeytown Lake, which is about 15 or 20 miles from the center of town. It started by accident. A vehicle was towing a trailer. A spark started a fire or something along those lines. The fire was burning in the wooded areas by the lake, but then the wind shifted and everything got really scary. We started losing structures as the fire moved.

As an agency, we had to put our emergency preparedness plan into action. For some context, the U.S. Centers for Medicare & Medicaid Services (CMS) in 2015 announced it was coming up with new Conditions of Participation (CoPs) for home health agencies. We started evaluating ourselves and preparing for these different CoPs, which included stricter requirements around agencies’ emergency-preparedness plans.

That benefited us. Overall, we felt that we were pretty prepared. When that fire started encroaching upon residential areas within our community, we were able to implement our plan, quickly alerting patients and coordinating evacuations. We evacuated patients into the Chico, California, area. In some instances, we evacuated them into skilled nursing facilities (SNFs). Our rock-star staff worked tirelessly to coordinate care for, at that point, 275 patients.

We had our command post at our office. Our first priorities were identifying high-risk patients and alerting the caregivers. We had employees losing homes. We had patients losing homes. We had to reassign staff, reassign patients. It was quite challenging.

How does that situation compare to the wildfires now?

Right now, we’re pretty safe. Our fire season doesn’t end until December, though. Who knows what can happen between now and then. Right now, we’re dealing with bad air quality. I’ve had to send staff members home because they may have an underlying condition like asthma, which could lead to difficulty breathing.

There was one day last week where it was 9:30 a.m., but it was pitch black because of the smoke.

What have been the keys to staying afloat and delivering care during these disasters? Again, you also operated through a historic blizzard right after that 2018 fire.

Having the right team is the key to it. Everybody on our team has that “I will do whatever we need to do to ensure that our patients and our employees have what they need” menality.

In regard to the blizzard, we had tons of snowfall for our little town, this torrential downpour of just snow. My phone immediately started going off the morning we woke up to it. It was my staff. We had people who couldn’t get to work. We had patients who had caregivers that were on shift that needed to be relieved.

We started another “command central.” We found people with big, big vehicles to get us into the office. When we got to the office, though, we were locked out because the roof had collapsed onto our main door. We had to get real creative, real quick.

How are you doing in regard to COVID-19? That can’t be a good mix with the smoke and breathing issues.

Everybody’s just trying to remain calm, remain vigilant. In the office, we have specific procedures that everybody follows. We wear masks within the office. We’re protecting each other in that respect. We’ve all tried to make sure we’re wearing the appropriate personal protective equipment (PPE) when delivering one-on-one patient care. All of our clinicians are screened over the phone on a daily basis, asked very specific questions. That’s all documented. Do you have a fever? Do you have shortness of breath? In terms of the intersection of COVID-19 and the fires, we want staff to change out their masks more frequently because of the smoke.

I know a lot of home health agencies are at a new normal when dealing with the coronavirus. At what point did Medical Home Care Professionals start to feel the impact?

We felt it when Governor Gavin Newsom issued the emergency order to stay at home — the shelter-in-place order. I remember it vividly. It was on March 18. We felt the shift right then and there. The next day, we came into the office and called our CEO. She was so supportive and said, “You guys, let’s think of the best way to do this. Let’s figure out what the shelter-in-place order means for our team.” We started looking at working from home. So, early March is when we felt the shift from COVID.

Shasta County has not had a very elevated conversion rate for COVID-19. I think we’re sitting at maybe 650 to 675 positive COVID cases since March. We really haven’t had big time exposure like most bigger cities. But we took every precaution that we needed to take, knowing what we knew. About 75% of our workforce is at home. We started doing multidisciplinary Zoom meetings.

How is Medical Home Care Professionals preparing for the fall COVID-19 surge?

We’ve taken a look at all of the protocols that we’ve put in place for COVID-19. We are also really promoting flu shots. We’ll start calling patients maybe more frequently than once a day — maybe a couple times a day. The other thing that we are going to do is continue ordering our PPE as we can get it. When this first occurred, who would have ever thought I would need to send one of my clinicians into the home in full PPE? We didn’t have an abundance of gowns. We didn’t have an abundance of N95s or surgical masks. We had to create our stockpile from nothing. We went from purchasing a box of surgical masks for $5 to now $50.

Did you come across any fraud schemes or shady PPE experiences?

We did. We were following a lot of our colleagues that were in the southern and central parts of the state. They were giving us leads on different entities. We went ahead and purchased 2,000 surgical masks from a vendor at one point. Our friends at Kaiser had purchased 1 million, so we thought it must be a good, reputable company. Well, they never got their supplies. Actually, they got them, but three months later. So did we, which is frustrating. There was another shipment, I recall, that came in — and the masks were soiled. They had molded, so we had to fight to get a refund for those.

We’ve talked about wildfires, a winter storm, the ongoing public health emergency and PPE scams. On top of all that, you’re also facing the transition to PDGM. How has that gone?

It’s gone. We were prepared for it. A couple years prior to launch, we had been to numerous conferences through our state association. We felt that we had a good ramp up for it. PDGM really has the philosophy of how we run our business anyway. We are in communication with our clinicians and with our patients on a daily basis. Care coordination is amazing at our agency. Our nurse leaders really coordinate patient care from the beginning of care to discharge. We had just a few areas where we needed to pivot.

That was with, for example, billing processes and Low Utilization Claims Adjustments (LUPAs). We had to understand all of the new ways that we were going to get reimbursed, then share that with our clinical team so they were more aware of the financial impact. But we’re doing okay with PDGM. Yes, we have had some challenges, some curveballs in there. But we’ve been able to adapt and pivot while working together as a team.

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