Bill Riemer calls it The Frankenstein Effect.
As Vice President Health Information Systems at AccentCare, Riemer adapts the organization’s technology to meet regulatory and compliance changes that impact assessments at the Start of Care. With addition after addition to the process, the Start of Care loses its core efficiencies.
“I think what’s changed over the last several years, in part as a direct relation to the COVID pandemic, is that things are getting a lot tighter,” Riemer says. “Over the years of all of the regulatory changes, what has happened is what I refer to as the Frankenstein Effect: we continuously add, but we never go back and review and look at how to gain efficiencies, how to increase patient care and quality and, most importantly, how to increase clinician satisfaction.”
Here is a look at how this effect comes to pass, and three tips on how to optimize Start of Care in the face of changing processes.
How to prevent the industry’s tricky changes from tripping you up
For the proposed payment rule for 2025, CMS is looking to collect four new pieces of data related to the social determinants of health (SDOH) category and looking to modify one other item. The four items proposed for collection are: one living situation item, two food items and one utilities item. CMS is also proposing a modification to the current transportation item.
If this all seems rather inside-baseball, you’re not alone. These proposed changes from CMS are just part of the many changing elements that home-based care providers have to account for at the Start of a Care plan. The result can be much more time spent entering data and checking forms and less time with patients.
“One of the downsides to our industry and the home health post-acute arena is that a lot of times, clinicians will see all of their patients during the day then they spend hours at home catching up on everything,” Riemer says. “I don’t think clinicians can ever 100% get away from their documentation, so our focus has been, where can we make it more effective?”
Over the past 12 to 18 months, AccentCare has focused on helping clinicians Start of Care assessments on the right track.
“I have an informaticist on my team who is an RN by trade — a board-certified informaticist — and she’s done ride-alongs in field studies and spent hours and days and weeks trying to take what is often muscle memory for an RN or an OT or PT and match it to the assessment itself to enhance the overall experience both for the clinician and the patient,” he says.
3 tips for optimizing Start of Care
In light of these challenges, Riemer recommends that providers take three steps to regain control of their Start of Care processes and their care assessments.
- Create a clinical council
A care assessment is not a tech project, Riemer says. It’s a clinical initiative. Providers should identify volunteers among their field staff who know the technology used in home care while also knowing what the Start of Care process entails. Find foundational principles that staff can follow even in a rapidly evolving landscape.
“Set up some work groups,” Riemer says. “You don’t have to have an informaticist on staff. You just have to know somebody understands the technology — both what can be done and what can’t. A lot of times clinicians ask for things that just can’t be done in the system. So that person needs to know how to step back and help the team collaborate amongst themselves on what makes the most sense for how they do their daily visits.”
- Approach care assessments like a project
In light of all of these constant changes, providers must approach changes to the care assessment processes like a project, with project leaders who drive the change forward. Don’t make the mistake of trying to govern by committee. Designate someone to manage the project and ensure you have leaders who are invested in the project’s success and have the authority to make a final judgement call when a decision needs to be made.
“Whether you go waterfall, agile, scrum — whatever fancy term everybody wants to use, there will still be a need to gather the requirements to document it from a business analyst perspective,” Riemer says.
- Lastly, treat this as an iterative process
The more things change, the more they remain constant. Like any process of continuous improvement, getting the most out of a Start of Care plan requires agility and flexibility around all sorts of external changes.
“This one is just the nature of the beast — in an iterative process, you always have to reevaluate what worked in the last initiative and assess whether it will work this time around,” Riemer says.
For Riemer, that iterative process has long included technology solutions from Homecare Homebase.
“Homecare Homebase is the core that represents all of our home health, hospice and palliative service lines, and affect the majority of our patients,” he says. “My first implementation with HCHB was around 2011. I’ve been a Homebase Homecare client ever since.”
HCHB delivers powerful new tools and intuitive software that’s easy to learn and use. From scheduling, routing, patient notes and reporting to intake, approvals, billing, compliance and payment, we give you everything you need to boost productivity and profits while empowering exceptional patient care. To learn more, visit hchb.com.
