Paul Kusserow is the President and Chief Executive Officer for Amedisys, the largest independent provider of home health, hospice and personal care services in the United States. As an industry veteran, Kusserow recognizes the growing pains and opportunities associated with change in the home health industry.
Kusserow highlights two changes in the home health industry: one, the introduction of patient data grouping models (PDGM) in January 2020, and two, the influence of technology. Both of these factors are not only reshaping the home health landscape, but are also impacting individual agencies and their approach to delivering quality care.
As baby boomers age, they continue to have a significant impact on society. In regards to their long-term care, they have overwhelmingly indicated their desire to age in place. Because of the significant population size of baby boomers, this drives up the need for caregivers and home care services. To meet this need, Kusserow points to the importance of integrating services, offering everything from personal care to hospice care for clients. Agencies that are able to provide a broad array of services and stay with clients as their needs evolve and change are able to deliver more effective care at a lower cost, according to Kusserow.
Medicare Advantage and managed care plans that are responsive to the needs of baby boomers understand the importance of integration in terms of cost and effectiveness. With an increasingly older population and one that is managing more and more chronic conditions for longer periods of time, these plans recognize that combined services drive rehospitalization rates down, ultimately netting a cost savings, and importantly, keeping baby boomers and others who want to age in place happy and content in their chosen environment.
Like most industries today, predictive modeling is vitally important in the home health space. According to Kusserow, Amedisys sees more than 50,000 clients each day in 42 states, and their 21,000 employees make more than 11 million client visits each year. In mining this data, Amedisys is able to predict what clients are at risk for rehospitalization and alter their plan of care accordingly. Kusserow states that the average rate of rehospitalization for managed care plans is in the low 20% range. With integrated care and software that helps them look closely at their client populations, Amedisys is able to keep its rehospitalization rate between at an impressive 1 and 3%. Additionally, Amedisys uses predictive modeling to help determine when a client should transfer to hospice care, which enables clients and families to access these services sooner and gain maximum benefits.
As most everyone in the home care industry knows, PDGM will go into effect on January 1, 2020. This is one of the largest shakeups in the industry in decades as agencies are being asked to reduce the cost of home health care delivery and are being encouraged to highlight value over volume. Providers will be rewarded for helping patients improve their health at a lower cost and eliminating unnecessary care.
CMS’ shift to value-driven care is based upon working to improve patient outcomes and reducing the effects and incidents of chronic health conditions. CMS believes that this will lead to better care for individuals, improved health care for communities, and an overall reduction in costs.
In looking at the changes forthcoming with PDGM, Kusserow indicates that there will definitely be some growing pains for most home health agencies. Specifically, Kusserow points to the potential for an 8% payment cut, elimination of the rural add-on, and the increased paper load in shifting from one 60-day episode to two 30-day episodes. Other potential impacts include limited or no access to home care in some areas and a disruption of services for clients. To counteract these potential impacts, Kusserow cites the steps Amedisys has taken, spending nine months preparing their systems and their staff. With careful preparation, particularly in understanding coding changes from the old system to the new system under PDGM, agencies can hit the ground running to ensure timely reimbursement for services, and importantly, service delivery without interruption.
While Kusserow does see changes on the horizon for the industry, he also firmly believes that home health care is the future as more and more people choose health care at home. To help home care agencies prepare for the changes and meet the needs, it’s important to stay on the cutting edge of how technology is changing the field and to provide ample training and preparation time as new and more innovative approaches to care are introduced.
The Help Choose Home podcast series provides information and resources for families about home health care services for senior loved ones. Podcasts are hosted by Merrily Orsini, president and CEO of corecubed , an award-winning private duty marketing agency.
Help Choose Home is a collaborative effort by the National Association for Home Care and Hospice (NAHC), Axxess, and corecubed to educate the public about the many benefits of the in-home care industry, which includes non-medical home care, private duty nursing care, medical home health, hospice, and other in-home health and wellness services.
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