Orthopedics
Our surgeries are outpatient, and go really well. They don't need Home Health.
That is great the surgery goes well. We expect it to go well! We love working with providers who perform outpatient procedures. That does not change our process as we can still see patients even if the procedure was outpatient and the surgery went well. Home health is for everyone post operatively... not just those that stay overnight, or "surgery doesn't go well".
Our patients aren't homebound
- I would ask more on what they think homebound means... Remind them S.I.T.
- Home health is indicated for all patients whom it is a "taxing" effort for them to leave their house. Patients under Medicare are allowed to leave for Short and infrequent outings, even if they are driving. Are many of our patients SOB when getting roomed in your office? These patients are very much appropriate for home health as this is "taxing effort".
We use cardiopulmonary rehab.
Great. Cardiopulmonary rehab it a great resource for patients. Do you happen to know the length of time before the patient is seen in rehab? (great to know your regions length of time... as it's normally 4-6 weeks out). In the meantime, we would love to get patients seen by a clinician in their home, manage their condition, make sure they are taking the right medications, and are able to improve their overall aerobic capacity in and around the home, as this will set them up for success in cardiopulmonary rehab.
Our patients are pretty healthy.
- Great we love healthy patients. Do you happen to see patients with diabetes? What about patients that have neuropathy? Did you know that our clinicians can work on managing their blood sugars as well as treat their feet. Also home health is for everyone 65+ especially if they are post operative no matter how healthy they are.
I don't know how to send a complete referral.
-all we need is a Prior note, diciplines, and a demographic. I can help ensure the referral is complete as that is part of my job.
We also can build protocols with your team to streamline care for patients post operatively as it acts as a standing order.
It's good for patients to get out of the house, that's why our patients go to outpatient
Yes we agree. Our therapists focus on getting patients up and moving early as well. Early rehab is the same in home, if not better, as we can make sure they are able to get in and out of their car, off their pain medications to drive, and focus on the same early interventions as outpatient (pain management, DVT prevention, early mobility, light strengthening). The whole goal is that we can set them up for success for outpatient.
Case management assesses the need for HH
If in an MD office (cardiology/pcp): That is great, however our goal is to work on obtaining patients prior to a hospitalization. We would love to help prevent those hospitalizations by working with your office directly as you speak with them about how to manage their s/s of ___.
Our patients are pretty compliant
- Oh wow that is great that you have such great patients. Can you think of a patient that recently called your office regarding how to take their medications (nebulizer, albuterol, steroids)? Did you know our clinicians can reinforce medication education and REALLY make sure they are compliant as we know not all patients are 100% compliant.
- Bring up other downfalls (patients being re-hospitalized, patients needing caregivers to give medications due to not understanding, patients SOB, patients not attending cardiopulmonary rehab... TRUST ME they have non-compliant patients).
Our procedures are really minor and don't need help.
- That is great that they are small procedures for the patients, but do you still have post operative restrictions? Are your patients always compliant with post operative restrictions? are your patients on new medications? What about pain management? Constipation....? Are patients able to get around safely in their home with the correct AD being non weight bearing?
These are things our patients are focused on early post operatively no matter how small the procedure is.
Wont the patient have a copay? Normally they don't want to pay much
- We are primarily a Medicare agency and work with both traditional and many Medicare advantage plans, these plans do not have a copay for the patient. These are the patients who home health is a benefit for.
If they have private insurance, we can take on a case by case basis and they may have a copay, however they will have a copay with outpatient therapy services as well.
***(If they have stayed inpatient or had a surgery... most the time OUR AUTH IS WRONG.. They most likely will have hit their OP max and won't have a copay they will either owe us or the hospital depending on who bills first).***
We don't want out our patients doing PT until 2-3 weeks post op.
- I would ask why as this gives you more information as to what they think the therapists are doing, and you can tailor your rebuttal to that.
One option:
- I understand. Did you know that our therapists are highly trained in educating patients on early post operative management such as pain education, wound assessments, DVT prevention, constipation prevention, as well as reinforcing any specific post op restrictions the MD wants. Do you ever have patients calling you for any of the above reasons? If so these patients are very much appropriate for home health (SN, PT, or OT).
We send patients to cardiac rehab
Great. Cardiac rehab it a great resouce for patients. Do you happen to know the length of time before the patient is seen in rehab? (great to know your regions length of time... as it's normally 4-6 weeks out). In the meantime, we would love to get patients seen by a clinician in their home, manage their condition, make sure they are taking the right medications, and are able to improve their overall aerobic capacity in and around the home, as this will set them up for success in cardiac rehab.
What would you even do with our patients?
Great question. Many things.
SN: Medication management, Inhaler/ nebulizer education, education on self management using zone tools, vital sign monitoring.
PT: Breathing exercises (Diaphragmatic breathing, resistive breathing training), Improving overall aerobic capacity through walking and exercises in the home.
OT: energy conservation, Activity modification
Our patients are non-weight bearing for a few weeks, and don't need therapy
Are your patients always compliant with non weight bearing restrictions? Our clinicians will ensure that they are safe, and utilizing the correct DME. Therapy is more focused on post operative management: Medications, following restrictions, dressing changes if needed, pain management, AD assessment and safety, transfers, and eventually setting them up for success for outpatient.
We are not able to work with one agency, the patient has the right to choose
- Medicare actually does want to you to partner with agencies that help your outcomes. Working with us allows you to have a say in your outcomes, as well as helping patients understand who you trust. They come to you for your clinical expertise and are looking for your guidance when choosing a home health agency to work with. Of course if a patients has a preference we honor that, but otherwise many patients do not know the difference between agencies.
We let the patients decide what home health agency they would like to use, as we are not allowed to tell them what agency that should use
While I understand your reasoning that is not correct. Medicare actually does want to you to partner with agencies that help your outcomes. Working with us allows you to have a say in your outcomes, as well as helping patients understand who you trust. They come to you for your clinical expertise and are looking for your guidance when choosing a home health agency to work with.
- I also like to remind them, that they do this for outpatient all the time, and it is no different when working with home health.
Our rehospitalization rates aren't that high
(This is when it is good to know your TRELLA data- because normally it is much higher than they would like to admit ;))
- Well that is amazing. Our goal then would be to work with you to lower it even more then. Let me remind you that this a free service for all patients on medicare plans and can be a resource to ensure the transition from your office is smooth when gong back home.
-If talking about heart failure... you can talk a lot about rehospitalization is highest within the first 2 weeks from hospitalization, and we work on helping patients' self-manage in the home.
I am pretty thorough when talking to patients about taking their medications as prescribed.
Great that is always helpful. We would love to add to that education to to ensure that patients truly understand how to self-administer in the home. Do you every get repeat questions from patients? Or what about patients that are just starting a new medication?
- you can always talk about other things that we do... not just meds, aerobic capacity training, assessment and education on exacerbations.
They can get home health through their PCP
Yes, however most patients do not speak with their PCP on home health needs and or have a recent visit with their PCP.
I am hear to talk to about patients that you think are appropriate and help improve outcomes / experience for your patient in YOUR office.
Home health doesn't have any equipment for patients to use post operatively.
The goals of care for the first two weeks post ___ are the same. No equipment needed. The goals are pain control, healing the surgical incision, medication education, range of motion, ADL safety, and normalizing gait by progressing from AD. None of those goals require fancy equipment.
- Remind them the benefits: No copay, extends medicare benefits, ensures they are ready for outpatient.
Case managers decide if they need home health.
- Ask how many patients stay overnight... Most likely not many...
- Those patients that stay over night are the only ones who "may get the option for home health". Our agency works directly with the surgeon to ensure we are treating the patients EXACTLY as he/she wants instead of getting orders through case management.
- CM can be great, but there are many downfalls of trying to get a patient out the door quickly. Us working with you pre-operatively allows the patient to have a smoother experience (limiting phone calls to the patient, and ensuring staffing right after DC, as well as ability to run insurance and ensure we can take the patient).
We don't "follow" for Home health
- Mostly "following" allows clinicians to have the correct provider listed just in case there are any post operative/ or cardiology specific questions. The PCP does not know how to directly manage their condition and will most likely contact you anways.
- Following normally just entails signing 1 page of a 485. If we build a protocol with you, that will limit frequency orders.
Can't you get these patients out of the hospital?
- Yes we can most definitely work on getting these patients out of the hospital. We would love to work with you on that. We have CTCs (or yourself) that work with CM in the hospital to identify patients.
- Not all patients are given home health, or were recently hospitalized, therefore we would love to work with your office directly as well.
I do not know how to identify who is an appropriate patient
- All patients that are 65+ with medicare that are post operative is an appropriate patient.
- All patients that it is a "taxing effort to leave the house."
May need to pain the picture for them: fall risk patients, non-community ambulators, patients that require assistance from another person, patients who utilize an AD.
It's a HIPAA violation to give you patient information pre-operatively.
- I would ask them if they do it with outpatient offices?
- While I understand your concern, that is actually not accurate. As long as the office has deemed them an appropriate candidate it is not a HIPAA violation. It is written in Medicare ruling that "surgeons may refer a patient to a particular home health care agency prior to the surgery by completing the patient's referral paperwork and sending it to the home health agency".
- Remind them all the reasons why to pre-op: MD say in care, insurance auth, easing transition for patient, securing a spot for staffing.