According to a New England Journal of Medicine article, one in five Medicare patients is readmitted to a hospital within 30 days of a hospital stay. Up to 76 percent of those readmissions may be preventable. Reducing hospital stays (when a brief stay averages $17,000) saves money and reduces the stress on the patients and their families. Working with Medicare to keep costs down is one way that home health agencies can help assure their survival and profitability.
IMS Home Health Care Inc. succeeded in achieving the Medicare goal of reduced re-admissions along with providing quality patient care, an achievement which has brought the small Donna company national and state recognition. IMS has been ranked in the top 100 home health agencies in the U.S. on the basis of its quality of care, quality improvements and financial performance for 2010. IMS also was one of 31 Valley healthcare providers who met the goal of reducing 30-day readmission rates: it reduced the avoidable 30-day readmission rate of its patients by 15 percent.
For IMS administrator Linda Gardner, being named to the top 100 by the industry’s leading provider of home health care information was a major surprise. “We didn’t apply for it. They found us. They had looked at financials and patient outcome. Part of the pride we feel in our accomplishment is that it makes the industry look good again,” she said.
Gardner acknowledged that home health has been an industry with a black eye. With well over 300 home health agencies in the four county region, less than 50 agencies participated with IMS in the National Care Transitions Project, funded by the Centers for Medicare & Medicaid Services, to reduce avoidable readmissions.
Gardener explained that Medicare doesn’t intend for home health agencies to see patients as long term clients, nor as long-term revenue streams. “The goal is to educate patients and make them self-managed. Most patients want to learn and to have their independence,” she said. The majority of patients are taught how to administer their own medications such as insulin and to take the responsibility for monitoring their health and recognizing signs of disease.
IMS Home Health Care was founded in 1998 as a home medical specialist when President Bill Carlson and his brothers, each with years of experience with medical supplies, took over a troubled home health business following a cyclical Medicare shakeout. The agency focuses on geriatric and chronically ill patients. Carlson, Gardner and Director of Nursing Cathy Vela agree that a big agency isn’t necessarily a better or more profitable business. They strive to keep IMS’s patient load small, typically around 100. They rely on three full time LVNs with others on call as needed.
“Once you get too many patients, you lose control in the quality of the staff and the attention each patient receives,” Vela said. “We like to focus on individual patient care. We put service above self. Everybody at IMS has responsibilities for quality assurance, everybody. We cross train. We ask everyone’s opinions, because we are a team and work as a team.
We are trying to be those people who keep them out of the hospital.” Because Congestive Heart Failure (CHF) causes more hospital readmissions than any other illness, IMS nurses talk to patients and their families about noting weight change or shortness of breath, indicators of CHF. “It’s a big collaboration,” Vela said “but you need educated patients. Patients talk to the nurses who bring adverse changes to the doctors’ attention. We’re the doctors’ eyes and ears. Doctors look good if their patients are not back in hospital time after time.”
In fact IMS’ LVNs send text messages directly to the doctor when they have a concern about a patient, and they get a rapid response. “We see ourselves as an extension of their office into the patient’s home,” Vela added.
IMS uses the CLOX test, an assessment not required by Medicare, to determine how well a patient is going to be able to follow instructions and stay healthy without intervention. Patients who can’t fill out a clock face reveal problems such as an inability to take medications on time. “To make sure a patient is safe, we have to figure out what will work for them.” IMS is dementia-certified.
While home health is a true hands-on sector, it is also increasingly technology-driven. “Electronic medical records is where we’re all headed. It’s the only way to get all the entities to communicate in timely fashion,” said Gardner.
IMS discharges patients regularly after stabilizing them and training them to assume responsibility for managing their health. Carlson and the staff continue to build relationships with doctors and therapy and medical equipment agencies who refer patients to IMS.
“Patients want to come back to us which is lovely. They trust us,” Gardner said.