Home Health agencies are learning to do more with less with all the cutbacks in reimbursement.  The upcoming sequestration, which cuts Medicare reimbursements to health care providers by 2%, makes it even more imperative for home health agencies to find ways to “tighten our belts” without sacrificing the quality of patient care. The following tips are just some ways to more efficient and manage cost

1. Cut the cost of supplies. Agencies often face challenges in managing cost of supplies. There are several ways you can cut these costs. Order supplies in bulk, and cut down on shipping costs by having them all ship at one time. Keep enough supplies on hand to meet your needs without having to do “rush” orders or multiple shipments of specialty supplies. Ask your management if you can substitute expensive name brand supplies with generic brand supplies.
2. Telemonitoring: Chronic illnesses such as hypertension and CHF can be remotely managed using telemonitoring. Patients can check their blood pressure, pulse, weight, and pulse oximetry remotely from home and transmit this data to the agency and or physician. This allows for daily monitoring by a nurse without the increased cost of onsite visits being made. While not an option for every patient, telemonitoring can increase compliance, management, and prevent hospitalizations.
3. EHR: Electronic Health Records have been proven to facilitate an increase communication between disciplines, physicians, and foster compliance with the plan of care. EHRs, because of their ability to be referenced in real time, allow clinicians to coordinate care and increase productivity. Add this in with the savings from the costs of paper, ink, toner, office supplies, charts, and banker’s boxes and storage costs and you have quite a bit of savings available to you quickly.
4. Wound Care supplies: Use generics when possible. Have clinicians only leave enough supplies in the home for a few days rather than the entire month or episode. Have the clinician take out enough supplies for one week at a time, and restock only when the patient needs more for the next week. This prevents loss of supplies if patient goes to the hospital, for example. Use clean supplies in bulk rather than sterile supplies if the physician okays this and the patient doesn’t have sterile wound care ordered. Remember, in the patient’s home nothing is truly “sterile” and we don’t set up sterile fields unless the physician specifically orders sterile wound care. For this reason, you can often order gauze pads, rolled gauze and the like in bulk packages, and keep in a zipper type-bag and use as needed. This is often a much more cost effective way to provide wound care. Also, recall that saline and gauze can only be used a certain amount of time after opening, so use smaller containers to prevent waste and prevent infection.
5. Manage Staff: As much as possible, use full time staff rather than contracted staff. Contracted visit are often paid at a higher rate than full time employees, so see if for your agency size it is more cost effective to pay benefits for a full time employee rather than several contracted employees. Try to control staff turnover, as the cost of training new employees is a real one. The decreased productivity alone in hiring and training new employees can cost an agency a significant amount of money.
6. Use LPNs/LVNs, COTAs, PTAs as much as possible. These professionals are very capable of performing tasks and interventions according to a plan of care, and as a part of a team of clinicians can do the same work for less money. When used with a “team approach”, you can achieve the same benefits with less salary requirements. The key is to ensure they have been properly trained in home health care and that coordination of care is being done correctly, often, and thoroughly.
7. Partner with IV companies in your area to provide SN visits and/or therapy on patients who require home IV or antibiotic therapy. In these cases, you can bill for the SN visits or therapy visits while the IV companies can bill for meds, supplies, dressing supplies for IV sites, and other costs associated with providing medications for the patient. While most of these patients are not Medicare patients, they are usually easy to manage and little cost to the home health agency since the IV company bills for tubing, fluids, medications, dressing change kits, and related supplies. The home health agency provides and bills for the SN visits to perform and teach the patient how to self-administer the drug, to change PICC or central line dressings, and to obtain labs or assess for signs of infection.
8. Keep your clinicians stocked with “on call” or “car stock” boxes of supplies. These basic stock items will prevent the nurse from driving to the office and costing you mileage just to pick up supplies. This also increases patient satisfaction as the nurse can deliver care when needed rather than having to wait until the supplies can be obtained.
9. Plan of Care:  Take the time to create a patient specific plan of care and frontload visits when possible. See the patient often at first and teach them how to care for themselves quickly, then decrease and follow up for a few weeks thereafter. Also, by creating a patient-specific plan of care, you can decrease the number of PRN visits needed as the episode progresses.

Resources:

Medline: www.medline.com

Phillips Telemonitoring:  http://www.healthcare.philips.com/us_en/products/telehealth/index.wpd