Saturday, December 1, 2012

PATH ALONG Model Friend To The Wisconsin Hospitalist

Many Wisconsin hospitals have employed a hospitalist staff to care for the inpatient population.  Hospitalist is a term used for doctors who specialize in the care of patients in the hospital.  A person must be quite ill to be admitted to a hospital.  Hospitalists are challenged to care for higher numbers of people with more complicated conditions.  Hospitalists are trained to better meet the increasing need for more specialized and coordinated care for hospital patients.

The Centers for Medicare and Medicaid (CMS) have enhanced current procedural terminology codes (CPT) to more accurately capture billable services related to a hospital stay.  Today the hospitalist is responsible for collecting the medical data required to insure the hospital is reimbursed for all the good care.  The hospitalist provides over sight to process that results in appropriate electronic medical documentation.  Five important data checks include:

1. Collected information supports the diagnosis for the hospital admission.

2. Collected information gives insight into justification for the treatment and procedures.

3. Collected information provides the reviewer a chronicological sense of the course of care.

4. Collected information lists the diagnostic test results and defines treatment.

5. Collected information demonstrates the promotion of continuity of care among needed provders both inpatient and beyond the hospital door.

Hospitalists are challenged to comprehend  medical necessity and proper setting and tactfully communicate this to both staff and consumer.   In today's hospital services and treatments may be medically necessary but if the services could also be performed in a less intense setting, this leaves the hospital at risk for reduced reimbursement. 

A person must be quite ill to be admitted to a hospital today.  Factors that may result in an inconvenience to a patient or the family do not by themselves justify an inpatient admission.   When a hospitalist is unsure about the patients need for inpatient services and needs additional time for evaluation the person can stay in the hospital but not actually be admitted. 

The patient may be placed in out patient observation (OBS) rather than admitted as inpatient.  There must be medical necessity for the observation services, and the medical necessity must be documented in the persons electronic health record.  The hospital would like the patient to remain in the room for at least 8 hours, which seems to be the magic number to demonstrate a reimbursable stay.  The codes can remburse at a higher amount cause the required discharge (to prevent hospital readmissions) service is included in the payment.

Today's hospitalist participates in discharge planning that promotes continuity of care throughout the community.  Medical necessity and proper setting encourages the hospitalist to develop a referral practice that utilizes an evidence based (PATH ALONG) model capable of reducing hospital readmissions.  Get the patient the medical service through the appropriate level of care delivery to best meet the defined need.  Facilitate access to supportive services designed to keep the person safe upon discharge (PATH ALONG) and reduce hospital readmissions.

PATH ALONG is an original Wisconsin model that connects inpatient providers to community staff who support the patient during health system transitions.  For additional information on PATH ALONG http://www.homecarepath.com/Pages/PRESSRELEASEOriginalWisconsinModelToReduceHospitalReadmissionRates.aspx






Friday, November 30, 2012

PATH ALONG is an original Wisconsin model for care transitions

PATH ALONG is an original Wisconsin model (service set) that connects inpatient providers to community staff who support the patient during health system transitions.  PATH ALONG is a trademarked model owned by Home Care Path LLC.  Researchers utilized data from January 2010 to now to formulate a three service focus on reducing hospital readmission rates. 

One aspect of extensive research focused solely on needs with scheduled day surgery.  Researchers discovered a consistent verbalized need for additional help secondary to changes in physical function.   These fairly frequent acute (temporary) changes requiring extra help are not efficiently addressed through chronic (long term) care management strategies.  It is not pragmatic to coordinate adaptive equipment for short spurts of intense need.

Research revealed the need for additional help is not in a skilled care category.  Tasks such as meal preperation, errands, transfers, bathing, dressing, medication reminders, scheduled toileting, organizing daily list, are categorized as non- medical unskilled care.  This speaks to pay source.  Community health planners can experience a difficult time with an identified need that does not interface with a ready source to pay for the delivery of service.

PATH ALONG confirmed the need for additional help with scheduled surgery through a comprehensive data review.  PATH ALONG determined the help was catagorized as a non medical in home supportive service.  Cost containment strategies involved training supportive staff for anticipatory response to short spurts of intense need. 

The patients surgery is scheduled allowing for referral and PATH ALONG staff time to plan with family to meet the acute needs with an organized (individualized) approach.  Safety and comfort  intertwine with interventions designed to bring a healing stability to post surgical recovery.  Communication is an important aspect of this supportive service .

The PATH ALONG model facilitates an easy referral processs for Medicare (CMS) and Medicaid certified providers.  PATH ALONG delivers a research based standard of service that translates to a comfortable collaborative presence during transitions of care.  Simply call 608-432-4286 to schedule an interview.  Look us up on http://www.homecarepath.com/Pages/WisconsinPATHALONGModelandScheduledSurgery.aspx

for additional information.  Staff can be there when you are working. 

Tuesday, November 27, 2012

PATH ALONG Reduces Hospital Readmission Rates

PATH ALONG is an original Wisconsin (service set) model designed to reduce hospital readmission rates.  The Centers for Medicare and Medicaid (CMS) have concluded the cost of hospital readmissions are too high.  To shape inpatient provider business structure The Centers for Medicare and Medicaid (CMS) have reduced the rate of reimbursement for a patient who is readmitted to a hospital in less than 30 days.  This change in CMS reimbursement has sent inpatient providers requesting help from the community.

New Model  http://www.homecarepath.com/Pages/PRESSRELEASEOriginalWisconsinModelToReduceHospitalReadmissionRates.aspx

What is PATH ALONG?  PATH ALONG is an original Wisconsin (service set) Model that connects inpatient providers to community staff who support the patient during the health system transitions.

Why PATH ALONG?  CMS has enacted regulatory policy that reduces the hospital reimbursement rate for patients that are readmitted within 30 days. 

Who is PATH ALONG?  PATH ALONG is a registered trademark of Home Care Path LLC a leading senior care provider serving south central Wisconsin. 

Why is this unique?  Because it is up and running and utilizes (low cost) non-medical staff.

What is the cost?  Approximately 20.00 per hour, paid by the consumer.

How does the consumer save?  One example would be preventing a patient from having to stay over night in a hospital under observation status which has a high out of pocket cost for the patient.

Do you review data?  A comprehensive review of Home Care Path LLC data suggests an ill person in need of inpatient treatment does better with the presence of a consistent person.

PATH ALONG has 3 clearly defined services that can  help inpatient providers better determine a persons need for referral. 

1. Inpatient advocacy provides a staff person to accompany the elder on the inpatient stay.

2. Temporary help with a scheduled day surgery sends staff to accompany the elder to the hospital for the procedure and follow the person in the home setting until the senior can get by alone.

3. Crisis intervention often called transitional counseling provides a staff person who helps the family with an immediate and a long term plan.  The focus is to bring needed service to the senior.

To refer: Simply call 608-432-4286 to schedule an interview. 

PATH ALONG is a service set designed to meet the changing needs of a larger population utilizing community inpatient resources.  Inpatient providers are challenged to acknowledge past perceptions of health care delivery that may be disruptive to quality and safety.  PATH ALONG is the Medicare (CMS)  Medicaid certified providers friend.







Saturday, November 24, 2012

Perceptive Calibrations Of Senior Care

Families are frequently called on to compare at home supportive care with residential assisted living.   Two models of care that seem to serve a similar population in a slightly different way.  Home supportive care sends a trained staff person to the seniors home to provide needed cares.  Residential assisted living moves the senior in to their own apartment with connecting halls and available staff to provide needed cares. 

It is helpful to use a managed care approach to establishing an agreed upon unit for comparison.  A gradation of hands on help fiscally calibrates staff utilization.  Our unit is one hour of hands on help in which staff would perform dressing, toileting, grooming, oral care, medication retreival, transfer, meals, bathing.  One staff person would only be able to help one individual at a time with these activities of daily living.  So our common accepted standard is one hour of care for one staff person to perform hands on cares for one individual who needs the help.

In our example the residential assisted living facility employs two trained staff persons per 16 residents.  This would mean 1 staff person is available to serve 8 residents. 

Each day has 24 hours in it.  Dividing the 24 hours by the 8 residents waiting to receive help from the one staff person we calculate 3 hours.  So, each resident can expect to receive 3 hours of hands on care per 24 hours, or one day.  Like a chemical equation this captures all that would be available to use.

The family pays the residential assisted living facility 3900.00 per month for the seniors stay.  There are 30 days in this month for our example.  Dividing the 3900.00 by the 30 calculates to 130.00 per day.  For 130.00 per day the senior receives about 3 hours of hands on care.  We can devide the 130.00 by the 3 hours to calculate a 43.00 cost per hour of hands on care. 

In this example using our agreed upon unit of comparison one hour of hands on care will cost about 43.00 per hour.

In this example our at home supportive care service (www.homecarepath.com) would charge 20.00 for an hour of our agreed upon unit which is hands on care.   One staff person would come to the seniors home and help with transfers, meals, bathing, grooming, oral care, haircare, medication reminders, and dressing. 

We can now express a cost comparison using our agreed upon unit as it takes place within the listed care  delivery models.  In the residential assisted living for 130.00 per day staff perform 3 hours of hands on care for the cost of 43.00 per hour. 

In the at home supportive care service for 130.00 per day staff perform 6.5 hours of hands on care for a cost of 20.00 per hour. 

If the senior seems to need more time , which model will provide more time for a similar investment?

Home Care Path is a leading senior care provider serving south central Wisconsin.  Services include:
-in home staffing with help for ADL's and IADL's
-inpatient advocacy for safe successful hospital stays
-crisis intervention with transitional counseling
-temporary help with a scheduled day surgery
-down sizing home contents when stuff matters
-packing and shipping with gift giving season
-communicate face to face on the computer across long distances
Simply call 608-432-4286 to schedule an in home interview.  2012 rates are 20.00 per hour.  Email lkutzke@homecarepath.onmicrosoft.com  We accept long term care insurance.  We can be there when you are working.  Services are tax deductible.  Valuing home and human life. 

Thursday, November 22, 2012

Valuing Real Estate

Historically accepted strategies for estimating the value of real estate include three approaches.  Seniors are encouraged to be mindful of the effect globalization has on the local economy when considering property value.

One approach to value is the cost.  Cost is a calculation that informs the buyer the price that would have to be paid for land and construction of a similar building.   One can look at the cost of the land plus the cost of construction less the depreciation.

Sales comparison compares the characteristics of one's property to comparable properties that have recently sold in similar transactions.  Characteristics would include the size of the lot, the size and age of the building, and more.  The sales comparison value is an estimate of a measure of the degree of characteristics.

Income capitalization is a speculative value of a rate of return.  The process involves the level of  (what market will bear) rent the property can be expected to generate.  This includes a projection of resale value. 

Seniors can use both a licensed realtor and a licensed appraiser when determining a sale price for their property.  Comparative market analysis is performed by a licensed realtor and includes a comprehensive list of the property and characteristics.   Some lending agencies will want a licensed appraiser to estimate the value of the real estate to prevent the buyer from over paying.

The globalization effect speaks of the geographical changes secondary to the alteration of the flow of money.  How stable is community infrastructure. Altering the flow of money shifts available community services which plays a direct role in buyer desire.   Simply where is your property in relation to the current economic activity in your region of residence.

Home Care Path www.homecarepath.com is a leading senior care provider serving south central Wisconsin.  Services include:
-in home staffing with help for ADL's and IADL's
-inpatient advocacy for safe successful hospitaal stays
-crisis intervention with transitional counseling
-temporary help with a scheduled day surgery
-down sizing home contents when stuff matters
-communicate face to face on the computer across long distances
-packing and shipping with holiday gift giving season
Simply call 608-432-4286 to schedule an in home interview.  2012 rates are 20.00 per hour.  Email lkutzke@homecarepath.onmicrosoft.com  We accept long term care insurance.  We can be there when you are working.  Services are tax deductible.  Valuing home and human life.

Monday, November 19, 2012

The Coleman Model Care Transitions

The Coleman Model flows from Dr. Eric Coleman  Colorado University of Medicine Division of Healthcare Policy and Research.  The Coleman Model is destine to improve relations between hospital staff and community based providers.

The Coleman Model is an evidenced based program.  Evidence based programs use interventions that have been validated by documented scientific evidence.  The program is required to employ the best evidence when choosing future actions.  Simply is what we are doing working. 

The Care Transition Coalitions were formed to create a way to reduce hospital 30 day readmissions by 20 percent over the next three years.  The Coleman Model is a structured intervention employed to manage the task of reducing readmissions.

The Coleman Model facilitates a coaching focus to post hospitalization interventions.  Does the person returning home understand how to take their medications as provider ordered.  Do they understand the signs and symptoms of a worsening condition.  Can the person verbalize the key information to tell their health care team?

Certainly follow up with the discharged person to determine what is occurring in the home has been proven beneficial.  The new twist is the reduction in hospital reimbursement for individuals who are readmitted in less than 30 days.  The potential loss of funding in the form of federal policy has a side effect of encouraging hospital staff to expand communication with community providers.

Home Care Path www.homecarepath.com would like to thank Dr. Eric Coleman for all the hard work. 

Home Care Path is a leading senior care provider serving south central Wisconsin.  Services include:
-in home staffing with help for ADL's and IADL's
-inpatient advocacy for safe successful hospital stays
-crisis intervention with transitional counseling
-temporary help with a scheduled day surgery
-communicate face to face on the computer across long distaances
-down sizing home contents when stuff matters
-packing and shipping with holiday gift giving season
Simply call 608-432-4286 to schedule an in home interview.  2012 rates are 20.00 per hour.  Email lkutzke@homecarepath.onmicrosoft.com  We accept long term care insurance.  We can be there when you are working.  Services are tax deductible.  Valuing home and human life.

Sunday, November 18, 2012

B Sure 2 Visit The ER Urgent Care This Holiday

Hospitals nation wide have reached out to the community for help with reducing hospital readmissions and fostering appropriate use of urgent, emergent services.  Wisconsin has organized a State Wide Transition Of Care Coalition Steering Committee.  This is in response to federal policy that reduces hospital reimbursement with a readmission in less than 30 days.

Long term health planners recognize the need for a paradigm shift.  The population needs education that maximizes utilization of the primary care provider.  Community health care providers (www.homecarepath.com ) who coordinate support in the home need to communicate strategies for responding to perceived urgent emergent needs.  Families benefit from feeling connected and safe.

Hospitals will benefit from defining a discharge process that includes the entire patient population and facilitates access to supportive service beyond the hospital door.  A large population of individuals with chronic health care needs may not qualify for public programs.  Discharge planners are challenged to communicate resources available to the family regardless of the pay source.  Historically social services has a hard time identifying and suggesting a needed service Medicare and Medicaid do not pay for. 

As a branding strategy local hospitals now call themselves medical centers to communicate the availability of a comprehensive menu of service for health related needs.  The medical centers publish and distribute elaborate newsletters to keep the community informed. 

This months issue of the medical center newsletter presents a large ad reminding families to visit the urgent - emergent care service during the holidays.  In need of urgent, ER care during the holidays, rest assured we are trained to treat colds, flu, fevers, cuts, scrapes, minor lacerations, sprains, strains, skin rash, bladder infection, minor aches and pains.  We have a physician available 24 hours per day. 

This is a clear example of a mixed message aimed at the population being served by the hospital.  Why struggle with getting in to see your primary( clinic doctor) provider when the Urgent - Emergent care service is wide open and begging for you to come in and visit. 

Regulations that form criteria for hospital admissions have tightened up.  This means individuals must be quite ill to be admitted to the hospital.  Families will report unsatisfaction with emergency room staff when a person is repeatedly taken in to the ER (Emergency Room) and no hospital admission occurs.  Some hospitals will order an observational stay which may not be covered by health insurance. 

Wisconsin families are being encouraged to form a relationship with their primary care provider.  Look to your clinic to help you manage the trouble some symptoms that cause you to reach out for help.

Home Care Path reminds families that calling 911 from your residence with an emergency is an avenue to receive immediate needed care.  If you feel you are experiencing an emergency get help immediately. 

Home Care Path www.homecarepath.com is a leading senior care provider serving south central Wisconsin.  Services include:
-in home staffing with help for ADL's and IADL's
-inpatient advocacy for safe successful hospital stays
-crisis intervention with transitional counseling
-temporary help with a scheduled day surgery
-down sizing home contents when stuff matters
-communicate face to face on the computer across long distances
-packing and shipping with gift giving season
Simply call 608-432-4286 to schedule and in home interview.  2012 rates are 20.00 per hour.  Email lkutzke@homecarepath.onmcirosoft.com  We accept long term care insurance.  We can be there when you are working.  Services are tax deductible.  Valuing home and human life.