Eye diseases such as Macular Degeneration and Low Vision are unknown to many, but can be very important for home health agencies, physicians and in particular, for those affected by them. If you don't know about these diseases, you'd be surprised to find how common they are and how devastating the affect can be on those living with these conditions.

Although somewhat unfamiliar at the moment, most home health providers will encounter these diseases in the near future - low vision will certainly affect your patients (it is likely already a significant issue). Moreover, most of us will experience a family member or a friend that receives a low vision diagnosis. The truth is simple - we are all in some way affected by this disease, we just haven't all realized it yet.

This brief article provides a new awareness of vision loss and the current status of the specialized medical field of vision. Within this specialty, we can observe a variety of opportunities for home health providers. More specifically, we can gain a glimpse of the gap to be filled - a need to be met. Furthermore, as we witness the impact of our fragmented health care system in vision care, we can identify a new opening for home health agencies in the continuum of healthcare delivery.

You will find that the medical field of vision, along with many other specialties, can become a vehicle for change that is both advantageous to home care and to the larger health care system. The medical field of vision is ripe for opportunity. If captured, agencies can further demonstrate their value to the larger health care continuum and foster the beginning of a new era.

Low vision, and the diseases that cause it, are a part of a new frontier in health care; a new challenge of the unknown ready to be conquered. Those living with the disease are often seen by many health care providers, including physicians, nurses, hospitals, and home health agencies. But it is generally a silent problem; one that cannot be seen from those looking from the outside in. Low vision represents a dramatic problem for many, often because it is wrapped in the unknown...an unknown existence, the unknown problems, and an unknown solution, in an unknown world.

Low vision represents isolation and fear to those who have it; however, it also reflects a need for those who can treat it. Yes, it is often an unmet need. A need early in its awareness, perhaps, but so were other diseases before they captured the attention of home care.

Beyond the humanistic element of the problem and the need, these diseases and their treatment represent another aspect that requires our attention - a need for improved communication, collaboration and unity within healthcare. As we are all aware, this is an issue that transcends low vision care and affects all aspects of the care delivery system.

Communication? Collaboration? Unity?

It sounds ethereal and ideological. However, it is a common understanding that our health care system, amongst all of its problems, is fragmented in nature. The reason, among many others, is in part due to the specialized nature of today's system. On the one hand, specialization is a good thing - It is good for patients and medicine, and it has dramatically improved patient diagnostics and treatment leading to better cure rates and outcomes. On the other hand, specialization has also created deep crevices in collaborative care between providers. Specialties may lack an understanding or awareness of the partners in their patients' care. These crevices are precisely what is separating the known from the unknown; from what you know about your patient to what you don't; from what you know about a disease and what you don't. And if we are talking about eye diseases and low vision, I would venture to say that the medical field of eye diseases and its effects certainly fall into this category. Ophthalmologists and retinal specialists are still unable to cure age-related diseases, and the physician-driven services they can utilize for rehabilitation are virtually non-existent. General practitioners are affected as well by the fragmentation; they may have no idea their patient has low vision.

What does all of this information mean to home health care? How do agencies make a difference?

* First, agencies can establish their place in the medical field of vision treatment by becoming experts in low vision home care and preparing to meet the needs of this unique population.

* Second, home health is poised by strength in numbers to address this problem. You are a built in solution! You are present, literally, in the very same communities as these physicians and patients! And in many cases, you are already treating these low vision patients, but because of the fragmentation you may never know it.

* Third, by accepting the challenge to provide your services to low vision patients, you will gain valuable insight into the role of home health throughout the care delivery system. You will grow accustomed to "getting outside of your comfort zone" as you begin to fill gaps within other medical specialties. You will find that your patients are happier, the outcomes better, and your agency will thrive.

How would this be accomplished? It is simple - we must do that which we do best: provide care to those in need, create collaborative relationships, and utilize our unique home health skill sets to improve care delivery. Home health agencies specialize in providing high intensity services through a sophisticated system of care coordination and disease management. In fact, amongst health care providers, home health agencies may arguably be the strongest force in health care to handle the wide array of integrated health needs of their patients.

To illustrate the power of home health in low vision, consider the following true story from a HomeSight-Certified Agency:

The endocrinologist was frustrated because his patient's A1C was higher than expected. The patient's log books showed a different story. Despite, multiple insulin changes made both during office visits and by phone, in addition to diet education, the efforts had not been as effective.

The home health agency nurse visits the doctor that day to discuss the value of home care. He recalls his frustration with his patient's A1C. As the nurse listens, she recognizes that the doctor only has a part of the information he needs.

She offers, "maybe the log book is inaccurate, or perhaps the patient is illiterate, is he applying the correct amount of blood on the strip, is his diet actually being followed?" The nurse encourages the doctor to allow a home health assessment/investigation to learn more.

During the first home visit, the patient was found to have vision loss. He couldn't see the meter or the log book well enough to record accurate information. He didn't want to disappoint his doctor by not keeping his records.

The endocrinologist didn't recognize that he wasn't aware of the complete picture, as treatment of visual diseases isn't his specialty. The endocrinologist was sitting across a crevice of information - Home health was the bridge.

Become a cornerstone of care delivery!

You can start right away. With HomeSight as part of your value proposition, you will be expertly capable of addressing a vastly underserved need in your community. You will dramatically improve patients' lives, all while gaining insight into new solutions for other specialty services suffering from the unknown.

©2010 Melicia Coleman, RN. All rights reserved.

About the Author:
Melicia "Lisi" Coleman is a Registered Nurse, Home Health Agency CEO, and Founder of the revolutionary HomeSight program. She has worked in the Home Health field for 16 years in various capacities including home health agency administrator and owner, quality and special programs director. Ms. Coleman has previously received the State Award of Appreciation from the Louisiana Occupational Therapy Association "for her perseverance, vision, and willingness to help others" and has additionally been honored by NurseWeek magazine as a nominee for the Nurse Excellence Award in Innovation and Creativity in recognition for her development of HomeSight. 

About HomeSight:
Inspired by home health clinicians, the HomeSight program delivers an innovative approach to vision rehabilitation by addressing the clinical, functional and psychosocial needs of patients with varying degrees of vision loss in the home health environment. Despair, anxiety, frustration and isolation-all feelings people use to describe life with low vision-are now replaced with hope as patients regain their independence and quality of life.
Designed by the innovators at LiveAbility, HomeSight was specifically created to meet agency needs now and into the future. The HomeSight Model is unique in that it helps agencies enhance performance in a variety of key areas:

* HomeSight facilitates competitive differentiation in today's red ocean of traditional home care referral sources;

* HomeSight provides opportunity to cultivate prosperous relationships with untapped referral sources in the blue ocean of ophthalmology and low vision

* HomeSight contributes substantial human value to those living with vision loss by restoring a sense of hope and independence.

Furthermore, the HomeSight Model fosters agency innovation and clinical excellence, in addition to helping providers discover new ways to convey the home care value proposition.

Backed by more than 12 years of research, the HomeSight model offers a 360 Degree Opportunity® by achieving a successful and rare blend of positive outcomes for virtually all facets of home health care.

Although you are not required to enter your projected number of visits to get the OASIS Analysis Report, you will find it is well worth your time.

When you enter your projected number of visits in the "Ordered Services" section of your software, it calculates your costs for an episode of care to compare with your expected reimbursement. In addition to calculating your costs, it will also make other reports available to you that give you information on:

- Average number of visits for each diagnosis
- Financial reports
- What referral sources are referring profitable patients
- Patients the agency is losing money on

So, just when you thought the OASIS Analyis was great all on its own, it's gotten even better now that you've read this!

M0110 is one of the most important items on the OASIS. Watch this video blog by Ann Giles, RN, BSN, HCS-D, COS-C to understand the key points and terms you should know for accurately answering this M item. 

Version 6.0.0.42 is now available for download. The biggest change in this update is a new feature that our customers have asked for - automatic update checks.

With this option turned on, the program will automatically check for available updates when you log in. If your program is already up-to-date, then nothing else will happen and you'll continue to work as usual. If your program needs an update, you'll be prompted to download and install it.

By default, this feature is turned OFF. If you want to turn it ON, simply go to the "Help" menu, select the "Updates" option and click "Auto check for updates at Login." That's it!

We've also added administrative control over who can check for updates. If you would like more information about these administrative features, contact support@ppsplus.com.  

We hope you like this feature. If you have any questions about any of this, please don't hesitate to call your Account Executive or our Support Staff. We'll be happy to lend a hand.

-Glenn

The post acute care market has undergone significant changes in the last fifteen years and all indications are that those changes will continue and be exacerbated as healthcare dollars become more precious and the glut of aging post war baby boomers put added pressure on existing infrastructures. The favorable economic factors associated with delivering healthcare in the patient's home, coupled with the fact that most patients would prefer to receive care in their own home, has and will continue to propel considerable growth for home healthcare entities. A recent study by a national concern provides an excellent example of this impending growth. Two of the three fasting growing job categories by percentage between 2006 and 2016 were in the home healthcare arena - home health aides and personal / homecare aides.

What is even more compelling about this study is that both those job categories started with by far the largest base number of job holders (approximately 765,000 in each of those two categories) and both grew to in excess of 1,150,000 - for percentage increases of 48.7% and 50.6% respectfully. A total gross job growth of in excess of three quarters of a million workers are and will be entering the ranks on homecare employees by 2016.

Telephony documentation by HHA's, personal care staff, and homemakers has a multitude of benefits, which put it in the lead above other documentation methods.

• 1.) Legislatures confronted with ever tightening budgets are looking at ways of minimizing fraudulent and abusive documentation associated with visits, especially alleged visits or visit lengths by non professionals. Telephony documentation systems provide hard to spoof electronic records verifying both the visit and the visit length. Numerous jurisdictions either already have or are contemplating mandating documentation systems, such as telephony, that minimize fraud and abuse.
  
  2.) Home care agencies face budget constraints as well. They must find ways to do more with less. Telephony systems offer unique advantages when utilized with non skilled workers.
  
  
  • a.) There is generally no initial capital outlay associated with telephony systems, making them most attractive to capital strapped home care agencies. Other systems utilizing laptops and hand held devices come at a considerable initial expense. Those costs do not end with the initial purchase however. Maintenance and replacement costs associated with such devices can often be considerably more over time than the initial capital outlay.
  • b.) Numerous detailed cost benefits analyses have repeatedly demonstrated that properly employed telephony systems save agencies in excess of twice what said systems cost. Savings are garnered in numerous areas, including but not limited to:
    
    • i.) Greater productivity by central office staff - the same core of central office staff can accommodate many more field staff visits
    • ii.) Real time visit data from the field means quicker turn around on billing
    • iii.) Cost savings associated with the elimination of paper notes can be substantial
    • iv.) Other costs associated with paper notes, such as files, file drawers, office space and off-site storage costs can be virtually eliminated with the telephony electronic visit note;
    • v.) Timely payroll for field staff enhances employee relationships and helps minimize turnover, a significant cost that few agencies consider but all can ill afford
    • vi.) Because telephony systems offer real time analysis of field staff activities or non-activities, agencies can, upon implementation of fairly basic processes and procedures, minimize or eliminate missed visits. In today's market environment agencies can ill afford to forego billing opportunities as a result of missed visits;
    • vii.) For those agencies that reimburse mileage, postage or other costs associated with employees returning visit notes to the office, the savings can be dramatic.
• 3.) More sophisticated systems often fail in key areas when applied to the non skilled workforce in the home healthcare arena.
  
  
  • a.)Training a home health employee on telephony can be completed in 30 minutes, and prepares them to utilize the system in the field immediately vs. training on laptops, handhelds and related devices which can entail multiple and lengthy training sessions. As a rule, turnover in employment within the non skilled ranks is considerable and thus time consuming and costly training within that segment of the workforce is wasteful.
  • b.) Training for central office staff when telephony is employed for home health aides, homemakers and companions is generally not intense. Many telephony systems seamlessly integrate with an agency's existing backend system performing billing, payroll and scheduling functions. Accordingly, training for central office staff is minimized to unique telephony features such as announcement capabilities and unique reports associated with the telephony system. In most cases, central office staff training can be performed in less than two hours
  • c.) In many cases non skilled workers will shun employment if required to employ devices they fear are too technical for their capabilities
  • d.) Studies indicate that patients often sense more technical devices employed by non skilled workers in the home create a barrier to their personal care
  • e.) Unfortunately due to the high turnover and related issues faced by agencies relative to non professional staff, expensive devices are often lost or never returned to the agency
  • f.) Unlike telephony, often the more technical devices do not provide a means or cost effective approach to verifying the caregiver was actually in the home or was there for the length of time being billed, thus exposing the agency to fraud and abuse claims.
  • g.) Often to be effective, such sophisticated technical devices require infrastructure, like wi fi or G3 connectivity to function as designed and to-date those infrastructure systems are not uniform or come at a significant additional monthly cost.
• 4.) Several telephony systems offer an effective means of communicating with non-skilled field staff. Those telephony vendors offer an announcement feature that allows the central office to create and deliver messages for their field staff. At least one system offers a mechanism whereby unique messages germane to the patient's care can also be cost effectively delivered to workers in that patient's home. No cell phones and costly monthly contracts are necessary to effectuate that solution.

For these and other reasons, homecare agencies wishing to benefit from the rapid growth being experienced by the industry, especially in the areas of home health aide, homemaker and companion visits, would do well to consider utilizing a telephony system for the documentation of such visits.

©2010 Don O'Rourke. All rights reserved.

Don O'Rourke has been the President of Dial-N-Document® since the company's founding in 1997. He graduated from law school in 1973 and served as a law clerk to the senior judge for the US Fourth Circuit Court of Appeals and thereafter enjoyed a successful career as a senior partner for a law firm. In 1984 Mr. O'Rourke started focusing exclusively on activities involving the healthcare industry and in 1997 became a cofounder of Dial-N-Document®, a telephony-based clinical documentation system focused primarily on the home healthcare industry. Dial-N-Document® has partnership relationships with several of PPS Plus Software partners, including HealthMEDX and Sansio.

The revenue increase is just the tip of the iceberg, though. The article, found in the June 28 edition of DecisionHealth's weekly publication, Home Health Line, also includes Snider's testimony of increased case mix scores and decreased OASIS review time.

"All of the nurses and certified coders here at PPS Plus Software have dealt with OASIS review and coding first-hand," said VP of sales, Mark Scott, RN. "We are very familiar with the complexities involved in ensuring that each OASIS is accurate before submission. It is extremely gratifying to us when we hear from our customers that our software has made this process much easier and that they are now receiving the reimbursement they deserve."

"This is what it's all about," added John Shinn, president of PPS Plus Software. "It feels good to know that what we do in our office every day is having such a positive impact on this and other agencies all over our country -- especially in these challenging times."

Click here to read the Home Health Line article.
Click here to read the follow-up blog written by Jennifer Warfield, RN, BSN, HCS-D, COS-C.

DecisionHealth's weekly publication, Home Health Line, is the nation's leading independent authority on home health care business, regulation and reimbursement. Click here to subscribe to Home Health Line.

Note: Click here for CMS' Table 4 mentioned in this video blog.

As PPS Plus Software's education director, I often speak to agencies that are frustrated with the decrease in their average case mix weight since the implementation of OASIS-C. So why is this a problem? Well, a decrease in case mix weight is ultimately going to result in a decrease in reimbursement. And loss of reimbursement in conjunction with recent proposed Medicare cuts can have a severe impact on an agency's financial status.

Agencies can take these proactive measures to ensure OASIS accuracy which will then result in financial accuracy:

1.) Implement in-depth and ongoing training for field and office staff on OASIS-C, as CMS frequently gives us new guidance or clarifications

2.) Develop a QA/PI program that includes software that allows you to check for coding or OASIS errors and/or inconsistencies

Training is the easy part. Assuring coding and OASIS accuracy can be a bit more challenging unless you have dedicated staff that will review EVERY OASIS with a fine-toothed comb. Finding the expert staff to do this job is hard enough, not to mention the time involved to accomplish this effectively (as we all know, gathering all of the needed information and making all the necessary changes to just one OASIS can take up valuable man hours).

That's why I (and everyone else here at PPS Plus Software) was so pleased to be informed that the proof of our software's effectiveness is in the pudding (or should I say ‘in the program'?) according to a recent article featured in DecisionHealth's weekly publication, Home Health Line.

In the article, Sharon Snider, director of Nason Hospital Home Health Agency in Roaring Spring, Pa., credits PPS Plus Software's Home Health Edition for helping to not only increase her agency's average case mix weight, but also her agency's revenue by an average of $900 per patient (while also dramatically decreasing the average time her staff previously spent reviewing the OASIS)!

Click here to read the article.

Home Health Line is the nation's leading independent authority on home health care business, regulation and reimbursement. Click here to subscribe to Home Health Line.

A Biloxi native, Mary is a true Southerner. She loves to be outdoors and enjoys everything the coast has to offer -- great food and lots of fun on the water.

As die-hard Saints fan and a woman who knows her way around ICD-9 coding and the OASIS, she will definitely be an asset (not to mention a great addition to the mounting number of black-and-gold devotees) here at PPS Plus.

Welcome, Mary!