The Time for Outcomes is Here

Posted on in Growth Strategies

By Greg Packer and Dave Lyman Today’s DME and complex rehab providers are facing many challenges, such as competitive bidding, decreasing reimbursements from third parties, narrowing networks, audits and increasing operating expenses. Through the Patient Protection and Affordable Care Act (PPACA), the federal government is making attempts to significantly bend the health care cost curve. While the attempts are channeled through a number of initiatives, including Shared Savings (Accountable Care Organizations), Bundled Payments, Independence at Home, and Value-Based Purchasing, the end goal is the same. Improve population health and reduce expenditures. Regardless of the program that a health system might be participating in, there are going to be three primary goals for each of the organizations:

  1. Improve outcomes
  2. Reduce re-hospitalization rates
  3. Reduce length of stay
Legislators, policy makers, health care providers, and patients will all agree that a patient’s preference would be to stay out of the hospital, reduce the length of time spent in the hospital, not go back to the hospital, and reduce the amount that it costs to access care at a hospital (or anywhere). Additionally, there appears to be a less-publicized concerted effort to reduce use of long-term care facilities like nursing homes. The bottom line is this: patients don’t want to be in institutionalized care and the government doesn't want to pay for institutionalized care when it’s not necessary. Being that it seems the end goal is to reduce utilization of institutional care settings, the question has to be asked: Where are these patients going to go? Knowing that it’s nobody’s intention to discontinue caring for patients, and that the patient population isn’t going away, it seems the only logical answer has to be this: Home. When it comes to home-based care, be it home nursing, therapy, infusion, or medical equipment, we know two undeniable things to be true.
  1. Home is the preferred place to be for the vast majority of patients; and
  2. Home care is an extremely cost-effective method to deliver health care and can measurably reduce the overall cost of care when delivered appropriately.
So, with the desired outcomes by all being largely driven by increased utilization of home care, the next question has to be: Where is home care in the Accountable Care Organization (ACO) and other CMS initiatives? To achieve reduced utilization of health systems and long-term care facilities, providers must develop strategic partnerships with both hospital-affiliated and independent home care suppliers. With all of the buzz from CMS, CMMI, and health care providers in general surrounding the ACO initiative, it is of great concern to those of us in the home care industry that providers are developing new models for delivery that must rely on home care as a crutch without CMS’ inclusion of home care in the conversation. In order for these programs to be as successful as we need them to be, home care providers have to have a seat at the table. Rather than view DME as a cost center, the industry needs a candid discussion about dramatic savings that DME produces, as well as possible growth in the DME arena that can even further enable the success of the above-mentioned cost-containment initiatives. The DME industry is perfectly positioned and very willing to deliver transitional care and disease management programs to the millions of patients they already care for. Successful transitional care programs have proven to dramatically reduce 30-day re-hospitalization rates. Disease management programs reduce overall utilization of the health care system. U.S. Rehab will be implementing an outcomes program in sometime 2015 with the Functional Mobility Assessment (FMA). Developed by Dr. Mark Schmeler and the University of Pittsburgh, the FMA is a 10-question survey that assesses a person’s ability to function while using his/her current means of mobility. The first assessment is completed when the patient is at an initial evaluation and a second assessment is completed 21 days after they receive new equipment. Through the use of this scale, we will gather information that shows patients have better outcomes when they receive the correct equipment while being fitted by the correct professional, like an ATP. We are currently doing a pilot project with a small group of members. Once we are ready to expand this to the entire U.S. Rehab membership, we will let you know. If you would like to participate in the pilot program, please contact me and let me know. Our industry must show the “powers to be” that we are in the home setting more than any other ambulatory entity and can help in the reductions of readmissions and decrease healthcare costs. We need to measure patient outcomes and compare to our peers so that we may be able to benchmark the data. CMS is not going to do this for the industry as they have for home health. However, the challenge remains. Without a seat at the table and being strung out by government initiatives, the industry simply cannot implement these programs. Suppliers desire to reposition themselves and be recognized as the savings centers they’re capable of being, but the current situation severely limits their capability to do so. U.S. Rehab is here to help our members get an outcomes program established to prove that even though the correct equipment may cost more up front, it will save money by reducing readmissions over time. In order to prove our worth, we must show the value that we bring in the continuum of care.