The Impact of Value-Based Purchasing on Home Health Nurses
By Jennifer Gibson, RN, HCS-D, COS-C
Value: a fair return or equivalent in goods, services or money for something exchanged; relative worth
Medicare's Home Health Value-Based Purchasing Model is new to the home health nursing space this year, but value-driven care has been gaining traction across care delivery systems for years. While the concept of VBP may not be new, the metrics used to define value and quality change frequently. Currently, STAR ratings, Consumer Assessment of Healthcare Providers and Systems results, and Home Health Compare are used to assess value of care provided by an agency.
The home health nurse's day-to-day workload differs greatly than our counterparts in a typical brick-and-mortar acute care setting. We still perform intricate wound care, IV therapy, LVAD therapy and disease management, but we work in the setting of a patients' residence and on their turf. Needless to say, this presents an entirely different set of challenges and opportunities to the home health nurse. We feel the impact of fighting traffic, connecting with physicians to obtain orders in a timely manner and managing patient and caregiver expectations. At the same time, we maintain professionalism, confidence and people skills during those Foley catheter changes done in dark rooms while keeping the family pet out of the sterile field.
How does the care we provide translate into measurable value? For home health nurses, it boils down to outcomes. Did the care we deliver improve the patient's outcomes? Did we decrease instances of infection, complication, exacerbation while increasing compliance and functionality through our services? Equally as important, did we ensure the patient was kept informed of the care they received in their home?
A nurse's workload should be structured so that valuable outcomes are demonstrated to the patient, the caregiver, the payer and the employer. This can be done by:
- Informing the patient of his or her rights and responsibilities before care begins
- Understanding the patient's outcome goals and sharing your goals for care
- Educating the patient and/or caregiver that standard precautions and hand washing are performed before and after care is given
- Calling the physician (or other team members) in the home to report changes and coordinate care
- Notifying the patient that you need to look at all their prescriptions and over-the-counter medications and supplements
- Ensuring that the patient is aware you are assessing their home for safety so that they can stay at home, where they want to be, without fear of injury
- Dressing in a professional manner and ensuring your name and title is clearly visible
- Ensuring the patient or family knows how to reach you or your supervisor
- Notifying the patient or caregiver when you will arrive and if you are running late for any reason
- Preparing and reviewing patient information before the visit begins
- Ensuring the patient is informed of ordered care and how you are going to carry out that care
- Focusing care delivery on interventions and goals that relate to desired outcomes and keeping the patient engaged of their progress
- Real-time documentation in the clinical record to ensure accuracy
These measures may seem elementary, but in an environment in which we are facing yearly financial cuts and doing more with less, it is easy to be distracted by daily stressors. Care delivery is not enough-we must ensure value is demonstrated and communicated. We not only know our value, but it is also up to us to ensure that our patients and our industry understand our worth as well.
Jennifer Gibson, RN, HCS-D ICD-10-CM, COS-C, is senior clinical services representative for Axxess and an RN with more than 20 years of home health industry experience. She is a certified OASIS and Coding Specialist.