Month: March 2011

CMS Posts Updated List of High Readmission Hospitals

For home health agencies interested in the Community-Based Care Transitions Program, a new list of high readmission hospitals has been posted as of March 3rd on the CMS website.

The list itself, available here, includes the highest hospitals by state, their location, and other information on discharges. Massachusetts hospitals are listed on pages 9 and 10.

As always, more information will be released as it becomes available.

Return to www.thinkhomecare.org.

CMS Clarifies use of HHABN for Face-to-Face Requirement

On the CMS Home Health, Hospice & DME Open Door Forum held today, March 2nd.,  staff from CMS discussed the use of the HHABN when discharging a patient because there was no F2F encounter within the required time frame.  This is a clarification of an earlier policy which said that the HHABN was not to be used in this situation.

Option BOX 2 can be used because the agency is ending services for administrative reasons such as lack of a F2F encounter.  It is a change of care notice only and there is no beneficiary liability for the care provided. Further written clarification from CMS will be forthcoming.

Metrowest Home Care & Hospice Honored for Their Work

Congratulations go out to MetroWest Medical Center which, in collaboration with MetroWest HomeCare & Hospice, has been awarded the 2010 Betsy Lehman Patient Safety Recognition Award. The award honors leadership and innovation in patient safety and the development of systems-based solutions through the implementation of best practices. The theme for this year’s award focused on the importance of transitions in care across the healthcare continuum.  Jane Pike–Benton, Executive Director at MetroWest HomeCare & Hospice, presented their innovative approach at the most recent statewide STAAR Learning Session and sent this along to the Home Care Alliance:

“ At Metro-West, we implemented a multi-faceted approach to the transitioning of patients that was designed and implemented via a strong cross-continuum collaboration between the home health agency and the hospital. The model includes:

  • the implementation of a ‘teach back tool’ for patients with heart failure both within the hospital and through their transition to home with home care services
  • the development of a standardized Heart Failure Protocol with front loading of home care visits, the use of a standardized teaching tool based upon evidenced-based research, an increase focus on medications, and the integration of phone calls by the home care case managers on non visit days
  • post hospital telephonic support via the use of a calling center in conjunction with the MetroWest HomeCare Nurse Specialist intervening for these patients when gaps in care are identified
  • the implementation of a Transition Care Coach who is also a MetroWest HomeCare Nurse who meets with the patients bedside prior to discharge from the hospital
  • the implementation of a Palliative Care Team with members from both MetroWest Hospice and MetroWest Medical Center

These initiatives demonstrate the importance of cross-continuum collaboration to our patients and to our health care system. Our entire team is committed to implementing new and innovative ways to provide care for our highest risk patients, and to demonstrate the value that home health care offers to hospitals and other health care partners.”

Among those sending congratulations to MetroWest HomeCare & Hospice and MetroWest Medical Center on their innovative approach to patient care across the continuum was HHS Secretary Judy Ann Bigby, MD.  Her comments as to MetroWest as a “shining example” were posted on the Commonwealth Conversations Public Health Blog.

Thank you to Jane and her team for demonstrating leadership in this crucial area of care transitions and readmission reduction.

Physician Face to Face Encounter Update

The Home Care Alliance wrote an article in the Massachusetts Medical Society’s newsletter in an effort to further educate physicians on the CMS face-to-face encounter requirement. The article was written at the beginning of the year and published in the February edition of “Vital Signs,” the MMS newsletter, although much has happened since then.

With one month left until the April 1st enforcement deadline, the Alliance continues to provide updates as they become available. To that end, some new important Q&A’s have been posted on the CMS website, which are available here.

A few of the new Q&A’s are listed below:

Return to www.thinkhomecare.org.