Madeleine Biondolillo, MD, the Director of Health Care Safety and Quality at MA Department of Public Health informed home health executives this week that efforts by the state to support better care transitions may eventually become more deliberate – possibly by adding care transitions “compliance” to the state survey process. In a discussing her Division’s plans with the executives, Dr. Biondolillo indicated a strong preference for “leveraging her Department’s regulatory clout” to drive improvement in the patient care experience. She shared a draft survey tool that DPH developed with the nursing home industry and that surveyors could eventually incorporate into the state survey process. The tool has been tested in four long term care facilities to date and has been shared with CMS as a possible national model for survey reform. The form incorporates resident/patient interviews using the 3-Item care Transition Measure (CTM-3), which Biondolillo suggested has the endorsement of the National Quality Forum for use in evaluating transition quality.
In response to questions and comments from some of the home health executives at the meeting, Dr Biondolillo:
– reflected on the possibility of introducing a determination of need (DON) process in Massachusetts for home health saying the DON rules may be reopened for changes in the coming year. The compelling argument for home care or hospice would, she said, be quality of care based, not economic.
– indicated a willingness to assist the Home Care Alliance in getting physicians and hospitals to understand the complex Face to Face rule
– expressed from her own personal experience as a physician support for home health efforts to change Medicare practice to allow Nurse Practitioners to sign plans of care
– agreed with sentiments expressed by at least one home health executive that there may be more that can be done to educate physicians that different patients may benefit from different post acute paths (i.e, directly with support home) rather than following a standard for all patients path through a rehab hospital and/or nursing home