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When it comes to reducing patient readmission rates and avoiding financial penalties, infections can be a home health agency's worst nightmare.

Improving infection control protocols to comply with CoPs changes

When it comes to reducing patient readmission rates and avoiding financial penalties, infections can be a home health agency's worst nightmare. One particularly dangerous type of infection, sepsis, has grown more prevalent in recent years and often leads to rehospitalization. 

What HHAs need today are robust infection control policies and procedures. While some agencies were previously not required to implement such programs, the new Medicare conditions of participation (CoPs) have made it mandatory that all HHAs have a comprehensive infection control protocol. 

Let's take a closer look at what this new mandate means for your organization:

Understanding infections in the home health – hospital relationship
Researchers from the Columbia University School of Nursing conducted a study of 199,462 patients at 8,255 home health care agencies. They found that 3.5 percent of patients developed infections during their stay, and that 17 percent of unplanned hospitalizations were due to infections.

The study was published in the American Journal of Infection Control in 2016. While it found a relatively small incidence of infections in HHAs, there has been a notable surge in sepsis in hospitals. As a referral partner, this increase presents a greater need for sepsis monitoring and vigilance in home health agencies. 

health Evidence-based protocols can improve infection control at home health agencies.

The rise of sepsis in hospitals
The number of sepsis cases in the U.S. has been rapidly rising in recent years. Between 2005 and 2014, the incidence of hospital stays due to sepsis nearly tripled, according to a report by the Healthcare Cost and Utilization Project published in June of last year. Sepsis is now the No. 1 reason for hospital stays, according to new data from the Agency for Healthcare Research and Quality, Bloomberg reported. 

To deal with the rise of sepsis, New York State now requires all health care agencies to implement new evidence-based screening and treatment protocols. As a result of the new processes, sepsis mortality has decreased nearly 16 percent in the past two years. Other states have followed suit, with Illinois, Wisconsin and Ohio implementing infection protocols modeled after the New York program. 

Thornberry Ltd. also updated its NDoc® solution to better address sepsis, adding additional patient screening questions and expanding the Signs and Symptoms table to capture more detailed information relating to the condition. With these tools, providers can institute more effective evidence-based treatment protocols. 

Changes to the Medicare CoPs
Infection control has always been a part of HHAs' provisions of care, as mandated by their state's requirements. Those that were accredited by the Joint Commission or CHAP already had to have infection control policies and procedures in place. However, CoPs changes have now made it mandatory that all HHAs have an infection control program. Read the release on the final rule here

"CoPs changes have now made it mandatory that all HHAs have an infection control program."

Enhanced infection protocols in EMRs
The sepsis protocols highlight a need for HHAs across the country to have more robust infection control programs in place. Many EMRs only give nurses the option to document Yes/No as to whether the patient exhibited signs of an infection, and reports simply gave the the option to show if the patient had a catheter and if they were on an antibiotic.There was no report to calculate the number and type of infection. 

However, Thornberry Ltd. has introduced enhanced infection control protocols. In NDoc®, clinicians can now fill out a new section that captures more information about current and potential infections and easily coordinate additional lab work and cultures. Then, they can run a report for the number and types of infections for all of the agency's patients to quickly get a better idea of infection risk and trends and determine whether the infection was likely agency-acquired. 

These new processes give a more detailed picture of what an agency has done to prevent and treat infection. This information can then be used for performance improvement initiatives and staff training. 

The number of documented sepsis cases has been increasing, but with improved infection control protocols now mandated for use by all providers by the new CoPs, HHA are better equipped to identify, treat and ultimately prevent infection. 

It's not pleasant to think about, but you need to have a plan in place for dealing with emergencies at your agency.

Complying with the new CoPs rule on emergency preparedness

Disaster striking your home health agency is not a pleasant scenario to imagine, but one that's necessary to think about. It's essential to have an emergency plan in place ahead of time so that you can quickly pivot operations and continue providing care to patients. 

Being prepared for a disaster is all the more relevant in the HHA industry at the moment because emergency preparedness is now a part of the Medicare conditions of participation (CoPs). HHAs are now required to have an emergency program. 

Here's what you need to know about developing emergency preparedness at your agency:

Understanding the CMS rule 
The Centers for Medicare & Medicaid Services now mandates that all agencies must have an emergency preparedness plan. Such a program should protect patient health in the event of an emergency that affects operations, and covers both natural and man-made events, according to CMS. 

CMS says the emergency plan should be based on four main areas:

  1. Risk assessment and emergency planning. 
  2. Policies and procedures. 
  3. Communication plan. 
  4. Training and testing. 

CMS requires that continuous testing of the plan is performed to see if it needs updating or changes from lessons learned. Read more about the rule here

Creating your plan 
Keeping these four guidelines in mind, your emergency plan should specify what steps to take in the event of a disaster. Think about potential scenarios, such as what should be done if there is a water main break, gas leak or shut off, blackout, fire or loss of power. How will you communicate with patients if a phone system is down? Are there steps you can take to prepare for an impending natural disaster, such as a hurricane or wildfire? What actions should be taken in the event of man-made event, such as a robbery or active shooter? How will the authorities be contacted? These and other questions need to be extensively explored. 

"Key to effective disaster preparedness is having constantly up-to-date information on patient needs."

Establishing a priority list 
Another important issue is determining how you will prioritize patient care in an emergency. How will you manage those patients whose care relies on electricity and water?

An EMR with disaster preparedness features will provide essential triage support. Using Thornberry's NDoc® solution, nurses can run a Priority List report which tells them which patients on oxygen need to be seen, those who can be called and those with support who do not need to be called or visited during that time. 

Having the information you need ready 
The key to effective disaster preparedness is having constantly up-to-date information on patient needs. In NDoc®, nurses can add to a patient's emergency plan at any time to specify what may be needed for the individual's care in a disaster. For example, the nurse can note that the patient needs bottled water, batteries, matches, flashlights, enough medications for two weeks and so on. This data then pulls to a report that can be instantly retrieved in an emergency. Reports can be run daily and weekly so staff and clinicians have the most updated information on patients. 

With an in-depth plan and an EMR enabling up-to-date patient priority reports, your home health agency can comply with the CoPs and be better prepared in the event of an emergency. 

2018 marks the fifth year in a row that Thornberry has won the coveted industry honor.

Thornberry awarded ‘Best in KLAS’ for record fifth year in a row

LANCASTER, Pa. (Feb. 1, 2018) – Thornberry Ltd.'s homecare and hospice EMR software, NDoc®, received the Best in KLAS award for the Homecare segment for a record-setting fifth year in a row.

For 2018, Thornberry was awarded a score of 93.1, surpassing all other vendors in the Homecare EMR segment by 9 points. The Best in KLAS designation is reserved for vendor solutions that lead the software and services market segments with the broadest operational and clinical impact on healthcare organizations. The recognition marks the first time in KLAS history that a vendor has been named Best in KLAS in the Homecare segment for five consecutive years.

"We are beyond excited to be named Best in KLAS this year," said Thornberry President and CEO Tom Peth. "We are thankful to our customers for their loyal partnership that allowed us to receive this recognition, and to our team for all their hard work day in and day out that enables us to achieve this success."

For the past 20 years, Thornberry has led the way in innovation in the home health and hospice EMR industry with its cutting-edge NDoc® software solution. With a suite of intuitive interoperability, compliance and protocol functions, NDoc® empowers clinicians and administrative staff to provide outstanding patient care. In a healthcare landscape of increasing change and data dependency, Thornberry supplies the smart tools and superior customer support providers need to improve clinical and financial outcomes.

2017 was an exciting year for Thornberry, with the company unveiling new protocols for treating CHF and other conditions, introducing support for complying with the new Medicare conditions of participation and developing functions to help providers reduce hospital readmission rates. These and other product innovations demonstrate Thornberry's commitment to ensuring NDoc® always helps providers navigate changes in care, reporting and reimbursement processes.

"We're excited about what 2018 will bring, and are working hard to deploy more innovative features in the year ahead that will empower our customers to meet new challenges," said Peth.

KLAS Research, a widely respected healthcare research firm, determines the Best in KLAS ranking through extensive surveys and interviews with current and previous customers of EMR vendors, gathering feedback on the efficiency and quality of health IT products. KLAS uses a stringent methodology that ranks vendors according to their ability to meet certain current and future expectations. The Best in KLAS score is based on key performance indicators that include sales and contracting, implementation and training, functionality and upgrades and service and support. The firm also evaluates vendors based on their ethics, transparency and commitment to customer service. Providers may request a report at the KLAS website.

"Best in KLAS is more than a ranking. It is a recognition of vendors committed to delivering superior solutions, said Adam Gale, president of KLAS. "It gives voice to thousands of providers who are demanding better performance, usability and interoperability in healthcare technology."

Thornberry will be recognized for its record-breaking win at the annual "Best in KLAS Award Ceremony" at the Rio Resort in Las Vegas on Monday, March 5 from 7-9 p.m.

About Thornberry
Founded in 1992, Thornberry Ltd. is the creator of NDoc® – a complete homecare and hospice management information and electronic medical record application. NDoc is a CCHIT Certified®2011 Long Term and Post-Acute Care (LTPAC) EHR additionally certified for Home Health. NDoc's key functional elements include clinical documentation and compliance, workflow management, financial management, business intelligence and document management. Powered by rapid information exchange technology, NDoc is a connectable application able to quickly share data with healthcare providers across the continuum. NDoc helps agencies increase clinicians' efficiency, improve patient outcomes, enhance employee morale and grow profitability. Learn more at ndocsoftware.com. "NDoc®" is a registered trademark of Thornberry Ltd.

About KLAS
KLAS is a data-driven company on a mission to improve the world's healthcare by enabling provider and payer voices to be heard and counted. Working with thousands of healthcare professionals, KLAS collects insights on software, services and medical equipment to deliver reports, trending data and statistical overviews. KLAS data is accurate, honest and impartial. The research directly reflects the voice of healthcare professionals and acts as a catalyst for improving vendor performance. To learn more about KLAS and the insights we provide, visit www.KLASresearch.com

Media Contact
Linda Peth
(717) 283-0980

If you're buying something online, it pays to do your research - and that's where KLAS comes in.

What is KLAS and why should I care?

If you're buying something online, you do your research. You rifle through the pages of Amazon reviews, learning what users liked and disliked about a product and their suggestions to future buyers. You trust the reviews because it's not just something that the seller made up: it's honest-to-goodness feedback that tells you whether the product is likely to be worth your investment. 

If you apply this strategy to buying home goods online, then you should definitely apply it when purchasing EMR technology for your home health agency. You won't find the reviews on Amazon, but you'll find them on the KLAS Research website. KLAS is a leading healthcare IT research firm that provides the definitive ranking of vendors in the industry – it's the trusted go-to guide for home healthcare executives making buying decisions for new technology. 

Here's more on what KLAS is, and why you should care about it:

History of KLAS
As business and healthcare both become more data-driven, the need for transparency is paramount. A desire for greater transparency was what was driving four members of the healthcare IT industry to create KLAS Research in 1996. Today, the firm has more than 130 employees who analyze data and interview clients to publish industry-leading KLAS reports and rankings. 

reviews Whether you're buying home goods or health IT software, it pays to read reviews.

Honest reviews 
You know how some Amazon reviews include a disclaimer that says the reviewer received the item for free as part of a contest or survey? You probably don't trust those ones as much as the reviews without those qualifiers. And when you're buying a large-scale software suite, the need for an impartial, balanced review is even greater. KLAS Research is lauded in the industry for honest, fair reviews, without kickbacks or other incentives tied up in the vendor evaluation process. With a commitment to honesty and transparency, you can trust the reviews you read without worrying they're sponsored content. 

Client-provided feedback 
KLAS data scientists delve into the numbers to figure out where EMR and other healthcare IT vendors stand. However, this isn't the whole picture. KLAS staff also conduct in-depth interviews with real-life clients of vendors to find out the human side of their business. Are people happy with their products and with customer service? Do they have a positive impression of their vendor? Do they think their organization has benefited from adopting the vendor's software? All these questions and more are addressed during the KLAS research process, and the results of these client interviews weigh heavily in KLAS annual industry rankings. 

"KLAS staff conduct in-depth interviews with real-life clients."

Holistic view of business 
Today more than ever before, healthcare providers and business executives want to put their money where their morals are. KLAS Research understands this and incorporates ratings in ethical categories into their vendor rankings. Does the vendor act ethically and strive to do good? Can their clients trust them? While on the surface these qualities seem distinctly un-quantifiable, KLAS has a thorough vetting process that addresses all aspects of a vendor's operations. 

Make an investment with confidence 
Buying a new EMR is a major decision, and one that is not to be taken lightly. The software you choose will have a profound effect on your organization. That's why you should depend on KLAS to help guide your buying decisions – their reports and rankings give you the information you need to know to make a purchase with confidence. 

To guide your New Year-strategizing, here are seven tips for preparing your home health agency for 2018.

7 tips for preparing for 2018

2018 is right around the corner, and while you're probably thinking about your New Year's Eve plans and setting some personal resolutions, it's also important to think about how you can prepare your home health agency for success over the next 12 months. 

There are a lot of changes coming for home health and hospice this year, and a lot of exciting opportunities to strengthen patient care, too. To guide your New Year-strategizing, here are seven tips for preparing your home health agency for 2018:

1. Review the past year
You can't effectively look ahead without looking back first. Review what worked and what didn't in 2017 so you can adjust your strategy and make improvements in 2018. Another area to review is the technology at your agency – perhaps your EMR's security was not up to par and it's time to make an upgrade. By reviewing the past, you can create an effective strategy and more realistic budget for the new year.

2. Set SMART goals
As you evaluate the past year and think about your HHA's priorities in 2018, set SMART goals (Specific, Measurable, Attainable, Realistic and Time-Bound) to help your agency stay on track. With all the hustle and bustle of the end of the year, SMART goal-setting can fall by the wayside, but taking the time to detail your ambitions and objectives makes it more likely you'll actually achieve them.

3. Make a plan to weather the transition to new conditions of participation 
This year saw the Centers for Medicare & Medicaid Services finalize new conditions of participation for home health agencies to participate in the Medicare program for the first time in decades. On Jan. 13, 2018, the changes will go into effect, which means your HHA needs to be ready to transition swiftly and smoothly. The new CoPs are designed to improve patient care and include some significant updates. A clear plan for implementation, effective staff communication and an interoperable EMR will help you successfully weather the transition.  

4. Dig into the details on OASIS, HIS and payment changes 
There are a variety of current and potential changes going on across the board that will affect HHAs and hospice providers in 2018 and beyond. CMS altered its "one clinician" convention regarding the Comprehensive Assessment:  Starting Jan. 1, 2018, clinicians will be permitted to gather feedback from other staff at the agency to aid in the completion of OASIS items related to the Comprehensive Assessment. You can read more about this change here. CMS also submitted a proposal to remove 35 OASIS items starting on Jan. 1, 2019, and while that's still a way off, HHAs should be ready to adjust their workflows accordingly. 

But that's not all. CMS updated the 2018 Medicare wage index and payment rates for HHAs, and also finalized proposals for the Home Health Value-Based Purchasing Model. 

And on the HIS side of things, the final version of HIS data submission specifications, which include will become effective on April 1, 2018. 

Going into 2018, make sure you understand the impact of these and other changes and how your HHA can be in compliance. 

5. Survey consolidation activity and referrals 
Consolidation is now "a defining factor in healthcare business models," as an article for the Healthcare Financial Management Association put it, and this is certainly apparent in home health. Several factors have driven consolidation in home health, including more palpable pressure to operate at a larger scale and at a higher level of operational efficiency as well as changes to how referrals are handled, advisory firm Harris Williams& Co. explained.

In fact, while M&A activity in healthcare overall slowed in the second quarter of 2017, it actually increased in the home health and hospice sector, according to Baker Tilly. The number of M&A transactions was up by 29 percent from the first quarter of 2017 and up 50 percent from the second quarter of 2016. 

Prepare for potentially more M&A activity in 2018 and consider how your HHA can strengthen its referrals arrangements in this more heavily consolidated landscape. 

6. Figure out how you can help partners reduce their hospital readmission rates
The new payment changes from CMS further incentivize the reduction of hospital readmission rates. Take a look at your existing strategy for reducing readmissions and see where it can be improved. It may be worth considering beginning to provide palliative care services at your HHA – a growing number of agencies are doing so to fill a gap in care while reducing readmissions for hospitals and other partner providers. 

7. Re-evaluate how ACOs are affecting you – and if you should join one 
In 2017, more than 359,000 clinicians joined ACOs, CMS reported. ACO participation is on the rise, with more home health agencies in particular joining in. The arrangement can help providers work together to reduce readmissions and costs and improve the quality of care, so consider if working toward joining an ACO should be a goal for your agency in 2018. 

With the tips above, you can set your HHA up for success in 2018. Happy New Year!

We've compiled a list of helpful questions and answers.

Q&A: What home health agencies need to know about palliative care

More home health care agencies are providing palliative care services to their patients. In many cases, this arrangement benefits providers, patients and their communities. 

As this is an emerging shift in home health, there is still much up in the air regarding palliative care. We've compiled a list of helpful questions and answers below:

Q: What is palliative care?

A: Palliative care is a program of services and support that are intended to control or reduce symptoms. Care is often administered over a long period, and can help individuals manage chronic illnesses. Palliative care is considered holistic and comprehensive, taking into account all aspects of a person's experience living with a certain condition. This means that palliative care is not just focused on treating an individual's illnesses, but on providing patient education, emotional support to patients and caregivers and strategies for living well with a long-term condition. 

Q: How does palliative care differ from hospice care?

A: While hospice care is typically offered to patients who are predicted to live six months or less, palliative care can be provided to individuals at any stage of their condition, including at the time of their initial diagnosis. Patients do not need to have been diagnosed with terminal conditions to receive palliative care. 

palliative care Palliative care can help patients with chronic conditions have a higher quality of life.

Similar to hospice care, palliative care can be jointly managed by a diverse team of healthcare professionals including doctors, nurses, home health clinicians and physical and occupational therapists. Unlike hospice, palliative care can include aggressive treatment. 

Q: What are the benefits of palliative care?

A: Palliative care is beneficial because it can help individuals have a higher quality of life while dealing with serious illness. With its holistic approach, palliative care can help reduce physical pain, support mobility and promote positive emotional well-being while dealing with illness. And since a palliative care plan is often developed by several of the patient's healthcare providers through a coordinated effort, clinicians can customize the nature of palliative care to suit the patient's needs and update the plan according to any changes.

Q: Why are home health agencies starting to provide palliative care?

A: Many home health agencies are beginning to provide palliative care because it can help keep patients with long-term conditions out of the hospital. Through the Value-Based Purchasing payment program, the Centers for Medicare & Medicaid Services has increased its penalties for hospitals, home health agencies and other providers that have high rehospitalization rates. HHAs have found they can effectively treat patients through an informal palliative care program to lower rehospitalization rates for both their agency and their partner hospitals.  

Patients who may not qualify for the hospice benefit because their condition has not yet become terminal can still receive support to help them reduce symptoms and have a higher quality of life.

"Palliative care can help keep patients with long-term conditions out of the hospital."

Q: How does palliative care services fit into Medicare payment models?

A: Medicare does not currently cover palliative care, and does not reimburse HHAs for providing this type of care. Instead, HHAs are finding that palliative care patients are covered under fee-for-service. However, HHAs can see financial benefits from providing palliative care in reduced hospital readmission rates and thus lower Medicare penalties. 

As the popularity of HHAs operating palliative care programs grows, it's possible CMS may re-evaluate their payment models. Effective January 2016, CMS began paying for voluntary Advanced Care Planning under certain payment systems. 

Q: Which types of technology does an HHA need to start providing palliative care?

A: Interoperability, or the capacity to effectively share patients' accurate and updated health information among providers, is of particular importance in palliative care. A comprehensive EMR like the Thornberry NDoc® solution can provide the intuitive and interoperable system HHAs need to successfully implement and maintain palliative care programs. 

Big changes are afoot in the home health industry.

Understanding the new Medicare conditions of participation

Big changes are afoot in the home health industry. For the first time since the 1980s, the Centers for Medicare & Medicaid Services has finalized new conditions of participation (CoPs) for home health agencies to participate in the Medicare program. If you haven't yet, read the rule in its entirety

The changes go into effect on Jan. 13, 2018, and CMS just released a draft of its interpretive guidelines on Oct. 27. That means HHAs need to do everything they can in November and December to familiarize themselves with the new rules – and the draft guidance – and prepare for January compliance.  

Background on revisions 
 In 1997, CMS proposed a rule that included landmark revisions to CoPs for HHAs. However, due to public pushback and major developments in the home health industry, CMS ultimately dropped the CoPs changes and kept the second half of the rule, which was the Outcome and Assessment Information Set (OASIS). 

Yet CMS held onto the idea that it could still update the CoPs as it had intended to six years prior. However, in 2004 the U.S. Federal Register interpreted a related act as actually "rendering ineffective any proposed Medicare regulations that had been outstanding for three years or more." As a result, CMS scrapped the 1997 proposal and set to work developing an entirely new CoPs rule, resulting in a proposal released in 2014 that was finalized this year. 

Understanding the changes 
The ultimate goal of the new CoPs is to improve patient care

"[The rule] … reflects current best practices for in-home care, based on recommendations from stakeholders and medical evidence," said CMS Chief Medical Officer Kate Goodrich. 

"The new rule emphasizes enhanced customization of patient care."

The new CoPs focus on three main areas: 

  1. Patient-centered care. 
  2. Data-drive collaboration. 
  3. Outcome-oriented processes. 

Patient-centered care: The new rule emphasizes enhanced customization of patient care through the creation of an individualized Plan of Care (PoC) based on a more patient-centered assessment. The patient-oriented goal is further reinforced with the conditions requiring HHAs to share clear and comprehensive documentation with patients concerning their rights, as well as written information about the details of their care.

Data-driven collaboration: The CoP rule demands greater care coordination efforts and expanded interdisciplinary communication to ensure all providers involved in patient care are focused on the patient's needs. This targeted approach places an even higher priority on interoperability of patient data between HHAs and other providers. Detailed PoCs need to be readable, shareable and accessible by all stakeholders.

Outcome-oriented processes: The new rule also emphasizes progress toward patient care goals. This is seen in its radically new Quality Assurance Performance Improvement CoP, which tracks HHAs' progress toward achieving specific outcomes. As part of QAPI, HHAs will have to undertake Performance Improvement Projects at least annually that measure progress in identified problem areas. 

Preparing for change 
If you feel that the new Medicare CoPs are overwhelming, you're not alone. But by learning as much as you can about the rule and its guidance now, and taking steps to prepare your agency to implement the changes, you can experience a smoother transition come January. 

We take an in-depth look at how a specific set of protocols can help treat and reduce hospitalizations related to congestive heart failure (CHF).

Using protocols to treat congestive heart failure

We recently wrote about how NDoc® protocols can help reduce hospital readmissions. In this post, we'll be looking more in-depth at how a specific set of protocols can help treat and reduce hospitalizations related to congestive heart failure (CHF). 

An urgent health crisis
Heart failure is a major public health crisis in the U.S. According to the American Heart Association, 6.5 million people have the condition, and by 2030 this number is expected to rise to more than 8 million. It is the leading cause of death in the U.S. 

heart Heart failure patients are vulnerable to rehospitalization.

Because of the complications often tied to HF, the condition is associated with high rehospitalization figures. In fact, according to a paper in the Journal of Cardiac Failure, the annual number of hospitalizations due to HF as a primary diagnosis has increased from 800,000 to more than 1 million over the past 25 years, and from 2.4 to 3.6 million for HF as a primary or secondary diagnosis. 

Furthermore, 50 percent of HF patients are rehospitalized within just six months of discharge, the AHA has found. 

These high readmission rates are bad news for providers, as the Centers for Medicare & Medicaid Services has been hiking up rehospitalization penalties. These financial punishments are causing hospitals to turn to outpatient and post-acute providers to help them decrease their readmission rates and thus avoid negative financial impacts. With the high readmission levels related to HF, providers are searching for more effective ways to help patients manage the condition. 

Outpatient and post-acute care providers rise to the occasion
As a result of the increased focus on rehospitalization, outpatient and post-acute care providers have reexamined patient care processes for HF, such as discharge planning, medication reconciliation, follow-up and disease management education. While one could argue post-acute providers are using comprehensive electronic medical records systems, their systems often lack streamlined and intuitive workflows that help clinicians and administrative staff keep track of the completion of best practices for reducing HF rehospitalization. They also very often face technical roadblocks to easily sharing this information with other providers in the continuum. 

Out of this need came the development of the NDoc® congestive heart failure (CHF) protocol. 

Using protocols to reduce HF-related rehospitalization
The team at Thornberry recognized an opportunity to enhance their NDoc® home health EMR to better support agencies in their effort to reduce HF rehospitalization rates. The team began creating an evidence-based program that was based on three components of HF patient care:

  1. Teaching. 
  2. Assessment. 
  3. Intervention. 

1. Teaching: Patient education is a cornerstone of disease management, especially for HF. By sharing diet, exercise and other HF treatment methods with patients, clinicians can help to reduce readmission rates by improving patients' self-management of the condition. A program is needed that ensures clinicians cover every applicable aspect of self-care education with patients. 

"Patient education is a cornerstone of disease management, especially for HF."

2. Assessment: To reduce readmission rates, clinicians must be able to accurately assess patients' conditions as HF and recommend appropriate responses. A program that detailed signs of HF would help clinicians stay organized when dealing with many patients. 

3. Intervention: Clinicians need to be able to effectively recognize if and when an HF patient's treatment plan needs to be altered or updated, and this information needs to be shared with and viewable by other clinicians and providers who may also see the patient. 

These three needs formed the basis of Thornberry's new embedded CHF protocols for NDoc. From there, the team developed elements, including knowledge deficit statements, standard order fields, new assessment statements, new outcomes and treatment and discharge fields that enabled staff and clinicians to more effectively assess and administer patient care to ultimately reduce readmissions due to HF. 

Thornberry rolled out its CHF protocol in NDoc® to great success. One such example case was at St. Joseph's Health System, a 400-bed acute care hospital using NDoc® in its home health division. The facility saw its hospital readmission rate drop from 66.7 percent in the third quarter of 2016 to just 11.1 percent in the fourth quarter. This also is an impressive comparison to the 33.3 percent readmission rate in the last quarter of 2015. 

The NDoc® CHF protocol has demonstrated it can help hospitals and the outpatient and post-acute care providers they depend on reduce readmission rates for HF patients.

This Thanksgiving, families across the country will share heartfelt words of gratitude, a delicious home-cooked dinner and, hopefully, their health history.

Why health providers should promote National Family History Day

This Thanksgiving, families across the country will share heartfelt words of gratitude, delicious home-cooked dinners and, hopefully, their health histories. In 2004, the U.S. Surgeon General established Thanksgiving as National Family History Day, with the goal of helping more people be aware of the health problems that may run in their families. 

According to the Department of Health and Human Services, a survey found that 96 percent of Americans think that knowing their family history is important. However, just one-third of these respondents said that they have ever attempted to collect and write down this history. Thanksgiving, when extended families are gathered together, presents an opportune time to have a conversation about shared health history.

history Thanksgiving can be an opportune time to discuss family health history.

Having this dialogue is important for both patients and their providers, and home health and hospice clinicians should do their part to support their patients in learning about their health history and their possible genetic risks. 

Why should providers encourage their patients to know about their family health history?
There are many serious diseases that can be passed down from generation to generation, including cancer, diabetes, heart disease and cystic fibrosis. Providers need to know whether there are certain conditions present in people's families so that they can evaluate their patients' risk for developing the same or related conditions and make more informed decisions regarding their plan of care. 

For example, if a person has a family history of diabetes, their doctor can recommend that they reduce their sugar intake, more closely monitor their diet and establish an exercise regimen. As noted in the article "Chronic disease: Genes matter, but so does environment," in Scope magazine, a publication of Stanford Medicine, it's imperative that clinicians have a full understanding of both a patient's family history and their lifestyle habits in order to create custom-fit plans of care. 

How can providers improve the discussion around family health history?
Home health clinicians have a number of tools at their disposal to help them support conversations about family health history with their patients. 

The first is the "My Family Health Portrait" tool from the Surgeon General. Both clinicians and administrative staff can encourage their patients to use the tool to easily create a record of their family health history. Another helpful resource is TalkHealthHistory.org, which has a variety of tips and best practices for gathering and recording family health history for both patients and providers. If patients express discomfort at talking to their family members about their health histories, they can use the helpful communication tips in this guide created by the HHS. 

Second, providers can put greater focus on discussing, updating and reviewing family health history information with each patient at each appointment and throughout care planning. They should use EMRs optimized for interoperability that enable clear and detailed family history information to be shared with all other providers that the patient sees. 

And third, home health clinicians can use protocols that support the provision of care for patients with highly inheritable diseases, such as heart conditions. The NDoc® congestive heart failure protocol, for example, takes into account family health history to help clinicians develop plan of care that respond to patients' individual needs. 

Making family health history a regular part of the conversation – at both the dinner table and in medical appointments – helps individuals take control of their health and well-being through customized strategies. When it comes to family health history, knowledge is power – and that's something we can all be grateful for this Thanksgiving. 

The best defense is documentation.

Agencies rely on documentation as audit fears spike

The buzz in the home health and hospice industry is that government audits are ramping up. The Centers for Medicare & Medicaid Services are sending out more Zone Program Integrity Contractors and Recovery Audit Contractors to look for evidence of noncompliance. ZPIC audits are especially worrisome – "the most feared type of Medicare auditor" – as they are tasked with investigating suspected fraud and are able to pursue civil or criminal prosecution against suspected agencies, as Home Health Care News explained.

Innocents could stand accused
In some cases, small mistakes in documentation can cause otherwise innocent agencies to be implicated in fraud. MedPro Health Providers, a home health agency in Chicago that was recently named the best small workplace by the Chicago Tribune, is dealing with one such nightmare right now, according to HHCN. A ZPIC audited the agency and then alleged it had made improper payments, in response halting its Medicare reimbursements. MedPro's owner is suing the contractor for failing to properly review the extensive documents it sent that rebutted the allegations.

"The consequences of even honest mistakes can be dire."

However, damage has already been done, with hundreds of patients discharged and staff let go. MedPro's lawyer estimates that 40 other agencies also may have suffered "unfair audit practices" by ZPICs. Those agencies may join the lawsuit. 

"[With an audit], you feel a little scare or threatened," said the owner of MedPro, Rizaldy Villasenor, in an interview with HHCN. "Right now, it's anger that I am feeling …. The worst thing is letting the team go because of this. If I'm going to close the company, I say it won't be this way."

Stay vigilant
When it comes to defending against audits and fraud allegations, documentation is key. Villasenor was able to send detailed records and materials supporting his claim that MedPro is in the clear, and the ZPIC's alleged failure to follow correct due process when reviewing his rebuttal statements has enabled Villasenor to fight back with a lawsuit.

 Agencies should use interoperable EMRs that support comprehensive documentation of all care activities, from reporting to follow-up. This way, the risk of important information falling through the cracks is reduced. Agencies ensure they have all their activities thoroughly documented and detailed, so that in the event of a ZPIC or RAC audit, they have the relevant information ready as proof of compliance. 

As they say, the best defense is a good offense – and in the homecare segment, this means having ample and robust documentation protocols in place well before even the first sniff of an audit. Thornberry's NDoc solution was designed to ensure regulatory compliance and defend against accusations of fraud. Contact the team today to learn how NDoc can help your agency protect itself and its patients.