Home-health equation: Adding cases, not costs
By building relationships with home health care agencies, same-day surgery managers are expanding their case volumes and revenues while helping patients recover safely at home.
Stanislaus Surgery Center in Modesto, CA, chose not to build a recovery care center or establish overnight observation because of the high costs, says executive director Michael J. Lipomi, MSHA. But by contracting with home health care agencies for post-op care, Stanislaus has been able to offer such procedures as laparoscopic cholecystectomies, anterior cruciate ligament (ACL) repair, lumbar and cervical diskectomy, and laparoscopic-assisted vaginal hysterectomies (LAVHs).
"What we’ve found is that the cost of home health care is about 30% of the average hospital postsurgical charge, and 50% to 75% of the cost of providing it in-house [with recovery care]," Lipomi says. The cost of home health care for two or three days ranges from $100 to $500, he says.
While the cost is usually reimbursed by the patient’s insurance, in some cases Stanislaus arranges to pay the home health agency directly. "The cost is almost insignificant relative to the cost of the surgery and the possible costs of trying to [offer extended recovery] in-house," he says.
The successful partnering of home health and same-day surgery requires well-developed protocols and patient criteria, Lipomi says. The surgery center has arrangements to transfer patients to a hospital if they need more intense post-op care. But that was necessary in only six cases out of 5,300 last year, he says.
"[Contracting with home health] is a great way to expand your horizons and provide better services to the community," says Lipomi. "It’s a great way to save health care dollars and, at the same time, to enhance the service you’re offering to patients.
Docs set protocol with home health
Developing a home health program begins with protocols that are developed by the medical director, nursing director, and surgeons, says Lipomi. They will determine what type of cases would be appropriate for the home-health model, he says.
The physicians also must work with the home health team to define and implement the post-op protocol, which includes creation of patient education material and a system of communications between home health and surgery center staff, says Harvey Billig III, MD, an ophthalmologist and founder of the multispecialty North County Outpatient Surgery Center in Templeton, CA.
For some centers, home health complements other services, including overnight stays or recovery care, and surgeons determine which patients are the best candidates for home health, Billig says.
"You want to have as many options available as possible [for the patient]," he says. "All of this is dictated by the physical status of the patient and the extent of the surgery."
At Stanislaus, all home health care patients receive a pre-op phone call from an agency nurse. After surgery, home visits are usually scheduled every four hours for the first 24 to 48 hours, says Lipomi. In some cases, home health nurses stay with the patient for a full 24 hours after surgery, he says.
"A nurse will either go home with the patient or follow the patient home," he says. "They’ll stay an average of two hours, until the patient is comfortable, and train family members to respond to the patient’s care needs."
Sometimes, home health nurses conduct a home visit to make sure the setting is appropriate. For example, if the caregiving spouse is physically disabled or elderly, he or she may not be able to provide the needed at-home care, Lipomi says.
Generally, physicians report that their patients do better when they’re able to recover in familiar surroundings, Lipomi says. "Patients are thrilled to be able to go home," he says.
When setting up a home health program, same-day surgery managers should carefully consider the choice of agencies, says Billig. "You want to assess from the doctor’s point of view who gives the best care," he says.
Realistically, because of managed care and other insurance constraints, you will work with at least several home health agencies, says Lipomi. In addition to checking out the reputation of the agencies, same-day surgery (SDS) managers should check for state licensure, Medicare certification, and accreditation by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations.
Spelling out the contractual arrangement with the agencies is also important, Lipomi says. The surgery center receives no direct subsidy or fee from the home health agency. The physician determines whether a patient is a candidate for the home health-assisted recovery, and the surgery center and home health agency determine whether the home setting and caregivers are appropriate. The surgery center discharges the patient into the care of the home health agency, Lipomi says.
The home health agency also must take financial responsibility, says Lipomi. In other words, if the agency has trouble with reimbursement, they cannot expect compensation from the surgery center. (Any cases that the surgery center covers financially are arranged in advance and at a discounted rate, Lipomi says.)
With the proper protocols, patient criteria, and contractual arrangements, home health and SDS make a winning combination for patients and surgery centers, says Billig. "Even though the surgery center gets not one penny of revenue from the home health part, just those extra cases [that surgery centers can take] makes a big difference," he says.
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