Home Health Clinical Strategy Based on Referral Source


More than ever, Covid-19 crises has demonstrated the value of having a holistic approach to patient management.  Covid-19 crisis has shown how age, underlying chronic conditions, socioeconomic status, and other risk-factors can influence mortality of a patient. 

In my prior post, I talked about how home care agencies providing high-quality, cost-effective care can position themselves as value-adding entities during this pandemic. All patients being admitted into home care are not alike, agencies must develop clinical training and management strategies that help clinicians case manage patients coming from different referral sources with different referral source based risk factors.  

Since majority (>75%) of home care patients admitted into home care services are from in-patient settings (short term acute care hospital, Skilled Nursing Facility, inpatient acute rehab) it is paramount for home care agencies to develop a specific clinical assessment focus and clinical...

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Hospital at Home & Covid-19


As the Nation seeks ways to provide safer care to a vulnerable population, post acute care services will undoubtedly play an increasingly important role in the healthcare system .  In the current times (COVID-19 pandemic), home care industry is best positioned to provide safe care in the comfort of patient's home.  

Hospital at home programs are gaining popularity during this pandemic,  and thus I wanted to share some components of existing programs, and my thoughts on "if you decide to go down the path!" 

Transfer Model

  • Patient is transitioned earlier (then traditionally estimated) from in-patient unit to home depending on strict clinical criteria and Physician to Physician collaboration and referral. 
  • The transfer model is for population at reduced risk of :
    • Further exacerbation of symptoms and can safely finish care in home settings.
    • Exacerbation of symptoms while being at high risk of iatrogenic complications and would be safer in...
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MD Verification at Time of Referral to Home Health

MD verification at the time of referral is a very important step for home care agencies.  If not done in a timely manner, it can lead to unintended inefficiencies.  72% of patients being referred are from acute care facilities, homecare agencies must develop an efficient process that helps them verify physician at start of care or better yet, at time agency receives referral.  This process can help prevent the trickle down negative effects such as:

  1. No physician to sign Plan of Care after care has been initiated
    • In over 21% of start of care (SOC) visits clinical staff finds problems with drug regiment. 
      • Not having a physician to help with medication reconciliation could leave the frontline clinical scrambling to get urgent orders during SOC home visit  
  2. High non-billable visit cost (not to mention revenue loss) on not being able to provide care for the full episode for patient in need.  
  3. Negative experience for patient and community...
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Pneumonia Management: Field Decision Tree - Home Health

In the past few blogs, I have talked about clinical management of vulnerable high-risk population in home care.  I want to use the algorithm (see below) as an example to demonstrate the standardized approach.  I suggest home care agencies  use the following operational processes for high-risk patients: 

  1.  At start of care, obtain patient specific parameters and orders from the physician (NP, PA) managing patient's home care services
  2. Establish baseline vitals, infection status, pain level (comfort function goal,) functional capacity (e.g. use 6 minutes walk test), behavioral status, etc.
  3. If/when patient's condition deviates from baseline for the worse, initiate the protocol and go down the decision tree.  

Algorithm below is an example of pneumonia management in field.  If you are a home care agency looking to develop similar processes, 

  1. Work with your referring physicians and hospital systems to establish protocols for the specific patient...
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Immune Senescence - Decline in Immune Function in Older Adults

Persons of middle-older age are more likely to acquire severe acute respiratory syndrome coronavirus (COVID-19) infection, and older adults are more likely to have worse outcomes. So, what makes older adults more susceptible?

As we age, our immune system goes through physiologic (quantitative & qualitative) changes. These age-related physiologic changes include:

  • Alterations in the barriers posed by the skin, lungs, and gastrointestinal tract and other mucosal linings
  • Changes in immunity including decrease in specific cell populations
  • Decreased antibody response to vaccines
  • Impaired immunoglobulin production

Having a chronic disease further weakens older patient’s immune response resulting in greater susceptibility to common infections. 

Skilled home care agencies predominantly serve older patients (average age 75) and therefore, it is essential for home care agencies to develop and actively implement standardized and holistic approach to assessment, care...

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Skipping to Covid-19

No Elective Surgeries and Skilled Nursing Facility population displacement has major implications for Home health agencies as these agencies will be managing a much high risk and high acuity patients. 

We are not sure what the post Covid-19 world will look like, but one thing is for sure! This is the time for home care agencies to shine!  Home care agencies that can deliver high-quality, cost-effective care will play a central role in managing Covid-19 and high-acuity non-Covid-19 patients in home environment. 

This new role will require home care agencies to shift its practices and be able to manage higher acuity population in home environment.  In order to accomplish this effectively, here are a few things to consider for home care leadership

Clinical & Operations Management

  • Educate and train clinicians in managing high-risk population at home
  • Build a risk based clinical case management strategy where your agency identifies the patient’s risk at...
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