The home health sector is a vital - yet often overlooked - segment of our national healthcare system. While in past decades, it may have been common practice to keep patients in the hospital for days or even weeks after an acute episode, patients are increasingly able to recover at home. And for patients nearing the end of life, they have the opportunity to spend their final moments in the comfort of their own home, surrounded by loved ones. The evidence clearly shows that home-based care is patient-preferred, cost efficient, and highly effective at easing patient transition out of the acute care setting in a way that ensures better outcomes and lower rates of hospital readmission.
But despite its benefits, many hospitals unfortunately have difficulty prioritizing home health as it is often not part of their core operations. As a result, many in-house home health agencies (HHAs) face significant challenges, not the least of which is difficulty recruiting and retaining qualified staff and caregivers.
In many cases, in-house home health and hospice operations face staffing shortfalls and challenges keeping up with incoming referrals, instead having to defer patients to other home health providers. In addition to staffing issues, hospital home health programs are tasked with managing an extensive network of outside vendors and consultants to handle their management, evaluation, and technology needs.
This is where joint venture partnerships present an opportunity to improve operations, streamline patient referrals and improve access to patients requiring home health following a hospitalization.
Just over a year ago, Baptist Memorial Hospital in Memphis and LHC Group – a national home health and hospice provider – joined forces to ensure patients leaving the hospital had access to the most appropriate post-acute care services to manage their post-hospital needs and keep them healthy and safe at home. Under the partnership, LHC Group took over the administration of Baptist’s home health and hospice programs, freeing the hospital to focus its resources on delivering acute-care services.
In a little over a year’s time, both the home health and hospice programs were not only able to strengthen their workforces, they also saw major improvements in patient-reported outcomes and their quality ratings.
On the home health side, the Baptist-LHC partnership was able to quickly bring in qualified staff - hiring 45 new home health nurses and training current employees to use LHC’s best practices and innovative approaches to care. Additionally, staff were able to use LHC’s proprietary technologies such as its electronic medical record management system, which gives clinical staff real-time access to critical information. And patients are able to use LHC’s Carelink call system, enabling round-the-clock contact with clinical staff.
Quality improvements soon followed. By the end of the year, the home health program’s quality star rating (measured on a scale from zero-to-five by Centers for Medicare & Medicaid Services) increased from 3.5 in 2016 to 4.0 by Q4 2017 - exceeding the national average.[1] The average daily patient census nearly doubled over this same period - from just under 500 to over 1,000 - proof that it is possible to improve quality and serve a greater number of patients at the same time.
Similarly, Baptist’s hospice program has expanded to benefit more persons and families in the area. As a service that uniquely focuses on satisfying a patient’s needs at the end-of-life, hospice staff must pay special attention to a patient’s clinical, mental, and spiritual needs. Prior staffing challenges made it difficult to deliver this kind of coordinated care to a large population and the number of hospice referrals Baptist was able to accommodate remained small. Furthermore, because the home health program was significantly larger part of Baptist’s operation, it became difficult to recruit for hospice-specific positions.
By working collaboratively, Baptist and LHC Group were able to expand the hospice care team, which also enabled the hospital to broaden and deepen its relationships with the surrounding patient community. Within a year, Baptist’s hospice program has been able to serve 35 percent more patients and families in the area while exceeding the national benchmark in all 7 CMS hospice admission process measures. The hospice program also exceeded the national benchmark in all eight Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures of patient satisfaction with a 92 percent overall rating, compared to the national benchmark of 84 percent. We were also able to exceed national benchmarks for controlling patient pain and effectively utilizing the integrated hospice care team in the last three days and seven days of the patient’s life.[2]
In an aging nation - where insurance companies and policymakers are increasingly keen on reducing acute care costs - the demand for home health and hospice services is only expected to grow. Hospitals and health systems around the country must ensure that they are well-equipped to meet this need through home health and hospice programs adequately staffed and trained to meet growing demand.
Though still in its infancy, Baptist’s partnership with LHC Group presents a window to what is possible when two providers with different capabilities team up to offer patients the care that best fits their needs.
Wanda Miller, BS, RN is the Area Executive Director for Baptist Trinity Home Care and Baptist Home Care Huntingdon. Rod Robinson, MSN, RN is an Area Vice President in LHC Group’s Legacy Hospice Division.
[1] Medicare.gov Home Health Compare
[2] SHP analysis of CMS Consumer Assessment of Healthcare Providers and Systems data