Have a quality assurance nurse review all patients on start of care to make sure clinicians are using the right visit frequency for at-risk patients.
Mercy Health — Tiffin Home Care in Tiffin, Ohio, uses this strategy when frontloading visits for at-risk patients to address re-hospitalization rates as part of its QAPI project, according to Mandy Ritter, a manager with the agency.
Tiffin Home Care started frontloading in late 2016. The agency finished the year with a 14% readmission rate, but by June 2017, that rate had dropped to 6%.
The agency isn’t alone. Other home health agencies have seen a decrease in re-hospitalizations directly tied to frontloading at-risk patients.
According to data from Santa Barbara, Calif.-based Strategic Healthcare Programs (SHP), the number of home health visits in the first week after discharge from the hospital may influence readmission rates (See benchmark).
Frontloading has always been a best practice, but not all agencies do it, says Arlene Maxim, RN, vice president of Program Development with Quality in Real Time (QIRT) in Floral Park, N.Y.
About 20% of agencies may actually frontload patients, and some of them aren’t doing it well, she says.
At Tiffin Home Care, using a quality assurance nurse to review patients at start of care helps catch any patients that may be a good fit for frontloading while still early in the episode of care, Ritter explains.
Ritter adds that the quality assurance nurse can also help identify trends and opportunities for training, for instance, if a single clinician tends to have more readmissions he or she may be a good candidate for follow up one-on-one training on frontloading best practices.
Conditions linked in the alphabetic index by the word “in” should be considered related even without provider documentation of such, making it equivalent to the way conditions are now linked by the “with” convention, starting Oct. 1 when the FY2018 official coding guidelines go into effect.
This means that, for example, come Oct. 1 you’ll be able to assume a connection between anemia and chronic kidney disease (CKD) even in the absence of provider documentation, due to CKD being a subterm under the term “in (due to)(with)” in the alphabetic index listing for anemia.
In such a scenario you’ll assign D63.1 (Anemia in chronic kidney disease) immediately after a code from N18.- (Chronic kidney disease (CKD)) for the CKD stage, according to tabular instruction. Currently, you can only assign D63.1 when provider documentation specifically links anemia with CKD.
The updated guideline reads “[t]he word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List.” [I.A.15]
An exception to this convention occurs when a guideline specifically requires that the physician document a link between two conditions. In these cases, the code-specific guideline will take precedence over the convention, according to the guidelines posted to the CDC’s website Aug. 10.
Patients who had two home health visits in the first seven days of care return to the hospital within 30 days 15.5% of the time, according to data provided Strategic Healthcare Programs (SHP) of Santa Barbara, Calif. In contrast, 36.4% of patients who had one home health visit in the first seven days return to the hospital within 30 days. The data reflects nearly 6.6 million episodes of care.