Duke Health Referring Physicians


Becoming Patient-Centric

In the first major overhaul of rules governing home health agencies in nearly 30 years, the Centers for Medicare & Medicaid Services and the US Department of Health and Human Services have issued a final ruling requiring home health agencies to become more responsive to patients and their caregivers—strengthening patient rights, care coordination, and improving quality of care. Although these rules specifically apply to home health agencies, it's likely their implementation will directly affect clinicians.

“What we’ll see is a modernization that increases flexibility, improves the conditions that allow for benefits, and becomes more outcome-based,” says William Dombi, vice president for law at the National Association for Home Care & Hospice. “This is all good.”

The new requirements will tentatively go into effect in July 2017. Exactly how these new rules will affect clinicians depends on where you’re sitting. Dombi says he doesn’t see referring physicians being affected. “Referring doctors probably won’t see much of a difference; there will be no added burden on them,” he says.

That said, by nature of its more coordinated and patient-centered requirements, the new rule will demand clinician attention in the following ways.

Three-Way Communication
Before the new rule, patients going into home health care were more passive recipients rather than engaged participants. A clinician would provide input, other health care staff would perform evaluations, and care was delivered according to this information.

“These [new] requirements make patients the captain of the ship, and the providers are the co-captains,” says Dombi.

This translates toward a much stronger and more collaborative dynamic among patient, home health agencies, and clinician. Discussions that include asking patients what their goals are and what they’re comfortable with, and then devising plans that are individualized according this feedback are going to be the norm.

Transparent Plans of Care
The new rule also requires that patients, caregivers, and physicians be alerted when significant changes are made to plans of care. Historically, patients don’t typically see their plans of care—instead, home health agencies have communicated directly with physicians, bypassing the patients.

Now, patients and their families have more opportunity for input. Related to this are stronger efforts linked to coordinated care between clinicians and patients. The rule mandates attention toward coordinating all of the services provided by the various health care professionals involved in the patient’s care.

“This is allowing for more completely addressing the quality of a patient’s care,” says Peter Notarstefano, director of home and community-based services for LeadingAge, a trade group for home health agencies, hospices, and other organizations. “There is more responsibility related to communication among everyone as home health agencies move into this real care coordination service.”

Include the Family Caregiver
In the past, home health agencies worked with a patient’s legal representative but not a “personal representative” such as a family caregiver. Now, they and clinicians will need to look at these caregivers’ preparedness to provide assistance when developing plans of care. This includes clinicians assessing other commitments that caregivers may have.

“These new regulations stress throughout that it’s important to look at caregivers as potential partners in optimizing positive outcomes,” says Notarstefano.

Other Notables
Other notable requirements include the responsibility of clinicians to approve any plans to discharge a patient from home health agency services. Patients must also be informed both verbally and in writing of their rights in clear, concise language that they can understand.

And, says Notarstefano, patients will have greater autonomy in deciding who has access to their medical records, and exactly what clinicians write as part of those medical records will become more important.

“[These rules are] ultimately about making patients more active participants and doing so in a way that is coordinated,” says Notarstefano. “It’s long overdue; we’re bringing the future into the present.”