Health Policy: Recommendations for Innovation

1. Health Policy: Recommendations for Innovation Mary Knutson, R.N., M.S.N., F.C.P. Health Vista, Inc. June, 2005

2. Introduction • As a Registered Nurse, working in home health care, long-term care, hospital, and other settings, I have ideas to share with legislators for improvements in: • Staff Satisfaction and nursing shortage • Quality of care • Communication • Financial health of organizations

3. We Need Creative Solutions! • More funding is not the only answer • More effective “vision” is to increase innovation, communication, and preventative care • Regulatory “bodies” should be responsive to concerns and ideas of health care providers • Should decrease costly regulations that are not proven to benefit quality of care

4. Private insurances often deny coverage based on “We only cover when Medicare covers” (Medicare covers 100% in home care if criteria are met, making the insurance benefit worthless) Discontinue homebound status criteria in Medicare home care Or require Medicare Supplement Policies to cover Skilled Nursing when the only reason for Medicare denial is homebound status Home Health Care Funding

5. OASIS (Outcome and Assessment Information Set) paperwork-costs outweigh its benefits OASIS paperwork for both admission and discharge totals 28 pages, even if home care is needed for only a few visits Do not require OASIS if skilled care is expected to be less than 3 weeks Allow a shortened OASIS discharge form if care < 2 mo. Reimburse agencies for admission paperwork Home Health Care Capabilities

6. Travel costs are high for R.N. to supervise Home Health Aide every 2 weeks per Medicare rules Regulations don’t recognize phone contact for even non-billable supervisory visits Some Tele-health skilled nursing visits may be done with approved equipment Allow OASIS visit by phone if nursing visit is within 5 days Allow phone supervision, or picture phones if no Skilled Nursing visit is needed Home Health Care Efficiency

7. Facilitate the process for income tax credit so home health care workers to be reimbursed for non-paid work miles Ensure that staff are paid travel time for all required travel if the agency bills it to third party payers Home Health Staff Satisfaction Inadequate travel reimbursement decreases staff satisfaction and retention

8. Change recertification period/direct supervision requirement from 55-60 days to every 50-62 days To allow for client choice, and efficiency of scheduling travel Promote use of care coordinators to work with hospitals and home care clients at risk of frequent hospitalizations Home Health Care Management Allow patient-directed care, and flexibility

9. Develop “Student Assistance Programs” for students and their families to have some free, confidential counseling visits for information and referral (similar to an Employee Assistance Program) Enroll Natural Family Planning Teachers (such as FertilityCareTMProfessionals) to be accessible and reimbursable through Medicaid programs Community Health Promote ideas for physical/mental/spiritual health

10. Nursing Shortage • Encourage online Nursing Assistant or Personal Care Worker programs • Increase accessibility to students outside of the school’s usual service area • Relax regulations-allow certification testing through the student’s home state (rather than the school’s state) Promote Nursing Assistant education, as they often re-enter school to become nurses

11. Health Education Resources • Creative solution: A government website with resources for Health Professionals • Presentations and learning activities could be downloaded and edited for use • Using online resources sharply decreases time and effort needed to develop them • This would save money in healthcare organizations • See my website at www.healthvista.net for an example

12. Vision: The Future of Health Care Is Home Health • Our challenge is to “tweak” the system to make it more efficient and effective • Everyone wins with innovative and efficient home care • Patients are glad to be at home • Home health care is less expensive than hospital or nursing home care • Families and neighborhoods stay together, helping one another