Face-to-Face

1. Face-to-Face Joint community venture Savannah, Georgia chatham county Shondra Davis RN Amedisys Home Health Dee Dee Seagraves RN St. Joseph’s/Candler Health System

2. What is Face-to-Face? • Documented face to face encounter with a physician or licensed non-physician practitioner (PA,NP, CNS) evaluating the patient to determine the patient meets guidelines to receive home health care

3. Guidelines for Face-to-Face • Must be related to the primary reason home health services are being received • Occurs within 90 days prior to or 30 days after date of home health services beginning with SOC date being day 1 • Verifies need for skilled services & homebound status per CMS guidelines

4. Significance in Reducing Readmissions • Establishes appropriate, patient-specific plan of care • Enables continuity of care during transition from inpatient to home setting • Promotes physician involvement

5. Issues Within Savannah/Chatham County • Lack of understanding of importance of FTF • MD refusing to sign & order home health • Patients discharged to community without appropriate services leading to increased ER visits and avoidable hospital readmissions

6. Housekeeping Details • Three local hospitals • Four primary home health agencies • One face to face meeting • Email discussions • Presented results to Savannah Coalition Group

7. Universal Form

8. QUESTIONS

9. Contact Information • Shondra Davis, RN, BSN, MHA-GER Director of Operations Amedisys, Inc.- Savannah 8301 Office Phone: 912-233-9800 Fax: 912-233-9050 Shondra.davis@amedisys.com • Dee Dee Seagraves RN, MSN, CCM, BC-NE Director, Clinical Care Coordination St. Joseph’s/Candler Health System Office Phone: 912-819-8262 Mobile 912-657-3583 Fax 912-691-9091 seagravesd@sjchs.org