What Is the Impact of the Affordable Care Act on Eldercare?

 

With the recent Supreme Court decision on the Affordable Care Act, and ultimately the implementation of Accountable Care Organizations (ACOs), healthcare providers involved in a particular client’s care will be accountable for patient outcomes. As Accountable Care Organizations begin to play a larger role in healthcare delivery, it will be imperative that providers within a given system (hospitals, doctors, home care agencies) work closely to ensure patients are effectively managed and ensure the best possible outcomes to maximize reimbursement.

 

With regards to BAYADA Home Health Care I feel our current model of healthcare delivery fits perfectly into this “new world”. Below I have highlighted three areas where our companywide practices align perfectly with ACO’s.

 

With ACOs, each provider will have a stake in client outcomes, so it will be imperative that a smooth transition occurs from each level of care. As clients move from a facility environment (hospital or skilled nursing), the primary factor in determining how smoothly these transitions occur is communication between providers about the client. It is our practice to gather as much medical information about our potential clients as possible prior to the start of care. Before we begin working with a client, our Clinical Manager, a Registered Nurse, visits the client to complete a thorough nursing assessment within 7 days of our shift.  Throughout the course of the assessment, she is trying to formulate a medical picture of the client, which will help develop the client’s unique plan of care. Our preference is to meet the client before they arrive at home, so that we can review the chart and if needed, ask questions of those currently providing care. When a client is in the home, we largely have to depend upon the client and/or family (if available) to provide this medical history, which is sometimes incomplete. Receiving medical history from the facility allows for more accurate information and reduces the possibility that key information may not be given to us.

 

After the comprehensive care plan is developed and care begins in the home, we review timesheets from each aide and/or nurse weekly for compliance with the care plan. In addition, the Clinical Manager supervises each aide or nurse on a monthly or bi-monthly basis. Care plans are reviewed on an ongoing basis to ensure accurate reflection of the client’s current condition. As a part of our case management duties, we also develop a medication profile for each client and ensure compliance with their medication regiment (if applicable). When required, our Clinical Manager also communicates with the client’s physician (s) to make them aware of any changes in the client’s condition. At the start of each case and ongoing, we provide soap, hand sanitizer, gloves and paper towels so that infection control practices are being followed at all times. Simply providing these resources, helps reduce the possibility of a client’s care being compromised by an infection control issue.

 

Ensuring our field staff are provided with the most up-to-date information regarding our clients’ care only helps to enhance the service we provide. Our company policy mandates anyone functioning in a Home Health Aides (HHA) role receive 8 hours of continuing education annually—the company provides these opportunities free to the HHAs if needed. Licensed staff (nurses and certified nursing assistants) are required to obtain continuing education credits to maintain licensure, so we track expiration dates and require updated copies for employees to maintain employment. We also hold annual competencies for nurses and aides as well as perform evaluations for each employee. In addition, our Clinical Manager also supervises each employee in the home while working with a client. This provides additional assurances the employee is able to adequately and accurately perform the duties of the case, that there is a good working relationship with the client, and the field staff is aware support is always available if needed.

 

The above characteristics are a normal part of our services, so I believe we will be more than prepared for the full implementation of ACO’s.