The demand for at-home healthcare has been growing for years, driven by the aging population, rising healthcare costs and the need for hospitals to reduce readmissions. A $228.9 billion industry in 2015, home health is expected to reach $391.41 billion by 2021, notes Zion Market Research.
That means more patients — and more paperwork — for the team of 25,000 in-home care providers at BAYADA. This is especially true in the Medicare-Certified business division, which accounts for a quarter of the agency’s business.
“Medicare-Certified business is short-term nursing, rehabilitative, therapeutic, and assistive home health care services for adults and seniors typically provided as a limited number of intermittent visits,” explains Andrew Gentile, division director at BAYADA. “For a client with a new diagnosis of congestive heart failure, we might send a nurse a few times per week and then a therapist maybe once a week. This would go on over the course of about an eight-week period. The goal is to make clients as independent and safe at home as possible.”
During home visits, BAYADA clinicians are responsible for patient care, capturing health data and providing disease management education. For Medicare-Certified clients, clinicians must also complete a thorough assessment during the first visit, answering a long list of mandatory questions that help Medicare determine how much care the patient needs.
“On paper, this was a 16-page document,” says Gentile. “Clinicians would complete some of it with the client, but most people took chicken-scratch notes and did the real documenting later. Then they dropped that document off at a local BAYADA office, where it was transcribed into a homegrown system BAYADA made 35 years ago. It was pure data entry at that point.”
Best case scenario, this took 30 minutes per client, and BAYADA was getting a thousand new clients each week. However, administrators often had trouble reading clinicians’ handwriting or needed clarification about contradictory answers.
“The assessment might ask if the person can walk greater than 20 feet and the clinician says no, and then it asks if the person can do things independently, and the clinician says yes. Those two answers don’t make sense, but there’s no built-in logic on paper that helps you progress based on previous answers,” says Gentile. “The person in the office would hopefully catch the mistake, and then there would be multiple calls to clarify.”
Accuracy is crucial to this assessment, says Gentile. It drives the amount of care a client will be able to receive, what types of interventions BAYADA should provide, and also impacts the Medicare reimbursement. “The more clinically-complex the patient, the more we are paid because it will take more clinical effort to care for them. We don’t get paid for each visit we make, but rather we are paid a lump sum to care for the client based on their clinical profile.”
The completion of the evaluation also dictates when BAYADA gets paid. “Medicare pays a portion when we submit the initial assessment and the rest upon discharge. We were getting that initial payment around day 45 when we were using paper.”
With this setup, it was immediately clear BAYADA needed to streamline this process, lighten the load for clinicians and improve Medicare billing.