High Acuity Care Program LifeGas. Living healthcare.

High Acuity Care Program

LifeGas. Living healthcare.

Objectives

In this competitive bidding environment it is important to look for new revenue streams. Hear how to target and service the high acuity patient population in your area through the REMEO Ventilator Subcontracting program:

•Discuss challenges homecares are faced with

•Describe how to market high acuity programs to referral sources

•Explain how to manage high acuity patients

•Discuss equipment and disposable management options

•Key billing tips for this patient population

Challenges in homecare

Regulatory / accreditation

Displacing technology

Reimbursement

Cost increases, overtime, DOT etc

CAPEXGetting referrals

Competitive bidding

How to Survive with All the HME Changes?

Cut Cost….. Check

Cut spending….. Check

Cut staff……???

Cut quality of care…..???

Solutions…..

—Take on new patient populations

—Offer more to your referral sources

— Outsource services

You benefit:

Accept ventilator patients – and sustain relationships with your case managers.

Increase competitiveness by marketing the ability to accept high tech patients.

Add a source of income, without adding staff or increasing capital.

Keys to success…

• Sales and marketing (getting patients)

• Billing & collection

• Develop or Outsource distribution

• Keep fixed costs to a minimum, implement a fixed cost model where possible

• Make your company unique

• Program focus (specialize)

Build core competence

Flexible operation

Differentiate

Home Ventilator Patients

•Home vents do require Trained staff (Respiratory Therapists)

•Home vents can be done with low amounts of clinical staff

•Home ventilators require a lot of staff and overtime

•Home ventilators will increase my liability

•Home ventilators will jeopardize my Accreditation Status

•Home ventilators are not Profitable

•Home ventilators take lots of capital

FACT FICTION

Getting started

Accredited for ventilator

equipment?Insure adequate Capital

Equipment/Supplies are

Readily available prior to

Start up.

Establish Policy Procedure and

Training

Check ventilators, trach supplies

on Medicare 855s form

Add ventilators bynotifying accrediting

body

Yes No

Check ventilators, trach supplies

on Medicare 855s form

Establish Policy

Procedure & Training

Marketing

LifeGas provides:

Monthly home visits by a licensed Respiratory Therapist

Respiratory Therapist on call 24/7

Equipment and gases

Care and training

Key Points for Referrals:

—Standard training time to discharge

the patient

—Availability to begin training in a timely

manner

—Willingness to work with hospital staff

on training

— Demonstrate On- call support

—Do what’s best for the patient!

Communicating The Program To Referral Sources

The placement and care of the ventilator dependent patient involves a partnership among the physician, hospital, home health agency and

equipment supplier. Because of the importance of ongoing patient care in the home setting and necessity of reliable response systems, the

referring hospital/physician may at times consult with the home health agency prior to any selection of equipment supplier. It is key to market

your program and services to both Hospitals and HHA.

Discharge Opportunities

ICU

• Crowded units

• Infection risk

• Very expensive

Solutions

Provide prompt training for timely discharges

Have availability of the latest technology quickly.

Ventilation & Weaning center

• Small units (<25 beds) with “home feeling”

• Weaning rate of 50-75% in the US

Home

•All equipment and supplies

•Care giver training

•Monitoring for weaning possibility

•On call

Caring for High Acuity Respiratory Patients

You manage:

All marketing

Intake and insurance verification

Maintain continued communication with physician and customer

Provide support to customer (business and after hours)

Billing and billing related duties

Key Factors

—Market Research

—Personnel

—Equipment needs

—Training

—Policy and Procedures

—Acceptance Criteria

—Follow Up

Market Research

•What patients are we targeting?

•How many patients are out there?

•How many competitors in the area?

•How can I be the best in my area?

•What do referral sources want from a vent program?

•What equipment combinations will the customer be looking for?

(Types/brands, etc)

•Will I get any spillover business from taking vent patients?

Personnel

•Need a minimum of 2 clinicians willing to share 24 hour call

•Lead therapist?

•Both therapists need knowledge and experience with vent

patients

•Must be a good teacher and also a good learner

•Must be able to make decisions & communicate effectively with

caregivers

•Telephone skills & support will be key to program success

Capital Equipment

Ventilators:

•average $10K/plus

•Different referral sources may want different types of equipment

•Technology changes often (5-7 year cycle)

•Patient or insurance provider may decide to change companies, leaving you with unused expensive capital equipment

Other equipment needs:

Portable suction

Specialty secretion clearance devices

Backup batteries

Backup ventilators

Disposable (Trach/Trach care kit/yaunker…etc)

New Technology- < 5years old

Ventilator Comparison

Brand Name Market Position Unique Feature Market Rental Price

Respironics Trilogy

ALS Patient Population/HomeC

areAVAP (Average

Volume, Assured Pressure)

$425.00-$550.00

GE I Vent 101ALS Patient

Population/Homecare

PRVC (Pressure Regulated

Volume Control)$425.00-$550.00

Pulmonetics Series

950/1150

LTC/Homecare Jack of all Trades $370.00 & $425.00

PB540 LTC/Homecare Internal battery $425.00-$550.00

LP10/Achieva/HT50 Medicaid

Homecare

Inexpensive $200.00-$325.00

Policy and Procedures

•Will be the most detailed and time consuming process of

the startup

•Responsible party must be well versed in

state/federal/accrediting body requirements

•Will take weeks/months to prepare

•Consider a consultant/guidance from industry

associations

TRAINING, TRAINING, TRAINING

• Internal staff training

— Policies & Procedures

— Equipment (try to standardize)

— Clinical training

— On call services

— Laws and regulations

•Patient/Family training

— Must be comprehensive

— Must include both homecare staff and hospital staff

— Must have competency check off and hands on

— Caregivers must know emergency response procedures

— Repetition, Repetition, Repetition. Take the time to insure compliance

— Must be flexible

Acceptance Criteria

What are the characteristics of a “good” vent patient referral?

•Is the patient stable?

•What is the home environment like?

•How is the patient’s family situation? Adequate caregivers?

•Relying on home health nursing is not the answer….

•Within scope of practice and state laws

•There are patients that are better off in another care

environment

Patient Follow Up

• Establish a policy for the Follow up. Home Visit s should be scheduled to

reduce/eliminate unnecessary readmissions.

Example:

Week 1 – A clinical home visit shall be conducted once within 48hrs following Home Set Up.

Week 2 – A clinical home visit shall be conducted 1 time.

Going Forward: Once monthly and as needed.

• Report any recommendations to the physician and maintain a strong

communication with the family/caregivers.

Other Considerations

—National laws

—State laws

—Delivery Tech vs

Respiratory Therapist

—Patients transferred on

unfamiliar equipment

—Patient improvement

National and State laws

Each state has different laws governing Respiratory Care

FAQ: Is applying NC considered Practicing Respiratory Care?

In some states yes, depending on the state Respiratory Practice act.

FAQ: Is applying CPAP and BIPAP considered Respiratory Care?

Again in some states yes, refer to your states Respiratory Practice act to confirm.

FAQ: Is applying Mechanical ventilation considered Respiratory Care?

Yes, this is considered practicing respiratory care in every state.

FAQ: What if I am unsure about the Respiratory Practice act interpretation?

Contact the Board of Respiratory Care in your state

Definitions

Equipment/ delivery tech- Is responsible for the delivery of equipment and instruction to the use of the equipment, safety of equipment, cleaning and disinfecting, and trouble shooting

Clinical Respiratory Care- Pertains to “hands-on” assessment and treatment of the patient in need of respiratory care, including:

•Observing and monitoring the patient

•Teaching disease management

•Clinical assessment

•Medication use & administration

•Patient/ caregiver education

Outsourcing Options

Equipment- Buy VS RentPurchasing Equipment

—has large expense up front which sometimes takes multiple years to make up

—Ventilator have high ongoing maintenance costs (500-2000 for pm’s)

Rental Equipment

—Factored in monthly price

—Easy to budget

—No maintenance costs

Billing ServicesPrepare staff “before” taking patients

Consider outsourcing if no support available

DisposablesDevelop a standard supply list to build off of

Game-Changing Revenue

Enhance your offering, without expanding your budget.

One vent patient provides the same revenue as seven home oxygen patients.

1:8

The bottom line

MC allowable Approx. net

Vent Home patientVent with suction, oxygen

$1745.55 $1396.00

Home oxygen patientStandard O2 with portable

$204.66 $163.22

It just makes sense.

Tracheostomy Supplies & Consolidated Home Health Billing (PPS)

According to Medicare guidelines, tracheostomy supplies must be provided by the primary Home Health Agency directly or under arrangement. This information can be found in the Home Health Training Manual, 2007, section 4.1.1.2, and section 4.1.12.1. Payments for these supplies are bundled into the home health agency prospective payment system, which means a portion of the prospective payment system rate represents payment for the supplies, including the supplies not listed in the plan of care. The home health agency, may make arrangements with the DME company providing equipment to the patient, or another provider, to provide the supplies needed in conjunction with the plan of care for the patient at a special retail price. If no arrangements are made prior to the patient’s discharge, the Home Health Agency will be responsible for providing any and all supplies that are referred to per the consolidated Home Health Billing System (PPS).

The following supplies are the most common to be denied due to Home Health Consolidated Billing (PPS)…………………..

•A4217---Normal Saline (Box of 100)

•A6402 ---Trach Drain Sponges (Box of 25)

•A4623 ---Trach Inner Cannula (Each)

•A4624---Suction Catheters--- (Each)

•A4629---Trach Care Kits (Each)

•A7525---Trach Mask, Adult (Each)

•A7526---Trach Collars, Adult (Each)

•A7521---Trach ,Various Sizes & Types (Each)

•A7520---Trach, Cuffless Fenestrated (Each)

Billing Reminders for Home Ventilator Patients

•If patient is prescribed oxygen, don’t

forget to have a qualifying O2 saturation

two days prior to discharge when

applicable

•It takes approximately three days for a

respiratory therapist to adequately train

the caregivers on the ventilator.

•Make sure to verify if patient will be

receiving home health services, due to

the fact that some trach supplies fall

under the consolidated billing (PPS).

•Verify if patient has had DME equipment

before from another provider.

Billing Tips Cont’d

•Don’t take a vent patient home on a

Friday, due to the weekend.

•Make sure to follow all standard

insurance verification of benefits for DME.

•Have all Dr.’s written orders in the office

prior to set up.

•Notify the local utilities company that

you have a ventilator patient in case of an

emergency.

•Ventilators use standard orders for

billing, there is no designated CMN for

them.

Thank you foryour attention.

LifeGas. Living healthcare.