HMEs need tools to prove their value in the health continuum

Wednesday, June 30, 2004

Medicare solvency has been a major topic of discussion in every major election over the past 10 years. The consensus says skyrocketing costs are the problem and that containment is the solution, but not everyone agrees who is to blame. Depending on who is doing the finger pointing, the culprits are overpaid DME/HME providers, inefficient government programs or bloated health-care insurers. In order to prevent the lack of awareness and perception that HMEs are low-value providers, we must demonstrate our value through the use of quantifiable evidence and measurable outcomes.

Chronic illness is a dominant feature of healthcare, and its dominance will increase as the large baby boomer population reaches retirement age. It is clear that the economy will not be able to support all treatments for all babyboomers all the time in high-cost acute and sub-acute care environments. We will have to face the issue of appropriate outcomes for chronic diseases with chronic treatments and absolutely have the responsibility to develop the framework from which we ultimately collaborate to develop these comprehensive outcomes.

Measuring outcomes gives the medical definition of “true health” for an individual or a population. However as one of my mentors once stated, there is little agreement as to how health and disease outcomes are defined . Comparative outcome data provides home care organizations with the information they need to succeed in today’s competitive and turbulent environment. Many organizations use cost accounting and other computerized systems containing the data necessary for performance improvement (PI) initiatives. However, they occasionally fail to seize total PI opportunities because they lack a key ingredient - integrated outcomes information.

Outcomes are measurable results as a consequence of the processes used and decisions made in providing care. Contrary to popular belief, they are not just clinical. Healthcare outcomes encompass three areas: cost, clinical and patient satisfaction. When improving care, it is inevitable that by changing one outcome variable, another will be impacted. This could lead to impaired decision making and missed PI opportunities. To obtain the real value of PI initiatives, an organization must integrate outcome information, or, in other words, consider monitoring the three areas simultaneously. Home care organizations across the nation are boosting their PI efforts but may not integrate their disparate outcome information and many providers conduct PI initiatives in silos of interest and responsibility. Accountants want to cut costs and respiratory therapists want clinical improvement while executives want to show high patient satisfaction scores. In other instances, home care organizations direct their staff to improve cost, clinical and patient satisfaction outcomes, but often fall short in accomplishing this mission due to a lack of department-to-department communications.

Outcomes Measures

Outcomes management is a technology of patient experience designed to help patients, payers and providers make rational medical care-related choices based on better insight into the affect of these choices on the patient’s life. Outcome management consists of a common patient-understood language of health outcomes, a database containing information and analysis on clinical, financial and health outcomes. The combined variables serve to estimate the relation between medical interventions and health outcomes, as well as the relations between health outcomes and money; and an opportunity for each decision-maker to have access to the analyses that are relevant to the choices they must make.

Next Steps

DME/HME providers bear a large portion of the burden to care for many patients with chronic illness but are consistently targeted with reimbursement cuts from Medicare and price compression. How can we cope in a constrained financial market when we face the largest number of elderly ever? More importantly, how can DME/HME providers continue to demonstrate their value in the healthcare continuum? We must develop enduring material that is evidence-based, outcomes oriented, succinct and compelling. The first step in this endeavor was the collaborative development of a white paper on the value of home care and long-term oxygen therapy (LTOT). The next step will be to equip homecare providers with the tools necessary to review and document data that demonstrates the value that we provide patients with chronic illness in the most cost-efficient environment - their homes.

Vernon Pertelle, MBA, RRT, CCM is national respiratory manager at Apria Healthcare.