Critical Thinking

Observations in Home Health

For the last year, I have primarily practiced in a Home Health environment.  I truly enjoy my current position, and wanted to share some observations about my experience.

  1. The Quality of Care Delivered is Practitioner Dependent.   When I was contemplating accepting a position in Home Health, several colleagues noted I better be ready to do a bunch of LAQs and ankle pumps.  While this perception appears to be held by many non-Home Health practitioners, it is not truly reflective of practice.   As in Outpatient, Hospital, or any other treatment environment, the quality of care delivered is truly dependent on the provider providing the care.  In actuality, my care appears to be much more individualized because all sessions are 1:1, and occur within the patients actual living environment.  As we discuss a bio-psych-social model of care, I am truly able to assess and manipulate the social context, much more so than during my time in other environments.
  2. Productivity is realistic and ideal.  During my time with a large, outpatient provider, I often became frustrated with their emphasis on productivity.  I also became frustrated that they paid very close attention to the units billed (I even lost out on a quarterly bonus one time, not because of productivity, but because I did not charge enough units that quarter—not sure how this could be a stipulation for bonus payout).  In home health, you are reimbursed per episode of care or point of contact, and not based upon a broken CPT code system.   This has allowed me to practice without fear of retribution for my decision to render (or not render) certain interventions.  It looks like many payers are moving towards this model for outpatient reimbursement within the next year or two…
  3. My Medical Screening and Management of Co-Morbid Conditions has greatly improved.  To qualify for home health services, my patients must exhibit a taxing effort to leave the home.   This may be due to COPD, end-stage Parkinson’s disease, etc.  I feel my attention to medical screening, as well within-session assessments, has greatly improved.
  4. We cannot prescribe Mobility equipment.  While we are unarguably the experts of movement and mobility, we must have a prescription from a physician or physicians assistant, to order equipment such as a walker or wheelchair.  This makes absolutely no sense to me…If anyone has a rationale to explain this process, please enlighten me.

Does anyone else have any observations of their clinical practice they want to share?   Please do so in the comments…

-Joe B

Did you read my recent article on MedBridge?  Check it out here: www.medbridgeeducation.com/joe-brence-patient-education-therapeutic-alliance

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4 replies »

  1. Joe,
    As you know, I’m in the process of making a similar move in clinical practice. I’ve met with an agency owner a couple of times, and he has tried to educate me about the reimbursement system in home health care. As far as I can tell, it’s only marginally less perverse and dysfunctional than the outpatient CPT coding system. It’s certainly as complex given the gyrations that the agency has to go through to determine a HHRG score based on clinical (C), functional (F) and service (S) domains.

    That said, at least the therapist doesn’t have some PTA with an MBA and a Gordon Gekko hairdo breathing down his neck every time his units per visit drops below some critical threshold.

    Good riddance to that.

  2. Hi Joe,
    We exchanged comments a few years back on the PT project. Since that time I’ve had 3 years in home health and wholeheartedly agree with your views in 1-3 of you above post. My question to you is, have you considered a cash-based model for private patients? In this circumstance, billing codes and reimbursement may be less relevant. Have you seen Jarod Carter’s blog/posts on this topic? I imagine as a PT of your caliber you’ll have no issue building something up quite quickly.

  3. Agree on all points, Joe. I would add that the home care experience is humbling.

    In the clinic setting, it is easy to become myopic, especially over-stating our roles in the patient’s health. Home health allows us to ‘zoom out’ and see the big picture and observe the patient as they truly are in the world and it provides us a more appropriate considering our place in it.

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