Life Sciences

Home health underutilizing billable service

Medicare & Reimbursement Advisor Weekly, August 28, 2009

There’s a managed markets opportunity in home health to carve out a leadership role, according to a poll I did of our Beacon Health readership. Home health agencies need to maximize payments and find ways to increase billable hours in a tightening reimbursement environment, and one thing that agencies underutilize is patient education. This is actually a billable service; agencies can be reimbursed from Medicare through their prospective payment system. Billable work could include teaching patients about appropriate use of medications or teaching a caregiver (e.g., family member, friend) how to dispense medication (e.g., how to inject insulin), and then checking back later to see whether refinement/refreshers are needed. Nurses could do this training, but often don’t due to lack of resources, said 83% in the survey. To support the gap, those overseeing this channel in managed markets may want to look at developing patient education tools that nurses could use as part of their billable time.

Humana, Outcomes partnership

Humana chose Outcomes Pharmaceutical Health Care to partner on the administration of its medication therapy management (MTM) program.

Adherence study

According to a new report from the New England Healthcare Institute “Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease,” poor medication adherence is one of the greatest wastes found today in healthcare. Estimated to cost the healthcare system about $290 billion annually, the study provides solutions to help improve medication adherence and specifically names pharmacists as one of the primary solutions.

The study suggests pharmacists should determine the reasons for underuse and work with the patient to find a solution. In addition, the pharmacist should monitor the patient for a change in compliance and document improvement in patient reportable symptoms attributable to the use of therapy as directed or the patient’s receipt of the next refill is within an appropriate interval, defined as +/- 20% of the days’ supply (i.e., within six days for a 30-day dispensed supply) for one month.

This MTM service would be documented as (1) Reason—underuse (160); (2) Action—patient compliance consultation (215); (3) Result—altered compliance (360). For more details, click here: http://www.pharmacist. com/AM/Template.cfm?Template=/CM/ContentDisplay.cfm&ContentID=20555.

Readmissions study sound bites

In a readmissions study I’m conducting with clinicians in hospitals, managed care, and long-term care there are some interesting sound bites emerging: Of patients readmitted to hospitals within 30 days, 18% in the study complain of the lack of effectiveness or tolerability issues from a generic they were switched to at discharge. And on a 1–10 scale, with 10 being highly likely to help reduce hospitalizations, 62% gave a 7 or higher when asked to rate how likely fewer formulary restrictions across settings would be to reduce hospitalizations The final paper will be published soon in a peer review publication. Note: To discuss these issues, call or write to me anytime. —Bryan Cote, Editor, MRAW.