Home Health Referrals from Hospitals

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New Insights on Marketing to Hospital Discharge Planners

November 25, 2009

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In this issue...

-- What Hospital Discharge Planners Really Want - Really!

-- Patients' Right to Freedom of Choice Makes it More Difficult to Get Referrals From Hospitals

-- November is Home Care & Hospice Month

-- Private Duty Home Care Benchmarking Survey and State Of The Industry Study

-- The Academy for Private Duty Home Care coming to KY and FL

-- Happy Thanksgiving!

-- About the Author

-- Permission to Reproduce

Welcome,

Welcome to this issue of Home Health Care Today, the leading electronic newsletter for home health care and hospice executives who want to grow their business and get ready for the future. Every other Wednesday, we bring you strategies and insights that will help you take your agency to new heights.

For ideas to grow your Private Duty Home Care business, subscribe to Private Duty Today, the bi-weekly newsletter for non-medical home care CEOs. Your complimentary subscription is available at www.privatedutytoday.com.

What Hospital Discharge Planners Really Want - Really!

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Last month I had to the opportunity to facilitate a focus group session with a group of twenty hospital discharge planners. Our purpose was to do three things:

Learn how they feel about their jobs and their hospital
Learn what they know and feel about home health care
Learn how they make decisions about referring to a particular home health agency

Our client is a large home health agency with three offices serving eleven counties in a southeastern state. They are affiliated with a well-known two-hospital health system serving the dominant city in the service area.

We have been working with the home health agency to develop a strategic sales and marketing plan, and to train their sales representatives, hospital liaisons, and office administrators. Our focus is developing and communicating specific strategies to differentiate this agency from it's competitors.

The agency's CEO was frustrated with their efforts to increase their share of referrals of patients discharged from the hospital to their home health agency. As an objective outsider, I was able to meet with the discharge planners, develop trust and rapport, and ask them clear focused questions that will help our client increase their market share.

Here are some of the things we learned from the focus groups:

The discharge planners feel great about their hospitals and their system
They feel very positive about their own home health agency
They feel very positive about two other home health agencies in the community
They are very busy, and looking for ways to make their jobs easier
Their focus on making referrals is "Freedom of Choice" and patient preference
They refuse to make any recommendations to patients about choice of a home health agency
They did not have clear understanding of how home health could benefit their patients
They did not have clear understanding of how home health could help them reduce length of stay
They did not have a clear understanding of how specific disease management programs could help them with patient discharges
Despite terrific market share already, there is a great opportunity for the home health agency to increase the number of patients discharged from the hospital who are referred to home health

While the discharge planners clearly had home health agencies that they preferred to work with, including their own, they were adamant that they did not influence the patient's choice. They did describe some examples where physicians from a specific group practice did write specific orders for the home health agency they preferred - not our client. When the doctor writes an order for a specific agency, the discharge planners discuss the doctor's request with the patient and still give the patient the right to choose.

The Opportunity for Home Health Referrals from Discharge Planners

In reviewing the notes from our focus groups, we identified five specific recommendations for our client to grow the number of referrals that turn into admissions:

1. To achieve the goal of more home health referrals from the hospitals going to the system's home health agency will require a significant investment in consumer marketing. Persuading consumers to choose your agency will be very expensive.

2. A more likely goal is to increase the percentage of discharged Medicare patients who are referred to home health. It was clear that the discharge planners did not have a clear understanding of how home health could benefit their patients, get better outcomes at home, and reduce rehospitalizations.

3. Achieving this goal will mean providing more education and communication to discharge planners so that they think differently about how they make referrals to home health.

4. The biggest opportunity for the system is to reduce LOS for specific disease states by developing clinical pathways from inpatient care to home health and discharging patients sooner. This process will require a strategy to address Freedom of Choice / Patient Choice and help patients see that they will be able to go home sooner when they select clinical programs designed specifically for their condition. This strategy will focus on creating a seamless transition from hospital to home health.

5. Another big opportunity is to work more closely with targeted physician groups so that they specifically write orders for this home health agency similar to the way one physician group writes specific orders for a competing home health agency. This strategy is based on communicating a competitive advantage of innovative specialty programs to the physicians, and getting them to specifically request the program.

Whether you are a hospital based home health agency, or a free standing agency, you will face new challenges in the future when in comes to marketing to hospital discharge planners. Now is the time to examine this situation more closely and develop new strategies for growth.

Patients' Right to Freedom of Choice Makes it More Difficult to Get Referrals From Hospitals

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As we conducted the focus group, we recognized that it will be much more difficult going forward to market your home health services to hospital discharge planners. They are taking the "Freedom of Choice" much more seriously, and that means it will be more difficult to influence the referral pattern.

Our dear friend, Elizabeth Hogue, Esq., just wrote a fine article entitled, "Discharge Planners/Case Managers Must Make Neutral Presentations of Patients' Right to Freedom of Choice of Providers." In the article, she gave four specific points regarding this issue.

All patients have a common law right to control the care provided to them.
Federal statutes of the Medicare and Medicaid programs guarantee freedom of choice.
The Balanced Budget Act of 1997 requires hospitals to develop a list of home health agencies for patients.
Hospital Conditions of Participation (COPs) of the Medicare Program include basic requirements for discharge planning.

For a copy of this article, call Elizabeth's office at 877-871-4062 or email elizabethhogue@elizabethhogue.net.

CMS also provides in the State Operations Manual Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals (Rev. 37, I0-17-08) Discharge Planning Section: pages 291-307 the following requirements;

"The Social Security Act (SSA) at §1861(ee) requires Medicare participating hospitals, as part of their discharge planning evaluations, share with each patient, as appropriate, a list of Medicare-certified home health agencies (HHA) that serve the geographic area in which the patient resides and that request to be included on the list.

In addition the SSA prohibits hospitals from limiting or steering patients to any particular HHA and must identify those HHA to whom the patient is referred in which the hospital has a disclosable financial interest or which has such an interest in the hospital.

The SSA, section 1861(ee) requires a hospital's discharge plan to include an evaluation of the patient's likely need for hospice care and post-hospital extended care services and to provide a list of the available Medicare certified hospice and SNFs that serve the geographic area requested by the patient. In addition, the discharge plan shall not specify or limit qualified hospice or SNFs and must identify those entities to whom the patient is referred in which the hospital has a disclosable financial interest or which has such an interest in the hospital. Therefore, we expect hospitals to provide a list of Hospice, HHAs or SNFs that are available to the patient, that participate in the Medicare program, and that serve the geographic area that the patient requests.

The list must be presented only to patients for whom post-hospital Hospice services, HHA services or SNF extended care services are indicated and appropriate as determined by the discharge planning evaluation. It is not expected that patients without a need for post-hospital Hospice services, HHA services, or SNF extended care services would receive the list.

The hospital must document in the patient's medical record that a list of Hospices, HHAs or SNFs was presented to the patient or individual acting on the patient's behalf. This serves as documentation that the requirement was met. "

Because of this renewed emphasis on the Freedom of Choice for patients, it will be more difficult for your home health care sales representatives and hospital liaisons to persuade discharge planners to influence patients in favor of selecting your agency.

That means, you'll need to find new ways to market and sell your home health services.

If you would like assistance and guidance in developing your home health agency's strategic marketing plan and training your sales reps and hospital liaisons, Leading Home Care can help. We've worked with hundreds of home health agencies over the past 20 years to help them grow their businesses and get ready for the future.

Home Health & Hospice Marketing Planning & Sales Training

November is Home Care & Hospice Month

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November is "National Homecare Month and National Hospice Month." The themes for 2009 are as follows: Homecare: Love in Action and Hospice: Great Care at Last.

The intent of this celebration is to raise public awareness concerning both hospice and homecare.

"Helping frail, disabled and dying Americans to stay independent and happy in their homes is our goal," said Val J. Halamandaris, President of NAHC. "Home care professionals and volunteers, along with modern medicine and technology, make it possible for sick citizens to be cared for in their homes where they can be surrounded by loved ones and precious mementos as they live their best quality of life."

This month, specifically November 9 - 15th, is marked as an occasion to celebrate the important contribution that home care aides make in providing personal care services to home care patients. The role of the home care aide is integral to providing care to elderly or disabled clients who need more extensive personal and home care than family or friends can provide. We join NAHC in celebrating home health aides and private duty caregivers in their commitment to providing quality and compassionate care.

Private Duty Home Care Benchmarking Survey and State Of The Industry Study

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If your home health agency also has a private duty home care business, you'll want to participate in the 2009 Private Duty Home Care Benchmarking Study. This survey will capture financial and statistical data from home care companies all the across the country so you can compare your agency to others if similar size and age.

You'll also be able to compare your agency to other home health based private duty companies, and other companies in your region of the country.

If you would like to have information about the state of private duty home care in America, and if you would like to know how you are doing compared to the industry, you'll want to participate in this survey.

Private Duty Benchmarking Survey

The Academy for Private Duty Home Care coming to KY and FL

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Want to grow your private duty home care business? If so, you'll want to have your Private Duty Director and key team members attend the upcoming Academy for Private Duty Home Care.

There are two choices:

December 2, 2009 - Louisville, KY

January 22, 2010 - Ft. Myers, FL

We're also putting the finishing touches on The Academy for Private Duty Home Care in Seattle, Washington on April 8, 2010, and Dallas, Texas on May 5, 2010.

Happy Thanksgiving!

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We're off to the family farm in Pennsylvania for a traditional Tweed family thanksgiving. I talked with my cousin, Cindy, and it looks like we'll have 56 people around the tables on Thursday. What a blessing!

What are your plans for this joyous season?

At this time of Thanksgiving celebration, as we pause to count our blessings, our thoughts turn gratefully to you with sincere appreciation for your confidence and support.

May you have a joyous Thanksgiving holiday and a prosperous, healthful New Year.

Happy Thanksgiving!

Stephen Tweed
Jason Tweed
Elizabeth Jeffries
Diane West
Julie Raque
Kyley Hoffman
Mandy Besek
Diane Buckles

About the Author

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Stephen Tweed, CSP, is Chairman and CEO of Leading Home Care ... a Tweed Jeffries company. For over 25 years he has been a recognized leader in strategy and leadership development for home health care & hospice companies and associations. He is the author or co-author of seven books, five of which were written specifically for the home care industry. He has served on the boards of directors of three not-for-profit home care agencies, and has served as interim President & CEO of a $25 million home care company.

Stephen is a past-President of the National Speakers Association, a 3500 member international society of experts who speak professionally. He is also the father of a 38 year-old son who is physically disabled and uses the services of home care on a daily basis.

Meet the entire Leading Home Care Team

Permission to Reproduce

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Permission is granted to healthcare publications, associations and companies to reproduce this article in your publication, or to distribute copies to your leaders, on the condition that you reproduce the credits and contact information as follows: "Reprinted with permission from Home Health Care Today. Copyright 2009 Stephen C. Tweed. To receive a FREE subscription to this newsletter, log on to www.leadinghomecare.com."

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