Home Health Agencies

Q&A from SNF at Home Webinar

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Home Health Care News themselves cited this October 2020 webinar as one of the most engaging webinars they had held in a long time. Hundreds of attendees from home health agencies country-wide tuned in to the session and asked a record number of questions about this endlessly interesting new model of care: SNF at Home.

Since we ran out of time to answer all the questions on the day of the webinar, we have listed them here as a resource for agencies who are curious about exploring and implementing this model.

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“Most agencies are well-positioned to try a SNF at Home model.”

| Sean Brauchle, Director of Strategy and Business Development at Saad Healthcare

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Questions & Answers on SNF at Home Model

Q: Is there a size of branch you think is appropriate for the model? What about a small branch/small staff?

A: Any size of agency is capable. What needs to be considered is the patient to clinician ratios.

Q: Will nursing be provided as if they were in a SNF?

A: Yes, the clinical intervention will be the same but not as often or as quick as a SNF without the use of technology.

Q: Do you see a role for mobile video consulting (e.g. for wound care) when you provide service in a patient’s home vs. in a SNF?

A: With the pandemic affecting patients’ ability to leave the home, video consulting is very useful. There are many ways to achieve the consult – i.e. telehealth systems and secure messaging systems. Video can provide a visual of the wound, as well as the environment as treatment of the ‘whole person’ versus the ‘hole’ in the person, as Amy Cassata alluded to during the webinar. However, video alone for wound care is not sufficient. Lighting is an issue, shaky hands, wound location – all these are issues that arise while on a video to treat a wound. Technology such as Swift Skin and Wound can be used to solve for these challenges.

Q: What does your company do?

A: Swift Medical is the standard in wound care management, delivering automatic measurements, advanced wound care visualization and easy documentation through it’s smartphone-ready Swift Skin and Wound software. Swift Skin and Wound streamlines clinical and administrative wound care management workflows, from image capture and automated risk scoring, to assessment scheduling and claims submission. Today, Swift Skin and Wound is used by more than 1,700 facilities to monitor over 200,000 patients monthly. To learn how Swift has digitized and transformed wound care, visit swiftmedical.com.

Q: What do you see as the role of personal care (non-clinical) home care services in this model and would they be willing to pay for this service directly under value based or capitated payment arrangements?

A: Personal care is a vital component of this model whether delivered by a family member or private company. This year most Medicare Advantage plans extended their coverage of personal care services. PC is not covered under home health. Additionally, ACOs may be willing to pay for these types of services.

Q: Do you have recommendations for remote monitoring connecting NPs or MDs to patients?

A: Many of the providers you are working with may already have a telehealth service that they are using, some of these also have RPM (remote patient monitoring). Some technology partners are innovating quickly, for example Swift Medical has a patient-facing wound care solution that enables patients and their caregivers to photograph and aid in wound documentation themselves.

Q: Is remote patient monitoring (RPM) reimbursable for home health? What about telehealth?

A: Currently it is not reimbursable under Medicare for Home Health but it’s cost can be reported on your cost report. Some Medicaid and insurance plans do reimburse for telehealth.

Q: How do you offset the meal issues? What screening tool do you use?

A: Social services can work with a variety of local services to provide meal assistance with the patients. Also, working with an RD that has the tools and screening necessary to provide adequate direction on the patient’s diet is a good idea.

Q: When you use special beds (e.g. Clinitron) or other required electric DME and have power outages, where does the patient go?

A: Always have a backup plan for the patient. In the event of a power outage then this backup would be used to ensure that someone in the home could transfer the patient to another surface during the outage. If it was for an extended period of time (days) then it could be considered to not use a specialty bed for those days or place in SNF or similar location temporarily if the needs of the patient cannot be met at home while the power is out.

Q: Are you breaking even? Are you receiving payments? (Asked to the agency that has been running a SNF at Home program for ~2 years)

A: Medicare pays for SNF at Home under the PDGM model. We are not taking a loss and have had positive margins. You need to closely watch visit utilization and not overdo it. (Specifically in the experience of Sean Brauchle of Saad Healthcare).

Q: Do you have a checklist for inclusion criteria or is it subjective?

A: The short answer is that it is subjective. The availability of resources in your home health agency are key in this model.

Q: You mentioned that the goals of a SNF at Home model are appropriate care for high acuity patients and avoidance of ED and IP readmits/admits. Is there data proving avoidance of readmit prevention during a SNF at Home episode?

A: We have not found any research proving avoidance of readmits. Anecdotally, Sean Brauchle of Saad Healthcare says, “Speaking directly to our SNF at Home model, we have not had one hospital readmission.”

Q: When you mentioned $1,900 for the first HHA 30 days – does it include DME and supplied?

A: No, DME is billed separately.

Q: How are you getting reimbursement for this new level of care?

A: (Sean Brauchle) Our model is reimbursed under Medicare Part A & B.

Q: How do we get to the decision makers for Medicare Advantage plans?

A: This is a question that many agencies ask with no easy answer. The way way is to provide data on your programs and cost savings, and how you can help the plan and their members. Also, obtaining data on how many members they serve in your area will help you determine the market mix and competition. This data can be found on the CMS data site.

Q: Do you foresee challenges obtaining medications in the SNF at Home model?

A: The model at Saad Healthcare employs nurse practitioners who can prescribe medications and we work with a variety of pharmacies who deliver medications to the home.

Q: Do you have MDs who specialize with medically complex children?

A: Yes, but usually it’s a collection of providers working together.