Providing Solutions for the Growing Trend Toward Home Healthcare - Industry Trend or Event

Health Management Technology, Sept, 1999 by Dempsey Nugent

Technology and consolidation improve productivity, reduce costs.

With increasing costs for traditional healthcare and a greater life expectancy rate due to medical and technological advancements, the trend toward quality home healthcare is on the rise. Although the expenditures for home healthcare services have dipped recently in response to Medicare reimbursement cuts enacted under the Balanced Budget Act of 1997, home health's cost-effectiveness and demographics clearly support the trend.

Home healthcare provides solutions to several problems facing today's healthcare industry, yet there are still many basic issues concerning the quality and integrity of patient care. Nevertheless, major advancements in information technology are enabling IT managers to address the significant issues.

Need for IT Systems

The expected climb in expenditures over the next few years has created a need for significant investments in both clinical and financial systems. It has also dictated an improved level of productivity for the healthcare professional. In order to minimize the economic impact incurred by home healthcare agencies (HHA), many are consolidating into larger, more efficient organizations covering expansive geographical areas.

The major factors contributing to the need for more advanced technological information systems are the new set of data collection requirements called OASIS, or the Outcome and Assessment Information Set, and the increased demands on the healthcare professional as a mobile worker. OASIS, sponsored by the Health Care Financing Administration (HCFA), is a group of data elements that represent core items in the assessment of an adult home care patient and form the basis for measuring patient outcomes for purposes of outcome-based quality improvement.

HCFA, in accordance with OASIS, has finalized two rules relating to home health agencies. One rule revises the existing HHA Conditions of Participation by requiring that HHAs begin collecting OASIS data. The other expands those new Conditions of Participation by requiring HHAs to report OASIS data to their state survey agencies. HHAs will be required to transmit the data electronically to the standard state system, which has already been installed by HCFA.

The Balanced Budget Act of 1997 includes a Medicare requirement for HHA prospective payment that also depends on the data acquired by the OASIS system. It is anticipated that the provision of the act will not be effective for HHA's cost reporting periods until October 2000--a year behind schedule. Both clinical and financial data are needed to determine the total cost of care delivery, often referred to as activity based costing. In addition, managed care organizations must also have outcome data to support the position that their agencies can get high quality patient outcomes in the fewest possible visits.

Increasing demand for higher productivity of the healthcare professional has dictated that the individual care provider operate in a mobile capacity. The healthcare professional, now potentially removed from the traditional corporate infrastructure, must have easy and convenient access to information, systems, and the breadth of the healthcare community. Such access must accommodate the traditional use of core information systems with a portable-computing device, and it must advance the use of collaboration amongst a distributed community of professionals via voice.

As demonstrated by the need for automation, there is an incredible opportunity for the use of applied technology throughout the healthcare industry. More specifically, within the home healthcare domain, now is the opportune time through effective technology deployment to realize cost savings, productivity gains, regulatory compliance, and more efficient ways of delivering quality patient care.

Using the Internet

In the world of technology, the Internet has become prolific. However, an exaggerated misconception of its value exists among the public--that the only relevant uses of the Internet are within research, marketing, or direct sales to consumers. Furthermore, there are many skeptics as to the safety and security of Internet-based systems.

On the contrary, in the coming years, Internet-based technology will provide the infrastructure for business-to-business relationships and the cornerstone of communications within the distributed staffing model, such as home healthcare.

Internet-based technology will provide the necessary infrastructure for healthcare professionals to access data warehouses, data marts, HEDIS reporting tools, and data mining systems.

User Access

In order to use this Internet-based infrastructure effectively, it is critical to clearly define to whom access is granted and to what level. Patient access via the Internet will become common. Access should be confined to their own patient records or indirectly to consumer-based information in the form of medical record or health record service bureaus.

Healthcare professionals' access to information and the care community via the Internet or intranet will be critical for the successful healthcare provider. Increasingly, healthcare is mobile, thus dictating remote points of access within a safe and secure infrastructure.