Goals
After completing this module, you will be able to do the following:
- Demonstrate an understanding of how agency practices, payor mix, and financial intelligence influence agency performance.
- Explore legislative priorities important to the home care industry.
- Discuss how home health care nurses can engage the legislative process and remain at the forefront of home health professional nursing practice.
Overview
This module will examine how finances and reimbursement impact home health care operations. To conclude our exploration of the home health care industry, legislative imperatives influencing the industry will be examined.
The Affordable Care Act has challenged the healthcare industry to provide care that is cost-effective yet demonstrate quality patient outcomes. The home care industry has faced reforms that require it to examine its practices to remain viable. The home health care nurse, as administrator, must be actively involved in the day-to-day operations to ensure the future success of his/her agency.
Today’s home health care nurse must take an active role in the legislative process to understand how health policy will shape the future of home care services. The opportunity to shape health care policy can be achieved through involvement in a legislative action network. As an example, the National Association of Home Care and Hospice (NAHC) provides education and information on legislative priorities that affect the home care and hospice industries.
Learning Materials
• Chapter 13 – Clark, M. (2015). Population and community health nursing (6th ed.). Upper Saddle River, NJ: Pearson.
• Case Management Society of America’s Standards of Practice for Case Management (2016).
• CMS Announces Payment Changes for Medicare Home Health Agencies for 2015
• NAHC Legislative Action Center
Discussion Question:
Choose one of the following prompts:
Changes to reimbursement and payment structures over the last few years have proven to be challenging to home health agencies. Discuss why home health agencies must examine their practices and payor mix to remain viable in today’s environment.
OR
As the Administrator of a Medicare certified home health agency you are responsible for analyzing and controlling cost variances to maintain agency viability. Identify three metrics you would use to analyze agency financial performance on a daily basis. Discuss why you have selected these metrics.