Introduction

For patients discharged from the acute care setting, the road home can be laden with potholes and speed bumps. The fear of the unknown after being newly diagnosed with a wound or the exacerbation of a health condition can be overwhelming for many patients. Caregivers are likely to have the same feelings as patients. This blog will navigate through some avoidable roadblocks and barriers to ensure a smooth ride home. By establishing manageable expectations and partnering with home health agencies that have proficient wound care programs, the patient and caregiver can genuinely be on the road to recovery.

Home Health Services

It is not uncommon for patients with wounds to be discharged home with home health services. This task is usually delegated to a nurse case manager or social worker within the hospital or hospital system. Some hospital systems have their own home health agencies, whereas others refer patients to services in the community. Ultimately, it is up to the patient to choose the services they use, and the patient should be educated about the options available to them. It is common for the staff member handling the discharge to have established relationships with several home health agencies and provide guidance to the patient and caregiver.

Once the order has been received for release, the hospital staff member reviews the options with the patient, and then the referral and discharge orders are sent over to the preferred agency. The agency will then review the referral, ascertain insurance coverage, and determine whether the referral will be accepted. This process can be time-consuming, and it can take anywhere from 24 to 72 hours for insurance to approve the case, for the home health agency to start care, and for the hospital to complete the discharge process. During this time, the home health agency will be setting up a date and time for the designated Registered Nurse to complete the intake or what is officially referred to as the start of care. Many factors can play into the timeliness of discharge from the hospital and admission to home health. Most agencies would like to be prepared when the patient is admitted. Still, the hospital often does not provide adequate wound documentation, thus creating a gap or a pothole right off the starting line.

Documentation, Reimbursement, and Further Considerations

Additional roadblocks include incorrect diagnosis of pressure injuries related to staging and wrong diagnoses of venous leg ulcers, arterial ulcers, and diabetic foot ulcers. With the rollout of the Centers for Medicare & Medicaid Services Patient-Driven Groupings Model (PDGM) program in 2020,¹ it is now paramount that the wound etiology is correctly identified and that reimbursement for the case mix is maximized.

According to PDGM guidelines, there is an opportunity to increase reimbursement to the home health agency related to the site of discharge and timeliness of admission.¹ For example, if a patient is discharged from the hospital and admitted to home health care within 24 to 48 hours, the home health agency can increase revenue for the initial certification period. This positive change encourages the home health agency to admit the patient and incentivizes avoiding delays in care, and as a result it has positively affected wound healing. Further matters to be considered are the availability of advanced wound care products and the level of teachability of the patient and caregiver. The home health agency will also consider the role comorbidities will play in the wound’s ability to heal.² Educating the patient and caregiver on the discharge process from the hospital and admission to the home health agency will boost confidence in the process, facilitate better adherence, and improve patient outcomes.

Conclusion

Taking time to provide a roadmap to the patient and caregiver will ensure fewer bumps in the road on the way home. Some actions the hospital discharge personnel can take to promote a smooth transition include complete discharge orders, correct diagnoses, and appropriate supplies sent home for at least three dressing changes. Additional resources include a contact name and telephone number for the home health agency and community resources.

References

1. Home health patient-driven groupings model. Centers for Medicare & Medicaid Services. Last modified December 2021. Accessed February 3, 2022. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealt…
2. Examples of home health care quality measures for consumers. Last reviewed November 2018. Agency for Healthcare Research and Quality, Accessed March 8, 2022. https://www.ahrq.gov/talkingquality/measures/setting/long-term-care/hom…

About the Author

Kari K. Harman, RN-C, CCM, CWCA, WCN-C, CSWD-C, FACCWS, DAPWCA attended Seminole State College where she received her Associate Degree of Nursing. Since receiving her degree, she has worked as a Charge Nurse, Case Manager, Wound Management Sales Account Specialist, Nurse Case Manager,Wound Education Specialist, and, most recently, a Director of Wound Management. She is an ambassador for ABWM, has been a guest speaker at multiple conferences, and is involved in several wound care professional associations. She will be graduating in August with her BSN. Kari is married with two sons and enjoys team roping and raising performance quarter horses when she's not promoting wound education.