Based on the information provided in the scenario and on an outside review of the relevant literature, students are to prepare a formal recommendation to the CEO on whether or not it makes sense to move forward with the home health service line given that they are a part of an Accountable Care Organization. In putting the recommendation together, the students should consider emerging healthcare trends, demographic patterns, competitors, risks, and financial implications, and whether a vertical or horizontal integration makes sense for the system. Finally, take into consideration any potential antitrust concerns, if applicable. The recommendation needs to be well supported, logically presented, and thoroughly vetted. Unit 6: Discussion 1 1 unread reply. 1 1 reply. Meeting Emerging Needs Introduction - In this LearnScape, the Board of Directors for the Bright Road Healthcare System is thinking of expanding services to include a home health agency in the community. The healthcare system is experiencing an increase in older patients and also has a problem with high readmission rates within 30 days of discharge for Medicare patients. The Board of Directors has charged the Chief Executive Officer (CEO) who is eliciting the support of a healthcare consultant, the student, to help determine whether or not to develop this service line. It is important to keep in mind that the Bright Road Healthcare System is a participating provider in an Accountable Care Organization (ACO). This LearnScape introduces another form of outpatient services, home health. There has been a push within the healthcare industry towards community-based health services (CBHS), which involves delivering more health services in the community as opposed to having clients travel back and forth to acute or residential care facilities. The cost of caring for clients in their home is less expensive then providing similar services in the acute and residential care facilities. Technology and a growing willingness of payers to reimburse for home care are making the delivery of health services in the community more feasible. There are an increasing number of providers willing to make good old fashion \"house calls\Health Care Delivery Learnscape 4: Expansion Expansion Introduction: Bright Road Health Care System is experiencing an increase in numbers of older adult patients and also has a problem with a high readmission rate within 30 days of discharge for Medicare patients. The Board of Directors of Bright Road Health Care System is thinking of expanding services to include a home health agency in the community. The Board of Directors has charged the Chief Executive Officer (CEO) to work with you, their health care consultant, to help determine whether or not to develop this service. You must analyze overall health care trends, population trends, disease trends, local trends and competitors, utilization of services, and other factors to determine whether or not to recommend opening a home care service. Your recommendation will include specific services provided, staff required, financial concerns, and a plan to build patient referrals. Characters: 1. 2. 3. 4. 5. Leila Chen, Senior Operations Consultant at Beacon & Assoc. Consulting Firm Amit Patel, Marketing Director of Bright Road Ken Bloom, Chief Nursing Officer (CNO) for Bright Road Kimberly O'Neill, Chief Financial Officer of Bright Road Tiffany Halpert, Chief of Medical Staff of Bright Road Locations: 1. 2. 3. 4. 5. Student's Office Hospital Conference Room Restaurant Coffee Shop Chief of Medical Staff's Office Health Care Delivery Learnscape 4 Final October 29, 2012 1 Health Care Delivery Learnscape 4: Expansion Scene 1: Meeting with Mentor, Leila Chen In this scene, the Student has dinner with their mentor figure, Leila, who assigns the Student the new project of assessing the need and implications of Bright Road's expansion into home health care. The student will be asked to prepare a recommendation to the Board. Location Scene setup On-screen characters Off-screen characters Restaurant The student is sitting across the table from Leila. Remains of dinner. Leila Chen None On-screen text: At a business dinner with your supervisor, Leila Chen . . . LEILA That salmon was delicious. It's nice to get out and have a good dinner with a colleague every now and then, don't you think? STUDENT Especially when the firm is paying for it! How long are you in town? LEILA I'm leaving in the morning. That's another reason I wanted to meet with you tonight. Bright Road has a new project for our team, and since I'm in the middle of the Medicaid audit, I thought this would be a good opportunity for you. STUDENT OPTION 1 Great! What do you need me to do? STUDENT OPTION 2 Are you sure? I haven't led too many projects myself. LEILA RESPONSE 1 I need you to gather information from the staff of Bright Road and make a recommendation by week's end on a new expansion project they're considering. LEILA RESPONSE 2 Of course I'm sure! All I need you to do is gather information from the staff of Bright Road and make a recommendation by week's end on a new expansion project they're considering. Health Care Delivery Learnscape 4 Final October 29, 2012 2 Health Care Delivery Learnscape 4: Expansion SCENE 1 STUDENT What kind of expansion are they considering? On-screen text: Remember to take notes as you go, so you can make an informed recommendation at the end. Student is able to open the notepad and take notes during the rest of the scene with Leila. LEILA Bright Road has not entered the home health care market, and they want to see if now would be a good time to do so. STUDENT OPTION 1 What exactly is home health care? STUDENT OPTION 2 Why are they looking at this option now? STUDENT OPTION 1 STUDENT OPTION 2 LEILA RESPONSE 1 Home health care is mainly postacute care and rehabilitation therapies that are delivered to patients in their home setting, rather than having them come to the hospital or other facility. LEILA RESPONSE 2 There are a number of reasons. First of all, it's a growing market that may be a good revenue stream for Bright Road. But the main reason they've decided to seriously consider it now is because they're being hit with penalties from Medicare for having a high readmission rate. This means, when a Medicare patient is readmitted to the hospital within 30 days of their first discharge, Medicare will reduce the amount of their reimbursement to Bright Road. STUDENT It must be a significant penalty for them to consider adding an entirely new division to help offset it. Health Care Delivery Learnscape 4 Final October 29, 2012 3 Health Care Delivery Learnscape 4: Expansion SCENE 1 LEILA That's just it. Part of what you'll need to do is determine whether the cost and risk of adding home health care services to Bright Road will be offset by the benefit. STUDENT OPTION 1 Sounds good. I bet Amit Patel, the Marketing Director at Bright Road will be able to help with information on the market, right? STUDENT OPTION 2 Should I talk to Kimberly O'Neill, the Chief Financial Officer of Bright Road? STUDENT OPTION 3 Anyone else I should interview at Bright Road? LEILA RESPONSE 1 Yes, I'm sure he'll be able to help you see how the market for home health care has evolved recently, and how there have been changes to the main target population, as well as the types of diseases people are facing, and challenges to modern caregivers. LEILA RESPONSE 2 Kimberly would be a great person to talk to. She's always good at filling in the numbers and taking an honest, no-frills look at the financials. LEILA RESPONSE 3 You should also talk with Tiffany Halpert, the Chief of Medical Staff. She's not exactly the biggest supporter of the expansion project, so it will be good to understand her reasons why. Ken Bloom, on the other hand, will help counterbalance her opinions. He's the Chief Nursing Officer for Bright Road, if you remember. STUDENT Okay, I'll be sure to talk with them, if they're available. Who should I send my recommendation to at the end of the week, if all goes well? LEILA I'll be back in town on Friday, so let's go over what you've gathered then, okay? Then, you can send me the recommendation, and after I go through it, I'll pass it to the Board. SCENE 1 STUDENT Good! I like having you in there as a buffer! This big project makes me a little nervous. LEILA You'll be fine. But, don't hesitate to call or email me during the week if you need anything. Good luck! END SCENE 1 Health Care Delivery Learnscape 4 Final October 29, 2012 4 Health Care Delivery Learnscape 4: Expansion Scene 2: Discussion with Marketing Director, Amit Patel The student meets with Amit Patel and they talk about the state of the market, regarding home health care. Amit is favorable toward the expansion, but is not necessarily aware of the financial implications and risks. Location Scene setup On-screen characters Off-screen characters Student's Office The Student faces Amit who sits on the other side of the desk. Amit Patel None. On-screen text: Meeting with Amit Patel, Marketing Director for Bright Road . . . AMIT So, home health care, huh? I was wondering when we'd finally start to look into that seriously. STUDENT OPTION 1 Have you been interested in home health care for a while? STUDENT OPTION 2 Do you think now's a good time for Bright Road to enter that market? STUDENT OPTION 3 What are the biggest changes recently in the marketplace? AMIT RESPONSE 1 Well, not exactly. I know it had a huge boom in the 60s and 70s. Then some late90s legislation slowed it down a bit. But, now with the changes in population and needs of the community, it's really picked up again. I think in 2011 alone there were 9,000 agencies across the U.S., serving 3 million people. AMIT RESPONSE 2 Yes. I think it's just the right time, actually, for Bright Road to step in. We've only got two other agencies competing in this region. There's definitely room for another. Health Care Delivery Learnscape 4 Final October 29, 2012 5 Health Care Delivery Learnscape 4: Expansion SCENE 2 AMIT RESPONSE 3 The biggest one, simply, is that people are living longer. There are more elderly people alive now than ever, and they're the ones who use home health care most. A study in the year 2000 showed that people aged 65 and over made up 70% of the market. Right now, Americans aged 65 and older make up 13% of the population. That's expected to rise to 20% by the year 2035. Plus, since the technology has gotten to a point where home health care can help a broader range of people and their needs, it's not just the elderly who have been taking advantage of it in recent years. STUDENT OPTION 1 Are you saying that young people are using home health care a lot too? STUDENT OPTION 2 Any other social or demographic changes that affect the market? STUDENT OPTION 3 What are the main selling points of home health care? AMIT RESPONSE 1 Yes! I mean, not in nearly as great a number as the aging populations, but for example, home dialysis. Instead of having to go to the hospital and lose such a major chunk of their day, young patients can get this service at home, even at night. This helps them maintain their independence and flexibility, something they value greatly. And, it helps many younger people in the workforce keep their jobs, since home health care requires less time and is flexible around their work schedule. Health Care Delivery Learnscape 4 Final October 29, 2012 6 Health Care Delivery Learnscape 4: Expansion SCENE 2 AMIT RESPONSE 2 Well, let's talk about caregivers for a minute. Traditionally, it's been family and friends who care for elderly or sick family members at home. I think recent estimates put the number at around 350 billion dollars of long-term care delivered by unpaid family members and friends per year. The issue is, since nearly 70% of those caregivers are women, and women have become a more integral part of the workforce in recent times, something has to give, if you get what I mean. AMIT RESPONSE 3 We've touched on some big ones, already, namely the flexibility and control over the schedule, and time saved. Those are huge. But, just as big, if not bigger, is the benefit of cost savings. Across the board, it's a much cheaper alternative to hospitalization or institutionalization, and it keeps people in their homes where most are more comfortable. STUDENT So, there are fewer women staying at home to care for sick or elderly family, which means more room for a home health care agency to move in and provide the care? AMIT Yes, it's also a matter of families depending on two incomes, too. Then, when a family or close friend gets sick, it puts a huge hardship on the family if one of the workers is required to stay home or cut back on work hours to care for them. STUDENT OPTION 1 What about the sick or elderly? What do they prefer? And, can you tell me about the financial and legal risks involved in home health care delivery? STUDENT OPTION 2 Are there policies coming in the future that you know will have an impact on this market? STUDENT OPTION 3 Have you looked into the numbers specifically in our region as to how many people are utilizing home health care? Health Care Delivery Learnscape 4 Final October 29, 2012 7 Health Care Delivery Learnscape 4: Expansion SCENE 2 AMIT RESPONSE 1 Well, I don't know too much about the legal risks. Obviously, there are insurance riders for this sort of thing. As far as financial risks, I see them as minimal. We're basically expanding our occupancy rate to include every home in our region. And, the demand is there for sure. It's clear that people widely prefer receiving care at home than having to go to the hospital or be admitted there. And in our case the same physicians can supervise their care. AMIT RESPONSE 2 You know, I'm not too certain at this point about the future of health care in our country. It's a big question mark that many people are obviously concerned about. I can tell you that, if we move to a situation where people are mandated to have some kind of health coverage, we are going to see a lot of home health care agencies sprouting up to meet the need. If people are going to pay for health care, you'd think that they'd gravitate toward a lower cost alternative in the setting they prefer, their home. AMIT RESPONSE 3 I can dig up some of those figures, I think. Give me a little time and I'll get you some data. STUDENT This is great information, Amit. Thank you for stopping by! AMIT You're welcome. It's a pleasure. Like I said, I'll send you some data soon. In the meantime, just let me know if you need anything else! Take care! END SCENE 2 Health Care Delivery Learnscape 4 Final October 29, 2012 8 Health Care Delivery Learnscape 4: Expansion Scene 3: Meeting with Ken Bloom, Chief Nursing Officer Next, the student meets with the Ken Bloom. They discuss primarily the types of services Ken sees Bright Road delivering through home health care. They also talk about the rise in certain diseases that are affecting the marketplace. Location Scene setup On-screen characters Off-screen characters Coffee Shop Student faces Ken across the table. Ken Bloom None On-screen text: Next, you meet Chief Nursing Officer, Ken Bloom. Don't forget to take notes . . . KEN Good morning! Thanks for meeting me here. I like to have about an hour of quiet time here before I start my day. STUDENT Well, I won't take too much of it up, I promise. KEN No, no. Today's time slot is for you, my friend. Take all you want. This is a topic I care about a lot, so I'm happy to fill up the whole hour, if needed. STUDENT OPTION 1 [BRANCHING 1] Great, so tell me your thoughts on the expansion. Do you think it will help reduce your 30 day readmission rate? STUDENT OPTION 2 [BRANCHING 2] Okay. Can you give me some details on what types of services Bright Road would offer through home health care? STUDENT OPTION 3 [BRANCHING 3] What are the drawbacks to expanding into home health care? KEN RESPONSE 1 I think it's a pretty complicated issue, but yes, overall it will help. KEN RESPONSE 2 There are a great number of home health care services we can provide, mainly postacute care, rehabilitation therapies and nursing services. KEN RESPONSE 3 That's a good question. There are always risks involved and I've talked to nurses on the front lines who have plenty to share about that. SCENE 3 BRANCHING 1 B1: STUDENT OPTION 1 Can you expound on that? Health Care Delivery Learnscape 4 Final October 29, 2012 9 Health Care Delivery Learnscape 4: Expansion B1: STUDENT OPTION 2 But, is it necessary? Aren't they other ways to improve the readmission rate? B1: KEN RESPONSE 1 Of course! You're giving Medicare patients another option to coming back to the hospital, and it's an option they would probably prefer, too. If we can lay out a plan on discharge that included home health care services to assist them with recovery or whatever medical condition they have, I'm sure they'd prefer it over coming back and getting readmitted to the hospital. B1: KEN RESPONSE 2 Right. I don't think it's exactly necessary. There are other factors at play, for sure. We tend to rush people through our hospital system too much. An extra day to make sure our elderly patients are stable could help reduce readmission within 30 days. Also, better education on what to expect on discharge will go a long way. Making nurses more available by phone is huge, too. If a patient feels supported when they're wheeled out of the hospital, they'll be less likely to come rushing back. BRANCHING 2 B3: STUDENT OPTION 1 Any new therapies that are now available in the home? B2: STUDENT OPTION 2 What are examples of postacute care services? Health Care Delivery Learnscape 4 Final October 29, 2012 10 Health Care Delivery Learnscape 4: Expansion SCENE 3 B2: STUDENT OPTION 3 What about rehabilitation therapies? What are those like? B2: KEN RESPONSE 1 Sure. Great strides have already been made in technology to deliver therapies that could never be done before outside the hospital setting. Things like pulmonary care, oncology therapy, intravenous antibiotics, hemodialysis, and even ventilator care. Not only are patients saving money by receiving these services at home, but they're improving their quality of life by being allowed to stay in a more comforting and preferred setting. B2: KEN RESPONSE 1 Postacute care is meant to help people transition from the hospital back to the community. It provides attention to physical and emotional needs of people usually at the end of their hospital stay when they're not quite ready to be on their own. Things like changing dressings, checking vitals, dispensing medication, even help with eating and bathing or shopping and cleaning. B2: KEN RESPONSE 3 Rehabilitation therapies are sometimes bundled right in there with postacute care, things like physical therapy, occupational therapy and speech therapy. BRANCHING 3 B3: STUDENT OPTION 1 What do nurses on the front lines say? B3: STUDENT OPTION 2 But you think the benefits outweigh the risks, though? SCENE 3 B3: KEN RESPONSE 1 I suppose it depends on the agency. Let's just say some have had less stringent standards than others in the past. Thankfully, since the Balanced Budget Act in 1997, when Medicare reimbursements were cut back, it weeded those agencies out of the system that were just in there to make a profit and didn't care too much about quality. Sure, there are still issues of nursing burnout. Sometimes it's more emotionally and physically taxing to travel to and provide care in people's homes. But, the upside of that is that nurses can see the patients' general satisfaction as higher than in the hospital setting as they often see the Health Care Delivery Learnscape 4 Final October 29, 2012 11 Health Care Delivery Learnscape 4: Expansion patient over a longer time period with less hospital hassles, and so there are more rewards there on a daily basis. B3: KEN RESPONSE 2 I definitely think the benefits outweigh the risks. It's not like we're building a new wing of the hospital that won't be used. We're sending nurses out into people's homes. If it doesn't pan out, we can simply stop offering the service. Of course, I understand we'll need to invest a good deal in training as well as the equipment needed. But, DMEs are providing the specialized equipment in most cases anyway. We'd just need the basics and transportation and contract with a DME. END OF BRANCHING. STUDENT OPTION 1 What about diseases and medical conditions that are on the rise? STUDENT OPTION 2 What are DMEs? Health Care Delivery Learnscape 4 Final October 29, 2012 12 Health Care Delivery Learnscape 4: Expansion SCENE 3 KEN RESPONSE 1 Unfortunately, we've seen autoimmune diseases like rheumatoid arthritis and Type 1 diabetes on the rise recently. Type 1 diabetes alone rose 23% between the year 2001 and 2009. An even more alarming statistic is the rate that Alzheimer's is rising nearly 43% from 5.4 million Americans afflicted with the disease in 2011 to an estimated 7.7 million in 2030. Respiratory and cardiac problems are also on the rise. So, like I said, unfortunately we have a need for home health care now that is only going to grow exponentially in the future. KEN RESPONSE 2 DME stands for Durable Medical Equipment. So, home health agencies are responsible for arranging for DME for the patient, but there are many private companies who actually provide the equipment. We wouldn't have to. STUDENT As always, Ken, you've been a great help. I appreciate it, and hope you have a great day. KEN Thanks, you too! Good luck with the recommendation! END SCENE 3 Health Care Delivery Learnscape 4 Final October 29, 2012 13 Health Care Delivery Learnscape 4: Expansion Scene 4: Discussion with CFO, Kimberly O'Neill The student meets with Chief Financial Officer, Kimberly O'Neill, who discusses the financial implications of the expansion. They review the statistics that Amit Patel sent. Location Scene setup On-screen characters Off-screen characters Hospital Conference Room Kimberly sits on the left side of the table. Stats projected on back wall. Kimberly O'Neill None On-screen text: Kimberly O'Neill meets you in the hospital conference room the next day . . . KIMBERLY So, how has the investigation been going? STUDENT It's coming along well. Home health care seems to be a growing market with a lot of demand now and more in the future. KIMBERLY Sure seems that way. Did you see the email from Amit with some statistics about our area? I can put them up on the screen if you want. STUDENT That would be great. Note: On the back screen, the following text appears: Regional Patients using home health care per year in our area: 55,000 Expected increase by 2022: 35% Money spent in region on home health care in 2011: $2 billion Expected increase by 2022: $2.7 billion Estimated 1st year market share: 2% Expected market share increase by 2022: 15% STUDENT OPTION 1 The money spent seems high, doesn't it? STUDENT OPTION 2 So, the big question then, is what would it cost us to provide these services? SCENE 4 STUDENT OPTION 3 What risks are involved? Health Care Delivery Learnscape 4 Final October 29, 2012 14 Health Care Delivery Learnscape 4: Expansion KIMBERLY RESPONSE 1 Well, not really when you consider that almost 120 billion dollars is paid to home health care every year. Obviously, it's not all from the patients. Only 7.9% of that is out-of-pocket. Most is paid by federal programs like Medicare. KIMBERLY RESPONSE 2 That's a good question. The cost to provide this service is something I'm still looking into in finer detail, but my initial estimate is coming in at 20 million a year. This includes salaries, training, equipment, licenses, marketing and the costly insurance rider. KIMBERLY RESPONSE 3 This is the biggest drawback in my opinion. While we'd have extensive and expensive insurance coverage in place, the risk of errors and consequential malpractice suits goes up greatly outside of the controlled hospital setting. And, aside from this legal risk, we have the financial risk that we will not be able to penetrate the market effectively, or economic or political and social factors affecting the market negatively in the years to come. STUDENT OPTION 1 Can you project legal costs for the future in this area? STUDENT OPTION 2 Are there ways to reduce the risk of not penetrating the market like Amit is projecting? STUDENT OPTION 3 Do you agree that the demand is only going to rise, like Amit and Ken Bloom are saying? SCENE 4 KIMBERLY RESPONSE 1 This is a tricky area. We have malpractice coverage that can extend to this service, but there are other types of lawsuits that can hit hard. For example, a home health care provider in Tennessee just had to pay over 9 million dollars to resolve a lawsuit regarding false claims they had allegedly made. KIMBERLY RESPONSE 2 Sure. We just need to make a huge splash very quickly, in my opinion. That means spending a great deal on marketing, training, staffing and equipment. Then, if smaller players try to encroach on our region, we can outperform, outprice them and, if that doesn't work, we could even buy them out. We can also market as a package, providing care across the continuum of needs with better communication at each level of care. KIMBERLY RESPONSE 3 All evidence points to a rising demand. I've seen the stats on the aging population increase, as well as the increase in certain types of diseases that Health Care Delivery Learnscape 4 Final October 29, 2012 15 Health Care Delivery Learnscape 4: Expansion could be treated with home care. The question is, are we going to be able to grow steadily with the market? Amit seems confident that there is room in our region for another major player, but there's no telling that a whole slew of other home health care agencies aren't going to appear in our area to meet the demand, too. That's where the risk is. The more players, the fewer patients and profits to go around. STUDENT OPTION 1 What about the issue with Medicare reimbursements being cut due to readmission within 30 days? Do you think expanding in home health care will help with that? STUDENT OPTION 2 Can't we factor the revenue from increasing Medicare reimbursements we'll be gaining into the expansion picture? KIMBERLY RESPONSE 1 There's no doubt in my mind that this will help. Instead of coming back to the hospital, patients will be able to receive Bright Road's care and attention in their home setting. It only follows then that our reimbursements from Medicare won't be reduced as much as they've been recently. SCENE 4 KIMBERLY RESPONSE 2 Of course it's a benefit. The question is, how big of a benefit? I really haven't thought about putting a number to it yet. STUDENT If you had to take a guess at increased revenue from fixing the Medicare reimbursement process, what would it be? KIMBERLY You don't let up easily, do you? (laughs) Okay, here's the deal. It's not a guarantee. We can't force patients to take the home health care service option. They have the freedom to choose. And, especially among our older population, it's hard to change long-held beliefs about how they receive medical care. They may believe that the level of care at home won't be as good as at the hospital. They may not feel comfortable with nurses coming into their home. What do we do, then, if that's how most of our patients feel? STUDENT Good question! I guess that's where good communication, education and marketing will come into play. KIMBERLY Right. Let me think about it a little more and I'll see if I can get you a number on that. I know you're trying to factor in everything, to make a solid recommendation, and I appreciate that. Health Care Delivery Learnscape 4 Final October 29, 2012 16 Health Care Delivery Learnscape 4: Expansion STUDENT I appreciate your help and your time, Kimberly. KIMBERLY No problem at all. I'll be in touch soon! END SCENE 4 Health Care Delivery Learnscape 4 Final October 29, 2012 17 Health Care Delivery Learnscape 4: Expansion Scene 5: Discussion with Tiffany Halpert The student meets with Tiffany Halpert, the Chief of Medical Staff for Bright Road. Tiffany is against the expansion and explains why. Student gets a text from Kimberly at the end of the scene. Location Scene setup On-screen characters Off-screen characters Chief of Medical Staff's Office Tiffany sits behind her desk. Student faces the desk. Tiffany Halpert None On-screen text: Your last interview is with Tiffany Halpert, Chief of Medical Staff . . . STUDENT Thank you for taking the time to meet with me, Tiffany. I've heard you have a unique opinion about the home health care expansion. TIFFANY Well, you could say that. I seem to be the only one willing to go against the grain and raise a few red flags. STUDENT OPTION 1 Don't you think that it will help with the poor readmission rate? STUDENT OPTION 2 So, you think expanding into home health care is a wrong move? STUDENT OPTION 3 What are your biggest concerns with the expansion? TIFFANY RESPONSE 1 It may help somewhat with the readmission rate, but I don't think it is the best answer to that problem. TIFFANY RESPONSE 2 I'm not saying the expansion is entirely wrong at this point. I think there are factors that shouldn't be ignored, that's all. TIFFANY RESPONSE 3 My biggest concerns are with quality, liability and financial risks. SCENE 5 STUDENT OPTION 1 Before we continue about home health care, what do you think is the best answer to the readmission rate problem? STUDENT OPTION 2 Could home health care play a part in solving the readmission rate problem? TIFFANY I think that the problem we're having with losing Medicare reimbursements due to readmission within 30 days is easily managed if we simply make our doctors and nurses more aware, and if we adjust some policies. Training on this issue has been totally lacking. We send out a memo, or we mention it here and there, but nothing solidifies a point like a few hours of training. We can then Health Care Delivery Learnscape 4 Final October 29, 2012 18 Health Care Delivery Learnscape 4: Expansion implement some policy changes, like the level and degree of education we provide our patients on discharge and the amount of time spent for that. Sure, home health care can be a part of the solution, but we're already referring patients out to other agencies for that. It doesn't have to be Bright Road who provides it. STUDENT OPTION 1 [BRANCHING 1] Can you talk to me about your concerns with quality? STUDENT OPTION 2 [BRANCHING 2] What about your concerns with liability and financial risks? TIFFANY RESPONSE 1 There's just less supervision in home health care. Nurses are not monitored as closely, and this could lead to lapses in quality. TIFFANY RESPONSE 2 Well, legal costs are tied closely to how well quality is ensured. But, as you know in life, accidents happen, mistakes happen despite best efforts to prevent them. Add to that the risk of a crowded market, and it's a one-two punch that knocks this option out of the consideration ring, in my opinion. BRANCHING 1 B1: STUDENT OPTION 1 Isn't quality more about training and proper accountability, and less about micromanagement? Health Care Delivery Learnscape 4 Final October 29, 2012 19 Health Care Delivery Learnscape 4: Expansion SCENE 5 B1: STUDENT OPTION 2 I'm assuming that there would be nursing managers and supervisors making regular quality inspections, right? B1: TIFFANY RESPONSE 1 You're right. We don't breathe down our nurses' and doctors' necks here at the hospital, either, but there's just a more relaxed environment in the home and I worry that this will translate into the level of care provided. I mean, things got so bad with quality, don't you remember the Clinton administration had to put in effect something they called Operation Restore Trust, in the 90's? All I'm saying is, why go down that road if we don't have to? B1: TIFFANY RESPONSE 2 Yes, of course. And then you have surveyors from outside agencies, too. BRANCHING 2 B2: STUDENT OPTION 1 Have you seen the market data from Amit Patel? B2: STUDENT OPTION 2 Are these risks any greater, do you think, than if you added another wing or another department or specialty to the hospital? B2: TIFFANY RESPONSE 1 Amit did mention some of those statistics in the break room the other day. I guess I could take a closer look and maybe that would make me feel better. I just think that we need to shore up our processes and our staff here at the hospital first before we start looking to expand in this way. Who knows? If we can get our act together a little bit better here, we may find that we don't need to branch out in this way. SCENE 5 B2: TIFFANY RESPONSE 2 I see what you're saying. If we want to expand at all, there will always be added risk and cost involved; cost to insure, cost to handle legal issues. And the risk of patients not showing up. That's a big one in my book. It just seems like the risk of adding a new specialty or division to the hospital is still less than starting an entirely new and external service. Health Care Delivery Learnscape 4 Final October 29, 2012 20 Health Care Delivery Learnscape 4: Expansion STUDENT OPTION 1 You don't think we could do both simultaneously? Home health care is not just a good way to fix the readmission rate problem, it's also a good opportunity, I think. STUDENT OPTION 2 I see what you mean. That's a bigger decision that the higher-ups need to decide. TIFFANY RESPONSE 1 Does Bright Road really need to diversify more at this stage? I don't think so. We've got a huge share of the market as it is, and last I checked, we were a profitable company. TIFFANY RESPONSE 2 Definitely. I'm glad you were able to stop by today, so I could add my two or three cents into your evaluation! STUDENT You've definitely added a lot! Thanks, Tiffany! NOTE: Student sees their phone appear with the following message from Leila, once they click on the flashing icon to view the text. TEXT FROM KIMBERLY STUDENT TEXT RESPONSE I think a safe number for increased revenue from saving those Medicare reimbursements is about $3 million a year. Perfect! Thank you, Kimberly! END SCENE 5 Health Care Delivery Learnscape 4 Final October 29, 2012 21 Health Care Delivery Learnscape 4: Expansion Scene 6: Review and Analysis with Mentor In this scene, the Student meets with Leila to review the information they've discovered. Leila will ask questions to help the Student analyze and prepare for writing a recommendation. Location Scene setup Coffee Shop The student sits across the table from Leila. Two cups of coffee, plates with halfeaten scones, on the table, etc. On-screen characters Leila Chen Off-screen characters None On-screen text: Meeting Leila for coffee the next day . . . LEILA You're right. The coffee is good here. I'm going to make this a regular stop when I'm in town from now on. STUDENT How are things at corporate? The Medicaid audit go well? LEILA Yes, thanks. I'm glad that's over. And, I hear your investigation has gone well, too. STUDENT Yes, I gathered a lot of very good information. Do you mind if I run some of it by you before I give you a written recommendation? LEILA Sure! I'm anxious to hear some juicy details. STUDENT OPTION 1 [BRANCHING 1] Well, first of all, the market seems prime for home health care. STUDENT OPTION 2 [BRANCHING 2] Economic and policy changes seem to be favorable toward a move into home health care. STUDENT OPTION 3 [BRANCHING 3] There are some who still think, though, that the risks won't outweigh the benefit to fixing the Medicare readmission problem. BRANCHING 1 LEILA RESPONSE B1 What factors convinced you of that? Health Care Delivery Learnscape 4 Final October 29, 2012 22 Health Care Delivery Learnscape 4: Expansion SCENE 6 STUDENT OPTION 1 Demographics, for one. People are living longer, and elderly are, by far, the primary users of home health care. STUDENT OPTION 2 People in the suburbs are looking for options closer to home and less costly, too. Plus, less and less caregivers are able to stay out of the workforce and stay home to care for a sick family member. STUDENT OPTION 3 A rise in certain diseases and better technology to meet the needs of people with these diseases in their homes. LEILA RESPONSE 1 That's true. Make sure you have some exact numbers in your recommendation, though. And, don't forget to address the other ages, too. I hear that young people with chronic illnesses are utilizing home health care more and more, because of the flexibility. LEILA RESPONSE 2 Wasn't there a Paid Family Leave Law put in place in 2002 in California? I think this was designed to help caregivers take more time off work to stay home with sick family or friends. Make sure you're aware of policy changes like this that can also affect the market. LEILA RESPONSE 3 Yes. You hear about Alzheimer's being on the rise, as well as other diseases like diabetes in both young and old. Be sure to mention specifically which services and procedures can be performed at home, thanks to the advances made in technology. I personally know about one, hemodialysis, because I have a friend who gets this done at home, and she said it's changed her life. She can still work during the day and, then, at night, a nurse comes to her home and takes care of the dialysis. Examples like these can go a long way. Just remember, Alzheimer's can only be handled in home in early to middle stages of the disease. Health Care Delivery Learnscape 4 Final October 29, 2012 23 Health Care Delivery Learnscape 4: Expansion SCENE 6 BRANCHING 2 LEILA RESPONSE B2 Can you give me some specific examples? These always help. STUDENT OPTION 1 There was legislation in the late 90s that slowed the growth in the industry a bit, but now, with mandatory health care laws coming like the one in Massachusetts and then of course national health care reform, it will definitely be in demand more. STUDENT OPTION 2 Well, social changes reflect less caregivers being able to stay at home, and more people looking for ways to save on time and money and to avoid sending an elderly parent to long term care. Let's not forget children either. Home care for children with major illnesses has also expanded. LEILA RESPONSE 1 I think you're referring to the Balanced Budget Act of 1997. Yes, this definitely put a cap on home health's seemingly out of control growth. It put stricter guidelines for quality in place and it effectively lowered the number of new agencies across the U.S. And, while I see your point with the move toward mandatory health care, it doesn't necessarily mean that people will choose home health care as a service. LEILA RESPONSE 2 And you think this will help ensure that people will utilize home health care? It sounds reasonable. Just make sure you have some numbers to back these statements up. BRANCHING 3 LEILA RESPONSE B3 First of all, do you think it will fix the readmission problem? Secondly, what about the risks involved? Are they too great? STUDENT OPTION 1 Well, the CNO seems to think it will fix the problem. But the Chief of Medical Staff thinks the problem should be fixed at the hospital level. SCENE 6 STUDENT OPTION 2 Tiffany Halpert thinks the legal and financial risks are too great. I talked with Kimberly, the CFO, and she feels the opposite. Health Care Delivery Learnscape 4 Final October 29, 2012 24 Health Care Delivery Learnscape 4: Expansion STUDENT OPTION 3 I think it will help with the readmission problem, but it should not be the sole solution. Better training and patient education and outreach needs to be put in place, too. There are some financial and legal risks, but in the long run benefits will top risks. LEILA RESPONSE 1 Sounds like they both want to keep the care of the patient in the hands of their own groups. Ken wants his nurses to play a bigger role, while Tiffany wants her doctors in the loop more. You have to decide which one has the best case based on the evidence you've gathered. LEILA RESPONSE 2 Here's a case where the numbers can help you make a good, final decision. Some people have justified concerns, but if they're not substantiated by facts, they shouldn't be given as much weight. Yes, there are risks, but since Bright Road isn't the first hospital to go down this road (I think nearly 25% of all home health care is provided by hospital systems) then I'm sure the numbers are lining up in favor of taking the risk more often than not. LEILA RESPONSE 2 That sounds reasonable. But, as far as I know, the hospital contracts with outside home health agencies. It makes you wonder, what will change if Bright Road offers the service themselves? If the patients don't take advantage of it, then we'll still have the high readmission rates. So, yes, better training and better education of patients and outreach at discharge sounds necessary. And, if Bright Road offers home health care themselves, they will be more likely to promote this option, especially since their own people will be involved and they can be more confident of the quality of the service. STUDENT These are great things to think about. Thanks, Leila. I'll have a recommendation to you by tomorrow afternoon for sure. LEILA And then I'll pass it on to the Board, once I go over it. I'm sure it will be great, though. You've done a very nice job. Thanks a lot! Health Care Delivery Learnscape 4 Final October 29, 2012 25 Health Care Delivery Learnscape 4: Expansion Scene 7: Making Your Recommendation Location Scene setup On-screen characters Off-screen characters Student's Office Student is sitting at their desk. None None On-screen text: In the body of the email below, type your recommendation on whether Bright Road should expand or not into home health care. Don't forget, you can use the notes you've taken throughout your interviews. Be sure to back up your recommendation with the analysis of the information gained from the staff. Your recommendation should be 250-500 words. To: Leila Chen Re: Bright Road expansion into Home Health Care Body of Email: NOTE: Student will be able to fill in their recommendation here. On-screen text: Congratulations! Your recommendation to Leila Chen has been sent! Good work! FADE OUT. End of Learnscape 4 Health Care Delivery Learnscape 4 Final October 29, 2012 26