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A Common Assessment Tool for Post- Acute Care

Traditionally Post-Acute Services like Home Care, In-Patient Rehabilitation Hospitals, Skilled Nursing Facilities, and Long Term Care Hospitals have resided in individual silos. Despite the fact that they are utilized, largely, post hospitalization, they have not had any common data sets, no uniform initial assessment tools, no common pricing components, and differing methodologies for assessing quality outcomes. The net effect of this is persons requiring post- acute services at discharge may find themselves discharged to different silos notwithstanding a similar acuity level. For example, two individuals discharged from the hospital for say, a lesser acuity stroke, may find themselves in totally different environments post hospitalization; one individual may be discharged to a skilled nursing facility while another may be discharged into home health with the entirety of the process being driven by individual treatment protocols of the discharging facility or treating physicians usual and customary practices.     

Now it’s certainly to be noted that exceptional care and outcomes can be driven from all of these discharge venues and that there are individual considerations that can make one or the other more appropriate a destination for any one of two individuals of similar acuity. That said there are tremendous benefits for patients and improved cost to the public health system in ensuring that these discharges are driven by patient specific characteristics and not simply historical treatment patterns, preferences and relationships.

Interestingly, the Medicare Payment Advisory Commission (MedPac), a 17- member Commission established by the Balanced Budget Act of 1997 to advise Congress on issues affecting Medicare payments to private health plans and providers, is beginning to turn their attention to the matter of post- acute services discharge. In its annual March report to congress, among many other recommendation, MedPac will recommended that Congress ask HHS (Health and Human Services) to implement a common assessment protocol for home health agencies, skilled-nursing facilities, inpatient rehabilitation hospitals and long-term care hospitals. The proposal is intended to facilitate comparisons of patient outcomes and costs across post-acute care settings. This is significant as it represents a first step toward moving to a post- acute discharge methodology that will be determined via specific patient assessment for best point of destination post hospitalization. It represents the basis for building a discharge process rooted in risk adjusted data that can serve as a foundation for developing best practices for the post- acute discharge process.

To the extent that patients want and the public health system benefits from the discharge of hospitalized patients into the least restrictive and lowest cost venue of care most able to meet their rehabilitative needs, home health care stands to benefit from this type of policy implementation. For patients with a home environment supportive of their return to it for rehabilitation, with assistance where necessary with ADL’s (Activities of Daily Living), making a singular transfer from the in-patient setting directly to home just makes more sense. The fewer steps or the shorter the step down from the in-patient to the home setting the more likely the care transition process is to be successful and the less likely the patient will find themselves re-hospitalized. From Medicare’s perspective it also creates an environment to lower overall post- acute care expenditures.

Home Health generally, and Pyramid Home Health Services specifically is highly focused on demonstrating its value to the healthcare continuum as the optimum manager of the care transitions process. Medicare policy changes that result in all patients indicating a need for post- acute care services receiving a standardized post-acute assessment will serve to increase the utilization of home health initially post discharge; both due to home health’s capabilities to serve as the patient’s least costly primary location for rehabilitation but also because of the greater level of coordination it brings to the overall transition to home process. In the post ACA (Affordable Care Act) environment where the concepts of global capitation with gain share put intermediaries and hospitals simultaneously at greater financial risk for and eligible to receive greater financial rewards relating to outcomes, these two  attributes, found in well organized and efficacious home health services, bode well for its longer term success.  In the final analysis, home is where the patient wants to be and its where the American Health System has to get them back to as expeditiously as possible when cost considerations come into play.


If we at Pyramid Home Health Services can assist you, your family, practice or beneficiaries with rehabilitation at home, visit us at or call us at 888-880-6565.

Care Coordination: Home and Community-based Services

There’s so much to discuss when it comes to home healthcare! We’d first of all, like to thank you for exploring our Blog site and being one of our first guests. Welcome!

One of the many goals of this Blog, will be to keep you informed of the weekly “goings-on” not only here at Pyramid, but within the industry as a whole. We’ll have a monthly topic, which in we’ll discuss multiple issues, offer statistical data, and talk about the pros and cons of home health service.

This month, we’re discussing the use of home and community-based services to avoid unnecessary hospitalizations, nursing facility placement and ensuring the highest level of customer satisfaction.

Not only is home health care a nice option for the patient, but it can also be a relief on the “system”.  Many patients that don’t have home care will use the hospital as their only means of staying on top of an ailment. Certainly, there are times when the hospital is the only option, but for the majority of patients, they simply need to be educated on how a home health service provider can improve their daily lives. Trips back and forth to the hospital are not only putting the patient at risk, but they’re expensive.

Home Healthcare facilities emphasize that care at home is designed to prevent avoidable repeated hospital stays that are costly for patients as well as government health programs such as Medicare. Such programs could become the model for millions of baby boomers that will rely on Medicare during their final phase of life. Hospitals are expected to reduce patient readmissions or otherwise face reimbursement penalties from Medicare. With a move towards home health services, the burden of payment into these systems is greatly reduced and the patient avoids unnecessary multiple trips to the hospital. There are several different kinds of home health services that we’ll discuss in future posts, but overall, In-Home Services provide individuals with assistance with activities of daily living and their families with a respite from the often intense demands placed on a family caregiver. In-Home Services are designed to allow individuals to remain at home as long as possible by bringing the custodial and nursing services often associated with a nursing home into the individual’s home.

Pyramid Home Health Services provides a full array of home and community based health services, including long-term-care, pharmacy, home health and hospice services. More than 4,000 individuals in 110 Missouri counties receive some type of home delivered health service daily from one of our Pyramid Home Health Services companies. These companies include Tri-County Group XV, Pyramid Homemaker Services, Tri-County Home Health, Pyramid Home Healthcare, Pyramid Home Health, Pyramid Home Health Services- Jefferson City, Tri-County Hospice Services and Pyramid Pharmacy.