1. Marrelli, Tina M.


We Need Your Participation!! It Is Free and Can Help Get You Ready for Pay for Performance


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You may know about the "Home Health Quality Improvement National Campaign"; your home health agency may already be participating. This campaign was launched officially at the Centers for Medicare & Medicaid Services (CMS) Central Office located in Baltimore, Maryland. The project was launched in conjunction with the Home Health Quality Improvement Organization Support Center.


On January 11, 2007, the CMS invited a number of home care organizations and individuals to discuss this important program. According to CMS data, more than 1 of 4 home health patient episodes will result in a hospitalization (CMS, 2007). The goal of the initiative is to reduce avoidable hospitalizations. Numerous organizations and other stakeholders and individuals came together at the daylong meeting, including the National Association for Home Care; American Telemedicine Association; the Visiting Nurse Association of America; American Occupational Therapy Association; The American Physical Therapy Association; the Visiting Nurse Association of New York Center for Home Care Policy and Research; the CMS and its contractors, including the state Quality Improvement Organization representatives; Gentiva Health Services; and more. Most state home care associations were represented at the meeting. I also attended, and having worked at CMS (then called the HCFA) for 4 years on home care and hospice policy and operations, it was like old times!! It was wonderful to see some folks at CMS whom I have not seen for a few years. Besides presentations on why we need to have participation, there were great, "real patient" videos, with the patients explaining why home health nursing and other care services made such a difference to their care and how it helped them stay out of the hospital.

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We have an opportunity to make a significant impact!! And there is no data collection required. We know too well from our patients, grandparents, or older neighbors just what happens when frail older adults are admitted. The risk of misadventures and other problems begin, and the elder begins a trajectory that sometimes was not the planned path when he or she was initially admitted for something "seemingly" simple. Consider these facts:


"Cardiac-related conditions such as heart failure, hardening of the arteries, heat beat irregularities, and heart attack accounted for four of the five most common principal diagnoses for hospitalizing elders in 2004," according to a report by HHS' Agency for Healthcare Research and Quality (AHRQ, October 11, 2006). In fact, these "conditions accounted for 2.4 million hospital stays; pneumonia was the second-leading condition, with 713,000 admissions; the next five leading reasons for hospitalizing the elderly included osteoarthritis, stroke, chronic obstructive pulmonary disease, rehabilitation care and electrolyte disorders, such as abnormally high sodium levels in the blood" (AHRQ). Interestingly, the leading causes of hospitalization of the elderly have remained largely consistent since 1997, according to AHRQ's report. But what it costs hospitals to treat elderly patents has not remained consistent. The average hospital stay for elderly patients costs hospitals $9,800 in 2004-a more than 25% increase over the $7,800 average cost in 1997 (AHRQ).


According to an article in the September 2006 issue of Health Affairs, "Medicare spends more than $300 million extra per year for additional care needed due to medical error or adverse events, such as care for a bed sore or postoperative blood infection (sepsis). Yet these extra Medicare payments cover less than a third of the extra costs incurred by hospitals in treating adverse events" (Zhan et al, 2006). It is easy to see that both hospitals and Medicare would gain financially by improving patient safety.


Here is how to get involved!! Visit State associations and other organizations/entities are serving as LANES. This acronym stands for Local Area Networks for Excellence. The overarching goal of all those involved is to unite the home healthcare community under the shared vision of reducing avoidable hospitalizations and improving the quality of patient care. We are in the position to counsel families and communicate with physicians about avoidable hospitalizations. Your LANE affiliate will assist you with agency reports, locating and using resources, providing intervention packets, and much, much more. The Web site is the one-stop spot to review and retrieve valuable information as you seek to avoid hospitalizations.


Please keep Home Healthcare Nurse in mind as you improve your numbers; we are interested in papers for publication that showcase "Programs That Work." I wish you all the best in this important project. I know that we in home care can make a quantifiable change in the healthcare system through the use of best evidence-based practice that will assist in decreasing avoidable hospitalizations for our patients. Together we can make a difference-this is home care's time to shine!!


Tina M. Marrelli




Agency for Healthcare Research and Quality. (October 11, 2006). Trends in elderly hospitalizations, 1997-2004. HCUP Statistical Brief #14. Available at[Context Link]


Centers for Medicare & Medicaid Services. (2007). National health care leaders launch campaign to reduce avoidable hospitalizations, save Medicare dollars [media advisory]. Home Health Quality Improvement. [Context Link]


Zhan, F., Mosso, A., & Pronovost, P. (2006). Medicare payment for selected adverse events: building the business case for investing in patient safety. Health Affairs, 25(5), 1386-1393. [Context Link]