HEALTHCARE SUPPLY AND DEMAND IMBALANCE 

The supply and demand imbalance in healthcare became apparent in the last 2 years when the pandemic started. The global health crisis posed a threat not only in the overall health of the entire human population, but also on the availability of healthcare professionals catering the needs of the patients. During the surge of the pandemic, a large portion of the population needed immediate care due to being infected with COVID-19 with no vaccines available and with limited treatment options. Not to mention, healthcare workers were also getting infected with the virus while on the job, which decreased the number of working hospital staff all the more. The demand for healthcare workers significantly increased while the supply remained the same, and in other accounts, decreased. In this instance, the remaining workforce in healthcare shouldered more patients than they could – patient to healthcare worker ratio further disproportioned which led to an imbalance in the demand and supply chain of workforce in the healthcare system. 

FACTORS LEADING TO LABOR SHORTAGE

Several factors were noted to contribute to the growing labor shortage the world is facing. While this labor crunch existed even before the pandemic, the COVID-19 surge exponentially increased this problem – with burnout among healthcare workers during the pandemic as a leading factor in what is known as the “Great Resignation”, wherein a large number of employees are resigning voluntarily. Insufficient staffing and long hours spent away from home during the pandemic highlighted the burnout felt especially by the healthcare workers on the frontlines.  

According to a new survey by Pew Research Center in 2021, “About a quarter of non-retired Hispanic and Asian adults (24% each) report quitting a job last year; 18% of Black adults and 17% of White adults say the same.”. They also conducted an analysis on the same year and found that “When asked separately whether their reasons for quitting a job were related to the coronavirus outbreak, 31% say they were. Those without a four-year college degree (34%) are more likely than those with a bachelor’s degree or more education (21%) to say the pandemic played a role in their decision.” (Parker & Horowitz, 2022).

Aside from the pandemic being a major contributor to the global labor shortage, another major cause has been identified. The aging population today, otherwise called as the “baby boomers”, has contributed to the rising demand for healthcare workers. A proportion in the older people are growing in number. As people age, chronic illnesses may arise and the need for care may also increase. Additionally, healthcare employees in their generation are approaching retirement age, necessitating the need to be prepared to replace them with a new batch of trained healthcare experts when the time comes. World Health Organization (2021) stated that “By 2030, 1 in 6 people in the world will be aged 60 years or over.”.

 

HOW CAN OUTSOURCING HEALTHCARE HELP DURING THESE TIMES?

The shortage of workforce in healthcare also weighs heavy on currently employed healthcare workers – work overload has been tough not only on their physical health but on their mental health as well, leading to burnout. Outsourcing healthcare offers different services that cater to the needs of healthcare workers to help decrease the burden of balancing multiple tasks at a time. 

Here’s how outsourcing healthcare can help mitigate labor shortage in the healthcare industry:

 

• Improved Patient-Centered Care – outsourcing healthcare can help relieve excess workload on healthcare workers.  Administrative tasks require a lot of time to accomplish, thus decreasing time spent on actually treating patients. Through outsourcing, in-house healthcare workers are able to narrow their focus and deliver quality care to patients.

 

• Increased Retention of Healthcare Employees – being able to readjust their focal point to the heart of their profession, healthcare workers perform better in their current position. Improved quality of work also leads to increased patient satisfaction, which goes hand-in-hand in giving a sense of fulfillment both for patients and healthcare workers. 

 

• Optimized Outcomes for Agencies – overall, agencies have better outcomes when outsourcing healthcare. Healthcare outsourcing companies have the necessary resources to efficiently complete various tasks – from administrative duties to medical expertise. Transitioning won’t be a problem because these are all trained and skilled professionals, updated with the latest regulations and protocols to ensure accuracy in all required tasks. Time spent on training support staff could instead be focused on creating an environment where their in-house healthcare employees thrive. This also helps healthcare agencies cut down on cost.

 

The global labor shortage may still exist beyond the pandemic, so it is imperative to act now. Deciding to outsource healthcare may be your best choice yet. 

REFERENCES:

• Parker, Kim, and Juliana Menasce Horowitz. “Majority of Workers Who Quit a Job in 2021 Cite Low Pay, No Opportunities for Advancement, Feeling Disrespected.” Pew Research Center, https://www.pewresearch.org/fact-tank/2022/03/09/majority-of-workers-who-quit-a-job-in-2021-cite-low-pay-no-opportunities-for-advancement-feeling-disrespected/. Accessed 20 Apr. 2022.

• News, A. B. C. “Pandemic Has Made Shortage of Health Care Workers Even Worse, Say Experts.” ABC News, https://abcnews.go.com/US/pandemic-made-shortage-health-care-workers-worse-experts/story?id=77811713. Accessed 20 Apr. 2022.

• World Health Organization. (2021, October 4). “Ageing and health”. Retrieved April 25, 2022, from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

 

 

FOR OVER TWO DECADES OASIS HAS BEEN CONSISTENTLY USED BY CLINICIANS AND HOME HEALTH AGENCIES 

Home health agencies have been using OASIS as a basis for quality measures for quite some time now. This patient-specific assessment tool has existed for over two decades, with revisions done periodically to enhance quality and development, and with the goal of ultimately improving the care provided to patients. OASIS has proven to be of great help to home health agencies.  

OASIS, otherwise known as The Outcome and Assessment Information Set, is a standardized assessment tool used to measure home health care outcomes comparatively. When we say comparatively, it is because it is done at two important points in a patients’ time when receiving home care – at the very beginning, and at the end. This is done to be able to determine a patient’s status before receiving home care, and after receiving home care at the end of a quality episode. By doing this, health agencies, physicians, and clinicians will have a quality measure report on patients’ improvement, unchanged condition, or worsening of condition with the end goal of having sufficient knowledge of the patients’ overall status and functional condition, and be able to apply these in improving patients’ overall quality of care. 

WHAT TO EXPECT IN OASIS-E 

On January 1, 2023, OASIS-E will finally be implemented. Looking back at the year 1999 when OASIS was first implemented, Centers for Medicare & Medicaid Services received a lot of feedback about the assessment tool as many experts suggested areas of improvement. Centers for Medicare and Medicaid Services first revised OASIS-E in 2020 with plans of implementing it in 2021 but unfortunately it got delayed because of the global health crisis that we faced since the start of 2020. A finalized version of the OASIS-E is said to be expected within this year. Nonetheless, providers should be preparing for the changes that comes with OASIS-E.

As of February 1, 2022, an updated draft of OASIS-E is posted on the CMS website. From what we learned from there, here are some of the updated fields on the new OASIS:

Section A Administrative Information

Item Removed:

• M0140 – Race/Ethnicity

Items Added:

•  A1005 – Ethnicity
• A1010 – Race
• A1110 – Language
• A1250 – Transportation
• A2120 – Provision of Current Reconciled Medication List to Subsequent Provider at Transfer
• A2121 – Provision of Current Reconciled Medication List to Subsequent Provider at Discharge
• A2122 – Route of Current Reconciled Medication List Transmission to Subsequent Provider
• A2123 – Provision of Current Reconciled Medication List to Patient at Discharge
• A2124 – Route of Current Reconciled Medication List Transmission to Patient

Section B Hearing, Speech, Vision

Item Removed:

• M1200 – Vision

Items Added:

• B0200 – Hearing
• B1000 – Vision

• B1300 – Health Literacy

Section C Cognitive Patterns 

Items Added:

• C0100 – BIMS: Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
• C0200 – BIMS: Repetition of Three Words
• C0300 – BIMS: Temporal Orientation
• C0400 – BIMS: Recall
• C0500 – BIMS: Summary Score
• C1310 – Signs and Symptoms of Delirium (from CAM©)

Section D Mood

Item Removed:

• M1730 – Depression Screening

Items Added:

• D0150 – Patient Mood Interview (PHQ-2 to 9)
• D0160 – Total Severity Score
• D0700 – Social Isolation

Section J Health Conditions

Item Removed:

• M1242 – Frequency of Pain Interference with Activity
• M1910 – Falls Risk Assessment 

Items Added:

• J0510 – Pain Effect on Sleep
• J0520 – Pain Interference with Therapy Activities
• J0530 – Pain Interference with Day-to-Day Activities

Section K Swallowing/Nutritional Status

Item Removed:

• M1030 – Therapies Received at Home

Item Added:

• K0520 – Nutritional Approaches

Section N Medications

Item Removed:

• M2016 – Patient/Caregiver Drug Education Intervention

Item Added:

• N0415 – High-Risk Drug Classes: Use and Indication

Section O Special Treatments, Procedures, and Programs

Items Removed:

• M1051 – Pneumococcal Vaccine
• M1056 – Reason PPV Not Received

Item Added:

• O0110 – Special Treatments, Procedures, and Programs

With these changes in mind, home health providers should prepare to undergo a lot of education and training strategy with the new information regarding OASIS-E before 2023 comes around. OASIS have been updated throughout the years since home health is ever-evolving. Until now, OASIS proves to be true to providing effective safety guidelines, timely and efficient assessment, and equitable and patient-centered documentation in quality home health measurement.  

REFERENCES:

• OASIS Data Sets | CMS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/OASIS-Data-Sets. Accessed 18 Apr. 2022.

• O’CONNOR, MELISSA, and JOAN K. DAVITT. “The Outcome and Assessment Information Set (OASIS): A Review of Validity and Reliability.” Home Health Care Services Quarterly, vol. 31, no. 4, 2012, pp. 267–301. PubMed Central, https://doi.org/10.1080/01621424.2012.703908.

 

A GREAT INNOVATION TO HEALTHCARE 

The shift in healthcare in the 21st century is going towards a positive direction with the help of technological advancements and continuing research on medical innovation. One of the trends in today’s modern medical world is telehealth – and this includes Remote Patient Monitoring. RPM is not a new concept since it has existed for a long time now, although its peak popularity was recognized at the height of the pandemic. From there, RPM became one of the services being sought-after by medical providers and patients because of its efficiency and efficacy in improving patient care. 

This innovation in healthcare can be adapted in home health care to help clinicians monitor their patients remotely using technologies that give information about the patient’s current condition – one of which is real-time report on patients’ vital signs. Even if patients are at their own homes, their current illness can be managed well through strict monitoring. For healthcare providers, this eases their worry about the current status of their patients by being knowledgeable and well-informed about their patients’ everyday health status. 

In fact, CMS stated that “proposed changes promote innovation to modernize home health by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form.”. (Centers for Medicaid and Medicare Services [CMS], 2018, para. 4).

HOW GAPS IN HEALTHCARE AFFECT THE QUALITY OF PATIENT CARE 

Healthcare providers always want the best for their patients, and patients always want the best outcome for their treatments received. But despite this, healthcare service delivery still could fall short in one way or another. These gaps in healthcare happen when inconsistencies occur during or after a service is provided, particularly when not enough communication is exchanged between patients and providers. 

Let’s take a look at some scenarios that manifest gaps in healthcare:

• Maintenance medicine not being taken on a regular basis
• Regular health check-ups being forgotten
• Diagnostic tests not done regularly (for those who need them)
• A patient jumping from one healthcare provider to another
• Patients unable to get the care they need due to remote location
• Patients’ newly diagnosed condition not shared with the appropriate health specialist 

As healthcare continues to progress over time, gaps in patient care can be abridged through technological advances. It is evident that sufficient and effective data collection on patients’ current status can help prevent these gaps that may lead to even more comorbidities for patients. Understanding and recognizing gaps in healthcare can assist in providing better patient care. 

BRIDGING THE GAP IN HEALTHCARE WITH THE HELP OF RPM

The data collected with RPM is shared with patients and healthcare providers which is beneficial for both sides:

• Patients become more aware of their condition, which helps them make necessary changes to their lifestyle to improve their quality of life
• Patients have the option to remain in the comfort of their homes all the while still receiving necessary care and education from healthcare providers, which also means lesser exposure to hospital-acquired illnesses
• Overall, time and energy spent for travel to the doctor’s office or hospital is lessened, greater expenditure saved due to lesser trips outside of home
• Healthcare providers are provided real-time data on the status of their patients, allowing them to make healthcare planning more in tune to the patients’ needs 
• Healthcare providers kept in the loop of patients’ condition, allowing providers the capacity to manage patients’ medical needs appropriately – necessarily adjusting medication when needed, regularly updating patient education, lesser chances of emergency-care visits through prevention
• Health care accessibility is improved for patients in remote locations, decreasing chances of missed opportunities for care 
• Generally, communication between patient and healthcare providers is improved and more in-depth with back-up data from RPM devices

RPM can be an adjunct to healthcare in providing a better quality of service. Preventative care can be highlighted instead of treating the after-effects of healthcare gaps that leads to development of chronic illnesses. 

WHAT ARE RPM DEVICES?

Remote Patient Monitoring devices use technology to remotely input patients’ health status through monitoring, reporting, and analyzing data collected from the device attached to the patient. 

Here are 5 RPM devices most commonly used by patients and healthcare practitioners:

• Blood pressure monitor – used to measure blood pressure with the use of a sphygmomanometer and could either be a manual or automatic BP monitor; BP monitoring is a safe and painless assessment used to measure one’s blood pressure; important for prevention and evaluation of overall health, and helps manage existing hypertension

• Pulse oximeter – used to measure oxygen saturation to determine if the patient has enough oxygen supply in the blood; device is usually clipped unto patient’s fingers

• Weight monitor – helps patients and clinicians keep track of patient’s weight regularly

1. Spirometer – used to measure ventilation, or the movement of air into and out of the lungs to help monitor its condition 
2. Blood glucose monitor – used especially for diabetic patients to measure blood sugar levels; vital to managing diabetes type I & II

These devices help give information regarding the patient’s status – if their health is on track or an if an immediate action is necessary to help improve patients’ health. With RPM, preventive measures could be taken so as to decrease risk of developing infections or comorbidities for patients, ultimately reducing financial cost for both patients and healthcare providers alike. It is clear why Remote Patient Monitoring is here to stay as it is considered one of the greatest innovations in healthcare.

REFERENCES:

• Centers for Medicare & Medicaid Services. (2018, October 31). Cms takes action to modernize medicare home health | cms. Retrieved April 27, 2022, from https://www.cms.gov/newsroom/press-releases/cms-takes-action-modernize-medicare-home-health-0

Health Equity and How it Affects Healthcare for All

For so long, the health care system has tried to provide equal health opportunities for everyone. Health equity is having a fair chance of attaining the best possible health for oneself through equal access to all forms of health care. It eliminates the factors that lead to unfair health opportunities. 

These factors include:

• Social factors – include wealth, environment and community where one lives, workplace, and income; social disparities affect an individual’s access to healthcare daily. People in the lower to the middle class have limited access to quality care. It is no secret that to get the best care possible, you need to have all the available resources such as financial resources, means of travel, and accessibility of the home environment to health care providers and institutions. The health and standard of living of residents in rural and underserved areas are impacted by the fact that many of them have limited access to care.

Higher-income (earnings and other money acquired annually) is associated with a lower likelihood of disease and premature death (Woolf et al., 2015).

• Racial differences – racial and ethnic minorities receive subpar care and are at a disadvantage when it comes to health. Discrimination could in turn lead to avoidance of seeking health care altogether. 

National Academy of Medicine conducted a study in 2005 and found that “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

• Educational gap – Educational disparities have a direct correlation with health disparities. Health behaviors and lifestyles can be improved with health literacy. The more knowledge you have about health, the more aware you’ll be of the consequences of not taking care of it. 

Lower-income families often live in resource-poor school districts, and they lack the resources available to upper-income families for making investments in early childhood enrichment activities. (Woolf et. Al., 2015).

These obstacles continue to pester for years, affecting the well-being and health of people from rural areas, individuals suffering from poverty, racial and ethnic groups, members of the LGBTQ+, and people living with a disability. Eliminating these obstacles as much as possible and improving accessibility for all is one of the best ways to advance health care. Health care advancement is not only proven through modalities and treatments made with modern technology but this advancement could also mean health equity for all.   

Addressing the Inequities in Healthcare this 2022-2023

Centers for Medicare & Medicaid Services is the biggest health insurance provider in the United States. One of CMS’ priorities this 2022-2023 is to address the different forms of Inequities in health care. 

Here are some of its highlights:

• Data collection will be expanded to better understand each unique individual’s needs.

A person’s demographic information will be included in the data collection. This information can be beneficial in improving inclusivity and ensuring that everyone gets to receive the best quality of health care there is.

• Assessing the gaps between CMS programs and policies to improve the overall quality of operations.

CMS is focused on making actionable and sustainable solutions to bridge the gap in health care by assessing current policies and programs and ensuring that inadequacies are addressed properly. 

• Increasing workforce capacities to be able to accommodate more people from all walks of life.

Healthcare providers must work closely with caregivers, families, and individuals to best understand the health disparities occurring in a specific area. Community-based services are also considered to be able to support the community in underserved areas.  

• Improving language access and services attuned to meet the needs of people across cultures.

Effective communication is key to achieving the best outcome in healthcare. Tailoring healthcare services to fit a particular group or community affects the quality of services that they receive.

• Expanding healthcare accessibility most especially to people with disabilities, know healthcare gaps that they are facing, and be able to address them accordingly.

As people with disabilities tend to have a higher risk of developing chronic diseases, CMS plans to make sure that health emergencies and disaster preparedness must be disability-inclusive. By breaking down barriers, health care accessibility will hopefully be within reach. 

One of CMS’ commitments is to prioritize health equity in all of its efforts, with the ultimate objective of providing everyone with equal access to health care and eradicating inequities. One of the best ways to promote health equity is to look within, reassess current plans and policies, and develop plans to further improve outcomes so that everyone has equal access to health opportunities, health literacy, and inclusivity. The process of eliminating health inequities may take a lifetime, but even just one step in the right way counts as progress. The future of health care lies in health equity for all.

REFERENCES:

• Implicit bias and racial disparities in health care. (n.d.). Retrieved August 1, 2022, from https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/
• Woolf SH, Aron L, Dubay L, Simon SM, Zimmerman E, Luk KX. Urban Institute and Virginia Commonwealth University Center on Society and Health. 2015. How are income and wealth linked to health and longevity?
• CMS Framework for Health Equity. CMS. (n.d.). Retrieved August 2, 2022, from https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/framework-for-health-equity

 

THE STATUS OF BEING HOMEBOUND

Not being able to do things on your own or go on necessary trips outside of the home could be frustrating to many people. Homebound patients are unable to leave home due to a number of reasons that prevents them from ambulating outside of the home independently.

Homebound patients are considered to be confined at home for the following reasons:

• When a patient is seriously ill or physically unable to go out of the house due to an injury that prevents them from independently doing it on their own.
• Requires the need for medical assistive devices such as a walker, crutches, wheelchair, or a special kind of transportation.
• Requires the need for assistance from another person in order to go out of the house.
• An individual has a disability and that prevents him/her from leaving the house since it is too physically or mentally demanding when done alone.

Centers for Medicare & Medicaid Services also defines homebound as leaving home infrequently and only for short durations, which includes receiving medical care, attending religious activities, going to adult daycare programs, and other unique events.

According to CMS, two criteria must be present in order for an individual to be considered confined to home.

For Criteria One, at least one of these factors must be met:

• Requires the need for supportive devices, special transportation, or another person’s assistance in order to leave their house due to an injury or illness
• Leaving the home is contraindicated as it may pose harm to the individual

For Criteria Two, these two factors must be met:

• The existence of a normal inability to leave home
• Considerable effort is needed in order to leave home

 

To be eligible to receive Medicare Home Health Services, one must be considered homebound with a need for medical services and under a physician’s care. One must also receive treatments in accordance with a set care plan after being examined by the physician with whom they’ve had a face-to-face encounter, or authorized by a non-physician practitioner (NPP). This must all be arranged by a Medicare-participating Home Health Agency (HHA).

(Centers for Medicare & Medicaid Services, 2015)

HOW BEING HOMEBOUND IMPACTS THE LIFE OF PATIENTS

For people with functional limitations, managing their chronic illnesses could be harder since going on trips to their primary care physician on their own can be taxing, and to some, may even seem impossible. Their health could be on the line due to their homebound status. Aside from their physical health, social isolation could also affect their mental health and thus, affecting the quality of the life that they live.

According to a study conducted in 2018, the “co-existence of social isolation and homebound statuses may synergistically increase risk of mortality.” (Sakurai et al., 2018).

THE IMPORTANCE OF HOME HEALTHCARE FOR HOMEBOUND PATIENTS

When homebound patients need urgent medical care, they typically call an ambulance to seek emergency services. The problem in this situation is that, while emergency care can help them with their immediate needs, the healthcare providers are unfamiliar with the patient’s medical history, which may lead to fragmented care. To address this healthcare gap, homebound patients need a healthcare provider who can constantly and consistently work with them to manage their chronic illnesses. Home healthcare can be one of the best decisions for homebound patients for them to be able to get the best possible care they can for their health. Home healthcare providers can help patients monitor, treat, and manage their illnesses, and patients are ensured that help can arrive at home whenever needed. They provide a comprehensive assessment of a patient’s functional status, and with interdisciplinary care, patients are assured of receiving the best care from their home healthcare provider.

If a chronic illness or injury is adequately managed at home, trips to the emergency room could be prevented and minimized. Home healthcare is also beneficial for a patient’s overall wellbeing, as evidenced by a study conducted in 2016 which states that “Patients and caregivers described a feeling of “peace of mind” knowing that they had someone to reach if anything were to happen.” (Shafir et al., 2016).

INTERDISCIPLINARY COLLABORATION FROM THE HOME HEALTH TEAM

Home healthcare aims to improve the health of homebound individuals. Home healthcare providers work with the patients to help them achieve their goals, both short-term and long-term. 

Patient-centered care is focused on goal-planning and treatment, different for each patient, which makes this personalized care the best option for patients confined to the home, with limited access to typical outpatient care.

The home healthcare team consists of these skilled professionals:

• Physicians
• Nurses
• Physical Therapists
• Occupational Therapists
• Speech Therapists
• Home Health Aides
• Social workers

Patients can regain some independence with the help of the home healthcare team. Through this interdisciplinary approach, they work together to achieve the common goal for their patient – helping them improve their functional abilities and manage their illnesses properly in order for them to have better health outcomes.

With the rising need for home healthcare, outsourcing home health medical coding is one way to address the ongoing shortage of medical healthcare workers. Administrative services are one of the tasks offered by home health medical coders to help medical health workers on the field focus on providing the best care for their patients instead of getting held back by tedious administrative tasks. Deciding to outsource home health medical coding can be tough as you have to make sure you have the right agency to be in partnership with.

LKN offers reliable Home Health and Hospice Coding and QA delivered by a team of health professionals who are highly knowledgeable with ICD-10-CM coding and OASIS review. LKN will guide you every step of the way as we create a custom solution that will guide you through the challenges brought by a constantly-changing industry and prepare you for success no matter what.

REFERENCES: 

• • Sakurai, R., Yasunaga, M., Nishi, M., Fukaya, T., Hasebe, M., Murayama, Y., Koike, T., Matsunaga, H., Nonaka, K., Suzuki, H., Saito, M., Kobayashi, E., & Fujiwara, Y. (2018). Co-existence of social isolation and homebound status increase the risk of all-cause mortality. International Psychogeriatrics, 31(5), 703–711. https://doi.org/10.1017/s1041610218001047  
  •   Shafir, A., Garrigues, S. K., Schenker, Y., Leff, B., Neil, J., & Ritchie, C. (2016). Homebound patient and caregiver perceptions of quality of care in home-based primary care: A qualitative study. Journal of the American Geriatrics Society, 64(8), 1622–1627. https://doi.org/10.1111/jgs.14244 

• Centers for Medicare & Medicaid Services. (2015, January 1). Certifying Patients for the Medicare Home Health Benefit.

https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2014-12-16-HHBenefit-HL.pdf