Home care program aimed at patient health, Medicare crackdown

Home care program aimed at patient health, Medicare crackdown

mjohnson@bradenton.comApril 7, 2014 

Jennifer Kotlarczyk, a therapist with Infinity Homecare, shares a laugh with Bruce Trace as he does his exercises in the kitchen of his Palmetto home. Trace is one of 32 people in Infinity's new patient empowerment program. MATT M. JOHNSON/Bradenton Herald

MANATEE -- A new home-health program targeting Manatee and Sarasota residents who have been hospitalized with major health events is aiming to keep those people from going back.

Infinity Homecare, a Lakewood Ranch-based home health care company with locations throughout Florida, also expects to save Medicare dollars as the federal medical insurance program cracks down on hospitals that repeatedly and unnecessarily admit patients suffering the same health condition. It's a new business model for the 700-employee company, but one its clients are embracing.

Bruce Trace, an 88-year-old World War II veteran, is one of 32 clients who have entered Infinity's "patient empowerment program." One night in January, he fell in the kitchen of his Palmetto home after feeling weak for months. Doctors who treated him at Manatee Memorial Hospital discovered that blood clots throughout his body had put him into congestive heart failure.

He was in such bad shape that his doctors told his wife, Dolly, he wouldn't survive the night.

"We thought we were going to lose him," she said.

Trace survived, and then went through rehab at the hospital and in Westminster Towers' Bradenton rehab program. When he got home in February, he was using a walker as he started a doctor-ordered home rehab program with Infinity.

Today, Trace can walk up and down the block without a walker. He carries a cane in his hand that he never uses. Infinity therapists coached him through a rigorous home exercise program to get him to this point.

It's the hardest he's worked in years.

"I was doing what I thought was sufficient," said Trace, formerly a semi-regular bike rider. "But I wasn't."

Responding to Medicare

Much as in Trace's case, Infinity is sending nurses and other health professionals into client homes to teach them how to take care of their own health after major health events such as heart failure, heart attacks and pneumonia. The company developed the program late last year as Medicare started refusing to pay hospitals and doctors when patients were readmitted for the same condition too soon -- in the agency's judgment -- after an initial health event.

Vernon DeSear, a spokesman for Manatee Memorial Hospital in Bradenton, said the Affordable Health Care Act authorizes Medicare to take the hard line on unnecessary readmissions.

Infinity's program taps into a good line of business as hospitals like Manatee Memorial try to avoid those readmissions. It also gets Infinity ahead of the curve in how it provides rehabilitation services. Shannon Abbott, Infinity's vice president of clinical strategies, said the patient empowerment program is based on outcomes, meaning Infinity helps patients meet health and mobility goals, and to stay out of the hospital.

The company is currently paid to work with patients on 60-day cycles, but Abbott sees that changing in the near future. As Medicare looks to cut its payouts, she said the agency will likely base future payments on whether and how many outcome goals Infinity helps its patients achieve.

Abbott said cases like Trace's are the ideal result. Her company designed the patient empowerment program late last year in response to Medicare's unnecessary readmission policy. The company is emphasizing several diseases this year to raise awareness, including congestive heart failure, chronic obstructive pulmonary disease and diabetes.

A typical result for patients like Trace would have been one or more emergency trips back to the hospital in the months following rehab, Abbott said. Those trips would have occurred after a patient failed to keep up with medications, weight goals, exercise, or to properly monitor disease symptoms.

Older rehab models relied on a telemonitor system, under which patients were taught to use a computer system to monitor blood pressure, weight and other vitals. That information was used by Infinity to guide rehab. But when the rented system left a patient's home at the end of rehab, no one - including the patient - continued to monitor these factors along any sort of structure.

"All you really did was make a patient dependent on a piece of machinery," Abbott said.

Patients get new tools

The new program teaches patients to use what they have at home to monitor their health. For example, a patient might learn to use a blood pressure cuff and a scale, then to track those results.

During his home rehab, Trace has tracked his exercise, weight, diet, medication and other vital statistics in a 44-page journal Infinity provides its clients. It's something he will continue to do after rehab.

Central to the program is goal setting. Abbott said clients are asked to set a goal for their recovery, whether it be walking to the mailbox or getting on a plane to visit relatives. Trace's goal is to get back behind the wheel of his car. He hasn't yet, but he said he will be driving again soon.

Abbott said Infinity expects the program to be used with a large number of its clients. For example, of the 15,000 clients Infinity saw in 2013, 568 had congestive heart failure as a primary or secondary diagnosis.

Dr. Tom Wilkinson, an internal medicine specialist who works between his own practice and Blake and Manatee Memorial hospitals, said Infinity's program is a refocus of what health professionals have learned about acute conditions recovery over the past few decades.

"They do so much better at home," he said. "They're happier, they live longer."

Wilkinson said Infinity's treatment method will likely lead to fewer readmissions, which is good for the patient. Home care, he said, is almost always the preferred treatment for patients recovering from an acute health condition. It's also a money saver.

"It makes more sense to provide care in the home for dollars a day, versus thousands a day in the hospital," Wilkinson said.

Matt M. Johnson, Herald business reporter, can be reached at 941-745-7027, or on Twitter @MattAtBradenton.

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