While home health and hospice care differ in purpose — hospice care focuses on easing patients’ end-of-life while home health looks to address specific illnesses, injuries, or chronic conditions in the patient’s home — they share a similar process: the use of an interdisciplinary group (IDG)/ interdisciplinary team (IDT) to improve overall care.
As noted by the Centers for Medicare and Medicaid Services (CMS) in the article Creating Effective Hospice Plan of Care, “The IDG works as a coordinated team to optimize patient comfort and dignity according to the patient’s and family’s needs and goals of care. The IDG must include (at a minimum) the professions of nursing, medicine, social work, and pastoral or other spiritual counselors.”1
On paper, home health and hospice IDG/IDT teams are tasked with providing complete, patient-focused care. In practice, this quickly becomes challenging thanks to the combination of at-home visits at differing times from different staff members, combined with the use of virtual and telemedicine technologies. The result? IDG/IDT teams need better ways to collaborate anytime, anywhere. Let’s examine four potential pathways for more comprehensive care.
1) Virtual Team Meetings
With staff typically no longer working in centralized locations, IDG/IDT meetings are fraught with challenges. While tools such as Zoom, Teams and WebEx offer a way for staff to dial-in, it’s easy for employees serving multiple patients in multiple locations to get caught up in current tasks and miss these critical collaborations. Software with built-in scheduling tools can help streamline both operations and connections to ensure teams are on the same page at the same time.
2) Make Time to Talk
Recent survey data found that in 2021 staffing remains one of the biggest challenges for home health and hospice IDT/IDG teams.2 In practice, this means fewer staff to serve more patients across provider networks — meaning that even with on-demand digital schedules they may still struggle to remember meeting details. As a result, it’s a good idea for leaders to connect with staff individually to assess their current workload and ask about operational concerns. Think of this as series rather than parallel collaboration — team leads can collect and collate staff data to determine the best way forward.
3) Robust Visit Documentation
The variety of services offered by IDG teams is expanding. For example, many providers now offer services such as art and music therapy along with physical therapy and emotional support. As a result, there’s a commensurate need to ensure hospice and home health visits are fully documented. Here, function rather than form is critical. Teams can use paper forms, emailed checklists or cloud-based data storage. So long as visit information is entered using consistent processes, it’s possible to collaborate on patient care needs even if every team member can’t attend key meetings in person.
4) On-Demand Data Access
Compliance also plays a critical role in evolving home care and hospice service. For example, recent changes to the home health prospective payment systems (PPS) model focuses on clinical characteristics and other patient information to “place periods of home health care into meaningful payment categories.”3 To ensure efforts result in revenue generation, teams need the ability to search and access both current and historic care data on-demand so they can design collaborative treatment plans that both meet patient needs and satisfy PDGM payment guidelines.
How Home Health EHRs Can Save Time and Help Manage Patient Goals
The Link Between Point-of-Care Solutions and Improving Patient Quality Care
1 CMS, “Creating an Effective Hospice Plan of Care,” August 2020.
2 eHospice, “New Hospice News Report Details Industry Outlook for 2021,” February 5, 2021.
3 CMS, “Home Health Patient-Driven Groupings Model,” December 4, 2020.