INTERVIEW
Home care part of total package of health care ■ What can you tell us about the mission and his-
tory of the Minnesota HomeCare Association? The mission of MHCA is to be the voice of home care through advocacy, education, and networking. The association has been around for 41 years. It was founded by a group of home care providers and has really grown in regard to the needs of home care, making sure that there are standards, and that providers have the resources they need to be able to provide good quality care. ■ Tell us a little bit about the different kinds of
licenses your members hold. Jennifer Sorensen Minnesota HomeCare Association Jennifer Sorensen is the executive director of the Minnesota HomeCare Association (MHCA). The St. Paul-based organization represents 250 members, including 90 percent of all Medicare-certified agencies in Minnesota. Sorensen co-chairs the Strategic Communications Committee for the Minnesota Council on Aging, is a member of the Reducing Avoidable Readmissions Effectively (RARE) Advisory Committee, and serves on the Preparing Committees Leadership Group of the Prepare Minnesota for Alzheimer’s 2020 initiative.
■ If a physician determines that a patient would
benefit from home care, then how is the home care provider chosen? It can be done by direct referral. Most of our agencies try to have a working relationship with physician groups, offices, things like that, in regard to referrals. They will actually go out and let the physicians’ offices know who they are and what services they provide. Some of the physicians’ offices are set up differently. They may have a medical social worker who is available to assist with the referral process, or a discharge planner may assist with patients coming out of the hospital. A lot of times it’s based off a list, or the client could be directed to call the health plan to find out who is in your network.
In Minnesota, we have four different classes of license. There is a class A, what is called a professional home health license. The provider may provide all home care services, such as nursing, physical therapy, speech therapy, occupational therapy, nutrition services, social services, home health aide tasks, or the provision of medical supplies and equipment. These services ■ Tell us about the “facemay be provided in a place of to-face” Medicare requireresidence, including a resiments and their impact on dential center, and housingAs an association, home care. with-services establishments. we would like to partner Face-to-face is a CMS federal The class B, or pararequirement for physicians to professional agency license, better with physicians have seen the patient and allows the provider to peron education and signed off on home care 30 form home care tasks and days prior to implementation home management tasks in collaboration. of services or within 60 days a place of residence. of services starting. If the The class C licenses the physician does not sign off individual paraprofessional caregiver. We skip D on that plan of care for the home health agency, and E, and go to F. Under this license, a provider Medicare will not reimburse the home health can provide home care services solely for a resiagency for any services rendered. dence of one or more registered housing-withIt’s one of those things that is very frustrating services establishments. The class F is the assisted because the physicians really don’t understand, living component; services provided under this because it doesn’t affect them, other than they have licensure include nursing services, delegated nursto schedule an extra appointment that a patient ing services, or other services performed by unlimay or may not necessarily need, and then they’re censed personnel. filling out another piece of paper. Minnesota is very complex in regard to the The ramifications of the physician not signing number of licenses. There is discussion and work that piece of paper don’t impact the physician at being done at the state level to revise the current all, but they impact the home care agency 100 perregulations to collapse all of these into maybe two cent. Home health agencies are relying on an different types of state licensures. action of the physicians, but it’s out of their con■ What are the kinds of health care services trol, so they spend a lot of time, resources, and provided by home care? back office staff getting that paperwork filled out and making sure that they’re seeing these patients. Skilled care is care for those who are in need of medical attention. Skilled services may include RN oversight; medication management; physical, occupational, and speech-language therapy; cardiac and pulmonary care; wound care; home health aide; social services support; and infusion therapy. There is also hospice and palliative care for those with terminal illnesses. All of these require a physician’s order. There are also other unskilled or companionlevel-care services. These services may include companionship, certified nurses aides assisting
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with activities of daily living, or even respite care and medication management, and do not require a physician’s order.
MINNESOTA PHYSICIAN DECEMBER 2011
■ This sounds like it’s an administrative burden for
the physicians, and there’s some resistance there. How do you deal with that? A lot of our members have worked together to put together a template so that it’s easier for the physician to read, see, and sign off. The home care agencies do a lot of hand-holding and calling and faxing. I think one agency faxed a form 14 times before they could finally get it signed. Other states are having bigger issues than we