Home Health Industry Still Not Seeing Referral Rejection Rate Improvements

Home Health Care News | By Joyce Famakinwa
 
Home health providers’ referral rejection rates skyrocketed in 2021. Two years later, the issue does not seem to be improving.
 
Referral rejection rates capture providers’ need to turn down new patients being discharged from the hospital or other care settings, often due to staffing constraints.  Home Health Care News and workflow management company Forcura examined the key metric as part of an online survey, with results released earlier this week.
 
Overall, 64% of industry professionals who participated in that survey said that their referral rejection rates have stayed the same or worsened since last year.
 
The survey examined the challenges that providers are facing in the current referral landscape, along with how they’re responding to these issues. It gathered insights from 154 participants who identify as professionals working at home-based care organizations.
 
More than half of the respondents surveyed said they held leadership positions, such as directors, vice presidents, C-suite executives and owners. 
 
For those surveyed, the majority of their referral sources were institutional. Specifically, 32% of respondents said they had more institutional referrals than community-based ones.
Only 17% of respondents said their organizations had an even share of community and institutional referral sources. 
 
More than 70% of respondents reported that staff at their organization use three to five methods for receiving referrals. Phone calls, referral portals and fax were the most common referral channels for participants. 
 
When respondents were asked to rank the importance of referral criteria — such as payer, primary diagnosis, services requested and requested start of care date — the payer type came out on top. 
 
While communication hasn’t presented a significant challenge for organizations with referrals, 31% of respondents reported having issues around accepting referrals without enough staff in place to deliver care…

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https://homehealthcarenews.com/2023/06/majority-of-home-health-professionals-arent-seeing-referral-rejection-rate-improvements/

Brain Stimulation May Prove Helpful to Acute Stroke Patients, Pilot Study Suggests

University of California, Los Angeles

Highly targeted electrical stimulation to the brain showed promise as a new treatment for the most common type of stroke, according to a pilot study led by UCLA Health researchers.

The study is the first in humans to test the feasibility of using a targeted type of electrical current, called high-definition cathodal transcranial direct current stimulation (HD C-tDCS), to treat acute ischemic stroke, which occurs when a clot blocks blood supply to part of the brain and accounts for approximately 85% of all strokes. Stroke is a leading cause of death and disability in the United States.

Many patients are not candidates for the two main treatments currently available for acute ischemic stroke: clot-dissolving drugs and a device that reaches into the bloodstream and yanks out clots. Even among those who are eligible for those treatments, just an estimated 20%–30% are disability-free three months after their stroke.

In their new study, published June 21 in JAMA Network Open, UCLA Health researchers tested HD C-tDCS as a novel therapy for acute ischemic stroke, in which a series of electrodes are strategically placed across the scalp to deliver a weak inhibitory form of electrical current to the part of the brain suffering from low blood flow.

This form of noninvasive stimulation has been used to treat certain neurological and psychiatric conditions, and the researchers had noted the electrical currents appeared to have an effect on the brain's blood flow. The researchers theorized it may be possible to use HD C tDCS to enhance blood flow to parts of the brain impacted by stroke and protect the threatened brain tissue, known as the penumbra, from irreversible injury.

The pilot study involved 10 acute stroke patients who presented to the emergency department or were admitted at neuro-intensive care and stroke units, were ineligible for currently available treatments, and were within 24 hours of stroke onset. Seven patients were randomized to receive active HD C-tDCS treatment, and three received "sham" stimulation. Using hemodynamic brain scans that acute stroke patients receive upon arrival, the researchers located the stroke area with low blood flow to where the HD C-tDCS treatment was delivered.

"This treatment was aimed at being as targeted and as individualized as possible, only to the area of the brain that has low blood flow or is suffering from stroke," said the lead researcher on this innovative project, Mersedeh Bahr-Hosseini, MD, a vascular neurologist at UCLA Health. "With this high-definition form of C-tDCS, we were able to refine this electrical field to focus it just on this area."

The first set of patients, which included 3 patients in the treatment arm and one in the sham group, received 20 minutes of 1 milliamp of stimulation. In the remaining patients, the dose was escalated to 2 milliamps for 20 minutes.

Researchers were able to efficiently provide the treatment in emergency settings, and patients tolerated the treatment.

Bahr-Hosseini said the most exciting finding was that in patients receiving HD C-tDCS, a median of 66% of the penumbra—the threatened brain tissue surrounding the core of the stroke—was rescued in the first 24 hours after stroke, compared to 0% in the sham group.

According to the hemodynamic brain scans performed soon after treatment, patients who received HD C-tDCS showed signs of improved blood flow that was greater in patients receiving 2 milliamps compared to 1 milliamp. In contrast, the blood flow decreased in sham group. "That was also very exciting, because it showed a possibly true biological effect of the treatment," she said.

Researchers are planning a new multi-site study with Johns Hopkins, Duke University, and the University of Pennsylvania, to gather more data on the treatment's safety and efficacy. The next study will also include patients who are eligible for the clot-dissolving drugs, known as intravenous thrombolytics.

Traumatic Brain Injury Should be Recognized as Chronic Condition, Study Argues

By American Academy of Neurology

People with traumatic brain injury (TBI) may continue to improve or decline years after their injury, making it a more chronic illness, according to a study published in the June 21, 2023, online issue of Neurology.

"Our results dispute the notion that TBI is a one-time event with a stagnant outcome after a short period of recovery," said study author Benjamin L. Brett, Ph.D., of the Medical College of Wisconsin in Milwaukee. "Rather, people with TBI continue to show improvement and decline across a range of areas including their ability to function and their thinking skills."

The study involved people at 18 level 1 trauma center hospitals with an average age of 41. A total of 917 people had mild TBI and 193 people had moderate to severe TBI. They were matched to 154 people with orthopedic injuries but no head injuries. Participants were followed for up to seven years.

Participants took three tests on thinking, memory, mental health and ability to function with daily activities annually from two to seven years post-injury. They also completed an interview on their abilities and symptoms, including headache, fatigue, and sleep disturbances.

When researchers looked at all test scores combined, 21% of people with mild TBI experienced decline, compared to 26% of people with moderate to severe TBI and 15% of people with orthopedic injuries with no head injury.

Among the three tests, researchers saw the most decline over the years in the ability to function with daily activities. On average, over the course of 2 to 7 years post-injury, a total of 29% of those with mild TBI declined in their abilities and 23% of those with moderate to severe TBI.

Yet some people showed improvement in the same area, with 22% of those with mild TBI improving over time and 36% of those with moderate to severe TBI.

"These findings point out the need to recognize TBI as a chronic condition in order to establish adequate care that supports the evolving needs of people with this condition," Brett said. "This type of care should place a greater emphasis on helping people who have shown improvement continue to improve and implementing greater levels of support for those who have shown decline."

A limitation of the study was that all participants were seen at a level 1 trauma center hospital within 24 hours of their injury, so the findings may not apply to other populations.

How Can You Make a Difference? Build Relationships With Your Members of Congress!

It is important to get to know your member of Congress. This may appear intimidating, but members of Congress are people too.  Most members of Congress are professors, attorneys, and businesspersons. Some of them are physicians, nurses, and doctors of various professions that understand why we are so valuable. These are real people who come from all walks of life, who are public servants seeking to improve public policy.   Advocacy is not just sending a letter but actually building relationships, so when important issues come up, we have somebody that will listen and take action on our behalf.

Here are four ways to do this with the help and support of your APTA Home Health Federal Affairs Liaison:

• Join hundreds of other APTA members by advocating for physical therapy and our patients on Capitol Hill in Washington D.C. on July 24-25 for APTA Capitol Hill Day. Attend advocacy training on July 24^th and meet your House Representative and Senators to talk about important issues that will impact the future of the profession. Registration is open today! Don’t miss your chance to give your patients a voice!
  
  
• Schedule a district office meeting when your member of congress is home for recess. Meet with them in the district simply by making a phone call to their office and asking for an appointment. Being a constituent makes you an important person. Knowing the issues is equally important. Read our Federal Affairs Liaison Briefing Memo for the latest update.
  
  
• Attend a town hall meeting. Often members of Congress will hold a town hall meeting where they will discuss important issues that they see as important to their Congressional district. It is a great opportunity for you to attend and raise issues that you also believe are important.
  
  
• Organize a college visit if you are a student. Your campus can host a member of Congress who represents the Congressional district where the college presides. The member of Congress can discuss issues of importance to your University and get to know you. Trust me, they will be grateful for exposure to potential voters.

We have seen, through the years, the profound impact advocacy can have on the profession of physical therapy. APTA has always been able to count on an extremely “deep bench” of seasoned advocates, who have continued to move the needle in the halls of Congress, but now we turn to you. Learn, Educate Advocate, Our Patients & Physical Therapy are Counting on Us!

Dr. Eva Norman, PT, DPT, CEEAA
APTA Home Health Federal Affairs Liaison
[email protected]