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Assessing the Problem: Quality, Safety, and Cost Considerations

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Assessing the Problem: Quality, Safety, and Cost Considerations

Population Health Problem
As life expectancy rises, so does the need for medical assistance (Braekers, Hartl,

Parragh, & Tricoire, 2016). Home healthcare professionals, including Certified Nursing

Assistants (CNAs), may be more likely to steal company time, leading to poor patient care.

As a result of wasteful and other deviant actions at work, intervention is required. The rise in

home healthcare can be attributed to several factors, including financial pressures on

hospitals that shorten hospital stays, falling birth rates, and an increase in patients with

chronic illnesses and other morbidities. To provide effective, high-quality care that results in

satisfied customers and a positive health outcomes, it is essential to address the issue of time

banditry in the home care industry. This idea to adopt an intervention for an improved

outcome stems from the fact that time banditry is one counterproductive work habit that

could impact a patient's outcome (Ndikom, 2021). More attention is being paid to the quality

of care provided to the elderly as a result of individuals living longer. These include programs

that compensate nurses' aides fairly for the time and effort they put into caring for the elderly

while ensuring their patients' health, ADLs, quality of care, and proper supervision are

maintained.

States must implement the EVV system to provide a foundation for home-based care,

as mandated by the 21st Century Cures Act (Musumeci, Watts, & Chidambaram, 2020). To

prevent the neglect of sick patients at home and any possibility of falsely documented home

care visits, EVV is an essential computer-based method. The system was implemented to

reduce dishonest practices and ensure patients receive proper care in the comfort of their

homes. Compliance and other components of quality assurance in healthcare use it

extensively. Most healthcare organizations rely on it to track down their workers and verify

the accuracy of their healthcare documentation. Every state should consider using the EVV

system mandatory when it comes to healthcare.

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EVV Impacts on the Quality of Healthcare

To prevent patients from being forgotten and to reduce the number of incorrectly

documented home healthcare visits, a method called electronic visit verification (EVV) has

been developed. It was mandated by the 21st Century CURES Act1, passed by Congress in

2016 and revised in 2018 to prolong compliance deadlines, that all states adopt EVV. EVV is

used only in home healthcare settings rather than in hospitals. Tracking and maintaining a

home care organization with paper timesheets is arduous and time-consuming. Electronic

visit verification is primarily carried out through GPS tracking and computer software. It may

also involve the use of telehealth tools that enable medical professionals to work from remote

areas by just calling in. A GPS can be used to monitor where nurses are, or a "check-in"

system might be implemented to ensure that nurses and other healthcare workers clock in at

patients' residences. Companies use EVV to maintain details on their staff and determine

remuneration. Integrating with payroll systems, EVV permits healthcare organizations to

verify that nurses are adequately compensated. Nurses might use the system to report their

hours worked while also updating patient records.

The EVV's primary goal is to protect Medicaid resources from being misused, but it

will not do so at the expense of patient well-being or care. The EVV significantly affects care

quality since it facilitates expediency, improved procedures, and accessibility to medical

records. Using EVV, it is possible to see and track the actions of caregivers. Clients can

review and approve or reject the hours or services entered by the care provider at the point of

service, which is then visible to the agency. This electronic program enables clinicians to

record precise in and out times, guaranteeing that patients entirely use their allotted time.

Home health and hospice services benefit since clinicians can devote more time to direct

patient care than administrative tasks.

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A patient's needs and preferences are prioritized in today's medical system. For this

among other reasons, EVV is indispensable. Preparing for EVV use necessitates both the

installation of new technology and the implementation of providers must keep in mind why

they are going through this process and why it matters as they help their carer adjust to their

new responsibilities. To help doctors give their patients the best care possible, EVV was

developed.

The EVV technique would guarantee that workers spent their allotted time providing

the prescribed care, that time banditry was reduced, and that clients received sufficient

assistance with ADLs without undue sacrifice. Certified nursing assistants should be fairly

compensated because they know what is expected based on the client's care plan. The

organization's strategic goals are consistent with developing a practical electronic visit

verification platform that might improve timekeeping and health care providers to clients

while guaranteeing that CNAs are paid fairly for their efforts. Moreover, there will be less

opportunity for fraudulent billing.

To ensure they are paid fairly for their time, employees may be more motivated to

show up to work on time if they know they will be using EVV. The quality of care that CNAs

provide to senior citizens in their homes would improve if they were prompt. Achieving data

integrity, speedy and accurate documentation, the opportunity to use a care plan template, and

equitable pay for equal effort within home care while preventing fraudulent invoicing are the

goals of the EVV. Care givers who are compensated fairly for their efforts are less likely to

engage in dishonest time-theft tactics.

Effects of Regulations and Guidelines

People who deliver or receive Medicaid-funded in-home care services cannot escape

the ever-present specter of Electronic Visit Verification. Workers must confirm their job

many times a day via the app, which records their whereabouts and what they have been

doing. EVV technology has been lauded for streamlining service delivery, reducing "fraud,
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waste, and abuse," and better managing a workforce (Mateescu, 2021). Although the federal

law that mandated EVV for all Medicaid-funded personal health services intended the system

to be "minimally burdensome," EVV systems made workers' duties more challenging by

focusing more on monitoring compliance than providing care. The demands of EVV systems

frequently stretched employees' efforts to make their labor visible to digital systems. Even

minor infractions of the regulations governing these systems could result in payment delays

or losses. EVV systems are significantly more intrusive than necessary because of state-level

policies and technological design. Many people get swept up in the data-collecting methods

of EVV systems when they monitor workers. Workers, their families, and friends are not the

only ones impacted by monitoring technologies. The outcomes of these decisions affect many

people in profound ways.

Since it EVV requires a great deal of effort and time to deliver services in the patient's

home, community-based standards and criteria are becoming more severe (Spetz, Stone,

Chapman, & Bryant, 2019). In addition, a patient's right to confidentiality is intrinsically

related to EVV technology. EVV may appear to be nothing more than a distributed clock, but

it constitutes invasive surveillance of Medicaid participants' daily activities. Biometric data

utilization in automated verification systems raises additional concerns. Ohio's devices use

voice recordings and electronic signatures from a client to verify documented work. Public

discussion has been about whether biometric analysis is used for speech verification or where

this information is stored. Data collected for one purpose is rarely kept for that purpose alone.

When caregivers sign into an EVV device equipped with GPS, they can provide a detailed

and tractable record of where their patients have been (Gooding, 2019). Impliedly, a log of

activity that is otherwise private and shielded by the Fourth Amendment. Individuals

participating in EVV initiatives should take the initiative to confirm that their information

will be kept from other state entities for more excellent monitoring or law enforcement
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involvement. Information directly related to Medicaid eligibility is protected health data, but

information that can be utilized to infer Medicaid eligibility is not.

The HIPAA Privacy Rule applies to healthcare plans, care delivery clearinghouses,

and providers engaging in certain electronic healthcare transactions. It sets national standards

for protecting patients' medical records and other personally identifiable health information

(Moore & Frye, 2019). The HIPAA Privacy Rule restricts the uses and disclosures that may

be made of an individual's protected health information without their authorization and

mandates the implementation of procedures to ensure the confidentiality of this information.

Individuals have the right to access and get a copy of their health records and to request that

their protected health information be amended or sent to a third party in electronic format.

The medical community, patients, and healthcare providers all stand to gain from the

widespread implementation of electronic medical records (EMRs). However, many hospitals

and clinics may need to be faster to embrace EMRs due to security and privacy worries over

patient data (Keshta & Odeh, 2021). As a matter of utmost importance, the confidentiality of

individual patients' health records must be maintained at all times.

Methods for Increasing Care Quality, Protecting Patients, and Lowering Costs
In order to prove that a clinician visited a patient at home, EVV alerts the operations

team upon the clinician's arrival and departure. Checking in on care opportunities that may

have been missed is also part of the monitoring process. In terms of possible harm to the

patient, missed appointments are the most concerning. Multiple outcomes could occur due to

a missed visit. It is possible that the patient no longer requires care or is canceled because

they were unhappy with the staff. By keeping records on their employees' whereabouts and

activities, hospitals and clinics can lessen the likelihood of patient harm caused by

carelessness and attend to other personnel concerns.

Clinicians must adhere to the appropriate care plan for every patient to guarantee

successful outcomes and prompt payment for services rendered. One must watch for signs
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that a clinician is either under or over-servicing their patients. Healthcare providers can learn

valuable information by comparing the actual period of a patient's stay at home with the

planned length of stay. Clinicians can easily change plans and treatment levels to enhance

patient outcomes by accessing more accurate data. Patients and their loved ones can also

easily track the progress of their care over time.

Keeping an eye on how far and long employees travel on average can help keep

expenses in check and boost productivity. The time and distance traveled to a patient's house

should be recorded for every visit. In many jurisdictions, time spent traveling to and from

work is considered "working time," which can increase the likelihood of accruing overtime.

Examining the daily tally of agency personnel visits is also crucial. If an organization has a

firm grasp of these figures, it will be better positioned to develop reliable workforce

projections for any organization's development and expansion. By keeping close checks on

the relevant cost parameters, hospitals may bring their spending plans in line with their

spending habits and seal any income gaps. Time, attendance, and care plan data are just a few

examples of data that may be automatically collected with EVV. In real-time, providers and

care coordinators can monitor all aspects of a patient's treatment, from billing problems to

suspected fraud and abuse. Even though its primary function is fraud prevention, EVV is also

a potent tool for enhancing service value and quality of life.

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References

Braekers, K., Hartl , R. F., Parragh, S. N., & Tricoire, F. (2016). A Bi-objective Home Care

Scheduling Problem: Analyzing the Trade-Off Between Costs and Client

Inconvenience. European Journal of Operational Research, 248(2), 428-443.

Gooding, P. (2019). Mapping the Rise of Digital Mental Health Technologies: Emerging

Issues for Law and Society. International journal of law and psychiatry, 67, 101498.

Keshta, I., & Odeh, A. (2021). Security and privacy of electronic health records: Concerns

and challenges. Egyptian Informatics Journal, 22(2), 177-183.

Mateescu, A. (2021). Electronic Visit Verification: The Weight of Surveillance and the

Fracturing of Care. Available at SSRN 4181895.

Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: History, Protected Health

Information, and Privacy and Security Rules. Journal of Nuclear Medicine

Technology, 47(4), 269-272.

Musumeci, M., Watts, M., & Chidambaram, P. (2020). Key State Policy Choices About

Medicaid Home and Community-Based Services. Kaiser Family Foundation.

Ndikom, K. C. (2021). Use of Electronic Visit Verification System to Reduce Time Banditry

for Optimized Quality of Care in Home Health Care by Certified Nursing Assistants.

Xavier University.

Spetz, J., Stone, R. I., Chapman, S. A., & Bryant, N. (2019). Home and Community-Based

Workforce for Patients With Serious Illness Requires Support to Meet Growing

Needs. Health Affairs, 38(6), 902-909.