Private Duty Nursing - A Historical Perspective
Private Duty Nursing originally started as patients or families hiring a nurse to care for a patient at home. The private duty nurse stayed at the patient's home and provided care for 24 hours, and nurses were hired and paid for by the patient. Early nursing schools trained the nurses mainly for Private Duty Nursing. Private Duty Nursing has evolved over a period of time to what it is today.
Private Duty Nursing is different from your traditional home health as it requires providing skilled care for medically fragile patients. Typically, the care is provided in longer shifts from 8 to 12 hours and for a limited number of patients over a longer period. These differences create unique challenges in scheduling, clinical documentation, communication, and billing.
COVID-19 has accelerated the trend of providing more and more skilled care at home. Patients prefer receiving professional care at home instead of a Skilled Nursing Facility or Hospital. Hospital at home and SNF at home models are being considered a lot more after COVID-19. Private Duty Nursing Home Care agencies are uniquely positioned to take advantage of this trend and grow. Private Duty Nursing Agencies can partner with Hospital Systems or Accountable Care Organizations (ACO) to provide skilled care at home.
Private Duty Home Care agencies can use the right technology and software platform to manage the challenges posed by unique and demanding requirements of providing skilled care at home. Using the right tools will enable home health care agencies to bring operational efficiencies to the organization and take advantage of these new opportunities.
Unique Challenges of Private Duty Nursing
The following are some of the unique challenges of providing Private Duty Nursing skilled care:
Scheduling
Private Duty Nursing requires scheduling nurses for long hourly shifts, unlike traditional home health. This is significantly different from visit-based scheduling. Finding clinicians with the right skills for Private Duty Nursing can struggle in the tight labor market. The following are the challenges Private Duty Nursing Home Care agencies face.
Quickly identifying a group of nurses with skills and availability matching patients' requirements
Communicating with nurses about available shifts and their willingness to accept the shift
Ensuring scheduled hours are within authorized hours
Working changing schedules easily and without a lot of manual efforts
Managing overtime, shift differentials, and split shifts to keep costs under control
Maintaining accuracy for billing and payroll
Clinical Documentation
Clinical documentation for Private Duty Nursing is significantly different from traditional visit-based home health documentation. In a long shift, nurses will have to juggle multiple treatments, like vitals, measurements, medication administration, etc., during the shift. The following are some of the challenges Private Duty Nursing Home Care Agencies face in clinical documentation.
Need to document care provided, like vitals, vents, seizures, etc. multiple times during the shift based on the order from the physician
Documenting Medication Administration and Treatment Administration with a long list of medications and treatments
Documenting interventions based on the care plan and frequency
Using generic Care Flow Sheets to document personalized care provided
Managing changes to medications, treatments, and care plans and transmitting these changes to the Point-of-Care in real-time
Juggling between providing quality care for a medically fragile patient and documenting the care provided promptly
Reviewing documentation for quality assurance and sending the documents to insurance companies and physicians
Communication
Private Duty Nursing Home Care Agencies provide care for patients with complex medical conditions. Communication with employees, patients, and clinicians is a major challenge. The following are some of the challenges agencies face:
Communication with nurses, patients, families, and physicians
Keeping a record of these communications
Communicating schedules, schedule changes, shift offers, and available shifts to employees
Real-time communication for modifications to medications, treatments, care plans, and care flow
Real-time alerts to nurses for missed medications, treatments, vitals, and measurements
Billing and Authorization
Private Duty Home Care Agencies work with multiple payers – Medicaid, Managed Care Plans, Commercial Insurances, and Private Pay. Working with different payers poses a multitude of challenges in obtaining authorizations and submitting claims. The following are some of the challenges agencies face in billing and authorization.
Working with multiple payers – Medicaid, Managed Care Plans, Commercial Insurances, and Private Pay
Meeting complex and constantly changing billing requirements for these payers
Obtaining authorizations timely and keeping the services provided under authorized hours
Reducing manual efforts to provide timely and appropriate clinical documentation with claims to payers
Leverage Technology to Address the Challenges of Private Duty Nursing
Even though technology might not be able to meet all the challenges faced by Private Duty Nursing Home Care Agencies, using the right technology and software platform will help the agencies meet most of these challenges. The following are some examples of how Home Healthcare Providers can use technology to address each functional area:
Scheduling
Although technology will not address the current labor shortage, it can help agencies efficiently manage their staff, improve productivity, and reduce costs by improving utilization. The following are some of the areas the right technology and software platform can assist.
Single integrated view to view and schedule all open shifts
Intelligent matching to present a potential list of employees based on their availability and match for the patient
Employee Portal to offer open and available shifts to employees and schedule their shifts when they accept
Provide alerts when an employee goes into overtime at the time of schedule to manage overtime cost-effectively
Prevent schedulers from scheduling shifts for patients when the authorization limit is reached
Ability to maintain one employee record for multiple services to consolidate time for payroll and overtime
Configurable schedule validations to reduce scheduling errors
Scheduling integrated with billing and accounts receivable
Clinical Documentation
Caring for patients with complex medical conditions is challenging by itself. Performing clinical documentation while providing care adds another layer of difficulty for the nurse providing skilled care at home. Right technology and software platform can ease the burden on nurses providing care. The following are some of the areas the right technology and software platform can assist.
Ability to switch back and forth to document vitals, measurements, medication administration, treatment administration, and interventions during the shift
Ability to document Medication Administration and Treatment Administration with a long list of medications and treatments
Option to document interventions based on the care plan and frequency
Ability to personalize patient care flow sheets and document
Easily update medication, treatment, and care plan changes
Real-time update of changes to medications, treatments, and care plan
Access to past clinical notes and clinical summary at point of care
Real-time alerts for missed vitals, measurements, medications, treatments, and interventions
Communication
Private Duty Nursing Agencies may underestimate the significance of effective communication in providing quality care for their patients. Agencies can leverage technology to meet communication challenges. The following are some of the areas in which the right technology and software platform will help:
HIPAA-compliant message tool to effectively communicate with employees and patients
Optionally convert message to a clinical record for the patient, if necessary
Easily accessible communication logs for patients and employees
Employee portal to communicate schedules, schedule changes, shift offers, and available shifts to employees
Real-time communication of changes to medications, treatments, care plans, and care flow
Real-time alerts to nurses for missed medications, treatments, vitals, and measurements
Access to past clinical notes and clinical summary
Patient Portal to communicate with patients and families
Billing and Authorization
Besides providing skilled care for medically fragile patients, Private Duty Home Care Agencies must work with multiple payers – Medicaid, Managed Care Plans, Commercial Insurances, and Private Pay. This significantly increases the complexity of billing for the services. Using the right technology and software platform will help agencies bill quickly and send accurate and clean claims. The following are some of the areas in which the agencies can leverage technology.
Integration with scheduling and clinical documentation to improve timely billing
Ability to prevent claims being sent without authorization
Built-in claims validations to send clean claims to payers
Configurable claims formats to meet complex and varying requirements (CMS-1500, UB-04)
Ability to send claims directly to Medicaid
Easily prepare clinical documentation to send to payers
Conclusion
CareVoyant understands the demanding requirements to manage Private Duty Home Care Agencies providing skilled care for medically fragile patients while managing other services like Non-Medical Personal Care, HCBS, and Home Health. CareVoyant software platform offers the right technology and tools to help a Private Duty Home Care Agency manage the agency operations and improve efficiency.
ABOUT CAREVOYANT
CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.
CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.
For more information, please visit CareVoyant.com or call us at 1-888-463-6797.
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