In October 2000, the Prospective Payment System (PPS) replaced the Interim Payment System (IPS) and dramatic changes had to be made in the operations of home health agencies if they were going to prosper. The new payment system rewards efficient operations rather than operations that accumulate a lot of costs. PPS will give agencies the opportunity to prosper that IPS discouraged.

The Challenge of Managing Today's Warfarin Patient.

PPS was designed to drive efficiencies. The management of a homebound Coumadin®/warfarin patient could be a time-consuming patient if left to traditional means. INR values have been identified as a surrogate marker for effective care for chronic warfarin management. The narrow-therapeutic window established by physicians make it challenging to keep patients stable given the other medications and additional disease states impacting the patient INR.

The goal of managing the anticoagulated homebound patient is to quickly and accurately obtain an INR value, manage the therapy and counsel the patient accordingly.

Traditional means of managing warfarin patients do not fit into the design of the PPS. Drawing a blood sample and encountering delays in lab communication cost Home Healthcare Agencies [HHA] time and money. Delays in obtaining INR values affect the accuracy of the counseling patients receive. Even one meal can impact an impending INR value and alter a home visit. HHA's require real-time INR information in order to maximize the value of each patient encounter.

Communication is extremely important between the lab, doctor, home health agency and the patient. Phone calls, faxes, PDA and traditional documentation require time and coordination. Protocols help in remote management but offer no improvement on how HHA's obtain the INR values for their patients.

Home Health Agencies can optimize their patient care if some of the traditional bumps in the road were removed. A key bump remains obtaining an accurate, timely INR test. Delays in receiving INR tests require additional follow up for every INR outside the pre-determined target range. In the days of the Interim Payment System, an extra phone call or patient visit wouldn't be problem. Today's PPS encourages the most efficient means to manage the patient. While venous blood draws and outside labs are traditional – they are not the most efficient patient management process offered today.