Time to Re-envision Your Agency

With continued cuts to Medicare Home Health, we are beginning to see some reputable Medicare Home Health agencies go out of business. To say the industry is in crisis would be an understatement. Living in the Medicare box can be very constraining and inhibits your vision. An inability to “see” beyond today can cause you to miss other opportunities outside the Medicare program.  So how do agencies survive? Perhaps now is the ideal opportunity to spread our wings and expand our horizons. While Medicare reimbursements decline, home health agencies need to look to other sources to make up the lost revenues.

Depending on your state, most Medicare Home Health agencies are already licensed to provide non-Medicare or government reimbursed services to their communities. Unfortunately, because of “Medicare think”, many agencies do not see or visualize other areas of service upon which they can expand. There are multiple opportunities in every community, depending on what the community looks like and what the community will pay for.

One potential profitable service an agency could develop would be an Occupational Health Program aimed at the small to middle sized businesses. Many larger companies already have an Occupational Health Program, or Employee Health program, and sometimes they are looking to outsource this service if the price is right.

To build a comprehensive Occupational Health Program, you need to know what business in your community views as value. To help them decide, you need to develop a catalog of potential services with associated prices that would make up their program. Elements of the program could include, but may not be limited to, the following;

• Monthly or biweekly or weekly Health Clinics for:

o BP checks with consulting and referral

o Diabetes check-ups, with consulting and referral o CHF check-ups with consulting and referral

o COPD check-ups with consulting and referral

o General health issues with consulting and referral

• Yearly flu shot clinics

• Pneumonia vaccine administration

• Health education and training (general)

• Health and safety training specific to the industry

• Health and Fitness classes

• Nutrition education and consulting

• Nurse Practitioner or physician examination and treatment

These are just a few of the services that could be offered through a comprehensive Occupational Health Program. If this is a program that would be viable in your area, you may want to engage the services of a Masters prepared Occupational Health Nurse Practitioner or a physician who specializes in this area of practice. You could add their services to the package which would potentially make the program more valuable to the prospective business owner. As you develop the program, and the marketing and sales plan, do not forget that community colleges are also employers and will sometimes buy some of the services you offer in an Occupational Health Program.

The goal of Kenyon Home Care Consulting is to encourage all Medicare home health agencies to begin to think beyond the Medicare box. Look for the opportunities that may exist in the community that will allow agency to not only survive, but to begin to thrive in the current environment of reimbursement cuts to their programs.

If you have found an opportunity, or need some assistance with identifying potential opportunities, contact Kenyon HomeCare Consulting. We can be reached at 206-721-5091 or by e-mailing gkenyon@kenyonhcc.com. We are here to help.

HELP! The Home Care Surveyors are here!

Have you ever said those words or heard them in your home care agency? All too often we are in agencies that react that way when the surveyors show up on the doorstep for the annual or semiannual survey. Panic sets in and everyone is on edge. Why? It’s usually because the homecare management is not sure everything is in order as it should be, and they are afraid they will be cited for deficiencies.  Minimize the “home care surveyor stress” with methodical systems that are maintained with a religious fervor.

Internal systems set up for compliance include:

• chart audits for completion of all required documents; e.g, initial assessment, care plan, signed orders and interim orders if clinical, visit notes that match the scheduled visits, and frequencies that match plan (again if Medicare Home Health).
• pre-billing audits to assure all required documents are in the file before the bills are submitted.
• personnel file audits to assure that all required documents are in the file including updated licenses, auto insurance, etc.

Clinical chart audits include:

• integrity of assessment to diagnosis and coding (if you are a Medicare Agency) and maintaining of the care plan with changes as appropriate.
• required supervisory visits.
• required reassessments especially for therapy (Medicare only agencies).

One of the most frequently cited items in a survey is the lack of congruency between the orders for the home care plans and what the home care aides report they are/are not doing. A home care aide plan of care needs to be followed exactly as written. If a client/patient does not wish a bath on the day it is scheduled, the aide should note that the client/patient declined, and not leave it blank.

The second most frequently cited area of the home care survey is the lack of updates to the plan of care for both the aide and any clinical services being delivered. Even if there are no changes, there must be evidence that the supervising staff member has reviewed the plan and signed and dated to that effect. Additionally, the medication profile requires maintenance. Even if you are only providing medication reminders to the client/patient, the profile must show evidence that it has been updated and is being maintained.

Staff education is another area worthy of attention and an audit system. For Medicare agencies, the required 12 hours a year of aide continuing education must be documented for each home care aide. For states that have mandated continuing education for aides in private duty agencies, there must be evidence that the aides have received the education. Some states require specific types of continuing education. Know your state laws and confirm you are keeping up with the requirements, and that your aides are attending the sessions as required and that the content matches the state requirements.

With strong internal systems in place and field supervisors effectively managing the external services mandated by the rules of the state and/or federal government, your home care survey issues will be minimized. Should you feel you need assistance with establishing any of the audit systems, call Kenyon HomeCare Consulting at 206-721-5091 or e-mail to gkenyon@kenyonhcc.com. We are here to help.

Website bounce rate is one of the most important metrics you should be tracking in your analytics. Bounce rates tell you what percentage of visitors click-away after viewing only one page of your website. This is obviously a critical statistic when you are trying to convert browsers into buyers. A simple mistake in your website strategy and design can send visitors away even if you offer the best homecare services in your area.

Here are 5 factors that may be boosting your homecare website’s bounce rate and tips to more effectively optimize your site:

1. No call to action. One of the main reasons visitors bounce from your website is that you haven’t made it easy for them to know what to do next. Attention spans are short (and even shorter online), so it’s important to make their experience smooth and natural to move from browsing mode to action mode. They want and expect guidance. They should know the next step to take within seconds of arriving on your website.

• How to fix it: Place calls to action strategically and prominently in the right places on the page. They should be above the fold and specifically relate to the reason a visitor landed on your website in the first place.

2. Too many options. While the call to action is important, having too many options will compete for visitors’ attention and cause confusion and frustration. This competition for attention naturally causes a higher bounce rate and the probability that the prospect will click-away from your website without taking the desired action.

• How to fix it: Stick to one option per landing page. If you want visitors to subscribe to your blog and buy your eBook, don’t ask for them to do both on the same page. Creating separate landing pages for each offer will reduce your bounce rate and result in higher conversions.

3. Unmet expectations. Visitors expect to see exactly what they asked for when they arrive at your website. If your page is about anything other than what is advertised, you can count on a higher bounce rate and lost revenue.

• How to fix it: Make sure the messaging in organic searches and referring sites is authentic and leads prospective customers to content that piqued their curiosity. Remember that the source of the lead can be just as important as the content on your website, so beware of referring sites that send you unqualified prospects.

4. Bad copy. Engaging, persuasive copy is crucial to reduce your website bounce rate and keep visitors wanting to learn more about your homecare services. The fastest way to lose prospective customers is to have dull, descriptive copy that doesn’t include the benefits of hiring your business.

• How to fix it: Create benefit-driven headlines, subheads, and bullets that make it easy for visitors to quickly scan content to see how your homecare company will fulfill their needs.

5. Poor design. A visually unappealing website is just as ineffective as bad copy. Put them together and you have a page that makes visitors flee to another site almost immediately – even if your homecare services are better than your competitors’. Template sites are the worst and are recognized by savvy visitors right away. An unprofessional design will hurt your credibility and increase your website bounce rate.

• How to fix it: Use high-resolution graphics, maintain your company’s branding, create an easy-to-navigate user experience, and make sure the copywriter and designer are literally on the same page. Your best bet is to hire a Web designer who knows your business and the intricacies of conversion optimization.

Avoid these common usability gaffs and implement these recommendations to reduce your website bounce rate and improve your conversion rate.

Scott Siders is the owner of Novo Writing, a company specializing in SEO (search engine optimization) copywriting and content marketing. Novo Writing works closely with businesses in a wide variety of industries to increase their exposure online, drive more traffic to their websites, and ultimately increase sales of their products and services. Novo Writing’s targeted online marketing strategies include optimized Web sites, article marketing, email marketing, blogs, social media, and much more. Get more information and start building a better brand by visiting www.NovoWriting.com, emailing scott@NovoWriting.com, or calling 714.335.5677.

There’s a lot of discussion about the education and learning needs of the home care caregiver staff; sometimes because it is required by law, and other times it’s because home care owners and administrators believe strongly in caregiver continuing education. However, how often do you hear about continuing education and training for the internal home care office staff? There are at least two major reasons to invest in the continuing education of your internal staff – a better educated staff means better service to customers and your continuing education investment goes a long way toward retention of this valuable resource.

One of the major challenges home care owners and administrators experience in providing this education and training is the lack of available courses or trainings that relate to the job the individual performs within the organization. That was one of my biggest challenges as a home care executive. It does require managers to employ creativity. Sending the receptionist to courses on “How to deal with difficult people”, as well as, courses on selling and phone presence was a real positive. The receptionist is the first contact with your agency and, therefore, creates the first impression. The old saying “you never get a second chance to make a first good impression” applies . A caller to your home care agency will make a decision about your agency in the first five seconds on the phone with your receptionist. If the exchange is less than positive, it takes an additional five to ten minutes with another person to revise a bad impression. Training your first line of contact is both desirable and critical to success of your agency.

The next position that is most frequently ignored is the billing and payroll clerical staff. If you do not have tenured payroll and billing staff in your office to train new employees, the employee will have to learn by trial and error. You want to avoid this if at all possible. What do you do if you are a new agency, or have no tenured staff, and your payroll and billing staff is new to their role? One of the more creative solutions I have seen is to negotiate some time with a respected home care agency for your new employee to shadow the payroll and billing staff of their agency. Frequently the financial software company you use will have other users who are tenured business owners and can provide you with a contact for setting up the learning experience. There should also be training for the billing and payroll software that you acquire. The software companies usually provide direct training on-site for the software which is something you want to take advantage of even if it costs more to do so.

The next biggest challenge for continuing education for the internal home care staff is to find on-going courses or classes that will keep your employee engaged and learning. One of the things we did when I was a home care executive was to make selected in-services mandatory for all employees annually. The in-services included the internal home care staff. This achieved two things: it provided inclusiveness for all the staff, and it signified to the internal staff that we valued them and their contribution to the agency success. Some of the mandatory in-services included customer service updates, safety in the workplace, and the staff “Brain Storming for the Future”. “Brain Storming for the Future” was an opportunity for all the staff to dream about the future of the organization, where they would like to see it go, and how that future would look and feel. All staff participated and contributed from their perspective position in the organization. It is a great way to build your teams and your home care organization.

The bottom line for your home care organization is that you recognize and invest in the internal staff of the home care agency. Undoubtedly, other home care agencies have other additional creative training and education opportunities for the internal staff. We would love to hear about them from you.

Each member of your home care is a valuable asset. To keep them interested and growing, learning opportunities must be provided for all. If you need assistance in designing an in-service training for your internal staff, or assistance with the overall management of the home care agency, call Ginny Kenyon at 206-721-5091 or e-mail gkenyon@kenyonhcc.com. We are here to help.

Many home care agencies strive for and claim they have excellent services, but rarely do we ever hear a home care agency talk about a culture of excellence  - one that sets them apart from other home care agencies. This discussion is essential for home health leadership. To better understand how to create a culture of excellence, we must first understand the two elements: culture and excellence.

What is organizational culture and why should it be of any concern for the busy home health executive? We go into many agencies that are self described as in a state of chaos or decline and are desperately in need of major change to correct the direction of the agency. We find the best laid plans fail because the culture of the organization does not support the changes being made. Understanding organizational culture helps us better understand this conflict.

Gareth Morgan describes organizational culture as: “The set of beliefs, values, and norms, together with symbols like dramatized events and personalities that represents the unique character of an organization, and provides the context for action in it and by it.” Beliefs and values are words that will pop up in other definitions, as well. Norms are described as traditions, structure of authority, or routines.” (From AdChoices)

Beliefs, values and norms are very powerful forces in a home health agency. How do beliefs, values, and norms originate? And, how do you change them if they are contrary to where the home care agency needs to go? Unlike creativity and entrepreneurial attributes, which are randomly spread throughout an agency, culture is created and sustained by the home health agency leader.

Culture starts at the top. If you, the home health executive, want to create a culture of excellence, you must first look at yourself. As an executive, this was the hardest thing I ever had to do! Yet, as it turns out, it has been and continues to be the greatest gift I have given to myself and those with whom I work.  Ask yourself, “If I was one of my employees, would I like working with me? Why or why not? The answers may surprise you. They did for me.

As a home health leader who creates a culture of excellence, you must inspire trust, safety, enthusiasm, appreciation, respect, inspiration and acceptance. How to gain this is the hardest and longest process of all. To begin this process, ask yourself the following:

~ Have I ever worked in an organization where I felt trust, safety, enthusiasm, appreciation, respect, inspiration and acceptance? Who was the leader? What were the traits they exemplified that lead to my feeling of joy in the organization? (I do not use the word joy lightly. People working in a culture of excellence have a feeling of joy in their jobs.) Make a list of all the attributes you appreciate in that leader.

~ What were their behaviors? How did these behaviors make you feel? List those as well. Be as detailed as you can be as this will help you model the behavior you want to emulate.

Excellence is the result of culture and a concerted effort to reward and honor the efforts and outcomes of all the individuals in the home health agency. Excellence is meeting and exceeding the expectations of your customer. Do you know who your customers are? Do you know their expectations of you and your staff? To shape a culture of excellence, everyone in the home care agency must have a clear idea of who are their customers… This includes the individuals we care for, their families, and the friends and neighbors involved in their life… Also included in the definition of the customer are all the individuals that refer potential clients to your home care agency. And, we can’t forget all your employees are customers to you and to each other. Multiple research projects have been conducted on staff retention. The top ten reasons cited for why employees remain loyal to their companies are:

1. Exciting work and challenge
2. Career growth, learning and development
3. Working with great people
4. Fair pay
5. Supportive management/good boss
6. Being recognized, valued and respected
7. Benefits
8. Meaningful work and making a difference
9. Pride in the organization, its mission and its products
10. Great work environment and culture

A culture that nurtures excellence stimulates what employee’s value about their organizations. An organization that fulfills all the ten listed values is an organization that has a culture of excellence. To build that culture of excellence, it starts with the top.

While all of the customer elements are important, the one most often missed, and the most critical for building a culture of excellence, is everyone involved within your home care agency is a customer of each other. If you are ready to create a home care agency with a culture of excellence, Kenyon HomeCare Consulting has a long history of assisting agencies to achieve excellence. We can be reached by e-mailing gkenyon@kenyonhcc.com or calling 206-721-5091.

Leading economists are predicting a gradual improvement in our economy this year.  This could bode well for all of us in Home Health, Hospice and Home Care (Private Pay).  As our economy improves, so will the financial status of many of our Home Health, Hospice and Home Care (Private Pay) clients.

So how do you take advantage of the resurgence of the market and the opportunities that this brings to your agency? Some already have a plan and we applaud you for that.  Every year should start with a plan for the year that includes where you are headed, your goals and your expected outcomes. The plan should also include how you are going to achieve those goals. Now more than ever those plans should include diversification strategies.

Home Health & Hospice Executive Coaching

Coaching support may be needed for some Home Health, Hospice and Home Care (Private Pay) agencies. Being able to look at your communities with a seasoned Home Health, Hospice and Home Care (Private Pay) Coach can make the difference between smashing success and mediocre results.  Having someone look objectively into your agency from the outside brings fresh insights and illuminates new opportunities that those inside the agency do not see or recognize.

As you start the new year, perhaps it is time to engage Home Health & Hospice Executive Coaching to assist you towards success in 2011.  To discover how, contact us.

Invariably, new clients ask why I include an extensive orientation program into the systems I design for them.  Often they are confused as to why I put so much time into it and don’t understand why they should pay for something that seems so obvious.  Orientation is much more than just familiarizing a new employee with the tasks you expect him or her to perform.  It is a tremendous opportunity to build staff loyalty, promote your public image, and help your business grow.     

As the saying goes, you never have a second chance to make a first impression.  Your orientation should start with who you are, the philosophy that drives your organization, and the belief that the people you have just hired are like gold to you.  In years past when I was running my own agencies, orientation was always a special day.  We created employee-specific handbooks for all new hires and made sure their name was on it.  For added flair, we placed a red rose on each book.  Continue reading “A Strong Orientation Program Lets Home Care Agencies Know Where They Stand” »

The contributions nurses make to the health and wellbeing of the patients we serve has a long history of positive results and outcomes.  Prior to the early 1920s, nurses worked with physicians as independent practitioners.  Nurses were sovereign in their decision making, and performed their jobs without interference or governance from any other discipline.

In the early 20s, the American Medical Association (AMA) began to see nurses as a threat to the fiscal stability of their medical practitioners.  Paul Starr’s enlightening book, “The Social Transformation of American Medicine,” outlines the purposeful and direct effort by the AMA to pass state and federal laws that put nursing under the direct control of doctors.  They were successful, and these laws, and more, are still in place today.

Yet, this stronghold is beginning to weaken. As modern healthcare puts more and more strain on our resources, nursing is reestablishing itself as a viable, strategic, and independent profession.  At the heart of this trend is the push for nurses to take their rightful role, in tandem with doctors, in the move to improve medical care in this country. Continue reading “Nurse Power: The New Voice In Home Health.” »

Are you beginning to feel like it is never going to end? Guess what? It isn’t. The latest data coming out of CMS indicates there has been a decline in the functional domain points that agencies are earning. The general feeling among OASIS-C experts is that when OASIS –C came out, most of us were so focused on the major changes in the wound care sections that we failed to pick up on the smaller changes in the functional areas.

While much of the wording looked the same, upon closer scrutiny it turns out these minor changes make huge differences in the scoring and, consequently, the points and the dollars. For those of you who read the Home Health Line newsletter, the July 12, 2010 issue gives excellent examples of how substantial these changes really are.

What is clear to me is that an assessment is not an interview. Our nurses and therapists must read the responses and be clear on the intent and meaning of each response. Most importantly, the assessing home health clinician must watch the patient demonstrate their functional ability. Continue reading “Surprise! CMS Did It Again and What We Need To Do To Fix It.” »

As we all know, Medicare is cutting back and there are continued issues with Medicare-Advantage and other insurance plans. This means home health agencies need to do everything possible to get the maximum allowable from Prospective Payment System (PPS) episodes. However, when I review the financial practices of many of the home health agencies I consult with, I invariably find my clients are leaving good money on the table because of inadequate assessments and coding errors. These mistakes or inadvertent omissions score patients for less than they should be scored. Undercoding takes away valuable resources yet is a relatively easy issue to fix.

In my own work, helping clients realign for financial and organizational growth invariably involves some degree of education and training. Making certain your entire staff is well versed in proper assessment and coding practices is an extremely effective way to ensure cash flows. Using a professionally designed dashboard will further help to align reimbursements. Continue reading “Home Health: Don’t Leave Good Money On The Table (Making the most out of PPS episodes)” »