Kenyon Connects

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.

There’s no end to the information available today on leadership. Typically it is about how important it is. If it is written about so much and seems to be the secret for success, why isn’t great leadership present everywhere? Many people in management may manage processes and systems well, but they may not be great leaders or even leaders at all. So what does today’s healthcare market need in terms of leadership?

The Encarta World Dictionary defines leadership simply as “somebody who people follow, somebody who guides or directs others”. It sounds simple, but in working with groups and asking names of leaders that come to mind, there seems to be a void – few if anyone can come up with a name.

How we have led up to this point prior to health care reform isn’t necessarily going to work in the future. We will need to shift from managing an admission, episode or patient event to managing a population and achieve a quality, outcomes driven system. That means managers need to embrace leadership and be equipped with a different set of tools and skills in order to transform the healthcare system.

It is a time to reflect on oneself as a leader and improve any area that might prevent us from leading well. Are we leaders? If yes, how effective are we? How effective are we at embracing this new world? Do we know what the “new world” in healthcare might look like? How good are we at implementing new things and achieving a target, and sustaining it for months and years? How good are we at hiring well and systematically hiring for fit? How good are we at engaging people and having them enthusiastically follow you to achieve a goal? Are you an authentic and transparent leader? Are you a truth teller or do you tend to skirt away from an answer or bend the facts just a little toward your benefit? Are you able to speak up in opposition, respectfully? Do you have to be right? Do you take credit for wins or do you shine the light on others? Do you take feedback well that helps you improve?

Upon reflection of these questions, there is probably at least one each of us can identify with as an area and opportunity for growth.

No matter what healthcare arena we serve in, home health, homecare, hospice or another area, we need to be part of the solution in transforming the system. The start of transformation starts with good leadership.

We must be able to crystallize a vision of the future with the caveat that it requires revisiting since today’s leaders must be able to embrace ambiguity and uncertainty. What is clear is that tomorrow’s healthcare dream is to truly achieve a quality, value based system that is economical. Only courageous leaders will get us there. So what is needed?

First, find a trusted colleague or coach who can hold up the mirror and give you honest feedback to help you grow as a leader. To lead others well we must develop the habit of working harder on ourselves than others. While we must become masterful at coaching and mentoring others, it starts with ourselves. While in graduate school a few years ago, one instructor poignantly articulated the reality of the higher one goes up the hierarchical ladder in an organization, the less likely people will be honest with you. In positions of authority, this truth can’t be over-emphasized. I learned this the hard way and found it to be true.

Since all of us have strengths and weaknesses, it behooves us as leaders to know them and be good at improving both. The quest to become an effective and great leader can be lonely at times, eye opening in terms of other people’s perceptions of you compared to your own, a constant learning journey, highly rewarding if you listen and put what you have learned into practice.

Frankly, these transformational times are exciting. To think that at even government levels we are embracing the word “innovative” is unprecedented and should give hope. It is an opportune time to challenge current thinking. It is a time to lead with courage into a future that doesn’t have known details. The only known is that we have the requirement to provide a quality service with defined outcomes. Our customer’s lives depend on us succeeding. What a laudable goal to achieve. As leaders, a goal such as this doesn’t get better, does it?

Terri Wallin, CEO and Consultant Wallin Enterprises,
Transforming the way you do business.

Wallin Enterprises formed because of Terri’s drive to help organiza­tions succeed with culture and sys­tem transformation. With extensive experience in clinical, adminis­trative and executive operations, Terri is highly skilled in leading system design. Terri is sought out by leaders to speak to and coach others on improved business and system/process implementation. She is a published author on ar­ticles related to quality and busi­ness outcomes as a result of system transformation changes. She can be reached at terri@wallinenterprises.com or 206.755.7747. You can connect with Terri at www.linkedin.com/in/wallinenterprises

We are beginning to hear a great deal about ACOs these days, and many in the home health industry are trying to find ways to be included.  Of concern is the emerging potential that ACOs will try to create their own home care agencies and bypass the existing agencies in their areas. Now, as never before, home health has the opportunity to step front and center in the health care delivery system.  To prepare for this opportunity, home health agencies must understand the guidelines and focus of the demonstration projects. Knowing this will help agencies prepare to partner with any ACO that may be developed in their area, or, in an ideal world, be part of one that a strong home health agency has developed themselves. Continue reading “Accountable Care Organizations (ACOs) and Home Health: What are the Opportunities?” »

In recent posts I’ve explored some of the reasons why it would be beneficial for the home health industry if Nurse Practitioners (NPs), Advanced Practice Nurses (ARNPs), and Physician Assistants (PAs) were given more independence to make decisions about care and to sign off on important Medicare reimbursement paperwork.  This will be especially true if Congress goes ahead with its plans to cut Medicare payments to physicians and more and more doctors refuse to include Medicare patients in their practice. 

But there are even more reasons why greater independence should be granted to nurses:  the times simply demand it.  Continue reading “It’s Time To Turn Advanced Nurses Into Home Health Decision Makers” »

Even as Congress is contemplating making further cuts to Medicare payments to physicians, there are laws in the works that could dramatically reduce the administrative burden and costs for home health agencies.  The Home Health Care Planning Improvement Act would allow Nurse Practitioners (NPs), Advanced Practice Nurses (ARNPs), and Physician Assistants (PAs) to order home health services under Medicare. A bill that has been slowly moving through both the Senate and the House, a recent study commissioned by National Association for Home Care & Hospice (NAHC) found the Home Health Care Planning Improvement Act could potentially do even more to improve quality of care to millions of Americans. Continue reading “Could This Pending Law Save Home Health?” »

It looks like physicians are realizing what all of us in home health have known for the past eleven years: major cuts in Medicare payments hurt.

With Congress returning next week for a lame duck session, doctors and the AMA are stepping up their campaign to press lawmakers to put off the major reductions in Medicare payments that are scheduled to take effect in December 2010.  If Congress does not act, physicians who treat the elderly under the federal program will see a 23% cut in their fees starting December 1, 2010. Continue reading “Home Health Update: Physicians Lobby Against Medicare Fee Cuts” »

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.” »

In a recent editorial, noted health policy expert Kenneth E. Thorpe, PhD, Chair of the Department of Health Policy & Management at Emory University’s Rollins School of Public Health, took the recent Centers for Medicare and Medicaid Services (CMS) cuts in home health to task. Citing the successes of home health throughout the health care system as evidence, Thorpe decries the cuts and finds them to be both politically and fiscally irresponsible. Thorpe goes on further to state that, “…the one notion Democrats and Republicans can all rally behind is that quality, innovative, and cost-effective health care begins in the home.”

Those of us who spend our days in home health know, first hand, the value of the work we do. More than any other care delivery system in the country, home health reduces readmissions to hospitals, decreases nursing home admissions, and helps patients with chronic illnesses, such as diabetes and hypertension, to be monitored and receive medication in the comfort of their own homes. Continue reading “Health Policy Expert Recommends CMS Reconsider Home Health Cuts” »

The health care reform bill was big to say the least. There are so many elements and different timelines it is hard to know where to begin – and even more difficult to keep track of it all. Gratefully, someone has taken the time to put together the timelines for the implementation of the different pieces of the bill. Much to my surprise, and perhaps yours, many of the key elements were activated this year. No longer can insurance companies deny coverage based on pre-existing conditions, deny coverage to an adult child who is in college, increase rates without justifying the increase to a government panel, nor can they put lifetime dollar limits on care. Additionally, starting this year, small businesses will receive a tax credit for the health insurance they provide their employees. Over the next five years other elements of the bill will become active. For a full list of the issues and the timeline for initiation, click here.

Today, Thursday, September 23, 2010, is a banner day for Americans.  Eight important reforms in the Patient Protection and Affordable Care Act went into effect.  These reforms give Americans new rights and benefits, effective immediately.  While all provisions of the law will be in place by 2014, today we can all rest a little easier because:

• Lifetime Limits have been abolished: Prohibits insurance companies from imposing lifetime limits on benefits so that Americans with private insurance coverage will never have to worry about their coverage running out.

• Preventive Health Services are now covered:  All new plans must provide FREE coverage for over 100 preventive services, including mammograms for women over age 40, screenings for colorectal cancer for those over age 50, depression, smoking cessation programs, and autism for children age 18 months to 24 months.

• The Appeals Process has been improved: Requires that new group or individual health plans offer an effective process for appealing coverage decisions, such as refusals to cover procedures partially or at all. Consumers first file an internal appeal with their insurers, but if they are not satisfied they can appeal to an impartial reviewer.

• Rescissions are prohibited: Prohibits the abusive practice whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs.

• The ability to choose your own doctor has been enhanced: Expands consumer choice by ending the insurance company practice of limiting a consumer’s ability to choose a doctor in his/her own insurer network.

• Restrictions on Emergency Room care have ended: For new plans, consumers can no longer be charged more for emergency services obtained out-of-network.

• Pre-existing condition exclusions for children has been eliminated: Bars health insurance companies from placing pre-existing condition exclusions on coverage for children through age 18 for any new plans

• Coverage to young adults has been extended: Plans that provide dependent coverage to children must now make that coverage available until the child turns age 26.

We’ll keep a close eye on what’s changing and when.  As for now, the next new round of improvements will take place on January 1, 2011.  What a healthy way to celebrate the New Year!