Running a Home Health or Private Pay agency without some kind of objective indicator to tell you how your business is really doing is a little like driving without a map.  A professionally designed Dashboard (sometimes called a Scorecard) works just like a map and identifies clear signposts that tell you whether or not your agency is on the right track.  A Dashboard helps you make informed decisions, implement course corrections, and gives you the information you need to keep your agency viable, on track, and financially healthy.

Frequently, when I go into an agency to assist with either a turnaround or to initiate an interim management contract, I find the agency administration has no real understanding of what is behind the financial reports they receive each month.  They know they are not making their numbers but they do not really know why they are behind.  In one recent case, the agency was experiencing a decrease in referrals and subsequent loss of financial reimbursements.  However, no one on the team could figure out why. When I looked at their referral numbers, I became aware of the fact that two of their top referral sources had retired.  However, the agency, while aware of the retirement, had not responded to the need to replace those sources with new ones.  This, along with the fact that their case weights had been dropping, created a significance decrease in income.  The Dashboard I developed for them tracked referrals, cost of referrals, monthly cost of visits by discipline, revenue by payor, discharges, case weight, average reimbursement per episode, the number of down coded cases, and associated lost revenues, gross revenues, and net revenues.   This data gave them a heads up on where they were going and made it easy to make much needed course corrections.

In another recent contract, it was clear the agency was losing money, but there was no data that indicated where changes needed to be made.  They had no idea of their productivity by discipline or the cost per visit by discipline, nor could they identify their average case weight and reimbursement per episode.  Without this vital information, they did not know where to even start looking to fix the problems.  I developed a Dashboard that collected and tracked that information.  Within weeks, it became clear the field staff was taking twice as long as other staff in similar agencies to accomplish the same tasks, and their productivity rate was only two to three visits a day.

Another indicator the Dashboard identified was mileage.  The average miles per day were about thirty. The Requests for Anticipated Payment (RAP) were thirty days out, however, the case weight did not reflect the acuity of the clients.  All the data pointed to a lack of OASIS education for case management staff.  Once the staff was educated, they could easily be held accountable for their case management responsibilities.  This allowed case weights to rise and cost per visit to decrease.  The ability to monitor data and review it on a weekly basis made it easy and feasible for managers to make smart corrections. As a result, the finances of the agency greatly improved.

In another agency, I was asked to review a specialty program to determine why it was losing money.  The only information they were tracking was financial data.  After reviewing the project and conducting extensive interviews with the program manager, I determined the real problem was not the non-skilled workers (as the owner had thought) but clinical staff productivity.  Furthermore, after discussions with the CFO, it was clear that costs were being spread based on revenues, not on use of internal resources. This meant the data was so skewed that corrective actions to get the right results could not be made.  If the manager of the program had been using a Dashboard, she would have known right away that the financial data was skewed and that her real issue was her clinical staff.

There is no absolute rule as to what should be on your Dashboard, but at minimum, it is wise to track your sales, the cost of those sales, the conversions, the average number of visits or hours attached to cases, and the average reimbursement each case generates for the agency.  If you are a Medicare agency, you also want to track your average HHRG score and case weight, as well as the average reimbursement per episode of care tracked.

Regardless of what you track, your Dashboard is your weekly and monthly report card. Knowing where you are at all times can help Home Health and Private Pay agencies remain viable and successful. Keep your eye on your end goal as well as your emerging data, and your Dashboard will help you arrive at your desired destination on purpose and on time.

As a courtesy, I recommend you remind anyone involved with your agency about the new law. In a world where so many are uninsured, it is nice to be able to deliver some good news.

To build quality into your organization, you must have a clear idea of what your customer wants from you. The initial intake and assessment visit are critical to identifying your customer’s desires and needs. Failure to identify what they are looking for often leads to unmet expectations and an unhappy client or family. Whenever I’m brought into a Private Pay agency to help build their business, I always do a review of their intake practices. Often it’s just a matter of rewriting the questions so that they better reveal desires and outcomes. Once that is accomplished, the plan for implementation becomes much easier and has a higher chance of success.

The next step in quality is that all services must be delivered in a way that creates the ‘wow ‘ element for clients. This ‘wow moment starts with the first phone conversation with your intake staff and continues through all levels of the customer experience, including how your home aide delivers care. To accomplish a sustained ‘wow’ experience, you have to have a stellar staff that loves coming to work everyday

How do you accomplish that? Actually, it’s relatively easy: take care of your staff and they will take care of you. Offer your staff continuing education. This can be on-site training or connecting them with local colleges that provide courses that will increase their knowledge base. Develop career ladders and advancement opportunities for those employees who want more from their jobs. Pay your staff equitably and be generous with praise and compliments. Develop a culture of best customer service that can be seen and felt by your employees as well as your clients and referral sources. Turn your company into a “learning” organization: learn what your customers want and deliver what your staff needs to fulfill those expectations.

As competition becomes fiercer, the successful Private Pay agencies will be those that are committed to and master the culture of quality. Well-informed staff that can readily deliver the “wow” experience is the wave of the future and a guarantee you will have loyal customers. Jump on board now so you don’t get left behind.

Since there does not seem to be a magical solution to make this happen, many administrators I’ve talked to have begun using a profile tool to help eliminate glaring hiring mistakes. The profile is a compilation of all the attributes demonstrated by star employees who have successfully held a position in the past. For instance, one client developed a profile of the ‘best home care aide’ that included being a team player, reliable, dependable, responsive to requests, compassionate, able to listen, a critical thinker, a self starter, sought continuing education, and had a strong commitment to customer service.

When interviewing a potential employee, holding him or her up to this profile helps eliminate hires that clearly do not fit your needs. While this does not guarantee you will always find the best employee, I am told by clients who use this tool that it really helps eliminate hires that do not match their organization. Creating a clear, codified list of desirable traits rather than just going on your gut instinct will truly give you a leg up when you are interviewing a potential employee. Until someone invents a magic elixir to do the job, a profile tool will have to do – unless, like me, you want to vote for the head stamp. Now, that would make hiring easier!

In order to sell your product, your heart has to be engaged. Forget the phrase, ‘It’s only business.’ In order to succeed, you must have an emotional attachment to what you are selling. This is particularly true in the healthcare field. It’s a tough world, and illness, life, and death are part and parcel of the everyday experience, so you’d better believe in and love what you do. If your heart is not there, selling becomes a chore, and a difficult one at that. No matter how dynamic your marketing tools or magnetic your presentation, your referral sources will know if you’re faking it and are just in it for money.

This impassioned commitment has to be observable to all the people involved in your business structure: your customer, their families and friends, your referral sources, and your employees. Failure to recognize and stay committed puts your agency at risk for failure and creates an environment where it is almost impossible to build your reputation. Stay tuned for future posts where I will explore how to show your customers your commitment is real.

But that doesn’t make it right.

Great customer service is one of the basic rules of good business. Honestly, I’m a bit fussy about customer service, and my expectations are high. If a company doesn’t perform as it should or if an item isn’t delivered when promised, I always get on the phone and give them a chance to make it right. If a customer service department is nice and helpful, I’m a customer for life. On the other hand, they get one chance to fail and then I’m gone.

The same holds true for a home health agency. Think what happens when your homecare aide is late or doesn’t show up at all. Most customers are forgiving the first time but if this is repeated, they will probably go elsewhere. How many customers have you lost to poor customer service? Do you even know?

These are important details to track. When I ran my own agency, I kept a complaint log and put one on all my employees’ desks. Every week, we collated the responses in the logs to see if we had any trends. When we identified a pattern, we took immediate steps to correct it. Sometimes it was the level of worker we had hired, sometimes it was the failure of the scheduling staff to clearly communicate with the workers. Whatever the reason, as with first impressions, you only have a very limited opportunity to get things right — so do it right the first time.

Another thing to be on the lookout for is taking your customers for granted. Sometimes, when you’ve worked with a company for a long time, they begin to take you for granted. Their customer service slips, things start going wrong and they are less and less interested in quickly fixing the problems. If your homecare organization is doing that with long time referral sources or with any of your customers, you are setting yourself up for long-term failure. Over the years, I have watched good companies that excelled prosper, and mediocre companies fall off the business radar. The difference between the two was their dedication to customer service. It truly makes you or breaks you.

Orientation is one of the first opportunities to ‘wow’ your new employees and transform them from ‘newbie’ hires into loyal, dedicated team members. Yet, along with teambuilding, orientation is an opportunity to give employees a wide range of tools and skills that separate your agency from the pack.

While it may come as a surprise, cooking and cleaning are the new ‘must have’ skills that are helping agencies across the country achieve success. Clients who hire an agency to provide services usually want an aide whose actions reflect their own standards for fresh-cooked foods, meals prepared from scratch, and a house that is free of dust, dirt, and grime. Yet, ironically, one of the most common complaints I hear is that aides do not know how to cook or clean properly.

Recently, I designed a cooking and housekeeping curriculum for a client in the Northwest to use as part of her orientation.  It taught new aides how to cook, prepare a menu, shop for ingredients, store food properly, and present meals in an appetizing manner. The orientation also included housekeeping tips that support health and wellbeing.  As a result of this training, my client’s new hire success rate dramatically increased. A win-win situation: her aides felt more confident when they arrived at a new job, and her clients felt they were more than getting their money’s worth from the agency.

Integrating training modules during orientation are the wave of the future.  If you have a specialty service such as Alzheimer’s or Dementia, your staff must be properly trained so they can respond to and care for clients with those diseases.  Educating your staff to your customer service expectations can be empowering as well.  Quality customer service can pay huge dividends down the line in customer satisfaction and build your reputation in the marketplace.  Remember, word of mouth is still the best advertiser.  Jumpstarting this awareness during the orientation process will give your staff and your agency a leg up.

A comprehensive orientation takes three full days to complete.  Often owners feel they cannot afford this kind of investment and try to in-service their trainings throughout the year.  The truth is – that never happens.  Aide staff gets busy and the administrative staff gets sidetracked.  In an overwhelmed work environment, proper training is never completed.

A clear-cut, three-day orientation filled to the brim with vital information on a full range of subjects is the most cost-effective and results-oriented way to train your staff.  It is also an invaluable opportunity to send the message that they are valued and that you are willing to invest your time and energy to help them be successful in their jobs.

In my experience as a consultant, it never fails that agencies that offer a comprehensive orientation to new staff discover their investment pays off in the long run.  They can see it in retention rates, improved customer satisfaction, and increased revenues.

In my capacity as a home healthcare consultant, I’ve read hundreds of agency evaluations where clients go on and on about how fantastic their caregiver is and openly state how grateful they are to have such a loving and sweet person in their life. And then comes that final punch: she cannot cook to save her life.

Aides with adequate cooking skills are far and few between. Last year, when I was working with a client who runs a very successful home health agency, I heard what I believe is a very common complaint. A client’s daughter had asked the home care aide to broil her father a steak for dinner. Instead, the aide boiled the steak, which is how steaks are cooked in her native country. After some thought and discussion with the administrative staff, I decided it was time to develop a culinary arts program for the aides, particularly for those who live in, as they are almost always required to cook.

Drawing on my own skills as a cook, as well as the talents of an expert who heads the Culinary Arts Department of a Continuous Care Retirement Community in the Pacific Northwest, I set out to design a program for my client. The gentleman I worked with had years of experience running community-based kitchens, as well as a clear understanding of the type of person who is hired for a homecare department.

The Homecare Culinary Arts program we developed gives aides a full eight-hour day in a commercial kitchen with a professional dietitian and a chef. Aides spend the morning with the dietitian and the afternoon at the cook top and oven with the chef. Throughout the day, they learn about nutrition, diet, food buying, storage and preparation and, of course, cooking.

In addition, we developed a Kitchen Kit so that aides would have all the resources they needed to prepare and present meals in a safe and appealing way. The Kitchen Kit contains a three-ring binder, eighty laminated recipes, and two cutting boards (a green one for vegetables and fruit and a red one for meats and poultry). It also includes a container of commercial cleaner for the boards and other preparation surfaces, as well as gloves to wear while preparing food.

The aides who have completed this course report feeling much more confident about their cooking skills, and the agency has experienced a dramatic reduction in ‘cooking’ complaints. As an added bonus, the agency is now using their new Homecare Culinary Arts program as part of their marketing to attract new hires and, as a result, are seeing improved recruitment and retention rates. Best of all, now when a prospective client asks if an aide can cook, the agency manager can utter an enthusiastic, “Yes!” and absolutely mean it.

Often we start by investigating what a Comprehensive Organizational Assessment would look like. Let me say up front that the fee for this type of assessment is worth more than its weight in gold. I don’t say this to drum up business for myself or other consultants. It’s just that change can be tricky, and if you don’t have a clear idea of where you are, it’s difficult to carve out a path to a better future.

A Comprehensive Organizational Assessment gives a clear perspective on what is really going on in all facets of your business. Sometimes these are obvious. Sometimes things are not so apparent. Without exception, even the best-run agencies in the country have hidden issues that can put the organization at financial risk. Often these are small things that go unnoticed until they explode into serious problems. In the personnel arena, every agency I’ve ever worked with has had some degree of internal moral dilemma that impacts recruitment and retention.

Compliance is another area that bears scrutiny. Regulations change all the time and it is almost impossible to keep up with every shift. Even when staff truly feel they have covered all the details, Comprehensive Organizational Assessment invariably unearths areas of compliance weakness. These inadvertent slips can be serious and, if not corrected, can put an agency’s license at risk. A Comprehensive Organizational Assessment protects the ’big picture’ and gives you the necessary tools to make changes.

The last and possibly most convincing reason to undertake a Comprehensive Organizational Assessment is that it can bring to light quality issues that improve your outcomes and increase your Home Health Compare scores. The Internet is making the public much more savvy and aware, and it is easier than ever for potential clients to conduct extensive research about your organization. These scores are an important indicator, and the higher they are, the better it is for your reputation.

Traditionally, Comprehensive Organizational Assessments have been tied to interim management contracts. This trend, however, is changing. More and more agencies contact me just to conduct an organizational review. These agencies tend to be forward thinking and usually have an extremely good track record but want to do better. They are looking for a competitive advantage. They clearly understand that having an outside expert review their work and deliver a summary of findings with plans for improvement will give their agency a leg up. If you are feeling a bit like you can’t see the forest for the trees, a Comprehensive Organizational Assessment might be just the ticket to spark up your agency’s performance and give you the competitive advantage you need to go from good to great.

So how did we get from childhood immunizations to adult inoculations? Research is showing that parents and other adults are prime carriers of the disease and they are giving it to the children. While counter intuitive to everything I’ve ever said about kids being little “germ incubators,” it turns out adults often might be the worst offenders.

So what does this have to do with home health? Even though the rest of the country is not experiencing the epidemic, the CDC expects to see incidents of Pertussis rise in other parts of the country starting this fall. For you and your staff, it probably means a Pertussis booster is in order so we don’t take the disease to our clients, patients or their families. It also makes it more imperative than ever that we follow all communicable diseases among our staff and clients/patients.

The incubation period for Pertussis is seven to ten days. It starts with a mild fever, runny nose and sneezing. One to two weeks later, a slight cough develops into uncontrolled coughing fits. While transmission of Pertussis occurs during the fever, runny nose and sneezing period, it is also spread through respiratory droplets coughed into the air. But there are plenty of other diseases out there we should be aware of.

The most effective way to track communicable diseases is to mimic what I did with my kids and their shots: keep a Communicable Disease Log. This will allow you to report illness among staff, clients, or patients, along with symptoms and onset dates. If you identify a trend, it must be reported to your local health department. Additionally, it may be time to remind all home health, caregiving, and office staff that if they are sick, they should not come to work.

The bottom line is if someone thinks they are coming down with a cold, it could be Pertussis and they should STAY HOME. Now is the time to prepare your agency and staff for an impending epidemic.

Don’t have a log? You can download my Communicable Disease Log here.

Download Infection Control Log (Word Doc 26KB)