When I was a kid and asked my Mother if I could go and play she would reply Yes, but. The “but” usually gave me appropriate safety parameters, such as: wear a heavy coat or curfew at 10 pm.

Later in life, I served a year in Vietnam and my one story is yes, while there I spent a week in a military field hospital, but it was for severe food poisoning caused by a bad tuna casserole at base camp. The “but” became a very important qualifier to the story.

So how does this apply to home health Medicare requirements?

There are aspects of the Medicare financial requirements for home health agencies (HHA) and hospices that fall into the category of yes, but. These three items are often cited by accreditation organizations, state surveyors and consultants:

1. Medicare requirement for accrual basis of accounting.

Provider Reimbursement Manual (CMS-Pub. 15-1) $2300. PRINCIPLE (excerpt) The cost data must be based on an approved method of cost finding and on the accrual basis of accounting.

The Medicare cost report is to be filed using the accrual basis of accounting. Yes, but Medicare does not require that your internal financial records be on the accrual basis. Many organizations prefer cash basis accounting for its simplicity and for their tax returns. You may choose to have your internal financial statements on the accrual basis but that is your decision and not a Medicare requirement. However, you do obtain better and more accurate information on the accrual basis of accounting. Providers who file cost reports need to convert their year-end financials from cash to accrual for the Medicare cost report.

(If you want a more detailed explanation of Medicare and Accrual Basis Accounting with cited regulations and examples, including the recording of PPS revenues, please contact me for a free copy of our whitepaper.)

2. Medicare requirement for operating budget.

ORGANIZATION, SERVICES, AND ADMINISTRATION 42 CFR 484.14

“Survey procedures for the application of conditions of participation for home health agencies interpretive guidelines.

Annual operating budget. There is an annual operating budget that includes all anticipated income and expenses related to items that would, under generally accepted accounting principles, be considered income and expense items.”

The surveyors often cite the providers for not being in compliance with this.

Yes, but not once……..twice;

a. Generally accepted accounting principles (GAAP) GAAP has no format or template for an annual operating budget. The American Institute of Certified Public Accountants (AICPA) does not have a format or template for a budget and neither does Medicare.

b. What kind of budget? There are more types of budgets than Henry the VIII had wives (6). An annual budget can be cash, fixed, variable, semi-variable, visit or day or episode based, seasonally adjusted, detailed monthly, detailed weekly, inflation adjusted, FIFO or LIFO. You can even have an annual budget based on 53 weeks which some Medicare providers do.

The key aspect here is ANNUAL which does mean updating and implied is the using of the budget. Don’t allow yourself to be cited for not having a proper annual budget as “proper” clearly is subject to discussion. However, you must HAVE an annual budget to have the discussion of the budget’s merit.

3. Medicare requirement for Capital Expenditure Plan.

CMS-MANUALS Section 484.14(i)(2) Standard:

“(i)There is a capital expenditure plan for at least a 3-year period, including the operating budget year. The plan includes and identifies in detail the anticipated sources of financing for, and the objectives of, each anticipated expenditure of more than $600,000 for items that would, under generally accepted accounting principles, be considered capital items.”

Yes, but how many home health care business providers plan to spend more than $600,000 in a three year period?

The key aspect here is to HAVE a capital expenditure plan even if it states the plan is not to have one. The acknowledgement of the requirement is what many of the surveyors are looking for. Please contact me if you want a draft plan that some of our clients have used.

Yes, a Medicare certified provider needs to know the requirements for accrual accounting, budgeting and capital expenditure plan. But, they should also be aware that knowing some of the details can save money and maybe from being cited by a surveyor. http://www.youtube.com/watch?v=d2FT4FprxDg

About Thomas E. Boyd

Thomas E. Boyd has over thirty five years of Medicare reimbursement experience including almost twelve years with one of the Medicare intermediaries for home health providers. He has been a business consultant to the home health care industry since 1989 and is a principal of Boyd and Nicholas, Inc., THE COST REPORT PEOPLE(R).

Mr. Boyd has spoken on home health financial and compliance issues before NAHC, NHPCO and more than twenty state and regional home health care associations.

Tom has a BA in Management from Sonoma State University and a MBA from St. Mary’s College. He is a Certified Fraud Examiner. He is a member of the HHFMA workgroup, the Association of Certified Fraud Examiners, and the U.S. Chess Federation.

Visit www.boydandnicholas.com or contact Tom at tboyd@boydandnicholas.com

Related Articles:

Nurse Power: The New Voice In Home Health

The Surveyors Are Here

Salvation for Medicare Home Health Agencies in Times of Medicare Cuts

Most business owners understand the importance of regularly updating their blog with fresh and relevant content. It’s simply the most effective and affordable way to attract customers online. But there’s a big difference between knowing what to do and how to do it.

Let’s take a closer look at the “how” with the five-step process for creating a content marketing strategy that leverages your blog:

#1 – Know Your Target Audience
Before you begin creating content, you need to know who you’re writing for and what they’re interested in learning. Figure out where your target audience hangs out and go there regularly to see what they’re talking about. You can start this process by doing Google searches on the types of products and services you offer, which will lead you to relevant industry blogs and articles. Joining LinkedIn groups and participating in conversations is another excellent way to see what’s going on, as is setting up Google alerts on keywords related to your business.

#2 – Develop Your Plan
Once you know your target audience you can plan out the ways in which you’re going to create your own unique content to connect with them. Use the research you performed in step one to develop an editorial calendar with your article topics for each month. This will enable you to more easily manage the content creation process.

#3 – Write Your Content
Now that you know your target audience and have your editorial calendar completed, it’s time to write your articles. Generally speaking, you want to write articles that are about 500 words to show the search engines you’ve created a substantial piece of content. Make your articles easy for readers to scan by using subheads and bullet points.

It may sound obvious, but remember that editing is an important part of the writing process. The last thing you want to do is publish a poorly written article with grammatical and spelling mistakes. That will send your target audience to a competitor right away and will damage your brand and reputation.

#4 – Optimize Your Content
Your articles aren’t going to be very effective if nobody can find them, so you’ll want to optimize them for at least one primary keyword phrase. Link these keywords to other content on your website, such as your products and services pages, to encourage readers to explore more of your website.

#5 – Promote Your Content
There are many ways to start promoting your content. Once you’ve posted the article on your blog, you want to leverage social media to distribute it. Share it across all of your social media platforms that are relevant to your target audience, such as your status updates on LinkedIn, Facebook, and Twitter. Start a conversation on the article topic in your LinkedIn groups. You also want to make sure each blog post includes social sharing buttons so that people who read and like your content can share it on their social networks as well.

One More Thing . . .
An often overlooked but critical consideration is allocating resources–both people and financial. Effectively managing the entire content marketing process can’t be done when employees or business owners have spare time (a difficult thing to come by when you’re running a business). Plan for success by dedicating an experienced in-house resource or look into outsourcing this role to a professional.

That’s it! Now you know the “how” of implementing a content marketing strategy for your business. If you have any questions before you get started, don’t hesitate to contact us at 310.792.8888 or email scott@novowriting.com.

About Novo Writing
Novo Writing is a SEO copywriting firm that specializes in content marketing. The company’s Business Optimization Program helps position businesses and their leaders as industry experts, build brand awareness, drive more qualified prospects to their websites, and improve rankings in search results. Visit www.NovoWriting.com or call 310.792.8888 to learn more.

Related Articles:

Are You Giving Your Customers Quality SEO Content?

Inbound Marketing for Home Care: A Marketing Wave You Should be Riding

5 Factors That Boost Your Website Bounce Rate

At first glance, you may wonder how having “the right heart” has such a profound impact on a home care agency’s financial success but, remember, home care is first and foremost a people-centered business. Those in the home care industry deal with the most intimate parts of a person’s life. When a person, most likely the eldest daughter, engages an agency for home care for their loved one, it is both an emotional and a financial decision. While in some businesses, cost is the deciding factor, in the home care businesses, it is the emotional factors that tend to hold sway. If the decision-maker “feels” that one home care agency has a more caring attitude and heart over another, they likely opt for that agency – even if it is more expensive. It’s helpful if the home care owners have “the right heart” for the business but as long as the staff who closely interact with the client are caring and compassionate, the business does well.

Of all the positions in a home care agency, the most important for demonstrating “the right heart” are the intake staff and the sales/marketing staff. These crucial positions have first contact with the direct client or the referral sources. A good first impression is critical. That means demonstrating the compassion and caring that the customer desires.

The first assignment for any start-up home care agency is to conduct a competitive analysis by calling similar home care agencies in their geographical area. There are several powerful components to this exercise. You discover what services other home care agencies are offering, their fee structure for different services, what is included in their services and what is extra e.g. nursing assessment free or for a fee. Finally, and most important, you get a good sense for “the feel of the agency”. How do they come across during the interview? If you were looking for an agency to care for your loved one, would you consider any of the home care agencies interviewed? If so, why? If not, why not? Your response can be very telling about the kind of home care agency you want to create.

Several outcomes tend to hold true for this type of analysis. First, the majority of the home care agencies interviewed made a poor impression. The most common finding is the person taking the call does not engage the caller. They either lacked the information needed to assist the caller or they were more intent on scheduling an assessment than fully understanding the client’s needs. The second most reported off-putting point is getting an answering machine, leaving a message, and never hearing back. The caring and compassion did not come across. Having “the right heart” was missing.

The second benefit of the competitive analysis is determining the needs and desires of the referral sources. Again, the most common finding is the lack of differentiation between the various home care agencies interviewed or not much of an impression. Most home care agencies were described as “vanilla” – nothing special. Rarely did the marketing staff seek to find the needs of the referral sources but were more intent on “making a sale”. This is a classic sales mistake. In order for the sales person to be successful, they must come across as a caring and compassionate person and be able to demonstrate the agency differences – beyond their charming personality. The differences can be types of services, fee structures, selection and hiring of care giving staff, or a difference in training and education. The individual responsible for sales has to have “the right heart” and they must have something special and unique to offer that creates value for the referral sources.

What can we glean from these conclusions? These findings point out the importance of hiring the right people with “the right heart” to present as the first face to the public. If you are struggling with getting business and need some assistance, call Kenyon HomeCare Consulting at 206-721-5091 or e-mail gkenyon@kenyonhcc.com. We are here to help.

To develop a home care agency process with intent means the home care management has assessed the needs of a certain process and designed that process using the latest technology. It also means that the process meets the outcome needs of the organization, both the legal and the financial requirements. However, just creating the process, without monitoring, eventually leads to less effectiveness and a loss of profit. Home care agencies that regularly monitor the internal processes to make sure they are as streamlined as possible, achieve the best outcomes. By doing so, they know well in advance of any breakdown in the process, as well as, the fix for the problem.

To grow a successful home care agency, internal operations must be developed that clearly define the process for recruitment and hiring, orientation, staff retention, continuing education and training, client intake, assessment of new clients, scheduling and staffing, supervision, handling of complaints, quality improvement, personnel evaluations, payroll and billing, collections, budgeting process, development of the dashboard or scorecard, internal and external communications, and the computer system operations. Every process needs to have documented what will be done, how it will be done, who will do it, when it is to be accomplished, and what the lines of responsibility and authority are for each process. If these systems or processes are clear to all and followed as developed, the chances of success for the home care agency are much improved and lend to a positive net profit. The processes, once designed, are not static but dynamic and are always in need of review and potential redesign.

So that you may fully appreciate the complexity and the value that well-developed and continually monitored internal processes bring to your home care agency, let’s take a look at a prime example of process design and redesign as it relates to the accounting of time and activity by the home care field staff. Twenty years ago, 90% of agencies were operating on a paper system. All scheduling and validating shifts was done manually on paper. A typical designed process would be to have the scheduling books laid out by geographic area with a scheduler responsible for each area. Home care cases were opened and assigned to the scheduler for that area. The scheduler would enter the case in her scheduling book with the days of the week and the hours listed for each client. She would then call all the aides that were available for those times to see who was available to cover the shifts. Once she had the shifts filled, the hours to be covered were in the log book, along with the name of the caregiver who would be covering either the shifts or the visits. Needless to say, this was, and still is a very labor intensive process.

The validation process was even more time intensive. All caregivers were required to have their visit or shift notes for the previous week turned in by a certain day of the following week. This allowed the scheduler to validate that each scheduled shift or visit had a shift or visit note dated and signed by the client. Once this was accomplished, the schedule could be sent to payroll and billing to develop the aide paychecks and client invoices. It was not uncommon for the validation process to take two to three days. It wasn’t out of the ordinary to have lengthy exception lists of shifts or visits that did not match the schedule or those missing notes entirely.

Over the intervening years, there has been an explosion of software programs that have dramatically improved the process of scheduling and validating. The admitting home care staff has the ability to do the admission on a tablet with a stylus with Cloud connectivity. Once the document is completed and signed in the home, it is immediately available to the scheduling staff. With the current systems, the scheduler can query the home care software to select caregivers that are available and meet the care needs of the client. The scheduler can simultaneously send a text to the selected caregiving staff with notification of an available shift. The available caregiving staff can easily text or call their acceptance. This innovation makes it possible for a home care scheduler to handle up to 100 scheduled clients. Under the paper system the maximum number of clients a home care scheduler could handle was about 50 and sometimes that was beyond the ability of the staff to manage. We have even seen a home care operation where a team of 4 schedulers schedule and manage 10,000 shifts a week or more. That agency pays close attention to their internal operations and with the on-going help and suggestions of all the staff, has created a sophisticated software system using telephony that maximizes every staff member’s time and efforts. The rewards are increased revenues, decreased internal operation costs with increased net profits.

In addition, there are systems that use GPS technology that allows the caregiver to automatically be checked in when they arrive at their clients address and checks them out when they depart. No longer does the scheduler have to start calling the caregiver if they do not check in or out on time. The scheduler only calls the caregivers who do not arrive at the shift as scheduled. This alone decreased the workload by another 15% to 20% adding to further decrease your internal costs and increase your bottom line.

Creating your internal processes and monitoring them frequently for improvement is critical to your success. In the long run, it may be vital to your survival. If you are struggling with how to create your systems or are stuck trying to determine how to improve your internal operations, contact us at Kenyon HomeCare Consulting or call 206-721-5091. We are here to help!

When you and others hear the word “manager”, what are the conscious and subconscious connotations? Do you think control, process, and responsibility? Likewise, what are the implications for the word “leader”? Do you think people, creativity, and charisma? The confusing part is when these descriptive phrases are assigned to the “manager”. Although the portrayal seems identical to the words used to describe a “leader”, there is a distinct difference between the two words and, subsequently, between the two roles. For that reason, a manager handles the budget, the work flow, the supplies etc. If you are in a position of authority in an organization and your responsibilities include people, the only successful role in working with your staff is to lead.

There is a great deal of information in the literature about management and leadership. One of the latest article on the qualities and characteristics of a good manager listed the following:

25 Attributes of a Good Manager: Self-Motivation: Integrity: Dependability/Reliability: Optimism: Confidence: Calmness: Flexibility: Industry Knowledge: Know When to Delegate: Organization: Basic Money Management: Business Hierarchy: Legal Implications: Written Communication: Public Speaking: Constructive Feedback: Active Listening: Ability to be Specific: Ability to Organize Presentations: Customer Service focus: Mediator: Team Player: Respect: Collaboration: Value Others (Posted on October 19, 2011 by Forbes)

While these attributes were meant to portray a manager, many if not most, also depict subsets of leader characterization. Nevertheless, there are distinct differences.

A recent article on The Seven Leadership Qualities of Great Leaders by Brian Tracy, provided additional insights into the differences.

First, “Great leaders have vision. They can see into the future. They have a clear, exciting idea of where they are going and what they are trying to accomplish and are excellent at strategic planning. This quality separates them from managers. Having a clear vision turns the individual into a special type of person. This quality of vision changes a ‘transactional manager’ into a “transformational leader.’ While a manager gets the job done, great leaders tap into the emotions of their employees.”

Second they have courage to take risks even when there is no assurance that there will be success.

Third the leader has integrity. “The core of integrity is truthfulness. Integrity requires that you always tell the truth, to all people, in every situation. Truthfulness is the foundation quality of the trust that is necessary for the success of any business.”

Fourth is humility. Humility is the willingness to admit when you are wrong, to admit you do not have all the answers and to take the blame when things go wrong and to give credit to others when there is success

Fifth is the ability to do Strategic Planning. “Great leaders are outstanding at strategic planning. They have the ability to look ahead, to anticipate with some accuracy where the industry and the markets are going.”

The Sixth attribute is the ability to focus on the needs of the company and help everyone else in the organization stay focused and concentrate on what each one needs to do to realize the goals and aspirations of the organization and individuals within.

The final and seventh attribute is cooperation, or the ability to get everyone working and pulling together is essential to your success. “Leadership is the ability to get people to work for you because they want to. Gain the cooperation of others by making a commitment to get along well with each key person every single day. You always have a choice when it comes to a task: You can do it yourself, or you can get someone else to do it for you. Which is it going to be?”  

In reading this, you may decide that you are a combination of both leader and manager. That’s likely true of most of us. However, if the primary responsibility of your role in the organization is for people and their well-being and performance, look closer at your leadership profile. Remember, you manage things and you lead people.

If you are managing when you should be leading and are struggling with this concept, give us a call. Kenyon HomeCare Consulting is an expert in mentoring and helping others develop leadership skills. Contact us at 206-721-5091 or e-mail Ginny Kenyon at Kenyon HomeCare Consulting. We are here to help.

The article reads as follows:

“Existing research on house-call programs point to their benefits. A study published last June in Health Affairs showed that costs for patients in a Hospital at Home program at Albuquerque, N.M.-based Presbyterian Healthcare Services were 19% lower than for similar inpatients, in part because of shorter stays, and fewer lab and diagnostic tests. Patients with conditions including pneumonia, congestive heart failure and urinary-tract infections who are sick enough to require hospitalization and live within 25 miles are “admitted” in their home. They are then visited daily by a physician and once or twice daily by nurses who administer infusions and perform routine lab tests and procedures”.

It’s no secret that the salaries and wages of home care staff is considerably less than hospital based staff. Home health is much more cost effective. Additionally, home visits are what Home Care staff are trained for. They do not need to factor home visits into their already busy inpatient schedule like the hospital staff nurse and nurse practitioners. This new opportunity, however, will require home care nurses and aides to become better educated about the acute aspects of chronic diseases and the care required. In addition, this will require a much closer relationship with the acute environments, including physician groups. We will be looking at true partnerships with each partner bringing their specialty to the mix for the benefit of the patient, as well as, other entities, like insurance plans, that share in the responsibility of caring for the patients.

CMS has indicated that there are 5 chronic diseases that account for over 80% of all Medicare expenditures. These diseases are COPD, CHF, Diabetes, Dementia, and Depression. To prepare for this opportunity, as mentioned above, all home care staff will need to become experts in caring for all phases of these diseases, as well as, the medications and treatments that are specific to each disease. Many nurses working in the home health field are familiar with and can provide adequate services for these diagnoses, however, adequate will not be enough for the future partnerships. All must become expert in those diseases and the management thereof.

While there is significant course work available to educate clinical staff on the 5 chronic e diagnoses, there is very little for the home care aides who must become our eyes, ears and noses in the home. Who spends the most time with these clients/patients? It is the home care Aide. Therefore, in order for an agency to partner with a Hospital at home, a Medical Home or an ACO, training and education for the home care aides must become a priority and it must be comprehensive.

This is a major change for the health care industry. Up to now, home care aides have been relegated to the role of “baby sitters” and not fully utilized to the benefit of the client/patient or the home care agency. We envision the training and education for the aides to be 8 to 12 hour courses for each diagnosis. The course material will focus on those areas the Aides will need to know to properly notify the nurses and help manage when the client/patient has an exacerbation of their disease.

The home care agencies that survive into the future will be those who see the future coming and prepare themselves with expert staff and data to provide the outcomes and client/patient satisfaction levels required by the potential partnerships.

If your agency is like many other agencies, the budget and available training staff for training is limited. If you need assistance with this critical endeavor to get in front of the future of your home care agency, please call  Ginny Kenyon at Kenyon HomeCare Consulting or call 206-721-5091.

As defined in Wikipedia, “interim management is the temporary provision of management resources and skills. Interim management can be seen as the short-term assignment of a proven heavyweight interim executive manager to manage a period of transition, crisis or change within an organization. In this situation, a permanent role may be unnecessary or impossible to find on short notice. Additionally, there may be nobody internally who is suitable for, or available to take up, the position in question.”

Unfortunately, we find that home care agencies see this interim management position as a place holder only and, as a result, do not get the full benefit of the interim management contract. Failure to fully use the expertise and time of the interim manager to re-envision, reform and make needed changes in the home care agency is a real lost opportunity.

“There are several factors that make the interim management offering increasingly popular and cost-effective to client organizations. These factors are characterized as a ‘value proposition’ that interim managers offer to their clients.”

“Although there is some variation at the elements of each interim management assignment, the following factors are typical of the interim management value proposition:

1. Return on investment. Interim managers add value by using their skills and expertise to help deliver an outcome, solution, service or mitigate risk that provides a meaningful ‘return on investment’ to a client. Interim managers are paid on the understanding of goals and objectives being performed and delivered, and not simply on the basis of attendance.
2. Speed. Interim managers can be in place within days as opposed to weeks or months which is essential when time constraints are paramount. Being practiced in engaging promptly with the situation, they become effective quickly upon joining a client organization. Because of their experience and expertise, interim managers also conduct and complete assignments effectively and with due speed.
3. Expertise. Interim managers typically operate at a senior level in the client organization, often being sensibly over-qualified for the roles they take on. They often bring skills and knowledge not otherwise in place, to address a specific skills gap or problem. Their experience and expertise enables them to be productive and make a noticeable impact from the outset, maximizing the likelihood of success.
4. Objectivity. Unencumbered by company politics or culture, interim managers provide a fresh perspective and are able to concentrate on what’s best for the business. Being independent operators, they are able to contribute honestly without constituting a threat to the incumbent management team. Not being part of a larger business they are not pressured to unnecessarily extend their assignment.
5. Accountability. Rather than taking on a purely advisory role, interim managers are managers who will take responsibility for and manage a business or project in their own right. They expect to be held accountable for results and by being instrumental in an assignment’s successful delivery. They give clients the peace of mind that the interim manager has stewardship of the project in hand.
6. Effectiveness. Operating at or near board-level gives interim managers the authority and credibility to effect significant change or transition within a company. Unlike a ‘temp’, they’re not just there to ‘hold the fort’. They actively add value to the client organization as a result of their expertise and approach, even when the work and the decisions to be made are difficult.
7. Commitment. Interim managers maintain high professional standards because their future work relies upon referrals and a successful track record. They therefore have a stake in the success of the assignments that they undertake.” Wikipedia the free Encyclopedia

Every productive home care interim management contract starts with a full organizational assessment. This ensures that the interim manager’s time is focused on those issues that place the home care agency most at risk. Once the issues are identified, expect the interim manager to outline a plan of action to address the identified issues with roles and responsibilities, and the goals to be achieved. The findings of the organizational assessment, along with the interim manager’s plan, are presented to the owners or corporate staff responsible for the home care agency for approval and to determine if there are other objects or issues that need to also be addressed.

It is recommended that the plan also be introduced to all home care staff, internal and field staff, so that all staff feel they are included and on board with the upcoming changes. Additionally, the staff most affected should have a separate meeting so their concerns can be addressed. Often we find that home care agencies are over-staffed in certain sections and cuts have to be made. It is the responsibility of the interim manager to address staff reduction concerns and set a plan for those eliminated from the home care organization. We would expect that this very difficult duty is handled with the utmost of respect and compassion for the eliminated individuals.

If it becomes essential that your organization finds the need to use an interim manager for a critical vacant position, please call Ginny Kenyon at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting. We’re here to help.

“Strategic planning determines where an organization is going over the next year or more, how it’s going to get there and how it’ll know if it got there or not.” (Carter McNamara MBA, PhD)

As noted earlier, strategic planning is a process that is a part of the organizations yearly activities. Many think this is a complicated and involved process. In reality, it is a simple process used to visualize your dreams for the future of your home care organization and implement the actions to make those dreams a reality. Simply put, strategic planning looks at three key points

• The present
• The future
• The plan (how to get from the present to your future)

The Present

“As you think about where your organization is now, you want to look at your foundational elements (mission and value) to make sure there has not been a change.” (My strategic plan)

While missions and values do not usually change, you want to re-visit them at least yearly to determine if they need to be modified or changed. The mission and values ultimately assist the management team in selecting those opportunities that match your home care agency and rejecting those that do not fit.

In conjunction with the review of the mission and values, an assessment analysis needs to be conducted to determine the agency’s current position, the strengths and weaknesses, including current threats and opportunities. This ensures that the strategic plan has a solid foundation.

The Future

This is the creative and exciting part of the process. The questions that determine the future of your home care agency are:

• Where is the home care agency going?
• What is the future that the home care agency wants to create? ‘

The basics of sustainable competitive advantage and your vision statement help define the future for your home care business:

“Sustainable competitive advantage: Sustainable competitive advantage explains what the home care agency is best at compared to the competitors. Each home care agency strives to create an advantage that continues to be competitive over the time. What can the agency be best at? What is its uniqueness? What can the home care organization potentially do better than any other organization?” “(My Strategic Plan)

“Vision statement: the home care vision is formulating a picture of what the home care organization’s future makeup will be and where the organization is headed. What will the home care agency look like in 5 to 10 years from now? “(My Strategic Plan)

The Plan

Building the roadmap to the future is the most time consuming element of the process, yet much like the home care plan of care for our clients/patients, it is the difference between failure or success. The process begins with developing long term and short term goals, and adds assigned responsibilities and time lines for achievement to each goal.

Effectively stated goals clearly tell what your home care agency wants to accomplish, when it is to accomplish it, how the home care agency is going to do it, and who’s going to be responsible. Each goal must be specific and measurable and include realistic targets for the plan.

Achieving your goals will require an honest look at what your home care agency will need to strengthen in terms of people, operations, and resources. Keeping employees, software, or operational systems that do not support your goals is a hard process to go through, but essential if the plan is to be successful.

Building the roadmap to the future of the home care agency is more vital now in this time of great change. Once built, it must be clearly disseminated throughout the organization, operationalized, and revised frequently to assure that your home care agency is on track…and stays on track.

Assistance with strategic planning is a core service of Kenyon HomeCare Consulting. If your home care agency needs support with this process, call Ginny Kenyon at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting.

Software is a good place to start. What software will you be or are you using? And, most importantly, is your staff using the software that way it is designed? All too often, while conducting a due diligence for sale or purchase, we find that a home care agency has a very good software product, but staff is doing “work around” because they want data or information in a different format. Do not allow “work around”! It increases costs and reduces the value of the company.

In addition to “work around”, we discover staff developing tracking sheets in excel or other programs. This only consumes their time and adds very little value to your home care agency. Regularly review all processes in your company for necessity and for value to the company in terms of information or data needed to make decisions. Systems and processes that are not adding value to the decision making process or document needed information need to be discontinued. Conduct a yearly evaluation of your systems and processes to make sure they meet the needs of your home care agency, add value, and are not taking staff time that serves no added value.

The recruitment and retention system is another internal system that needs to be reviewed and refined annually. As with other systems, the more routine you can make the system, the less time and money it costs. Who is responsible for placing caregiver ads, reviewing submissions to assure applicants meet requirements and for scheduling interviews and testing? When is this done and how many people need to be involved in the system? How often is the system reviewed for potential cost savings? In addition, what is the cost of the retention system? Is it achieving the desired results?

Payroll and billing is another essential part of the infrastructure. If you are on a computerized system with a good point of care application, most of the billing and payroll will be created when it is time to roll payroll or billing. In addition to the payroll and billing system, the system for collections will have a direct impact on the value of an agency. A sound collections system assures that your home care agency’s accounts receivable are never more than 45 days. This will also increase the value of the home care agency. The more automated your systems, the less the cost is to your operations and the more valuable your agency.

Your management team also influences the ultimate value of your home care company. Who is responsible for decision making in different areas of the home care agency? Frequently, we find the owner has retained decision making in their position. Failure to invest in your managers and give decision making authority over their areas of responsibility ultimately makes your company less valuable. Your job, as the owner, is to eventually make yourself obsolete. Doing so places the value in your home care agency – not you – when you’re ready to sell.

If you are having difficulty establishing internal systems that are cost effective and achieve desired results, Kenyon HomeCare Consulting is here to help. We are here for you. Call Ginny Kenyon at Kenyon HomeCare Consulting at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting. We are here for you.

Simply defined, quality is what our home health, home care and hospice customers and payors tell us it is. Expectations drive the quality issue. Since expectations can be broad based on who is defining them, how do we set a list of quality indicators that meet the customer’s expectations – indicators we can measure?

It is fair to say, because we are in the caregiving business, the first expectation of our customers is that our home care caregivers will care about them and their issues. That sounds pretty simple – until you define what caring looks like and how you’ll measure it. One measureable criteria is following the care plan. Is it being completed as designed? For home care, care plans are developed around the client’s wishes for care. If it is not being followed, we need to know why. It is also regulation that aides follow the plan of care.

Another element of measureable criteria for the care plan is the frequency with which the aide has identified needed changes to the plan and notified the supervisor that the client needs have changed. For clinical staff, the frequency of care plan updates and changes are also a clue to engagement and the quality of the care being provided. When the plan of care is not being followed, and there are no updates or changes to the care, it may be an indication that the caregivers are not engaged with the client/patient or are not “tuned” into the needs and wishes of the client/patient. While this is still a subjective measure, it can be used as an indicator of caring.

A second big issue for customers that relates directly to quality of care is the knowledge of the caregivers and their use of knowledge. Outcome measures, depending on how they are applied, can be a good indicator of expertise and skill in caring. For example, your private duty home care agency may expect aides to monitor the client’s blood sugar values and report when the values fall outside the range established by the clinician. The aide needs to be taught about blood values including how to read the monitors and determine if the reading is within or outside the established range. Additionally, the aides need to be taught the presenting symptoms of high and low blood sugar and what to do in each case for the client. Education and training are critical to quality home care services. IF there is one practice that will provide a strong return on investment, it is education and training of the field staff. Train, Train and train some more.

Whatever parameters you set to measure knowledge, it must be indicative of the diseases and disabilities common in the home care agency’s client case load and should be reflected in the ongoing in-service training program for the agency. For instance, if you have a high proportion of clients with Diabetes, we would expect that you would have initial and ongoing training for Diabetes. Thus, training is always driven by the caseload mix.

With competition becoming increasingly fierce, now more than ever, the agencies that win will be those perceived by their customers as caring and knowledgeable. So, while we all know how to track the agency’s financials and regulatory requirements, you also want to add quality indicators of caring and knowledge to the dashboard.

If you are struggling with trying to figure out how to increase the business of your home care agency and need some help with identifying and applying quality indicators to your agency call Ginny Kenyon at Kenyon HomeCare Consulting at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting. We’re happy to help.