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• Corecubed

  Corecubed helps home care agencies with everything from branding (including logo design) and corporate ID needs to website development, brochure development and any other need you may have. Our MOST program provides access to a library of themed sales, recruitment, design and advertising materials created by a team of home care and home health experts, to educate, communicate, and differentiate your agency.

  www.corecubed.com

• Creating a Culture of Excellence in Home Health

  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.

• Get in Lock-Down Mode to Keep Your Website Secure

  The Internet is an amazing tool for marketing, communicating and doing business, but the downside of the World Wide Web is that, unfortunately, nothing online can be absolutely guaranteed as 100 percent safe and secure. Viruses and malware can infiltrate computers, social media accounts, and websites. You can get infected without even knowing it, simply by visiting an already infected website, if your computer is not up to date on its software and security patches.

  Even the most sophisticated and seemingly secure sites are vulnerable to tech-savvy hackers. Luckily, however, website software is updated frequently with new features, enhancements, and fixes designed to patch holes or vulnerabilities in the software’s infrastructure to ultimately keep your site running smoothly and securely. So, if you have a website, it is essential to stay informed and up to date on the latest software for your site, or to partner with a legitimate firm that does just that. A monthly check of updates is essential, and immediate updates when a security patch is issued are imperative.

  Fighting a Cybercriminal Gang and Winning!

  WordPress is one of the most popular platforms to build websites, and last month, 30,000 WordPress blogs were hacked and infected by a “cybercriminal gang whose primary goal is to distribute rogue antivirus software,” according to this article from Networkworld.com. While these kinds of hacks are nothing new, what is most relevant is the following: “Many of the blogs compromised in these recent attacks were running outdated WordPress versions, had vulnerable plug-ins installed or had weak administrative passwords susceptible to brute force attacks,” said David Dede, a security researcher with website integrity monitoring firm Sucuri Security.

  When a business builds a website, it is oftentimes considered “done” and no updates or maintenance is secured. Unlike a brochure or a printed piece of marketing material, a website is a living and changing marketing/business tool. Many websites are compromised because site owners/administrators fail to keep their website software up to date; thus, vulnerabilities in the old software can be discovered and exploited. When a website is hacked, and there is a malicious result in visiting that site, Google may completely block the compromised website from being shown, adding it to a blacklist of infected pages. This blacklist is used by web browser companies to block known infected sites, so when users try to visit an infected site, a warning message is shown, informing them of the danger. This is helpful in that it helps prevent the virus from spreading, but it’s definitely not a good thing for your company’s website to be on that list. And it’s hard to remove that label even if the site has been cleaned.

  Playing It Safe

  The time and money involved in investigating and fixing these hacking messes far exceeds the time it takes to provide a simple maintenance strategy on an ongoing basis. In order to decrease your vulnerability online, follow these steps:

  • Keep the website software and back-end up to date: As mentioned earlier, website software is updated on a regular basis in order to keep sites safe. Either make a routine of updating your software on a regular basis or hire someone to do that. You can use this site: http://sitecheck.sucuri.net/scanner/ to search for known viruses on your website.

  • Strengthen all your passwords:A strong password limits the ability of hackers to gain access to your site. The U.S. Computer Emergency Readiness Team recommends the following when creating passwords:~ Don’t use passwords that are based on personal information that can be easily accessed or guessed.~ Don’t use words that can be found in any dictionary of any language.

    ~ Develop a mnemonic for remembering complex passwords.~ Use both lowercase and capital letters.

    ~ Use a combination of letters, numbers, and special characters.~ Use different passwords on different systems. Additionally, it’s a good idea to make your passwords at least 8 characters long. Check that any password access to a site is terminated when employees or web masters leave.

  • Keep an eye on your site: If a website does get infected, the site owner should be the first to know about it. Monitor your site regularly for signs of a virus and always have a routine back-up of the site. How do you know if your site has a virus? Things will look and act differently. If it feels strange to you, or unusual, then check it out.

  If a site gets hacked, it’s important for your business and marketing efforts to get it back online as quickly as possible to avoid being quarantined by Google. A good web developer will offer a maintenance plan and a service because, once a site is hacked, your site’s log files need to be examined to determine the source of the hack or virus. Once the source has been found and the virus has been cleaned, the web developer will download any necessary patches to prevent any further infections from happening, and clean up any messes that the hackers left behind.

  While there are laws against hacking, including 18 U.S.C. 1029, which deals with making and using devices and programs to gain unauthorized access to secure computer systems, the hackers are managing to keep ahead of the law in this still “wild frontier” of the Internet. In the case of website security, it seems that for now the best defense is a good, solid offense.

  Merrily Orsini, MSSW

  Merrily Orsini, MSSW, has a unique background that combines skills in technology and people. As President/CEO of corecubed, an internet marketing company, she works with talented staff to service clients in 35 states and Canada. Her roots and her passion, however, are in home care. She is a pioneer in the geriatric care managed in-home care model that she created, grew and sold in 1996, garnering her, for that venture, the prestigious Ernst & Young Entrepreneur of the Year Award for service businesses in Kentucky and Indiana.

  Visit her blog www.MerrilyOrsini.com to follow her weekly insights and read where she is speaking, and the articles she writes for national publications. Tweet her @MerrilyO and find her on FaceBook.com/merrily.orsini. See examples of her creative work at www.corecubed.com.

• Getting the most from your Home Care Software Vendor

  I love TV shows and movies that take me behind the scenes of an interesting place like a hospital, a counter-terrorism organization, or even a fashion magazine. With the one exception of The Social Network there’s not a lot of insider information for you to see about what happens inside of software companies, so today’s post will give you a few insider tips that you can use to get them most from your software vendor.

  Before digging into the insider tips, here are a few reasons why it’s in your best interest to maximize the value of your software:

  • Good software should allow you to focus more on providing quality care rather than administrative overhead
  • There might be a newer version of the software that is better than the one you’re using
  • You might not be using all of the features that can help you save time and money
  • You’re vendor might be able to innovate with you to achieve your next level of growth or innovation

  Here are a few tips to help you get the most value from your software:

  • Stay in touch with your vendor: If there are things that you don’t like and you don’t tell them, they can’t help you. If your vendor is a larger company, go to their user’s conference. If they’re on the smaller side, request a periodic discussion with them (e.g., Quarterly).
  • Suggestions work better than complaints: Chances are that your suggested improvements will benefit other customers of your vendor, too. So if you can tell your vendor how to make the software better, they’re likely to listen.
  • If there’s a bug, tell the vendor exactly how to reproduce it: The programmer assigned to investigate the issue might not be an expert on the software where the bug is or about your operations. If you can tell them the exact steps that they can use the produce the problem, they’ll be able to fix it faster.
  • The best software vendor relationships are strategic partnerships: As you set strategy, have a discussion with your software vendor about whether they can help you achieve your objectives. There’s a chance that incorporating your ideas will not only benefit you, but also help them to succeed.
  • Make sure to ask what’s on the vendor’s priority list: Understanding what the vendor is focused on can be helpful in several ways. First of all, they might be working on things that align with your strategy. If they’re not, it’s good for you to know what their focus is so that you can assess how long to stay with them.

  Even in large software companies, there is usually a single person who decides what changes to incorporate and in what priority order to make the changes. So you can be well served by following the above advice.

  Ken Accardi is a self proclaimed “home care software geek” who serves as Chief Technology Officer for the visionary software company Ankota. Their blog at www.ankota.com/blog focuses on home care technology, care delivery, home care entrepreneurship and the future of home care.

• Improve Your Home Care’s Efficiency & Profitability with Internal Processes

  Over the years, we have had the privilege of assisting more than 80 home care agencies to start, grow, and develop their business. In addition, we have provided organizational assessments to about half as many home care agencies. Needless to say, we have the unique opportunity to experience multiple organizations and their functions first hand. One of the most significant observations we have made is those organizations that establish their internal operating systems with intent are those that are the most effective and profitable.

  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!

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

  Inbound marketing continues to grow in importance for home care, and while it hasn’t made the more traditional outbound marketing techniques irrelevant, it is the way that more and more customers are finding the home care products and services they need. In fact, of all the daily online searches, nearly half (46%) are searches for information on products or services. This means clients are now looking for you, and not the other way around. Is your home care agency easy to find?

  In this new marketing landscape, home care agencies should be shifting considerable focus from pushing their services out to prospective clients to pulling customers into their sites with inbound marketing techniques. According to Google, 70% of the links that search users click are organic, or not paid. This means that shelling out money for pay-per-click ads probably won’t get your home care agency the return on investment you were hoping for. So it’s time to start focusing on relevant, search engine optimized content, social media, and blogging, all of which can help bring potential clients to your virtual doorstep.

  Use Your Website & Your Knowledge & Get Found

  A good way to show potential clients that your home care agency is a home care authority is to provide them with relevant, timely resources that help them solve a problem, make a decision, or simply inform them. Staying current with ever-changing industry information shows potential clients that you are an authority within your industry and understand clients’ needs.

  Including industry-related resources to your site is also great for search engine optimization, or SEO. While a home care agency’s website should be a hub of relevant information and communication, it should also be easy to find when potential clients are searching for the services you provide in your area. Search engine optimization is a key aspect of online marketing as inbound marketing continues to replace outbound marketing efforts (advertising, PR, email campaigns, etc) as the number one way in which consumers find the products and services they need. Industry-specific keywords help companies get found and get customers.

  In addition, incorporating a blog and staying current with social media can improve SEO and give a home care agency another forum in which to be found online. Blogging provides a virtual soapbox where agencies can voice their industry expertise and inform their customer-base with up-to-date information. Using keywords within your blog and posts on Facebook, Twitter, and LinkedIn will further your SEO efforts and help you be found on the great world wide web.

  A Match Made in Marketing Heaven

  With all the buzz and focus going to inbound marketing these days, it’s important not to neglect your tried and true outbound marketing. In fact, the two work together quite well. Ensure that your messaging across both inbound and outbound materials is uniform and targeted to the right audience, and include links to your website, blog, and social media sites on all print materials and email campaigns. Post news releases and print articles to your blog, and don’t forget to share them on Facebook! For a successful, well-balanced plan, use all your marketing strengths to create the total package.

  Merrily Orsini is the founder and manager of CoreCubed, a full service integrated marketing communications agency with a focus on using the internet as a component of a strategic branded approach. Specialty is senior and elder care businesses, the private pay industry in home care, home health, Hospice, hospitals, geriatric care management, assisted living and retirement communities. Experienced and successful in marketing to and reaching those seeking niche products and services targeted to a mature affluent audience. She if the creator of MOSTSM, the first industry turnkey monthly marketing communications program designed specifically to increase billable hours and referrals for private duty home care, home health and Hospice.

• The “Yes, But” That Saves You From Surveyors

  Guest article by Thomas E. Boyd, with Boyd & Nichols.

  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

   

• The Key to Home Health Care Survival: Diversification

  Thirty years ago most home health agencies were nonprofit Medicare agencies. Many had private pay home care as part of the organization services. At that time, most of the Medicare agencies were VNAs or attached to a hospital system. We had our Medicare caseload and he private pay which also included the DSHS Chore Services personal care program. There were few free standing private pay agencies.

  Approximately twenty years ago, many of the Medicare home care agencies began to drop their private pay programs. At that time the Health Care Financing Agency, HCFA, now CMS, began to allow for-profit organizations to participate in the Medicare Home Health benefit. When the Medicare rule enforcement began, agencies that ran private pay home care with the Medicare began to close the private pay sections because they were losing money. Running the agencies under the Medicare license were considerably costly with less income to balance the P&L.

  We are now coming full circle with Medicare Home Health and Private Pay services. We see articles in the industry media about the need for diversification. They allude to the inclusion of home care private pay services as another revenue stream for the Medicare Certified agencies. For Medicare Home Health agencies considering this move, there is one word of caution: run the new private pay company under a separate license.

  In looking back at why Medicare Home Health and Hospice agencies divested themselves of the private pay, it is clear that applying the Medicare rules to private pay made the private pay business a loser. In addition, the home care private pay business is a very different type of business and must be run differently. While Medicare is highly regulated, private pay is either moderately regulated or not regulated at all depending on the state. Managers of home care private pay agencies must be open minded and able to respond to the environment without regard to the constraints of Medicare. We have found that Medicare Home Health or Hospice staff has difficulty moving out of the regulated box they live in. Our recommendations if you’re considering this addition? Run the home care private pay under a separate license with different home care staff.

  Diversification, to include a private pay program, may still not be enough for a home care agency to survive in today’s business. As the competition becomes more intense for the private pay line of business, we see the need for home care private pay agencies to differentiate themselves from others. No longer will the tried and true personal care services only guarantee success. Private pay home health must add additional streams of revenue in order to survive and grow. There is no single set of services that will fit all agencies. Just as all politics is local, so are home care services.

  Diversification takes two different forms in the private pay industry: additional lines of services like Cruise Companions, Day Surgery Support, Mom and Babe, pharmacy drug reviews with recommendations and counseling, home modifications and Holiday Helpers just to name a few, and value-added products that are part of the service packages. Value-added products include such things as Life Alerts, pharmacy discount and delivery, and financial management support. When addressing value-added services, the services are included in the hourly or daily rate. The clients do not pay extra for these services or products. They are part of agency package. As long as the client is a customer of the agency, they automatically receive the product or service. The cost of the value-added is embedded in the hourly or daily rate by calculating the cost of the value-added feature and dividing that cost by the hours or days of services currently provided by the agency. Sometimes the extra charge is as little as $25/hour more with the benefit to your client being many times greater!

  Whatever services or value-added elements you select, make sure your particular customers view these services or products as added value they are willing to pay for. With this in mind it is critical that you survey your customers to make sure they see what you have to offer is something they want.

  If you need help determining what other services or value added elements would be appropriate for your home care agency to go beyond mere survival, call Ginny Kenyon at 206-721-5091 or e-mail us at Kenyon HomeCare Consulting. We are here to help.

• The Surveyors Are Here

  As an administrator of Home Health, Hospice and/or Home Care sometimes those are the last words you want to hear. As a Home Care consultant, I realize I am not the only one who ever felt that way. Over the course of time I’ve learned how to no longer fear those words because I knew that my house was in order. Getting your home health agency in order can be a tall order with all the federal, state, agency and program rules, but it is achievable. Living from survey to survey is not the way to run a home health agency. There are steps that you, the home care administrator, can take to assure all is as it should be when the surveyors walk through the doors of your home care agency.

  The first step is to understand the rules of each of the home care programs for which your home care agency is accountable. The clinical director and each supervisor must understand the Conditions of Participation for Medicare Home Health or Hospice depending on their program responsibilities. Additionally, they need to know the state rules, as well as Department rules, if you are working with any special programs in Medicaid. Your own company rules add an additional layer to this complicated set of rules.

  During the course of the reading of the rules, you will find that several questions arise as to interpretation and required process inherent in the rule. When this occurs, your national and/or state home care associations are available to assist. If your state has a strong survey team, they can also be helpful in interpretation of the rules and what the state or the program is expecting. You may find that surveyors have their own interpretations and you need to validate or disprove those.

  Knowing the rules and the correct interpretations will help during a survey if you are being told to do something that you know is not the rule. For Medicare Home Health and Hospice rules in general for the Medicare program you can access the State Operating Manual through CMS. It is highly recommended that you have a copy, either electronically or paper, for your staff to access when there is a question on the Medicare programs. For the state rules, it is suggested that you have a current copy available to the staff. This applies, as well, to any special programs you provide services for through the state. The bottom line? Have the available resources and a culture of inquiry when rule questions come up. Only with full understanding of the rules and the requirements can you make the needed changes.

  The next step is to make any process changes needed as a part of the discovery in the rules. The rules give you great latitude as to how they are implemented. The outcome is that you must achieve what the rule requires. To that end, every policy and procedure needs to be reviewed for compliance with the rules, and to determine if the process is achieving the desired outcome in the most efficient and effective way.

  Remember, any policies and procedures that you change must be communicated to your Board and to the staff affected by the changes. A cost benefit of your process assures you are not adding additional, unnecessary burdens to your staff and adversely affecting your financial bottom line. As noted, you have great latitude to implementation of the home care policies and procedures. Use the creative thinking of your staff to come up with better less expensive and time intensive ways of achieving your outcomes. With the growth of electronic services, many processes once achieved by paper and personal delivery can now be achieved by electronic means. Get creative!

  Work to make the changes stick. Set up systems to ensure the staff are making – and keeping – the changes. You cannot allow them to think of the changes as the flavor of the day and revert back to the old way of doing things. Change is difficult. As the leader, you have to drive this process to assure the change keeps heading in the right direction. Those who cannot or will not get on board with the changes need to be helped to find other opportunities elsewhere.

  Lastly, hire the right people and train them properly. One of the most effective ways to assure the words “the surveyors are here” are not an issue, is to make it a policy that all newly hired staff must read the rules of the programs they are working in and are able to find those rules implemented in the policy and procedure manual. Seems like a lot to require, but on the other hand, how much of your time goes into fixing the problems after the fact? Throughout the first three months of employment, a new staff person can easily read the rules and the policy and procedure manual. Doing it right on the front end decreases the large costs on the back end when things are not understood and done correctly leading to citations and added costs of writing off billings because of failure to understand and follow the rules.

  Should you find you need some help call Kenyon HomeCare Consulting, at 206-721-5091 or e-mail GinnyKenyon. We are here to help.