Category Archives: Home health agencies

Conditions of Participation, Home health agencies, Uncategorized

No Emergency Plan yet? Programs must be in place by November 15, 2017


Last month’s reprieve from continuing pre-claim review demonstrations by the Center for Medicare and Medicaid Services and the announcement that CMS is considering a delay in the start date for new Conditions of Participation has created a sense of cautious relief in the home health field.

Many home health professionals are wondering if the reprieves and delays reflect a trend away from increasingly stringent compliance demands on home health agencies in recent years.

But gambling on the advent of a more relaxed regulatory climate could have negative consequences for agencies – including CMS citations for non-compliance beginning in November for agencies failing to meet new Emergency Preparedness Program requirements, warned J’non Griffin, president and owner of Home Health Solutions LLC.

“It’s really important not to lose our sense of urgency in home health,” J’non said. “Emergency Preparedness Programs should be a priority for agencies right now. The programs take a while to put into place, and CMS has said that agencies will be expected to meet EP requirements by Nov. 15, 2017, or be cited for non-compliance.”
A proposal CMS is now considering to push back the start date for revised Conditions of Participation is not expected to impact the Nov. 15 effective date for Emergency Preparedness Programs.

“This means that regardless of whether CoPs are implemented on July 13, 2017, or pushed back six months until January, 2018, home health agencies will need to have in place their Emergency Preparedness Programs by this November,” J’non said.

Community wide disaster drills

To avoid non-compliance, beginning Nov. 15, agencies will need to have already conducted the community-wide disaster drills which are part of the CMS-mandated Emergency Preparedness Programs.

This requirement has been one of the most intimidating to many agencies, according to J’non, because it requires them to pool efforts with local and state emergency agencies and health care coalitions to conduct full-scale community exercises.

Under the Final Rule mandating home health Emergency Preparedness Programs, two of these drills are required annually for agencies to test their emergency operations, although one of the drills may be a tabletop exercise.  Agencies experiencing real emergencies may be excused from one of the required yearly drills.

Some agencies have not yet begun efforts to coordinate the disaster drills because they are hoping additional guidance will be provided when interpretive guidelines for the new CoPs are issued.

“Agencies really shouldn’t wait for interpretive guidelines to be issued. CMS has specifically addressed this issue, stating that agencies must perform their community wide disaster drills by Nov. 15,” J’non said.

On its web site, CMS states:

“We realize that some providers and suppliers are waiting for the release of the interpretive guidance to begin planning these exercises, but that is not necessary nor is it advised. Providers and suppliers that are found to have not completed these exercises, or any other requirements of the Final Rule upon their survey, will be cited for non-compliance.”

Agencies unable to comply

Agencies unable to conduct a community-based exercise by the deadline may be able to document why and avoid citation for non-compliance as long as reasons are valid, J’non said.

In rural areas, for example, agencies may not have access to the same resources as agencies in more populated areas. In a community in which an annual disaster drill is already scheduled to take place after the Nov. 15 deadline, it may make more sense for an agency to wait and join existing community efforts.

Agencies who find themselves in these or other situations which hinder efforts to comply with the disaster drill mandate must thoroughly document efforts to coordinate a community wide drill, explaining why it was not possible within the time frame, according to J’non. They will still need to conduct and document a facility-based disaster drill, she said.

On its web site, CMS identifies these documentation requirements:

“The documentation should include what emergency agencies and or health care coalitions the provider or supplier contacted to partner in a full-scale community exercise and the specific reason(s) why a full-scale exercise was not possible.”

Where to find help

Home Health Solutions offers an Assembly Kit that breaks down the development of an Emergency Preparedness Program into 12 easy-to-follow steps, offers a Sample Plan to follow, and provides more than 30 assessment tools and forms which will be needed to capture the right information for creating a fully compliant Emergency Preparedness Program.

It’s designed to simplify the process for busy agency executives with a format anyone can easily follow to meet CMS requirements.

The Assembly Kit can be purchased at: www.homehealthsolutionsllc.com/solutions-shop

The CMS web site offers resources such as checklists, links to emergency preparedness agencies, planning templates and many other aids to assist agencies in developing Emergency Preparedness Programs.  The website also provides a State-by-State listing of Health Care Coalitions. The information can be found at:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html.

Conditions of Participation, Home health agencies, Uncategorized

What PCR reprieves, CoPs delay could mean

Future-gazing: A delay or not?
Either way,  there’s work to do!

It seemed almost too good to be true, like some April Fool’s Day prank offering false hope to home health agencies braced for a new onslaught of federal regulations.

Just one day before home health agencies in Florida expected to join Illinois agencies in a long-fought Pre-Claim Review (PCR) demonstration by the Centers for Medicaid and Medicare Services, two announcements by CMS changed the game. At least for now.

 After months of deadlock, a temporary reprieve from massive new regulatory changes – not just in Florida but nationwide – suddenly shifted from highly unlikely to plausible.

 CMS announced Friday that it would grant Florida a second reprieve from the PCR demonstration scheduled to begin April 1, suspend for at least 30 days the PCR program in Illinois which has been underway since August, and possibly give home health agencies an additional six months to prepare for new Conditions of Participation in the Medicare program.

   “These two developments made for an interesting Friday in home health,” said J’non Griffin, owner and president of Home Health Solutions LLC. “The PCR delay in Florida really was an 11th hour save. The clock was ticking, and agency personnel were attending last-minute PCR training workshops every day last week in cities all across Florida to get the information and training they needed to be ready for the PCR launch.”

 But brand new CMS administrator Seema Verma, who was just confirmed to her position at the Department of Health and Human Services on March 13, was also seeking information last week. She asked to meet directly with home health care providers and advocates from both Florida and Illinois, where the nation’s first PCR demonstration began last summer. The new CMS administrator said she wanted to hear their concerns about the impact of increasing regulatory demands on home health.

   Following that meeting, CMS on Friday announced plans for a 60-day public comment period to seek information that will be evaluated in determining whether to delay the implementation of new CoPs, standards which are widely expected to be difficult, time-consuming and costly for agencies to put into place. Under the current timeframe, agencies are required to meet new CoPs by July 13. The six-month delay, if approved, will give agencies until January, 2018, to make the necessary changes.

Soon after that announcement, word came from CMS that the PCR demonstration in Florida would no longer begin on April 1 as scheduled — and that the ongoing PCR demonstration in Illinois would be suspended for at least 30 days. CMS offered no further timetable for PCRs to resume, but promised a 30-day notice will be provided before that happens.

Relief, hope — and politics

Home health professionals across the country greeted Friday’s news with a mixture of relief and cautious hope for a changing climate in Washington D.C. regarding federal regulations on home care.

New Health and Human Services Secretary Tom Price has been described as knowledgeable about and supportive of many home health issues by William Dombi, Vice President of Law for the National Association of Home Care. At the 2017 Illinois Home Care and Hospice Conference last month, Dombi painted Price as a potential ally for home health, telling attendees that Price was considering supporting a CoPs delay.

But less than 100 days into a new administration, the Department of Health and Human Services headed by Price is still coming together, with many of its senior positions still unfilled.
And, as battles continue between lawmakers over the government’s specific role in health care, many of our nation’s health care policies have yet to be determined, much less put into place.

“It’s definitely a good sign for top officials in D.C. to actively seek input from home health and listen to our concerns, but there are still a great many unknowns right now,” J’non said. “No one really knows exactly how all this is going to play out.”

The future of PCRs and CoPs

What will the delays in Florida and Illinois mean for PCR demonstrations?

Industry experts believe it is likely that CMS will make changes to the PCR model before continuing with the demonstration first launched in Illinois last August. The demonstration in that state proved to be so chaotic, confusing and largely unsuccessful in its initial months that CMS was forced to pull the plug on expansions planned for Florida the following October and into Texas, Michigan and Massachusetts by the beginning of the year.

With the issues that plagued Illinois corrected, what might the revised demonstration look like?

“It really isn’t possible to say for certain at this point,” J’non said. “It seems more important to note that the PCR demonstration will go forward. This is a delay, and not a repeal. Agencies in all states still need to add PCR readiness to their ongoing training efforts.”

Under the current model, agencies in states where the PCR demonstration operates have the choice to participate or not. However, those who do not submit the proper paperwork for review prior to filing actual claims will automatically lose 25 percent of any Medicare reimbursement on claims not previewed.There has been no word at this time that the 25 percent reduction for non-participation will change.

While dramatic, last-minute PCR suspensions in Florida and Illinois grabbed most of the attention on Friday, the CMS announcement regarding a possible delay in the implementation of new Conditions of Participation could have a more immediate impact on most of the nation’s 30,000 home health providers.

The implementation of most new CoPs would be delayed until January 13, 2018, under the proposed rule.

Agencies would have extra time to meet some of the Quality Assurance and Performance Improvement (QAPI) standards required. Phase-in requirements would give agencies until July 13, 2018, to implement performance improvement projects, allowing six months after the January 2018 start date to collect the data they will be required to use in their data-driven performance improvement projects beginning in July 2018.

Administrators would be affected 
   Additionally, the proposed rule would grandfather all administrators employed by agencies prior to January 2018, so that they do not have to meet the new personnel requirements identified in the revised CoPs. 

  Of particular interest to agency administrators is what new personnel requirements will mean for future employment, and their ability to move from a grandfathered position at their current agency to an administrator position at a different agency.

Under the new CoPs, administrators who do not meet the requirements would lose their grandfathered exemption when they leave one agency to take a position at another agency, J’non said.
The clock is ticking

One of the primary arguments for delay of a start date for new CoPs has been concern about the lack of interpretive guidelines, which Surveyors will use to evaluate whether agencies have met the standards.

Agencies have expressed concerns they are not certain exactly what Surveyors will be looking for, particularly in the areas of data-driven performance improvement projects.
CMS agreed, in its announcement on Friday, that there is merit to that argument, and that is one of the reasons the delay is being considered.

“With so many other major clinical and operational changes to implement in such a short period of time before July 13, which is the start date effective under current law, there has been growing concern in the industry about the lack of time in which to put all of it into place,” J’non said.

   New Conditions of Participation were approved in January, giving agencies only six months to make the required changes. It was the first time in almost three decades that CMS addressed the standards set out for home health agencies under CoPs.

“With such a limited amount of time, agencies really need to be making the necessary changes now, without waiting on interpretive guidelines,” J’non said. “Guidelines are more for the benefit of Surveyors. Agencies must meet the standards as they are set out in the CoPs.

“It’s important to remember that the delay is only under consideration at this point, and the July 13 start date could remain in effect,” she said. Many agencies will not have the resources to make necessary changes on their own, especially under the current time frame, and will need to outsource much or all of the work, J’non said.

Even if the delay is approved, and extra time is granted, many of the new requirements will be so labor-intensive that agencies will still need to rely on outsourcing, she said.

Delays aren’t repeals

  J’non offered this advice to agencies wondering what these delays may mean and how they will affect preparation timelines:
“It’s important to note that, as with PCRs, a possible delay is not the same thing as a repeal,” J’non cautioned. “Agencies need to proceed as if the July 13 start date will remain in effect. If they wait, and the start date is not delayed at the close of the 60-day comment period, it will be too close to July to be able to implement the required changes by the deadline.”

EDITOR’S NOTE: This article first appeared in The Absolute Agency, a free monthly e-newsletter published by Home Health Solutions as a best-practices guide for agency administrators.
To subscribe, click here.

Conditions of Participation, Home health agencies, Home health management

10 Things Your Agency Can Do NOW to prepare for new CoPs


EDITOR’S NOTE: This article first appeared in the March 1 issue of The Absolute Agency, a free best practices resource emailed to agency administrators each month. To subscribe, click here.

It’s been almost 30 years since CMS changed the rules for home health agencies participating in Medicare, but the summer of 2017 will usher in both small and large changes in operational aspects of home health care.
Agencies must be prepared by July to meet most of the newly revised Conditions of Participation, although emergency preparedness plans won’t have to be in place until November.
If you’re feeling intimidated by scope of new changes on the horizon,  Home Health Solutions owner and president J’non Griffin has this advice about how to swallow an elephant:
One bite at a time.
 Home Health Solutions will be focusing in greater detail on these and other aspects of the revised CoPs during the next few months, but there’s no need to wait to get your agency ready for the changes. Here’s our To-Do List of 10 simple tweaks, small changes and easy projects you can do right now to prepare for July and get ahead of the game.

1. Create An Organizational Chart.
If your agency doesn’t have one, start one.  Establish a clear chain of command.
Already have an organizational chart? Great! Make sure that it has a Clinical Manager who is responsible for making assignments, coordinating patient care and performing many of the functions currently falling under the duties of a Supervising Nurse.  Having a Clinical Manager is one of the new CoP requirements.
This doesn’t have to be one person. It’s OK to have more than one Clinical Manager on your chart.  Neither will your Clinical Manager have to be an R.N. Under new CoPs, the professional in this role may be nurse, therapist, social worker, even a doctor.
Your organizational chart will need to be in writing, along with all other agency policies.

2.  Create or Review Existing Job Descriptions.
 You’ll need a job description in writing for each person who works at your agency – and the job description will need to include licensing requirements as applicable for specific positions. This will vary from state to state, so resist the urge to copy a great job description from an agency in another state.  You’ll have to make sure you do your homework so that your job descriptions are unique to your agency and match your state’s requirements.
Make certain, in the case of your Clinical Manager, that the job description highlights the primary responsibility as COORDINATION of services, patient care, etc.

3.  Check Your Watch. 
Now make it a habit. There’s no time like the present to start cultivating a new habit, and your entire staff is going to need to become much more time-conscious under new CoPs.  Clinicians will need to get into the habit of including the TIME in all visit notes.
There’s new wording in the CoPs, and it’s all about what time it is: time of arrival, time of departure, time that a service was provided,  and what time it was when someone on your staff spoke to a physician. It’s no longer enough to record the date on which an order was received; you’ll need to record the time, too.
Give your staff plenty of time to get into the habit; start requiring the documentation of time today.

4.  Start collecting phone numbers and contact info.
Under new patient rights established by the CoPs, you’ll be required to share with patients the phone numbers, addresses and contact information for a variety of state and federal agencies serving your area, including:
— Agency on Aging
— Center for Independent Living
— Protection and Advocacy Agency
— Aging and Disability Resource Center
— Quality Improvement Organization

5. Update Your Patient Info Packets
While you’re adding the list of numbers and contact info to the patient rights and information packets you provide to your patients at Start of Care, spend some time reviewing and evaluating exactly what you’re handing out and how well it is organized.
Is it easy to understand? Can you edit or rewrite any portion of it to make it simpler or any clearer? Does it spell out clearly how a patient, caregiver or representative is to report a problem or file a complaint – and to whom?
Under new CoPs, you’ll need to make sure to provide the patient with the name, phone number and contact information for both the agency administrator and clinical manager.
Make sure to include in writing your agency’s transfer and discharge policies. New CoPs will require you to provide this information to patients.
There are many other new patient rights requirements, too, but working now on these particular elements now can put your agency ahead of the curve.

 6.  Take steps to erase language barriers.
Make certain your agency can easily provide interpreters and copies of patients rights and information in the native language of the patient. Even if your agency does not currently serve patients who speak a language other than English, you must be prepared to overcome language barriers in the event that such a patient needs your care.
Start developing a plan now for securing interpreters as needed, and draft a written policy addressing how your agency will handle this situation should it occur.

7.  Medication Regimen Review.
Make sure you are conducting a review of all meds the patient is currently using and perform a reconciliation. Clinicians are already asked to do this as part of OASIS, but under new CoPs, your agency will be required to review all medications a patient is taking — including those prescribed by other care providers —  to identify, review and resolve any discrepancies.

8. Speed it up!
Work on getting faster in every aspect of your agency’s operation. Tighten your deadlines and stress to your staff the importance of streamlining and expediting paperwork.  Under new CoPs, you’ll need to have summaries prepared much faster, meet expedited turnaround times, be able to provide complete information to patients by the next home visit upon request, and follow through on discharged patients within a 5 business day window, providing a discharge summary to the agency, physician or other entity into whose care the patient is being transferred.

9.  Take a new look at how to safeguard private health information.
Under new CoPs, you’ll need a detailed written policy establishing procedures to be followed in the event of loss, theft or destruction in any manner of a computer on which private medical records are stored.  This is a good time to start detailing that policy.

10. Start working on your agency’s Emergency Preparedness Plan. 
Agencies have until November to get together the detailed Emergency Preparedness Plan required by new CoPs – but this is a complex undertaking with many components, and getting started today is the best course of action.
Start by calling your local Emergency Preparedness Agency today to set up a time to meet with a representative who can help you with one of the most intimidating pieces of this project for many agencies: the coordination of communitywide resources and other facilities.  FEMA already has access to much of the information you will need for your plan, including detailed studies and existing coordination plans which can be incorporated into the unique plan you will be required to craft for your agency.
As an example, you’ll need both a Hazardous Risk Assessment and a Communication Plan. Flood Risk Assessments from FEMA for your area may provide the specific information you will need to include in your own assessment. Your local agency may also help you develop a workable Communication Plan specifying how to get in touch with staff, patients, patient families and caregivers, as well as other facilities in the community in the event of a disaster which takes down phone and/or power lines, knocks out satellite communications and makes normal channels of communication impossible.

Cross these 10  items off your To-Do List and you’ll already be 10 sizeable bites into the elephant as the calendar turns toward July, ushering in the revised Conditions of Participation.
Bon appetit!

Home health agencies, Home Health News, Pre-claim reviews

What’s next for home health? Experts at conference admit they’re baffled

In a week of intense debate in the nation’s capital over efforts to repeal and replace Obamacare, the future of myriad home health regulations remains as uncertain as other health care issues. 

But one thing IS certain, according to Home Health Care Solutions owner J’non Griffin, who joined other home health experts at the 2017 Illinois Home Care and Hospice Conference & Exhibition near Chicago this week. Whether lawmakers change, repeal or leave in place existing Medicare requirements, agencies must continue to streamline their processes and focus on quality improvements to remain profitable in the increasingly challenging home health  field. 

Agencies in Florida hoping for a reprieve from an April 1 rollout of pre-claim reviews by the Centers for Medicare and Medicaid Services are likely to be disappointed, according to keynote speaker William Dombi, who serves as The National Home Care Association’s Vice-President  for Law. 

The eyes of the nation remain fixed on the D.C. debate over replacing the Affordable Health Care Act with an as-yet-unnamed plan which has been alternately dubbed Trumpcare,  Ryancare and Obamacare Lite. How the proposed replacement would impact home health has not yet been determined.

Meanwhile, the clock ticks inexorably toward the April 1 deadline in Florida, leaving little time or attention for NACH’s efforts to derail PCRs.

“The Washington perspective is that we are all crazy at this time. No one knows at all,” Dombi told hundreds of home health professionals attending the Illinois conference. “My concern is that day after day, hope of something in Florida diminishes.” 

NAHC has prioritized stopping the PCR process in additional states, including Florida, and curtailing the process in Illinois, which became the first state to undergo a PCR demonstration in August, 2016. Dombi said NACH is petitioning CMS to allow agencies which have had consistently high affirmation rates to opt out of the PCR process without being penalized financially. 

But NAHC’s efforts to get lawmakers to support the repeal of PCRs have been largely overshadowed by the bigger repeal efforts on Capitol Hill, and the political fallout. Republican lawmakers unveiled the replacement health care act promised by the Trump administration this week to major discord in Washington D.C., with condemnation from Democrats, the American Medical Association, the American Hospital Association, and even some Republicans. 

What will happen next is anyone’s guess, Dombi told conference attendees. He describes the situation as “very chaotic.” 

As federal lawmakers grapple with complex issues such as the extent of individual rights to health care, whether responsibility for health care is a federal or state priority and whether the role of the government in health care should be as partner or provider,  Dombi sees some areas of hope on the horizon for home health. 

The new administration’s Secretary of  Health and Human Services, Tom Price, has a sound grasp of many home health concerns and a history of support for many of them, Dombi said. 

Price has indicated some support for delaying new Conditions of Participation for Medicare which are scheduled to become effective July 13, Dombi said.  The new CoPs will require many operational changes for home health agencies, and there is some concern within the industry that there is not enough time for agencies to fully implement all the changes.

With no interpretive guidelines released four months away from the implementation,  NAHC believes surveyors aren’t ready for new CoPs and has been lobbying for a delay. Word in D.C. is that Price is “seriously considering” NAHC’s position, according  to Dombi.

However, it is important to note that no delays of PCRs or CoPs have been approved at this time. Industry experts at the Illinois conference strongly encouraged agencies to proceed as if new Conditions of Participation, Pre-Claim Reviews and Value Based Purchasing initiatives (in which agencies are rewarded or penalized depending on how well they make improvements) are inevitable. 

No one knows if or when or where CMS will expand Value-Based Initiatives beyond the nine states in the current trial, whether PCRs will proceed to other states after the Florida rollout, or exactly what will happen next in home health, but agencies must be prepared anyway, PPS Plus educator Jennifer Warfield told her conference audience.

“Even if the actual term Value Based Purchasing goes away, the future of your agency is always going to be tied to its improvement processes,” she said. 

Joyce Ryan Boin with Strategic Health Care  Solutions encouraged agencies to redirect their focus toward education and ongoing strategy for measurable improvement. 

“We’re not in Kanas any more,” she said. 

 EDITOR’S NOTE:  Check out HHS Owner J’non Griffin’s four-part webinar series on the new Conditions of Participation, providing an overview and highlighting compliance strategies for agencies to develop a QAPI program. The series begins March 15 at 10:30 a.m. CT, and will continue March 29, April 11 and April 25. 
For details or to register, click here.

 

 

 

Home health agencies

The Fickle Millennial: Meet the new work force at your agency door

fickle: adjective – changing frequently, especially as regards one’s loyalties, interests, or affection.

By JASON LEWALLEN
HHS Director of Sales and Marketing

There’s a new worker on your home health agency doorstep, one of a rising labor force segment known as Millennials, with a great outlook, an impeccable resume, and a sincere desire to make a positive difference in the world.

As an employer in the home health industry, you know the risks that come with every hire. Training is time-consuming but necessary, and carries a substantial price tag. It also places an additional burden on an agency staff already stretched thin by patient needs and compliance burdens.

There’s no guarantee that your agency’s investment in any new hire will pay off; in fact, odds are that this worker will not remain at your agency for a full year before moving on. Some home health experts estimate that up to one third of all newly-hired clinicians leave their new positions within the first six months.

Certainly it’s fair to wonder how the advent of the Millennial worker will affect those odds. This is a matter of growing concern among home health agencies and other employers nationwide, as young adults whose coming-of-age near the turn of the 21st century bring fresh attitudes and new demands to the workplace. Fair or not, Millennials are developing a reputation for much less employer loyalty and far greater expectations of job fulfillment than previous generations. They are more likely to feel discontent and switch jobs at a much higher rate than any previous workforce.Changes in our workforce initiated by a Millennial mindset are expected to accelerate as more enter the labor force and transition into management positions. In the next 8 years, U.S. Chamber Foundation estimates that 3 out of 4 workers will be Millennials.

What does this mean for home health?

Employee retention is a particular concern for home health agencies, who have learned from disappointing and frustrating experience that many of the clinicians they hire will not make it past the first quarter of employment. One in three of every new hires leaves an agency before the first six months are up, according to Heather Calhoun, Director of Appeals and Special Projects Coordinator for Home Health Solutions LLC.

“It takes about six months before a new home health or hospice clinician really begins to know what they are doing in this field,” Heather says. She works with agencies of all sizes to conduct a series of new-hire orientation and training programs for HHS, and finds the turnover rate is the same regardless of an agency’s size, ownership or geographical location.

Heather believes this is because the work often turns out to be more challenging than expected. Many nurses come to the home health field from a hospital background, where they are accustomed to less autonomy and more structure – and, often, more sharply defined duties with advance scheduling. They are surprised by increased scrutiny on their documentation, frustrated by constant schedule changes and can quickly feel burdened by a fluid scope of duties.

“Some of them also find that they just don’t like going into nasty houses, but that’s just part of what we do in this field,” Heather says. “This is a different type of job, and some people just can’t handle the hassle.”
With staff turnover and retention already major concerns for the home health field, how will agencies adapt to an emerging, and perhaps more fickle, workforce?

The solution begins with gaining a better understanding of the Millennial mindset.

Who are they?

In 2016, Millennials surpassed Baby Boomers as the nation’s largest living generation, according to statistics from the U.S. Census Bureau. For reporting purposes, the Census Bureau defines this population segment as the more than 75 million people who were born within the past 36 years.

They are tech-savvy and well steeped in social media connectivity, and nearly one quarter of them are likely to sport tattoos or body piercings, according to U.S. Chamber Foundation statistics. Almost 70 percent of them have never been married, and they seem in no rush to follow the historical trappings of growing up.  In general, Millennials tend to take years longer than Baby Boomers to reach traditional milestones such as home ownership or parenthood.

Some experts claim Millennials are the hardest working, most motivated and socially conscious generation of workers we have ever seen. Others experts claim that they are lazy, uncommitted and have a deep-seeded belief that they are entitled to privileges and provisions that generations before them had to work to obtain.

Regardless of which view you take regarding Millennials, it is becoming clear that it will require a different approach from employers to successfully engage and retain them, but we are just beginning as a society to pay more attention to the how and why of it.

Thought leader Simon Sinek recently made waves across social media with his release of a video discussing Millennials in the work place. (Click here to watch the video) In the video, Sinek takes issue with the parenting skills that he believes made Millennials what they are today. Evaluating an entire generation that seems to be set up for emotional failure makes the future look glib and hopeless. Sinek charges in the video that the responsibility for engaging Millennials belongs to employers who hire them. I disagree with several of the points that Simon makes (like marginalizing an entire generation), but overall I agree with his overview of the many challenges Millennials are facing and their outlook.

The good news is that Millennials aren’t without work ethic or potential. They want to love their jobs. On survey after survey, Millennials score as much more interested in the kind of work they do, job flexibility and balancing work-life demands than in salary levels or promotions.

More of them finish college (63%, according to the U.S. Chamber Foundation) than previous generations and feel a vested responsibility to a higher cause such as helping others, the environment, or simply “doing the right thing.”

Those characteristics perfectly position this generation to find purpose and fulfillment in our industry. So how do we as employers align our message with their need for a job with meaning?

Point out the obvious

Home health and hospice providers are already providing a service that fits well into the scope of work Millennials find appealing. We are providing services in most cases to the most fragile and dependent section of our populace, and our work can absolutely be considered “doing the right thing.”

So why would a Millennial leave a company providing such worthwhile service?

The answer is simple. They don’t understand the value they provide and the impact they are making.
Taking the time to acknowledge employees and the good work they are providing is key. The positive work is already there, but making sure that you acknowledge their impact will motivate employees to do more. This tends to push back insecurity and, as they see you as an authority figure, will give them the assurance that they are achieving something of value.“

Our goal is not just to hire, maintain and motivate our staff, but also to learn the tools to show them they are appreciated and recognized on a regular basis,” Home Health Solutions Onboarding Specialist and Operations Coordinator Christina Nuqui told a group of home health care professionals at the Home Care Association of Florida’s Winter Warm-up Conference earlier this year.

Among Christina’s suggestions:

  1. Create a formal Employee Recognition and Appreciation Program. Establish, at a minimum, an “Employee of the Year” system to recognize workers. To the extent possible, build on the annual recognition with many more opportunities. Add an “Employee of the Month” or “Star of the Week” program. The reward can be a small gesture, perhaps a $10 card to buy coffee, or add the employee’s name to a jar for an end-of-the-year drawing to win a larger prize. Remember that Millennials particularly value time off work, so consider offering a day off as a reward.
  1. Create an informal culture of appreciation. Being ignored is anathema to the spirit of productivity. On the other hand, simple words of appreciation and encouragement can reap an orchard of benefits. Make it a point to praise your employees in front of co-workers, and highlight achievements on office bulletin boards or in agency newsletters. Millennials may especially appreciate being recognized on the agency’s Facebook page as having made worthwhile contributions. Yes, it takes extra time to do these things, but the payoff is invaluable.

Provide a voice

We’ve all seen and heard of Silicon Valley software companies that provide full service restaurants, sleeping rooms, and even video arcades to entice potential employees. While that can draw talent, that is rarely what ensures loyalty to an employer.
Loyalty is built on an emotional level rather than with financial reward or access to enticing perks. Kevin Kruse, author of Employee Engagement, defines employee engagement as “the emotional commitment the employee has toward the organization and its goals.”

Getting employees – especially Millennials — to buy into your agency’s goals means making sure they feel that their input is welcomed and valued, that their suggestions are opinions are listened to, and that feel they have a valid stake in the ultimate success.

It may be as simple as putting up a whiteboard in the agency office with a big, “What do YOU think?” written across the top. Invite employees to answer questions such as, “What did we do well this week?” and “What do we need to do better?” Be sure to acknowledge what employees write there.

Give them a career path

Ambition runs stronger in this generation than many that have come before it. According to Britt Hysen, the editor-in-chief of MiLLENNiAL magazine, “60 percent of Millennials consider themselves entrepreneurs, and 90 percent recognize entrepreneurship as a mentality.”

Historically, career advancement was necessarily guaranteed, but college graduates today are looking to build a career that is rewarding and full of growth opportunities.

The Deloitte Millennial Survey 2016 discovered that 63% of Millennials say that their leadership abilities are not being developed.

How are you developing your Millennial talent? Do you provide opportunities to develop new skills or give them opportunities to prove themselves?

Invest in their tech aptitude 

Each time an agency brings in new technology or invests in a new electronic medical records software, challenges abound. In general, Millennials possess a near sixth sense for technology.

Don’t get me wrong; there are plenty of exceptions, but you will rarely have to show a member of this generation how to send or upload a photo and how to operate new equipment. They have been taught or have simply learned how to type, interact with computers, and generally how to find information that they may not have quick access to. This combined with an aversion to “doing things the way they have always been done” makes them an asset worth developing.

 Loosen the reigns 

Of all the changes home health and hospice agencies must make to better engage and retain Millennials, this may be one of the hardest and most important. Work flexibility has moved from a “nice perk” to an absolute requirement for much of this generation. They have seen the ill effects of distant parents and consider it vital to maintain good work/life balance.

As an employer, try to cut them loose when they request it. Studies have concluded that Millennials not only respond well to that flexibility,  but tend to work harder and stay longer when necessary.

In Conclusion

The home health field is growing more challenging and complex each year, with increasing regulatory demands and growing pressure to adapt quickly and thoroughly to constant change. There has never been a stronger need for smart, self-motivated employees with a passion for helping others and an innate appreciation for flexibility on the job.

Millennials bring that skill set to the home health marketplace.

Employers who take the time to understand this generation’s need to be valued and to feel they are providing value will be able to successfully tap into this burgeoning segment of the labor force, creating the professional environment necessary to turn  fickle  Millennials into long-term, committed employees.

About the author:
Jason Lewallen has helped hundreds of agencies grow and rise to their potential. He is an industry author, a technology evangelist, a seasoned speaker, and a trusted voice. His passion comes in the form of assisting agencies to have the resources and finances they need to fulfill the mission that each agency set out to do.

EDITOR’S NOTE: This article first appeared in The Absolute Agency,  the e-newsletter Jason prepares each month for Home Health Solutions as a free best practices resource for administrators, executives and leaders in home health and hospice.
Click here to subscribe to The Absolute Agency.

 

 

Coding, Home health agencies

Outsourcing: Tips for choosing the right partner

Economics of Change

Editor’s Note: Jason Lewallen is Director of Sales and Marketing for Home Health Solutions and a noted speaker, blogger and author in the home health field. This article first appeared in SOLUTIONS, the monthly e-newsletter from HHS.

By JASON LEWALLEN

Outsourcing is a hotly debated issue in the home health and hospice industry.  Home health agencies know they need to narrow their margins while maximizing their reimbursement, but historically, it has been thought to be more beneficial to have a person on staff to handle each part of the process. This especially applies when it comes to clinical matters.  Legal risks, privacy concerns and the delicate nature of our business makes us wary about trusting another entity with these matters.

Whether outsourcing is the right option for your home health agency depends largely on how you answer the following questions.

Do you really need a specialist?

In a fluid health care market where guidance changes frequently, regulatory demands are constantly evolving and penalties are formidable, agencies recognize the indisputable value of staying fully informed and well trained. Even so, agency leaders often struggle to justify hiring specialized services. The simple fact is you would not ask a plastic surgeon to treat cardiac issues. Even as a legally practicing physician with a medical background that encompasses many of the basic concepts of how the heart works, the plastic surgeon lacks the specialized training needed to adequately address the cardiovascular system.  The best results could be expected from the cardiac specialist.

The same logic applies to obtaining the best results for your home health agency by outsourcing coding services. The best clinical consultants who handle coding and OASIS review are uniquely trained to maximize your reimbursement and reduce your compliance risk.

How will outsourcing affect reimbursement?

The difference in reimbursement when switching from in-house coding to outsource coding varies from agency to agency. There is always a chance that you have an optimized coding team who can deliver optimum results, although that is not what is commonly discovered. A reputable provider will work with you to evaluate whether you are achieving the maximum reimbursement that you are due. Remember, this is money that you should be receiving when there are no coding errors.

While averages vary, most outsourcing partners can generate $200-$300 per chart for a majority of  their clients simply by correcting coding errors and helping review the OASIS to ensure compliance. At a loss of just $100 per chart, an agency might be looking at $20,000 in recovered losses for just 200 patients.  Outsourcing has other benefits in addition to making agencies more profitable. It frees agencies from worrying about benefits, sick days, or performance issues.

Can you trust the specialist?

This can be a loaded inquiry. We’ve all known a few subpar medical professionals, and frankly there are coding firms which do not perform at the necessary level of expertise.  Having a partner who will ensure that you get the full reimbursement due to your agency for each episode is critical.

Choosing the right one requires knowing what to look for and what to avoid.

Here are a few tips:

  • The right firm will have credentials, experience and a reputation in the industry for consistent performance. It will offer a demonstrable commitment to monitoring industry regulations and providing the support you need for clinical and financial success.
  • Look for a firm headed by a confident, approachable coach who is in demand as a leader and teacher in the industry and can build a solid case for increased outcomes for your agency.
  • Verify that you are working with a team of experienced clinicians who know how to evaluate a clinical narrative. Some outsourced coding providers will certify non-clinical individuals to save money. In the long run, this can damage the integrity of your organization and more often can help to drive down your outcomes scores as well as your reimbursement.
  • Another valuable area to explore the process and ease of accessibility. Some outsource providers will require you to scan or fax mass amounts of information or have a long series of steps that make working with them seem like you are working for them. Others will not be able to guarantee that you will receive your work in a timely fashion. These days, the best providers can actually work within your electronic medical record (EHR) system to improve the timeliness of chart completion while minimizing the work required of clients.Regularly scheduled reviews to evaluate your coding and OASIS for optimization can help you determine whether an in-house coding specialist or an outsourcing partner may be the more viable and cost-efficient solution. Your agency may well have the top-notch coding talent that is helping you get the maximum reimbursement, but in today’s home health market, can anyone afford not to be sure?
Home health agencies

Top Four Fall Priorities for Home Health Agencies

solutions-october-4-ways
Where is your home health agency’s focus this fall?
Smart home health agencies are focusing their efforts on housekeeping,  trying to shore up bottom lines by rectifying errors and inconsistencies that result in costly claims denials, and scheduling crucial training for all agency staff.
The four cornerstones for success in today’s home care market are  training, internal reviews and audits , preparation and streamlining operations, according to Home Health Solutions owner and president J’non Griffin.
If your agency isn’t working on at least one of these areas right now,  it’s losing ground in the effort to stay abreast of industry regulations and maintain clinical and financial success.

Training

Did you know home health agencies lose, on average, $200 to $300 per episode to coding and OASIS errors?
The money agencies spend on staff training is more than recouped in improved performance of its employees. Home Health Solutions provides convenient online training courses available through our online store for continuing education credits.
But we realize not every agency has the same training needs, so we also work with agencies to provide customized training and education.
Our goal is to provide the solutions your agency needs. Contact us today to talk about how we can help you.

glitch-hunting-promo

Self audits and review

The goblins and gremlins may not getcha  this Halloween season, but the glitches sure will.  Errors and inconsistencies are the hobgoblins of the home health field, resulting in costly claims denials , Survey issues and more.
Smart home health agencies are conducting self reviews and analysis on every level to find glitches before surveyors do.  But there’s only so much time in a day — and it’s often hard to be objective about self evaluation.
Our Mock Audits are the resource agencies need to experience firsthand the same thorough investigation a real Survey would bring, allowing agencies to clean up errors before there are costly consequences.  Click here for details about the value of a Mock Audit.

Preparation

When CMS suspended rollouts of pre-claim reviews after a disastrous initial experience in Illinois, home heath agencies breathed a collective sigh of relief.
But the reprieve is only temporary, and smart agencies are using the extra time to get prepared.
From Value-Based Purchasing to pre-claim reviews,  a new way of doing business is on the horizon for home health agencies, and meeting the new requirements is going to take a strong commitment to adequate preparation.
Here’s an easy and inexpensive first step for agencies looking ahead to pre-claim reviews:
Order our DIY Pre-Claim Review Preparation Kit for just $25.  It’s the compass your agency needs to get started on the road to preparation.

Outsourcing

Compliance is costly.
It takes time, manpower and relentless commitment on the part of home health agencies to stay up-to-date on current regulations — and it can’t come at the expense of an agency’s primary focus on patient care.
More and more agencies are determining that the most cost-effective means of doing business is to outsource all or some portion of operations.  And we’re not just talking about coding, OASIS or billing.  Some agencies need help with specific aspects such as developing POCs, handling ADRs or service specific probe reviews.
We can help.
No matter what your need is, we have the solution.
Give us a call today at 888-418-6970 and see what we can do for you.