By Colin Conner, CEO of Encore Care.
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A few years ago, I was referred to a client that seemed, on the surface, to be an easy yes. The referral matched our service model, and we had a good relationship with the payer. Our reimbursement for services was also comparable to others in the area.
After reviewing all the information in the referral, everyone in the room seemed to agree that we should accept the case for services. So, rather than asking, “Should we take a case?” we asked: “Can we staff it? Do we have a caregiver qualified to serve this client in their ZIP code for the shifts needed, with the skills needed and enough backup to cover for call-offs that will inevitably occur?”
Those questions were important because delivery capacity, not the number of referrals generated, should determine growth in home-based care.
Capacity is local.
Company-wide headcount is a sexy number but generally a poor indicator of how much capacity you actually have. And by “how much capacity you actually have,” I mean available caregivers within a given ZIP code or service area who can deliver care during specific times of need.
You must calculate capacity at the local level by considering:
• Available caregivers by ZIP code or service area
• Shift and backup coverage for the specific case
• Credentials or client-specific training required
• Supervisor availability to support the assignment
• Authorization actually in hand, not pending
• Travel time and overtime exposure the case will create
Don’t let growth become a reliability problem—or an unintended compliance problem—by taking on a case that you have not made sure can be covered.
Workforce is the delivery system.
Last-minute changes and unscheduled requests to cover other clients can place tremendous stress on the field caregiver. Long drives between assignments can also be extremely stressful for caregivers.
Additionally, being sent into a very difficult client’s home without any preparation and/or proper training and support can create extreme frustration and a rapid decline in caregiver morale.
In contrast to the notion that good caregivers can survive in tough home environments, such caregivers leave home care because of minor things. For example, they cannot reach the home office person who promised to answer their call, or their latest paycheck has not arrived yet or contained errors that the home office hasn’t handled in a timely manner.
Factors like these, both large and small, can quickly lead to a turnover problem that is difficult to correct once it starts.
Data should trigger decisions, not just describe what’s happening.
The following metrics should be monitored by leaders collectively as a team, rather than by each department individually:
• Number of uncovered visits
• Percentage of overtime
• Late documentation
• Expired authorizations
• Outstanding payroll issues
• Denied claims
• Delayed cash collections
• Client complaints
• Service disruptions
Data should both track exceptions in home health care and drive leaders to solve problems. The same person or department needs to be assigned to each exception, set a response date and establish an escalation process in case nothing is done by that date. Knowing the exceptions are happening should be the first step toward addressing those exceptions in a way that supports caregiving staff and promotes quality service.
A Practical Standard
Centers for Medicare and Medicaid Services (CMS) requires Medicare-certified home health agencies to have a formal patient acceptance-to-service policy. That policy needs to evaluate prospective patients against criteria such as the patient’s needs and the agency’s ability to provide services, in relation to the current caseload, average case mix intensity, staffing and competence of staff. This requirement is intended to make sure providers can deliver the necessary services to patients.
So before approving a new admission, a new market or a new service line, I ask one simple question:
How are you going to staff this, supervise it, document it, handle a call-off, get all of the authorization required and accurately bill it?
Until we have clear answers to that question, we cannot say yes to a new admission, a new market or a new service line. However, those opportunities are certainly something that we can start to build a plan around.
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