Wednesday, May 07, 2014

On a Clear Day ... You Can See Tomorrow

By Stephen Tweed

In the middle of the Bering Straight, between Alaska and Siberia, are two small islands;  Little Diamede and Big Diamede.  Little Diamede is in the United States.  Big Diamede is in Russia.  They are separated by the International Date Line.

If you stand on the highest point on Little Diamede island on a clear day, and look to your west, you can literally see tomorrow.  Big Diamede is 23 hours ahead and it is tomorrow there.

Those of us who work and live in home health, hospice, and private duty home care aren't able to stand on Little Diamede island and see tomorrow.  But the real visionary leaders in our industry have the ability to watch the forces and trends that are shaping our industry, and anticipate what the future may bring.

Pay Attention to the Forces

Over the past 30 years, I've been leading home health agencies in the strategic planning process, and I've identified five specific forces that drive change in our industry.  Forces are the outside pressures that cause change.  Here are the five that we watch:
  1. Economic Change - what is happening in the economy in the US, around the world, in your state, and in your community that will have an effect on your agency?
  2. Demographic Change - what is happening with the demographics of our country and your community that will impact your agency?
  3. Consumer Choice - consumers are more knowledgeable and informed than ever before about their choices in home care and hospice, yet they still make decisions based on emotion rather than logic.
  4. Technology - what's happening with technology that shapes your future?
  5. Political Change - how do politics in Washington, in your state capitol, and in your local community affect what's happening in home care and hospice?
As we monitor these outside pressures, it helps us to see the trends, or patterns of change, that are caused by the forces.

Ten Trends Shaping the Future
  1. From highly competitive to extremely competitive
  2. From prospective payment to bundled payments
  3. From Government payers to private payers
  4. From acutely ill patients to chronically ill patients
  5. From 80 year old patients to 90 year old patients
  6. From front line sales to C-Suite sales
  7. From laptops to mobile devices
  8. From office stored data to data in the cloud
  9. From free market to single payer
  10. From local and state to Federal regulation
We identify trends by constantly watching what's going on in our world and capturing facts, data, information, and knowledge that helps us develop a clearer understanding of these trends and what's driving them.  We also monitor the trends over time to determine whether these are truly trends or just a blip on the radar because of some unusual event.

Get Ready for the Future

Once we have a more clear picture of what's likely to happen in the coming months and years, then we can develop business strategies to get ready for the future.  As I say to all of my audiences during speeches and seminars,  

"I'm not trying to predict the future.  My crystal ball is broken, 
but I am working very hard to anticipate what is most likely to happen
 and to develop strategies to get ready for the future." 

If your agency is built on a strong foundation, has top talent in place, and has a clear vision for the future, you can move forward with a high level of certainty that you can adapt to the changes that are taking place more effectively than your competitors.

Survival of the Fittest

In 1999 and 2000, I had the opportunity to serve as the interim President and CEO of the VNA of Louisville, KY, a $25 million home care business that is affiliated with what is now Kentucky One Health.  That was right in the middle of the Interim Payment System that was brought about by the Balanced Budget Act of 1997.  During a three year period from October of 1997 to October of 2000, over 25% of the home health agencies in the US went out of business.  The huge reduction in Medicare reimbursement caught many agencies unprepared, and they were not prepared financially or strategically to survive.

In the past three months, I've had several conversations with industry thought leaders in home health care that are suggesting that the implementation of the Affordable Care Act could have an even more devastating effect on our industry than BBA '97. 

Six Strategies to Survive and Prosper

If you want to be among the fittest who will survive these changes, here are six specific strategies that you can implement to make sure you are among the fittest agencies in your marketplace.
  1. Anchor Your Agency on Solid Ground -  Update your agency's Mission, Vision, and Values and make sure they are still relevant to today and tomorrow. Assess your leadership team to make sure you have the talent necessary to navigate the fog and the coming storms.
  2. Pay Attention to the Trends - Engage your leadership team in regular conversation about these trends and others and talk about what you see as most likely to occur.  Talk about what you need to do to get ready for the future.
  3. Focus on Creating Competitive Advantage - There are over 12,200 home health agencies, 4,500 hospices, and 20,000 private duty companies.  There is more competition out there than ever before.  Make sure you and your team are really clear about what makes you different and don't get caught up in the delusion that just because you've been around a long time you can compete.
  4. Build on your Strengths - Do an objective assessment of your agency's strengths and weaknesses and build on your strengths.  Focus on what you do best.
  5. Shine your Light Brightly - Now is the time to let your consumers and referral sources know what makes you different, and why they should do business with you. The more you can grow your market share now, the better off you will be as the economic fallout begins to happen
  6. Get your Financial House in Order - Make sure you collect data, analyze that data, and have a clear picture of your agency financially and strategically.  Make sure you have the financial resources to weather a financial storm of reduced reimbursements, changes in payers, and increasing costs of doing business.  
Join us in Iowa

For a deeper insight into these forces and trends, consider joining me in Des Moines, Iowa on June 26, 2014 at the Iowa Alliance for Home Care Annual Conference and Exhibition.  I'll be presenting the opening keynote speech, and two breakout sessions.  The topics will be:
  • "On A Clear Day ... You Can See Tomorrow"
  • "Crafting Your Uniqueness:  Seven Sources of Competitive Advantage in Home Health, Hospice, and Private Duty"
  • "Lessons from the $5 Million Private Duty Mastermind Group"
The leadership team at the Iowa Alliance for Home Care would love to have you join us in Des Moines for this exciting and informative conference.  Here's a copy of the Agenda for the Conference.

If you would like to join us,  Register Here.  

Tuesday, May 06, 2014

Amedisys "bilking the system"?

"Home health services are a large and growing part of our federal health care system. Health care dollars must be reserved to pay for services needed by patients, not to enrich providers who are bilking the system."

These are the words of Sally Quillian Yates, U.S. attorney for the Northern District of Georgia, in commenting on a settlement reached with Amedisys, the Baton Rouge, LA based home health company.  Amedisys will pay $150 million to resolve allegations that it inflated Medicare billings and had improper financial relationships with referring physicians, the U.S. Department of Justice said.

Amedisys is one of the nation's largest home health providers, operating in 37 states, Washington, D.C., and Puerto Rico.The agreement resolves False Claims Act allegations that, between 2008 and 2010, some Amedisys offices billed Medicare for unnecessary services and for patients who were not homebound, and misrepresented patients' conditions to increase its Medicare payments.

The settlement also resolves seven whistleblower lawsuits, six in Pennsylvania and one in Georgia. The whistleblowers, mostly former Amedisys workers, will split more than $26 million.

What do you think about this situation?  What impact does a news story like this have on the perception of home health care in America?  Give us your comments.  

Thursday, May 01, 2014

Six Proven Ways to Work with a Bad Boss

By Stephen Tweed

A colleague sent us an article from INC. Magazine by Peter Economy called, 
"6 Proven Ways to Work with a Bad Boss".  It caught my attention because of the statistics on the opening paragraph:

"According to research on the topic, three out of four employees say that dealing with their boss is the worst and most stressful part of their job. Two-thirds say they would happily take a new boss over a pay raise."

Our research at Leading Home Care shows that turnover continues to climb in home health care, hospice, and private duty home care.  The top technique for retaining talented employees is showing appreciation and recognition.  When people feel valued and appreciated they tend to stay in their current job.

The article in INC. went on to give the six proven ways:
  1. Don't be a Jerk yourself
  2. Say Something
  3. Make her life easier
  4. Reduce Dependency
  5. Be True to yourself
  6. Learn by (negative) example.
For the details on these six ways, read the article.  

More importantly, since you are a leader in home care, let's look at solutions.

Six Ways NOT TO BE a Bad Boss 

1.  See the Bigger Picture.  In research on leadership in home health care, a survey of 200 home care CEOs identified "Seeing the Bigger Picture" as the most important competency for a manager or supervisor.

2.  Communicate Expectations and Directions.  Every organization we have ever worked with in 30 years in home care has said they have a communication problem.  There are lots of reasons for this, but a big one is not clearly communicating what you expect.  Be clear about goals, action plans, expected outcomes, and how you will measure performance.

3.  Be Decisive.  Learn how to make decisions quickly and effectively.  Communicate your decisions and help your team members understand why you decided the way you did. Help your team members learn to make decisions.  Then give them the authority and responsibility.

4.  Be a Coach.  Great coaches earn the respect of their team.  They help their team master the fundamentals of the game.   They give specific and immediate feedback.  They lift players up when they are down, and the bring them down to reality when they get to arrogant.  Be seen as a coach ... not a Boss.

5.  Set Priorities and Manage your Activities. Be clear about what is important to you in running your department.  Have clear goals.  Track performance.  Then focus your time on achieving your goals and developing your team.  Set aside time on your calendar for team meetings and one-on-one coaching.  Set aside quiet time to work on those actions that are important but not urgent.

6.  Have a Plan.  Once you have worked with your team to set goals, then define the specific actions you will take to achieve those goals.  Have a system to track the most important activities and the progress toward your goals.  Track results and share the data with your team members.  Let them know how they are doing in moving toward the goal.

If you would like to explore ways to help develop the leadership team in your home health agency or hospice, let us know.  At Leading Home Care, we have provided education and training for leaders and managers in home care for dozens of agencies and hundreds of managers. We'd love to work with you too.  

For a list of topics and descriptions of keynote speeches and learning seminars by Elizabeth Jeffries and Stephen Tweed, visit our web site.  

Wednesday, April 30, 2014

May 4 - 10, 2014 is National VNA Week

By Stephen Tweed

Several weeks ago, Elizabeth and I had the privilege of spending three days in Las Vegas for the VNAs of America annual conference.  It's always a delight to reconnect with our friends and clients from the various Visiting Nurse Associations across the US.  VNA's have played a huge roll in the growth and development of Leading Home Care.

The Story begins in 1982 when I received a call from our pastor who had just been elected Chairman of the Board of the local Visiting Nurse Association in Oil City, Pennsylvania.  (Read the rest of the story)  Since then we've worked with over a hundred VNAs across the country from Portland, Maine to San Diego, and from Key West, Florida to Seattle.  Our work with VNAs has centered on four specific service areas;  strategic planning, leadership development, marketing strategy, and private duty home care.

I've also served on the Boards of Directors of three different VNAs in Oil City, PA; Reading, PA; and Louisville, KY; and as the interim President and CEO of the VNA in Louisville. Over those year's I've been active in the VNAs of America, attending as a board member, keynoting our convention, and providing educational programming for members.

This coming week, May 4 - 10, 2014, we celebrate National VNA Week as we salute VNAs and all of the not-for-profit home health agencies and hospices who come together to exchange ideas, solve problems, and support home health care in America.

Here's Your Home Health Trivia Question

How well do you know the history of home health care in America. Here's your trivia quiz for today?

When was the first organization formed that became a VNA?

 Write your answer in the comment field below, and then we'll post the answer.

Tuesday, April 01, 2014

Refocusing on Home Health Care and Hospice

By Stephen Tweed

Since 1982, we've been working with home health agencies and hospices across the United States to help you grow your business, develop your leadership teams, and get ready for the future.  Our client list represents a who's who in the home care and hospice industry.

For the past ten years, we've also put a significant amount of energy, research, and talent into studying the private duty home care industry sector.  We've done so much work in that sector that many leaders in home health and hospice think of us primarily for private duty.


A dear friend of ours, Bill Gove, the first president of the National Speakers Association always said, "Don't forget what brung you."  He meant, stick to your knitting. 

Well, we've always stuck to our knitting of business strategy and leadership development for home health care and hospice, but we also added the third leg of the tripod, Private Duty.  Now, it's time for us to come back to our original focus.  So, we've rebuilt our web site at Leading Home Care to reflect more accurately the three things we do:

Keynote Speeches and Learning Seminars

If you are looking for a keynote speaker or workshop leader for your next association convention, corporate meeting, or franchise conference, I'd like to ask you to consider either Elizabeth Jeffries, RN, CSP, CPAE, or myself - Stephen Tweed.  Elizabeth and I have both been speaking professionally for over 30 years. We met at the National Speakers Association Convention in Atlanta in 1990 and married two years later.  Together, we formed Tweed Jeffries LLC, and later Leading Home Care ... a Tweed Jeffries Company and Executive Mastery ... a Tweed Jeffries company. 

Strategy and Business Growth

If you are considering holding an executive strategy retreat, a board of directors retreat, a sales and marketing retreat, or you just need someone to talk with you about business strategy, then give us a call.  Personally, I've facilitated the strategic thinking and planning process for over 500 different companies.  Using a unique technique called Storyboard, we help you ...
  • make ideas visible,
  • stimulate creativity,
  • apply critical thinking,
  • and turn strategic initiatives into focused action plans
Talent Management Solutions

To quote the national champion head basketball coach of the Louisville Cardinals, Rick Pitino, "If there's one thing I've learned from professional basketball, it's that talent wins and wins consistently."

We've learned that same thing in home health care, hospice, and private duty home care.  The agency that can recruit, select, train and retain the top talent wins in the marketplace ... and wins consistently.

I'd like to extend this personal invitation to you to visit our new web site for Leading Home Care.  Take a few minutes to explore, watch the videos, and consider what support you need to grow your business and get ready for the future.  Then give us a call  at 502-339-0653 to discuss how we can help YOU!

In addition to these services for home health and hospice, we continue to support owners and CEOs of private duty companies through The Academy for Private Duty Home Care®.

And if you want to improve caregiver recruiting, selection, training, and retention, then you'll want to visit Caregiver Quality Assurance®.

No other company brings you the experience, the talent, and the resources to grow your home health agency, hospice, or private duty home care like Leading Home Care.  Take a moment to take a look!

Monday, February 03, 2014

Could your Photo Copier create a HIPAA Violation?

Dear friends,
The following article is about the application of HIPAA requirements to information stored on photocopiers.  Feel free to share this information.  If you decide to use this material, please include our copyright designation that is shown at the end of the article and send us a copy of any publication in which the material appears. 
Please do not hesitate to contact us with comments, questions, or requests for additional information.
Elizabeth E. Hogue, Esq.
Office: (877) 871-4062
Fax: (877) 871-9739
Twitter: @HogueHomecare
HIPAA and Photocopiers
The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (DHHS), the primary federal enforcer of HIPAA requirements, recently settled alleged violations by Affinity Health Plan for $1,215,780.  OCR’s investigation and settlement were based on digital photocopiers that were leased by Affinity.  The photocopiers had hard drives that stored all information copied by the photocopier.  The information stored included medical records and other documents that contained protected health information (PHI).
Affinity terminated its lease of the photocopiers.  CBS Broadcasting subsequently purchased a photocopier that had been leased by Affinity.  The staff at CBS found the PHI on the hard drive of the photocopier and a representative of the CBS Evening News contacted Affinity to inform Affinity that PHI had been inappropriately disclosed.  The PHI of up to 344,579 individuals may have been disclosed without meeting applicable requirements.  This revelation triggered an OCR investigation and the settlement described above.  This investigation and settlement serves as a reminder to providers to make certain that hard drives are wiped clean before any equipment is disposed of by terminating leases, sale, etc.
Providers should also take this opportunity to review what constitutes a breach under new rules effective on September 23, 2013.  According to these rules, “breach” excludes the following:
-        Any unintentional acquisition, access, or use of protected health information by a workforce member or person acting under the authority of a covered entity or a business associate, if such acquisition, access, or use was made in good faith and within the scope of authority and does not result in further use or disclosure in an impermissible manner.
-        Any inadvertent disclosure by a person who is authorized to access protected health information at a covered entity or business associate to another person authorized to access protected health information at the same covered entity or business associate, or organized health care arrangement in which the covered entity participates, and the information received as a result of such disclosure is not further used or disclosed in an impermissible manner.
-        A disclosure of protected health information where a covered entity or business associate has a good faith belief that an unauthorized person to whom the disclosure was made would not reasonably have been able to retain such information.
-        Except for the above, an acquisition, access, use or disclosure of protected health information in a manner not permitted is presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised based on a risk assessment of at least the following factors:
o   The nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification;
o   The unauthorized person who used the protected health information or to whom the disclosure was made;
o   Whether the protected health information was actually acquired or viewed; and
o   The extent to which the risk to the protected health information has been mitigated.
Based upon the above, providers should be reminded that not all disclosures of PHI are breaches. Providers should apply the criteria above on a case-by-case basis to determine whether disclosures fall into an exception described above.  If requirements of an exception are met, providers will not be required to provide notice of breach to patients whose PHI was compromised.
©2013 Elizabeth E. Hogue, Esq.  All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

Friday, January 03, 2014

Home Health Employees Biggest Frustration - "Idiot Bosses"

What is your level of staff retention for 2013?  How many of your high quality nurses, therapists, or
clinical managers resigned this past year? 

An article in the December 21, 2013 issue of USA Today described two different surveys that show that many workers are planning to leave their jobs in 2014, and distrust of their bosses is the biggest reason. 

Would you take a bullet for your boss?

More than 70% of people who were asked that question in a recent survey conducted by bodyguard David Simmonds, whose job it is to do just that, said no way would they stand between someone with a gun and their boss.

Another survey — this one conducted by British recruitment firm Staffbay — found that of 15,000 workers 87% wanted to leave their current role and would be job hunting in 2014. When asked why, 53% said: "I don't trust my boss."

What exactly don't they trust? Many respondents said they didn't trust them "to do the right thing by them and their career." Others felt they weren't valued at all.

In a 2012 study, US Government data reported that healthcare jobs turned over at 28% percent.
Between 43% and 75% of nursing aides turn over each year, studies have found, compared to a 27% rate for all healthcare and social-assistance jobs in 2012, notes WSJ. And the 2013 Private Duty Benchmarking Study from Home Care Pulse showed that personal caregiver turnover was 52.5% in 2012, up from 49.8% in 2011 and 46.2% in 2010. 

What do Nurses Want Most in Home Health Care?

A study conducted by Leading Home Care asked a group of home health nurses and their managers what was most important to them creating a great place to work. 

While the nurses listed:
  1. Feeling valued and appreciated
  2. Doing meaningful work
  3. Having a Servant Leader for a boss
The Nursing Managers thought their nurses most valued:
  1. Meaningful work
  2. Pay and benefits
  3. Appreciation and recognition
While the managers felt that pay and benefits was second on the list for nurses, the nurses themselves put pay and benefits seventh out of seven.  What they really want is to be valued and appreciated by their managers. 

Look First to Your Managers

In his best selling book, "First, Break All the Rules", Marcus Buckingham of Gallup said, "... people leave managers, not companies.  So much money has been thrown at the challenge of keeping good people ... when in the end, turnover is mostly a manager issue.  If you have a turnover problem, look first to your managers." 

Several years ago we were working with a large home health agency that had a recruiting issue and a retention issue.  We worked with their leadership team to develop a strategic recruiting and retention plan.  We first filled all of their current job openings.  Then we focused on retention and the solution was the creation of an ongoing Leadership Development Institute to help their managers develop the knowledge, skills, and attitudes to be the kind of bosses that nurses want to work for. 

There is plenty of data to show that as the economy improves, more and more home health workers will consider changing jobs.  Now is the time to make sure your agency has in place strategies to create a great place to work, and to retain your top talent. 

Now's the time to consider talking with Leading Home Care about creating your Strategic Recruiting and Retention Action Plan .