Thursday, December 13, 2012

Disease Management Works to Keep People Healthy

We get a regular email letter from our friend and professional speaking colleague, Joyce Gioia, called the Herman Trend Alert.  It was started by our dear friend and Joyce's late husband, Roger Herman.

Joyce is a strategic business futurist, certified management consultant, and author.  Her latest e-letter caught our eye because it pertains directly to what we do in home health care.

Disease Management Works to Keep People Healthier - December 12, 2012
Disease Management is a process by which government agencies, health care providers, and insurance companies with a vested interest support people who have chronic diseases in
making good lifestyle and nutritional choices. Published in the peer-reviewed journal, "Population Health Management", this international study shows the very positive effect that disease management has on hospital admissions and Adjusted Length of Stay (ALOS).

Three years ago Australia's largest not-for-profit health insurer, the Hospitals Contributions Fund (HCF) launched a chronic disease management program, the My Health Guardian program, to help people with heart disease and diabetes to self-manage their conditions.

For participants with heart disease, the difference in percentage change in hospital admission rates compared to non-participants were reductions of 7.2 percent and 12.0 percent after 12 months and 18 months, respectively. This group also recorded statistically significant improvement in readmission rate after 12
and 18 months and ALOS after 18 months. For diabetes sufferers, the difference in percentage change in hospital admission rates was decreased by 7.8 percent after 12 months and 13.4 percent after 18 months for program participants compared to non-participants.

Last December, a strategy report issued by the United States' Department of Health and Human Services detailed that more than 25 percent of Americans have two or more chronic conditions. They defined chronic conditions as those requiring continuing medical care, that often limit people's ability to perform activities of daily living, including heart disease, diabetes, obstructive lung disease, high blood pressure, kidney disease, osteoporosis, arthritis, asthma, H.I.V., mental illness, and dementia, among others.

Not surprisingly, the problems get worse, as people age. Two-thirds of Americans over 65 and three-fourths of those over 80 have multiple chronic diseases.  Moreover, 69 percent of Medicare dollars are spent on people with five or more chronic diseases. Numerous studies worldwide point to a reduction of costs, when
disease management is applied. One study was mentioned in our Herman Trend Alert

This latest study from Australia is just another example highlighting the importance of disease management. As health care providers and insurance companies look for ways to reduce costs, disease management will be at the top of their lists.


Special thanks to Ernie Clevenger, author of the MyHealthGuide Newsletter for the Self-Funded Community for covering the Australian study in his recent newsletter.

Thursday, November 29, 2012

Predictive Modeling Software Helps Home Health Agency Decrease 30-day Hospital Readmissions by 35.9%

DAYTON, Ohio, Nov. 13, 2012 – Alternate Solutions HomeCare (ASH) directors reported a 35.9 percent average rate decrease in 30-day hospital readmissions from the third quarter of 2011 to the third quarter three of 2012. One factor directors at ASH attribute the dramatic decrease to, is the use of Medalogix predictive modeling software, which has enabled them to specify and streamline appropriate clinical interventions. 

“Medalogix analyzes existing patient data to pinpoint the top 10 percent of patients most at risk of readmission, so we know on an daily basis where to focus our clinical resources most heavily,” said Chad Creech, ASH chief development officer. “It’s a reality that warning signs can be missed by clinicians during weekly visits. Medalogix’s monitoring safeguards and helps us better care for our patients.”

Medalogix compiles existing clinical data that ASH already generates, like OASIS-C and patient records, and then utilizes a predictive algorithm optimized especially for Alternate Solutions. Clinicians then log into a clinical portal that is updated with new patient data and risk rankings every hour. These risk rankings detail which patients are most at risk, why they are at risk and what clinicians can do to successfully intervene. The system is designed to prevent trips to the Emergency Room and readmissions to hospitals.

“The information given to us by Medalogix each day allows us to look at patients differently,” said Tessie Ganzsarto, ASH president. “To know that much about your patients and their critical areas in near real-time allows us to be proactive and react much faster than we could in the past.”
Considering the Affordable Care Act (ACA) provision that grants Medicare the ability to withhold payment form hospitals if a patient is readmitted within 30 days, ASH’s 35.9 percent average rate decrease in 30-day readmissions is a critical advantage as agencies vie for patient referrals from hospitals who are acutely aware of the need to reduce their readmissions in order to avoid substantial penalties and fines. A few notable benchmarks detailing ASH’s readmission rates since partnering with Medalogix:
  •      Doubled ASH’s identification of at risk patients.
  •      Decreased ASH’s 7-day readmission rate by 50 percent in the first month of deployment.
  •      Drove ASH’s June, July and August readmissions rates 3 percentage points below the national average.
“Lowering readmissions is key to providing the best care possible to our patients and serving our hospital partners under pay for performance standards,” said Creech. “It’s been a major area of focus and the most recent data demonstrates our efforts are working.”

“Keeping patients healthy, at home and avoiding costly and unnecessary hospital readmissions to the hospital is our primary concern,” said Lisa Morrison, ACH chief clinical officer. “It’s been a combined and strategic effort that has helped us significantly reduce readmissions.”

ASH is employing several strategies to reduce readmissions and is more precisely targeting these interventions using Medalogix Risk Rankings. A few examples of these strategic patient interventions are:

  • Structuring staff bonuses around successfully lowering readmissions
  • Revitalizing patient treatment plans based on best practice standards
  • Implementing telephonic phone calls to at risk patients

“My motivation in developing Medalogix was to keep patients out of the hospital while simultaneously helping hospitals adjust to reform,” said Dan Hogan, Medalogix CEO. “These most recent readmission figures are encouraging as they show the plan is working.”


About Alternate Solutions Healthcare System: Founded in 1999 by Tessie and David Ganzsarto, Alternate Solutions is recognized as an industry leader in post-acute strategic partnerships. It has strategic partnerships with health care systems in Ohio, Illinois, Wisconsin and West Virginia, and is in conversation with several groups throughout the country to form more. Alternate Solutions has received numerous awards and recognitions for excellence its fields, including being ranked by HomeCare Elite™ in the top 1 percent of home health care agencies in the United States. The award is based upon an analysis of performance measures in quality of care, quality improvement and financial performance.

About Medalogix: Medalogix was formed out of the idea that homebound patients would benefit from a more in-depth analysis of the risks associated with their medications, and that home care agencies, when armed with that analysis, would be better able to remediate that risk.  A litany of studies has shown that patient outcomes are far better the longer a patient can remain in the home.  It is Medalogix’s goal to assist home care agencies with the process of identifying those patients on their census that are most at risk of requiring unplanned hospital care.  The company combines its knowledge of medication risk with a home health are agency’s own clinical data to build a predictive modeling capability that is more accurate than any other risk assessment toolset on the market today.

Marketing to Assisted Living Facilities without Violating Anti-kickback Laws

Part 2: Utilization of Post-Acute Services by Residents of Assisted Living Facilities (ALF’s): Renting Space

Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739
Twitter: @HogueHomeCare

As the number of years in which they have been in business increases, ALF’s are more eager to help their residents “age in place.”  ALF’s often view availability of services from post-acute providers; including Medicare home care, private duty home care, hospice, and home medical equipment (HME); as essential to allow them to achieve this goal.  While ALF’s want to encourage utilization of these types of services by residents, ALF’s cannot lose sight of the fact that the healthcare industry is highly regulated.  With ever-increasing emphasis on fraud and abuse compliance, ALF’s and post-acute providers cannot afford to violate the law.  How can ALF’s encourage the use of services available from post-acute providers by residents?  What are the potential legal pitfalls that ALF’s and post-acute providers must avoid?

A key legal pitfall for arrangements between ALF’s and post-acute providers includes violations of the federal anti-kickback statute.  This statute provides, in part, as follows:

(1) Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind--

(A)  in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this subchapter, or

(B)  in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this subchapter,

shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both.

(2) Whoever knowingly and willfully offers or pays any remuneration (including kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person

(A)  to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under this subchapter, or

(B) to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this subchapter,

shall be fined not more than $25,000 or imprisoned for not more than five years, or both..."

A kickback occurs when a provider makes referrals to another provider and then something flows back from the provider that receives referrals to the provider that makes referrals.  The application of this statute to arrangements in which post-acute provider receive referrals from ALF’s is clear.  ALF’s make referrals to post-acute providers.  If something flows back from post-acute providers to ALF’s, there may be an impermissible kickback.  An example of such a potential kickback occurs when post-acute providers rent space from ALF’s from which they received referrals.

There are, however, a number of exceptions or “safe harbors” to the above statute.  The next article in this series will focus on how ALF’s can meet the requirements of the space rental safe harbor so that post-acute providers can rent space from ALF’s in order to enhance the provision of services to residents.

©2012 Elizabeth E. Hogue, Esq.  All rights reserved.

Reprinted with Permission.  

No portion of this material may be reproduced in any form without the advance written permission of the author.

Tuesday, November 27, 2012

Palliative Care Today: Impacting quality of life in home health care hospice

By Chris Willis, MSW, LSW
OneOnOne Hospice Solutions

One of the fastest growing home health care programs in our country is Palliative Care.  Hospitals, home health agencies, hospices, and long term care organizations are starting Palliative Care programs.  This trend is demonstrated as the National Hospice Organization, which was formed in 1978, changed its name to National Hospice and Palliative Care Organization in 2000. 

There seems to be some confusion as to ‘what is palliative care?’ Whether seeking the answer from the many resources in the medical and care communities on online with the internet, each source states it a little differently.  

NHCPO  defines Palliative Care as “treatment that enhances comfort and improves the quality of an individual’s life during the last phase of life.”

In the 12 ½ years spent with one of the premier hospices in the state of Arizona, I have come to define palliative care as “a service that provides patient driven care to individuals diagnosed with a serious, chronic or terminal condition.” This definition grew from our experiences with patients who were seeking care that would assist and empower them in a manner and route that was specific to them. Today, more home health and hospice agencies are creating palliative care services and programs within their current care offerings to ensure that no one is left without the services they need. This type of care benefits the patient as well as your agency by providing a unique supportive angle that offers a follow-up opportunity which improves conversion rates.

As the director of a hospice Palliative Care Program, explaining palliative care was a frequent occurrence. These discussions were not just with patients and their support systems, but also with countless medical professionals who were seeking and learning more about how our services were supporting their patients’ needs. Palliative care affords an agency the opportunity to truly honor the comfort approach “the patient way” by supporting them on their life journey. Also, palliative care bridges the gap by allowing you to bill for your services if deemed medically necessary, regardless if a patient is eligible to utilize their hospice or home health benefit.

A Palliative Care Program gives your agency the ability to provide bio-psycho-social support, knowledge and resources to an individual and their support system by a designated team of professionals, as defined by your agency and license(s). For the patient and their support system utilizing a palliative care program, it assures them that they have others to accompany them on their life path, to keep them informed of what to expect, and to prepare and support them with open and honest discussions about their disease process. Whether seeking aggressive or comfort care, or both, the patient has the ability to choose. For an agency with a complete palliative care program, it reinforces their company’s commitment to providing “comfort as the patient defines it,” while leveraging themselves with their community partners.

OneOnOne Hospice Solutions was created so that we may assist, empower, and strengthen agencies and their teams as they define their individual palliative care programs.  Through our experience we have learned that you need these four key components to create a successful Palliative Care Program:

1.       A tracking system enhanced by an agency’s current intake system to ensure that “no one is left behind.” This includes policies and procedures, intake system analysis and needs assessment tools to differentiate services offered by an agency,
2.       A marketing toolbox specific to your service area, which includes internal and external needs, assessment tools, market trends, referral and intake forms, policies and procedures and more,
3.       A commitment for side-by-side support from creation to launch by a trained palliative care professional to agency leaders and team members; and finally,
4.       A community partnership initiative derived from key influencers in the service area to ensure the delivery of complete and seamless compassionate care to patients and their support systems.

Palliative care is an ever-growing and changing service that reflects the needs of patients and their support systems. Although relatively new, a comprehensive palliative care program should be seriously considered by every home health care and hospice company as a way to care for their communities in the future and differentiate their service offerings.

About the Author: Chris Willis, MSW, LSW is a social worker, educator, marketer and leader with over 20 years of Healthcare experience, Chris’ extensive knowledge in elder care has built her expertise in providing resources and solutions that meet individual needs. Chris recently joined the OneOnOne HomeCare Solutions team through the newly-formed OneOnOne Hospice Solutions Division, designed to assist individuals and agencies to enhance hospice and palliative care services. She is a proud graduate of The Ohio State University.

Wednesday, November 14, 2012

Retain Your Records for Ten Years

The Medicare Conditions of Participation require home health agencies to retain their records for five (5) years after the month the cost report to which the records apply is filed.  Our friends at Boyd & Nicholas, The Cost Report People (R), tell us that the Accountable Care Act has new provisions that extend that. 
The ACA added a new record retention requirement to maintain for seven (7) years from the date of service ordering and certifying documentation for home health. That documentation includes written and electronic documents relating to written orders and certifications and requests for payments for home health services, which is a large part of the record.
We recommend that agencies retain records for 10 years since that is how far back the federal government can go to look for false claims filings.

Saturday, November 10, 2012

How Are Medicare Cuts Affecting Your Agency?

By Stephen Tweed

Last week I was speaking at the NAHC annual conference in Orlando on the subject of "Serving More Patients."  We had a terrific audience and engaged in some great conversations.

One of the questions I was asking home health agency leaders as well as some of our colleagues who provide financial services for home health agencies is about the financial performance of home health in general.  The responses I received indicated to me that many agencies are feeling the pinch more this year than last year from the Medicare cuts in reimbursement.

This message was reinforced as looked at the third quarter 2012 financial results from the Big Four publicly traded home health companies.

Almost Family reported third-quarter net income of $4.1 million, down from $4.8 million or 17% from a year earlier. Revenue for the quarter fell to $85.1 million from $86.2 million or 12%.

Amedisys reported that revenue from services increased by 1.4% to $375.6 million while net profit by 19.2% compared to the third quarter of 2011.

Gentiva reported total net revenues of $424.4 million, a decrease of 6% compared to $449.7 million for the quarter ended September 30, 2011.

LHC Group reported
  • Net service revenue for the third quarter of 2012 was $158.9 million, compared with $153.4 million for the same period in 2011... an increase of 4.2%
  • Net income attributable to LHC Group for the third quarter of 2012 was $6.3 million, compared with a net loss attributable to LHC Group for the third quarter of 2011 of $38.0 million, which included a $45.0 million after tax charge related to the company's settlement with the Department of Justice. 
 As a result of the downturn in their home health business, these companies have added other services that show more revenue growth or better margins.

Almost family has put renewed emphasis on their personal care business (private duty) with revenue rising to $19 million after their acquisition of Cambridge Home Health Care in Akron Ohio.

Amadisys CEO Bill Bourne commented on his company's performance in areas beyond home health.   "Overall, we were pleased with bottom line results for the quarter and remain on pace to meet our earnings plans for the year. Job and investment tax credits benefitted quarterly results. Operationally, we displayed our second consecutive quarter of positive year-over-year episodic admissions growth, continued to grow our managed care business and our hospice average census was up considerably.

During the quarter, Gentiva acquired three agencies to expand the Company's geographic coverage and leverage its existing home health and hospice capabilities in given markets.  In July 2012, the Company acquired Advocate Hospice based in Danville, Indiana.  In August 2012, the Company acquired Spokane, Washington based Family Home Care, which provides both home health, hospice, and private duty services, and North Mississippi Hospice which is based in Oxford, Mississippi

LHC Group provides  home health, hospice and private duty locations in its home-based division and long-term acute care hospitals in its facility-based division.

These results and financial reports indicate that many home health agencies have recognized the need to diversify their revenue streams, adding hospice, private duty home care, and other related services.

In 2012, we have seen significant increases in requests for assistance in developing business growth strategies for hospice and private duty arms of successful home health agencies.   In fact, we've done more work in the hospice sector in 2012 than we have in a number of years.

So what does this all mean?

Home Health Care has always been a challenging business with financial ups and downs on a seven year cycle.  This downturn has been on a slightly shorter cycle that in the past - 4 years - and is mostly due to the political upheaval in Washington and the early effects of the Affordable Care Act. 

Looking forward, it appears that home health care will continue to be negatively affected for the next couple of years, and companies will continue to seek other revenue streams in hospice and private duty. Meanwhile, the private duty marketplace has slowed its growth because of the general economy, the volatility of the stock market, and the dramatically increasing competition. 

The good news is that we are an amazingly resilient industry sector, and we will recover.  I've been speaking, writing, and consulting in home health, hospice, and private duty home care since 1982.  I've seen four major economic challenges in 1989, 1997, 2008, and now 2012.  After each one of these disruptions, the industry came back stronger, growing faster than before.  We'll come back from this one as well.  The question is, "How many agencies will go out of business this time?"

Three Things You Can Do

1.  Serve More Patients.

Now is the time to shore up your market share by developing and implementing new strategies for sales, marketing, and public relations.  The competition is hungrier than ever, and you can't grow by doing the same old same old.

2.  Refocus Your Leadership Team

Leading is easy when business is good and cash is flowing.  Leadership becomes more difficult when competition increases, growth slows, and margins erode. Now's the time to refocus your team, assess your strengths, and make sure you have the right people on the bus.

3.  Put More Focus on Other Revenue Streams

I've worked with hundreds of home health agencies that have hospice and private duty home care.  Most home health agencies do a lousy job in the private duty sector.  I've written many times about "The Four Big Barriers to Success."  But the big thing is to pay attention to your private duty business.  Put the right person in charge, give them some autonomy, and invest in growing the business.   


Monday, November 05, 2012

Proposed Settlement May Extend Coverage to More Medicare Home Health Patients

Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739
Twitter: @HogueHomeCare

A proposed settlement in a nationwide class-action lawsuit may provide coverage for skilled nursing care and therapy services to Medicare beneficiaries who do not show a likelihood of medical or functional improvement.  The lead plaintiff in the case is Rosalie Glenda R. Jimmo of Bristol, Vermont.  She has been blind since childhood and her right leg was amputated due to complications of diabetes.  She is in a wheelchair.  Ms. Jimmo is joined in the lawsuit by another plaintiff, Ms. Rosalie J. Berkowitz of Stamford, Connecticut.  Ms. Berkowitz has multiple sclerosis.  The Medicare Program denied coverage for skilled nursing and physical therapy on the grounds that she showed no improvement as a result of these services.

The proposed settlement means that CMS will rewrite the Medicare coverage manual to allow for payment for services if they are needed to maintain the patient’s current condition, or to prevent or slow further deterioration, even if patients’ conditions are not expected to improve.  This significant change in coverage may mean that many more patients may be eligible for the Medicare home health benefit.  The proposed settlement was negotiated with attorneys from both the Justice Department and the Department of Health and Human Services (HHS).  The proposed settlement has been submitted to the judge in the case in the Federal District Court in Vermont and is now awaiting approval.  If approved, the changes in coverage will apply to both fee for service Medicare and Medicare Advantage Care patients. 

If the proposed settlement is approved by the Court, the Court will certify a nationwide class of more than 10,000 Medicare beneficiaries.  The members of this class’ claims for services under the Medicare Program were denied before January 18, 2011, when the lawsuit was filed.  The plaintiffs in the lawsuit argued that statutes and regulations governing the Medicare Program do not require beneficiaries to show that their conditions are likely to improve.  Provisions of the Medicare manual and other guidelines of the Medicare program used by Medicare contractors to process and pay claims erroneously establish more restrictive standards that were never intended. 

If finalized, this change in policy is likely to be welcomed by home health agencies.  Over a period of many years, agencies have been stymied in their efforts to provide services to patients like the plaintiffs and similar patients across the country.  The historic lack of coverage for services to such patients has caused home health agencies to confront difficult legal, economic, and ethical dilemmas.  Even if agencies could afford to continue to provide substantial free services to such patients, it appeared that the provision of free services violated applicable prohibitions of the Office of Inspector General (OIG) of HHS regarding the provision of free services to patients that exceed $10.00 at a time or $50.00 in the aggregate during a calendar year.  Agencies would welcome relief from difficult dilemmas and an opportunity to provide care to as many patients as possible. 

Stay tuned for news about whether this proposed settlement is finalized and resulting changes in coverage!

©2012 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.  

CMS Issues Waivers for Hurricane Sandy Relief

In emergencies such as Hurricane Sandy, the Centers for Medicare and Medicaid Services (CMS) responds with flexibilities set in place by statute, ensuring that the most vulnerable populations receive the care they need.

On Nov. 1, CMS held a special Open Door Forum on Hurricane Sandy and the special flexibilities given to CMS in circumstances like natural disasters. CMS policy experts described how CMS can assist agencies in exercising these flexibilities and waivers. Policy experts explained a 1135 Waiver and provided guidance on program flexibilities during an emergency.

Here is a link to a resources page with up to date information on the waivers granted for home health and hospice in those states affected by Sandy.  

CMS releases Medicare Home Health updates for 2013

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule to update the Home Health Prospective Payment System (HH PPS) rates for Calendar Year (CY) 2013. Payments to home health agencies are estimated to be virtually unchanged next year, decreasing by approximately $10 million in CY 2013 (about 0.01%).   This reflects the net effect of a 1.3 percent home health payment update, an updated wage index, an update to the fixed-dollar loss (FDL) ratio, and a case-mix coding adjustment intended to offset coding changes unrelated to changes in patient health needs.

Here's a link to the CMS Fact Sheet. 

At Leading Home Care, we will continue to gather facts and data about how these changes are affecting home health agencies across the country.   During our visit to the 2012 National Association for Home Care Meeting in Orlando, it was pretty evident how much the 2012 cuts have negatively affected home health agencies across the country. 

Thursday, November 01, 2012

Fabulous New Health Care Commercial - Stethoscope

A friend sent me a link to this new commercial called, "Stethoscope."  He said, "Please don't play this until you have great sound.  It's really great.  It's not political, and you'll love it."

So I clicked on the link, and here's what I found.


What do you think?

Tuesday, October 30, 2012

Points of Learning from Disaster Plan Deployment

By Stephen Tweed

After the lessons learned by home health agencies in the wake of Hurricane Katrina in 2005, state home care associations and local home health agencies and hospices created Emergency Preparedness Plans to deal with future national disasters.  In interviewing leaders in home health agencies whose patients and employees were directly affected by the aftermath of the storm, we were able to document some simple strategies to get ready for the future. 

Here are some things you can learn from their experience:

  • Maintain a checklist of everything that you might need from your office in the event of a disaster which causes you to work from somewhere else. Make sure you have copies of this list, and all of the information you'll need in an off-site location.
  • You need to be 100% automated, with schedules, patient lists, and staff information complete and up to date. You can't have people working from paper schedules on their desks until they have time to input the data into the computer system.
  • Have your IT system in a secure data center that has backup power and internet connections so you can access the system from remote locations.
  • Maintain an up-to-date roster of all employees with contact information.
  • Have personal cell phone and home phone numbers for all staff.
  • Use your telephone contacts and keep in touch with your staff and patients using your telephone tree. Limit use of radio and TV to contact your patients unless all other communication systems are not operable. This can lead to confusion, and given the power outage you can’t always rely on media. The more “business as usual” for the patients, the better. It helps them remain calm.
  • Have alternative locations for your emergency operations center identified and prepared in advance. If something happens to your office today, where will you establish your operations?
  • Have a master map of every phone line, fax line, and internet connection into your building. Know who to call at the telephone company to re-route each phone line and internet connection.
  • Have a plan to access a back-up electrical generator in the event power is out for an extended period. Since the home health agency is in a commercial office park and not near any healthcare facility, they were down the list of priorities to have power restored by the electric company.
  • Have a disaster plan for your answering service, and review it with them regularly.
  • Keep a list of schedules and patient lists printed out ahead of time. When you know a storm is coming, run the lists and get them off site.
  • Have extra car chargers for laptops and cell phones.
  • Have wireless internet cards for your laptops.
  • Remember, home care staff need transportation. With payroll down, mileage checks were delayed, so agencies provided gas cards to staff in need. 
  • Keep your senior leadership team visible at all times during the emergency. Your staff wants to see leadership in action.
  • Remain calm and understand the importance of “emotional intelligence.” Keep your leadership team focused on taking action that serves the patients and the staff.
  • Supply food. There’s something about having food available that creates a special bond between members of a team working through an emergency situation.
Stay tuned for the stories of home health and hospice heroes in action during Sandy, and the lessons we can learn for the future. 

What is your story from Sandy? 
What have been your experiences in implementing your agency’s disaster plan? 
What points would you add to our list?

Heroes of Home Health & Hospice in Action on The East Coast

As Hurricane Sandy roared ashore just south of Atlantic City, NJ around 8:00 pm eastern time on Monday, the heroes of home health care and hospice across the region were in action executing their emergency preparedness plans.  Most agencies we know of have some form of plan to put into action in the event of a major catastrophe such as Sandy.

We will be bringing you the actual stories as we get details.  I'm writing this to you in early afternoon, about 18 hours into the storm. Power is out over much of the region, and emergency officials are still assessing the deaths and the damage.

Meanwhile, unseen by most folks, home health and hospice nurses have left the security of their own families to go out into their communities to care for their patients, assure safety, and in some cases make rescues.  If you have a personal story about how you and your agency responded to this disaster, please share it with us so that we can let the world know that home health and hospice are there for our patients and our communities.

Thanks to all of you who are out there serving.  We will keep you in our thoughts and prayers. 

Sunday, September 30, 2012

Selling to the C Suite

Muffin Marketing is Dead.  C-Suite Selling is in.

You can no longer grow your home health agency or hospice by bringing muffins to the hospital discharge planners and working on developing a personal relationship.  Hospitals are blocking access to discharge planners like never before.  There are too many sales reps, and discharge planners are over worked and under appreciated.

If the future, if you want to get a steady flow of referrals from your local hospital, you'll need to learn how to manage C-Suite Selling, and make a compelling cast to the top executives that your agency can save them money, reduce their stress, or help their marketing process.

There are seven steps in the home health care sales process.  Let's look at how each one applies to selling the C-Suite.

1.  Prospecting.  Find our the names, titles, and contact information for the hospital executives who are being help accountable for reducing hospital readmissions, and for reducing the overall cost of hospital care.

2.  Make the Approach.  Develop a clear, concise strategy for getting an appointment with these key decision makers.

3.  Develop Rapport. Rapport is a harmonious relationship based on trust, confidence, and comfort. We have shown that good rapport is 90% of the sale.  If you have a good relationship with a high potential prospect, and probability of doing business goes up. If you are unable to develop that harmonious relationship, the probability goes way down.

4.  Determine Needs and Wants.  To present a home health program that will save money, reduce readmissions, and help the hospital grow, you really need to understand their business. You need to understand the multitude of critical issues that hospital executives are facing.  You need to help them get claer about which issues are most pressing that you can help solve.

5.  Present your Program.  In our sales training system, we've identified the Four P's of a Powerful, Persuasive Presentation - Problem, Premise, Program, Promise.  You need to develop specific, focused sales presentations base on your understanding of the hospitals key problems, the premise on which you can help solve these problems, the program you offer that will get those results, and the outcomes you promise to achieve if they go with your program.

6.  Close the Sale.  Ask for the business.  Use one key closing question. "What would it take for you to give us one patient referral to test our program?"

7.  Service After the Sale.  After you get that first patient, get results, give feedback, ask for feedback, stay connected, and ask for the next patient.

If you want to move your agency from Muffin Marketing to C-Suite Selling, give us a call and we'll show you how.

Call Julie Raque at 502-339-0653 to set up a telephone appointment with Stephen Tweed.

Help Hospitals Slow the Growth of Health Care Costs

Several years ago, Dr. Corey Waller, an emergency department physician at Spectrum Health in Grand Rapids, MI, noticed a small group of patients were frequent flyers in the emergency department.  Dr. Waller decided to quantify what he had noticed anecdotally.

Blodgett Hospital, Spectrum Health, Grand Rapids, MI
The result was a list of 950 patients who had visited the Emergency Department at two of Spectrum's hospitals more than 10 times each in the previous year.  These frequent flyer miles totaled up to 20,000 hospital visits and an estimated $40 million in costs. 

Another study at Southcentral Foundation Health System in Anchorage, Alaska, discovered that most of their system's high utilization patients fall in to three categories:

1.  Patients with chronic mental illness
2.  Patients who are "medically fragile elderly"
3.  Patients who engage in self-care and have few family resources

How Can Home Health Help?

What if you were to approach the director of the Emergency Department of your local referral hospitals and offer to work with them to help identify their frequent flyers.  Then develop clinical pathways to deal with these frequently recurring chronic conditions that result in return visits to the ED, or readmission to the hospital.

Get the ED Director to encourage the Emergency Room staff to refer their frequent flyers to your home health agency.  By applying your clinical pathways to these folks, and by tracking the results, you'll be able to demonstrate to the ED Director, and the hospital administration the value of home health care in reducing readmissions and overall costs.

Apply These Same Principles to the BIG THREE Medicare Diagnoses

Once you have developed a relationship with the ED and have proven that you can help them reduce readmissions,  then approach the Director of Nursing and the Chief Financial Officer to see if you can work with them to identify the frequent flyers with the Medicare BIG Three ... Heart Attack, Congestive Heart Failure, and Pneumonia.  Over 2000 hospitals will be penalized 1% of their Medicare reimbursement.  Beginning this past Monday, 10-1-12, because their readmission rates for these three diagnoses are higher than norms set by Medicare.

Muffin Marketing is Dead.  C-Suite Marketing is IN

You can no longer grow your home health agency by bringing muffins to the hospital discharge planners and trying to build a personal relationship.  Hospitals today are blocking the way for sale reps to reach the discharge planners.  There are too many reps, and the discharge planners are over run with sales people.

In the future, you will get referrals from hospitals by proving to the C-Suite officers ... Chief Operating Officer, Chief Financial Officer, Chief Medical Officer, Chief Nursing Officer ... that you can get results that are measurable, and that save them money.  In the future, content marketing is king. The agencies that can provide concrete data and information and show they can get results will get the referrals. 

The future of strategic marketing in home health care will be focused on developing proven methods to help your key referral sources solve their most pressing problems, and then developing a sales and marketing message to convince them that you can be an integral part of the future.

Stay tuned for future articles as we continue to research and report on C-Suite selling and Content Marketing.  Call us if you would like to facilitate a new strategic marketing planning process for your home health agency or hospice. 

Friday, September 07, 2012

3,000th member joins Leading Home Care Network on Linked In

This past week, the 3,000th person was approved for membership in the Leading Home Care Network on Linked in.

Tony Buccheri, International Franchise Support Specialist with Right At Home in Omaha, NE is member number 3,000.  Tony works with the master franchises in the UK, Brazil, China and Canada to help them recruit, train, and support franchises in those countries.

Right at Home now has 250 franchise locations on four continents serving the elderly and the disabled.

We are delighted to welcome Tony, and the other 2,999 members to the network for ongoing conversations about the issues facing home health, hospice, and private duty home care.

If you would like to engage in these discussions, log on to Linked In and search for the Leading Home Care Network.  Click on the join button, and you will be considered for membership. The group is limited to current CEOs, Administrators, Owners, and other leaders who are currently employed by a home health agency, hospice, or private duty company.  There are also a limited number of sponsors, affiliates, and faculty from The Academy for Private Duty Home Care.

We do not allow other vendors, recruiters, or individuals who are not affiliated with home care to be members of the group so that we can keep the discussion relevant and not be clouded with self promotion and job placement postings.  If you have suggestions about how we can make this discussion group more valuable to you, please leave a comment below.

Sunday, September 02, 2012

Who will be Member Number 3,000?

This past weekend, we approved member number 2,999 to the Leading Home Care Network discussion group on Linked In.  Who will be the next person to join?  In just over a year, nearly 3,000 leaders in home health care, hospice, and private duty home care have joined in our discussions around the topics of most interest.

This group is limited to leaders who are currently employed by a home health agency, hospice, or private duty home care company.  We want this to be an active discussion, so there are no vendors, recruiters, or non-home care folks who clutter up the discussion with self-promotion or job ads.

As a result, we are getting into some very interesting in-depth discussions that you will find interesting.

Here are the current hot topics:
  • Do you and your mid-life siblings have communication problems?
  • Wondering of anyone who owns a for-profit home care company has considered starting a non-profit to serve those who are in the gap?
  • Do you have a set minimum number of hours for private duty?
  • I am amazed at the misconceptions around home care.  I talk with doctors every day who don't know much about home care.
  • How do personal care agencies handle non-compete issues with clients and caregivers?
  • Does anyone do live-in care.  If so, how do you bill clients and pay your caregivers?
  • What scheduling / management software are you using?
  • Press release from the DOJ on marketing bonuses for Medicare Agencies. 
If you would like to participate in these discussions, or start a thread of your own, just log on to Linked In and search for The Leading Home Care Network.

We look forward to seeing you there.

Comment Period Closing for 2013 Home Health PPS Rule

The deadline is 5:00 pm eastern time on September 4, 2012 to comment on the proposed PPS rules for 2013.  The proposed PPS rule that was published in the July 13, 2012 Federal Register at where you can find the process for submitting comments.

The National Association for Home Care & Hospice has identified four issues of concern, and is encouraging home health agency leaders to review these issues, and make comments.

1.  Acute Care Hospitalization Claims Based Measure.

CMS proposed to use claims-based Acute Care Hospitalization measure in place of the OASIS-based measure. This would provide a more accurate accounting of hospitalization rates, especially since home health agencies must now often rely on patient self-reporting of hospital stays for OASIS.

2.  Home Health Face To Face Encounter

NAHC will once again urge CMS to rescind the current F2F documentation requirements which have proven costly to home health agencies and burdensome to physicians and support personnel, including discharge planners. Despite continuous efforts by home health agencies to educate physicians in the intricacies of F2F documentation requirements since 2010, doctors remain confused, and often uncooperative. Further, NAHC believes that agencies have incurred increased administrative costs associated with education, tracking and resending of documentation, as well as the inability to submit claims for countless episodes of care when physicians failed to document F2F encounters, or document correctly.

3.  Therapy Reassessments

The new rules regarding therapy assessments have added new burden including scheduling problems and increased costs to home health agencies. 

4.  HHRG Grouper Diagnosis changes

CMS’ proposal to ‘enhance’ the HH PPS Grouper will eliminate assignment of case-mix points to the majority of diagnosis codes that are replaced by V codes, and limit the ability to report all Diabetes, Neuro1 and Skin1 codes in the limited spaces at M1020 and 1022. In addition, CMS’ proposal could limit case mix points for fractures when coding rules require that they be reported as secondary diagnoses.

NAHC received information from over 300 home health agencies about the effect of the proposed change to Grouper logic on clinical scores. This change will reduce payment of affected episodes by an average of $200 per episode.

As we have said over and over again, your state and national associations are the grass roots of home care in America.  We encourage you to be involved in your association, and to actively participate in the legislative and regulatory process.  Take a few minutes to review these changes to the HH PPS Rule, and submit your comments.

Wednesday, August 15, 2012

Over 2000 Hospitals to be Penalized for High Readmission Rates

According to a report from Kaiser Health News, more than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.

Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.

Here are some key points from this report:
  • Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills.  
  • A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. 
  • 1,933 hospitals will receive penalties less than 1 percent.
  • Massachusetts General Hospital in Boston, which U.S. News last month ranked as the best hospital in the country, will lose 0.5 percent of its Medicare payments because of its readmission rates, the records show.
  •  The smallest penalties are one hundredth of a percent, which 50 hospitals will receive.
  •  The penalty will be deducted from reimbursements each time a hospital submits a claim starting Oct. 1. As an example, if a hospital received the maximum penalty of 1 percent and it submitted a claim for $20,000 for a stay, Medicare would reimburse it $19,800.
  • 1,156 hospitals where Medicare determined the readmission rates were acceptable will not lose any money.
Where do your local hospitals fall in this list?  What can you do to help them reduce readmissions?  This data may be helpful to you in preparing your next presentation to the C-Suite officers at your local referring hospitals.  

What has been your experience in having conversations with your local hospitals about reducing readmissions?  What results have you achieved in developing strategic alliances with them?  We'd love to hear your comments.

Nurses Indicted for Receiving Kickbacks for Home Health Medicare Referrals

Chicago - August 13, 2012 - A home health care agency in suburban Lincolnwood, two nurses who are part owners of the company and a third nurse affiliated with them, along with two marketers, were indicted on federal charges for allegedly participating in a conspiracy to pay and receive kickbacks in exchange for the referral of Medicare patients for home health care services, federal law enforcement officials announced today. 

Defendants Marilyn Maravilla and Junjee L. Arroyo, both part owners of Goodwill Home Healthcare, Inc., and three other defendants allegedly conspired to pay and receive approximately $400,000 in kickbacks to themselves, nurses, marketers and others for the referral and retention of Medicare patients that enabled Goodwill to bill Medicare approximately $5 million.

Also indicted were Ferdinand Echavia, a licensed nurse who referred patients, and Jean Holloway and Rakeshkumar Shah, both of whom marketed Goodwill’s services to Medicare patients.  The 29-count indictment was returned by a federal grand jury last Thursday and unsealed on Friday following the arrests of Holloway, 41, of Bellwood, and Shah, 46, of Des Plaines.

The information about this indictment should cause all owners, CEOs, and administrators of home health agencies and hospices to review the methods they are using to compensate and pay incentives to employees and non-employee marketers. This is only an indictment and has not yet gone to trial, so we'll need to watch and learn more specifics about what these home health agency owners were actually doing that caused the Office of Inspector General for HHS, the United States Attorney for the Northern District of Illinois, and the FBI to investigate this home health agency.  The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011, and is part of the Health Care Fraud Prevention & Enforcement Action Team.

We'll watch for more details, and lessons you can learn from this case about what to do and not to do in compensating sales and marketing staff in home health and hospice.

Top Techniques for Recruiting Nurses and Therapists

By Stephen Tweed

Before the economy crashed in the fourth quarter of 2008, one of the biggest challenges facing CEOs of home health agencies and hospices who wanted to grow their business was the shortage of nurses and therapists.  We were seeing dozens of agencies who were in a position to grow, but didn't have the clinicians to meet the need.

Then the market tumbled, the economy sagged, unemployment sky rocketed, and very quickly health care professionals stayed put in their current jobs.  As turnover shrank, home health agencies no longer faced the extreme pressure of the nursing shortage.  Many agencies were still needing to hire more PTs, OTs, and STs.

While the staff shortage has not returned to the level that is had been in 2008, we project that you will see turnover increase in home health care and hospice as the economy recovers.  One survey we saw suggested that a significant number of employees are currently dissatisfied with their current job, and will change jobs as soon as the economy recovers enough to give them some level of confidence.

What does that mean for home health and hospice?  It means we need to be prepared for the potential of higher turnover, and put in place process for recruiting, selection, and retention of critical staff members including nurses and therapists.  We'll address retention and selection in future posts, but in this article I want to talk with you about your strategies for recruiting clinicians.

Back in 2006, Leading Home Care conducted an industry wide survey of owners, CEOs, and administrators of home health and hospice organizations to identify the recruiting methods they were using, and the methods they found most effective in finding high quality applicants.

At that time, the Top Ten Techniques were:
  1. Employee Referral Program
  2. Networking in your community
  3. Your agency's web site
  4. Daily and weekly newspapers
  5. Telephone recruiting
  6. Continuing Education courses
  7. Your company's electronic newsletter
  8. Direct Mail Post Cards (to state RN Licensure list)
  9. Your company's paper newsletter
  10. Advertising in church newspaper
Since then, we have monitored the techniques our clients and seminar participants are using, and we have conducted interviews to keep on top of this subject. While these top ten are still very relevant, we see local and national job web sites going up in importance.  Sites like and seem to be working well for some people.

However, we have also see a number of companies fall into the trap of only using online recruiting sites, and forcing all applicants to go through an electronic application process.   This puts up a big barrier to entry, and eliminates many high quality applicants.

The thing we know about recruiting clinicians is that the very best ones are already happily working for someone else.  They are not reading the job ads in the paper, or searching online job sites.  To find them, you'll need to use other approached like your employee referral program, networking, and direct mail.

Once you have filled the funnel a regular stream of high quality applicants, the next step is to put in place a selection process to choose only the best candidates.  More on that in a future post.

What are you seeing in your recruiting of clinicians?  What's working for you?  What's not working?

We'd love your comments.

How Much Will Health Care Reform Cost Your Consumers?

By Stephen Tweed

Sitting on at airplane this afternoon on my way to Atlanta, I saw an interesting tid bit under the title, "Notable and Quotable".  The writer, Jonathan Tobin, said "there may be some voters who are indifferent to the impact on the economy of health care reform... But will they stand for an increase in the price of Pizza".

Then he goes on to quote our neighbor here in Anchorage, KY, John Schnatter.  John is Papa John of Papa John's Pizza.  John says Healthcare reform will cost his company 11 to 14 cents per pizza, and 15 to 20 cents per order filled.  John says that "the Obamacare government surcharge will be passed on to consumers".

That raises the question of how much the new law will add to the consumer's cost of a Big Mac, or a Coke?  Tobin suggests that this across-the-board surtax on virtually all expenditures will hit the poor a lot harder than the rich.

So what impact will this have on us in home health care, hospice, and private duty home care?  Well first, the cost to provide insurance for our employees will go up.  Then the cost of everything we buy will go up.  In home health and hospice, we won't be able to pass it on to consumers, because Medicare and Medicaid pay the bills.  Half of the cost of health care reform is being paid for through reductions in payments to health care providers including $500 billion in Medicare cuts.

For private duty home care, the added costs can't be passed on to Medicaid Waiver, so they will be passed on to private pay consumers.  How much more will you have to charge per hour to pay for the added costs?

Reading this brief quote from Papa John has causes me to question how much cost we will have to pass on to you, our consumer, when you attend a seminar, when you attend your state association conference, when you register for a webinar, or when you buy an eBook.

When you throw a pebble in a pond, the ripples continue out to the edges of the pond.  What will be the ripple effect of paying 15 cents more for Pizza to cover the cost of healthcare reform?

I'd love your comments on this concept.

Monday, July 30, 2012

Home Health Care's Role in Accountable Care

By Stephen Tweed

The other day I was preparing for our bi-weekly online sales meeting with a home health agency sales team in southern California.  During our last meeting, the sales reps had been asking some questions about having contracts with IPAs (Independent Practice Association).  It turns out that many physicians in the state are members of an IPA, and these IPAs contract with health insurance companies, and for our client to get referrals for home health, they needed to be part of the provider network for the IPA.

In researching this issue, I discovered a lot of information about IPAs and Accountable Care Organizations.  That led us to an interesting conversation about the role of home health agencies in forming ACOs.

There's good news and bad news about home health and accountable care.

The good news is that the work that we do in the patient's home can contribute significantly to reducing the overall cost of care for an elderly Medicare beneficiary.

The bad news is, most health system executives and physician group administrators have little or no knowledge of home health care, the positive outcomes of patients receiving home care, and the role we can play in reducing costs.

The other bad news is that our industry has not made significant progress in reducing the percent of patients in home health care who return to the hospital during a 60 day episode of care.  According to CMS, 19.2% of Medicare patients are readmitted to the hospital within 30 days of discharge, and 28.2% are readmitted within 60 days of discharge.  When we look at the Home Health Compare web site, we see that currently 27% of Medicare home health patients are readmitted to the hospital within the 60 day episode.

We've got to be able to demonstrate that home health agencies can have a material impact on the quality of care, the cost of care, and the efficient operation of an ACO.

What you can do to be part of Accountable Care?

As we continue to study how home health agencies can be a part of accountable care, here are three strategies to consider:

1.  Learn about ACOs

Before you consider how your agency will participate in accountable care, you need to learn as much as you can about the concept of ACOs, how they are included in the Patient Protection and Accountable Care Act (Health Care Reform), and what types of organizations are authorized to form ACOs.  For some background information, here are a couple of links you may find helpful.

2.  Learn about the ACOs in your service area

While the discussion of ACOs among home health care leaders is wide spread, the number of actual ACOs that are beginning operation is relatively limited.  Here are two lists of ACOs.  Check to see if any are in your area.

80 Accountable Care Organizations to Know

31 Pioneer ACOs

You can also learn more about the Pioneer ACO by reading the fact sheets from CMS.

3. Get to know the ACO C-Suite Executives in your local service area

Selling home health services to ACOs will be a C-Suite to C-Suite sales process.  Don't expect your front line sales reps or even your Director of Marketing to make the sale.  The CEO and executive team of your home health agency will need to develop relationships with the C-Suite members of the ACO. You'll need to gain their confidence, get the big picture of their approach, and determine how they will contract with other providers.

Then you'll need to put together a powerful, persuasive sales presentation on how your agency can help them achieve their goals, save money for Medicare, and share in the savings.

Let us know about your Experience with ACOs

If you have an ACO in your local marketplace, and you have made contact with them, we'd like to know about it.  We're continuing to gather data and anecdotal information about how home health agencies are participating in this innovative process.  

Increase the ROI of your Home Care & Hospice Association

By Stephen Tweed

Every year, I spend ten to twenty days speaking for state and national home care and hospice associations across the US and Canada.  I'm a huge advocate for home care associations, and I think every owner of a home health agency, hospice, or private duty home care company should be a member of at least one national association and one state association.  I believe you should be active and participate in as many association events as possible.

Stephen Tweed with The Cavett, 
As many of you know, I have been active in all three of the national home health and private duty associations.  I have also been very active for over 25 years in my professional association, the National Speakers Association.  I've chaired committees.  I've served on the National Board of Directors.  I served as National President in 2003. I achieved the associations highest earned designation, the Certified Speaking Professional or CSP.  For the past four year's I've served as Chairman of the NSA Foundation, the charitable arm of our association.  And this past July, I was awarded The Cavett,  the lifetime service award that is given each year to the member who most represents the spirit and values of our founder, Cavett Robert.

Over the years, I've spend thousands of hours and hundreds of thousands of dollars in my role as a member, a leader, and an evangelist for the National Speakers Association.  I even have a line item in my company's P&L for my NSA expenses.  At the same time, I've been able to track millions of dollars of revenue in my company over the past 25 years to specific ideas, strategies, and techniques that I learned from my fellow professional speakers.  It's been a terrific return on investment for me and my company.

What's Your ROI on your Association Membership?

What return are you getting on your membership in your state or national association?  How do you know?  What are the benefits of belonging to your association, and how do you measure it?  How much revenue or profit in your company can you track to value you have received from your association?

At our national convention in Indianapolis this summer, I was having a conversation with my friend and colleague, Ed Rigsbee. Ed is a nationally known expert on association member recruitment and retention.  Ed has developed a method to measure ROI on association membership, and to use that information to evangelize to association members and prospective members.

After our conversation, I went to Ed's web site and read a number of articles he has written to help associations measure, increase, and sell the ROI of membership.  Here are six points I got from Ed's articles that I think you can apply to your own national, state, or local home care or hospice association.

1.  Put a price on it.  Anything that you provide to your association members that has value should have a price for non-members.  If you do free webinars, put a non-member price on the registration page.

2.   Make Knowledge Management a Members-only benefit.  Anything that relates to knowledge about our industry has value.  When your association provides knowledge, make sure it is only available to members.

3.  Focus on Benefits versus Features.  Too many of our associations focus on the features of membership. They list all of the deliverables you receive as a member.  We need to focus more on the tangible benefits that association members take away from conferences, conventions, publications, and online learning. 

4.  Dollarize the line items of members benefits. For each of the features that your association provides to its members, define the associated benefits. Then find a way to measure the value of that benefit to members on an annual basis, and put a dollar figure on it.  When the dollar value of membership exceeds the dues, time, and cost of participating, then the membership becomes a real value and the member gets a measurable ROI.

5.  Nuture Your Member Recruitment Evangelists. My friend talks about "Evangelists" as those members who are actively seeking out others in the the home care and hospice industry and inviting them to become members of the association.  You can become a true evangelist for your association when you can demonstrate significant dollar value in return for your membership.

6.  Re-recruit your existing members.  Too often, members of your association get complacent about their membership and forget the real value.  Then when times get tough and their lives get busy, the focus on othe things and drop out or reduce their participation in association activities. We need to keep reaching out to our association members and re-recruiting them into the value of belonging.

If you would like to read more about how you can measure the ROI of your association membership, or if you would like to get new ideas on how to make your home care and hospice association more valuable to its members, take a few minutes to read through the long list of terrific articles and videos on Ed Rigsbee's web site.  

Ed Rigsbee, Association Evangelist