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

Sunday, July 29, 2012

Ten Tips to Survive your next Medicare or Medicaid Survey

By Stephen Tweed

It's the call you dread.  "The surveyors are in the lobby."  Responding to a state survey is one of the most difficult and intimidating experience a new agency administrator faces.  But it doesn't have to be an intimidating experience.  There are some things you can do to get ready, and some things you can do during the survey to make it a positive experience for you and your agency.

Whether or not you agree with the Federal, State, and local laws regarding home health care and hospice, or the standards for accreditation set by The Joint Commission, CHAP, or ACHC, they are mandated and must be followed.  Surveys are designed to determine whether or not patient needs are being met, and whether or  not your agency is meeting the Conditions of Participation for Medicare or Medicaid.

You can make the survey process an asset for your agency by meeting and exceeding the standards.  Use the survey process as a tool to make your agency more productive, more patient centered, and more profitable.

Our good friend, Nancy Allen, CEO of Solutions for Care in Jacksonville Beach, Florida gives us ten specific steps you can take to survive the survey experience:

1.  Remove the Fear ... Start off on the right foot!  Educate your receptionist and office staff about the nature and purpose of a survey.  Remember that a pleasant greeting is the best way to start every survey visit.

2.  Act as if you have had a survey before.  In other words, follow the words of the great sales trainer who teach, "Fake it until you make it."  Develop a focused plan to be ready for the survey when it happens.  It's inevitable.  Put together a "Survey Binder" with all of the information you will need to respond to the surveyor. Keep it up to date.

3.  Hospitality 101:  The Proper Care and Feeding of Surveyors.  Have a place set aside for the surveyors when they come.  Make sure they are comfortable and have the resources they will need for their day (s) in your office.

4. Remove the Mystery.  Ask what type of survey is being conducted.  Be prepared for each type of survey ... State Licensure, Medicare Survey, Medicaid Survey, Complaint Survey, Follow Up Survey, Accreditation Survey.

5.  Who's Looking? Information about your organization that has been reported to Medicare or Medicaid is readily available to surveyors.  Be familiar with the information that is available about your agency.

6.  Study the Regulations.  The time invested in getting to know the regulations backwards and forwards is time well spent.  Since these rules are constantly changing, it's important that you have at least one member of your team whose job is to keep up to date with all federal, state, and local regulations as well as accreditation standards.

7.  There's Always Room for Improvement.  View the surveyor as someone who can be helpful in providing input for your quality management team.  Your agency and the surveyor have many of the same goals; ensuring that patients receive the highest quality care, and meeting the COPs.

8.  Avoid the Easy Deficiencies!  The best way to be deficiency free is to have systems in place to make sure that you are always ready to meet the regulations and standards.  Without solid systems in place, things fall through the cracks.

Order a Copy Today
9.  Control your Growth.  It is not unusual to see out-of-control behavior in home health agencies that want to grow quickly.  While growth is a good thing, controlling the rate of growth is important to make sure you do not outpace the capabilities of your people and your processes.

10.  Find your Niche.  Think outside the box.  Don't do what everyone else is doing in your local marketplace.  Look for opportunities to stand out from the crowd, and focus in the specific needs of a narrow segment of the market.  

For more tips, techniques, and strategies to survive the surveyor, you will want to order a copy of the 3rd edition of Nancy's book, Survivor!  Ten Practical Steps for Survey Survival.  

Friday, July 27, 2012

New Study Shows Wide Variation in Hospital Strategies to reduce Readmissions

I was reading through several discussion groups on Linked In the other evening, and came across a posting leading to an article by The Commonwealth Fund that reports on the results of a new national study -
Contemporary Evidence About Hospital Strategies for Reducing 30-Day Readmissions -
about strategies used by hospitals in reducing avoidable readmissions for CHF and AMI.

In reading the report, I was struck by the fact that the recommended strategies to reduce readmissions do not include the use of home health care or private duty home care.  Yet we know from our research that the two most common causes of readmission are medication compliance and follow up visits with a primary care physician.  Home Health and Private Duty are in excellent positions to make sure patients take their meds and see their doctors.

That suggests that our industry has a lot of work to do to reach the executives of hospitals and health systems who are looking for solutions to the readmission problem. 

What are you finding in your local marketplace regarding hospital leaders and their awareness of home health care and private duty home care as part of the solution to the readmission problem?

What have you tried that has worked in communicating with them?

What results have you seen in reducing readmissions?

Tuesday, July 10, 2012

What to Do When There's Too Much To Do

By Stephen Tweed

Is overwork slowly killing you, emotionally, physically, or spiritually? It doesn’t have to! Help is on the way.

My friend, Laura Stack’s newest productivity book, What to Do When There’s Too Much to Do: Reduce Tasks, Increase Results, and Save 90 Minutes a Day, is in bookstores now. Laura has created the first-ever “Work Less, More Success” guide to time management! Instead of “do more with less,” her newest productivity handbook shows you how to “do less to achieve more.” Simply stated, the central message is “It's better to do less, not more, so you can do better, more focused work.” 

This message really resonates with home health agency leaders who are overworked, overstressed, and over-committed.  You know from reading our newsletters for years that my theme is focus, focus, focus.  You get more results with less effort when you focus. 

Laura Stack knows your to-do list is already packed to capacity, so her new book lays out a system to let you work less and achieve more. Following the PWF, you’ll organize your life around the tasks that really matter and - this is crucial - let go of those that don’t. Dozens of practical strategies will help you reduce your commitments, distractions, interruptions, and inefficiencies. You’ll shrink your to-do list and save time - around ninety minutes a day - while skyrocketing your results and maintaining your sanity. I highly recommend her unique approach to workflow.

Do yourself and your leadership team a favor and click on the link and order a copy of  What to Do When There’s Too Much to Do: Reduce Tasks, Increase Results, and Save 90 Minutes a Day today!