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.