Medicare can be saved! Homecare is a cost saver

 

Analysis of Medicare Data Indicates that Post-Acute Care Reform Could Extend the Medicare Trust Fund by Two and a Half Years, Potentially Save $100 Billion

 

 

Research identifies new path for improving care coordination and increasing the efficiency of the Medicare program

WASHINGTON, Oct. 10, 2012 /PRNewswire-USNewswire/ -- A comprehensive analysis of Medicare claims data finds that the Medicare program could save as much as $100 billionover the next 10 years and the life of the Medicare Part A Trust Fund could be extended by 2.5 years if post-discharge patients were served in more clinically appropriate, cost effective settings and care delivery was restructured. The Clinically Appropriate and Cost-Effective Placement (CACEP) project, released today by The Alliance for Home Health Quality and Innovation, details opportunities for reducing post-acute care spending by improving the process of transitioning patients following hospital discharge.

The final CACEP report builds upon a series of working papers assessing the volume, payments, patient pathways, and readmissions of various types of post-acute care episodes. The analysis also presents analytic models indicating Medicare savings.  Modeling suggests the utilization of a clinically appropriate and cost-effective care model, which shifts patient care settings under the current delivery structure with payment incentives for clinically-appropriate placement, could reduce Medicare spending by $34.7 billion over a 10 year period (2014-23).  

The report further examines the financial impact that more aggressive payment reforms would have on the Medicare program.  Models indicate that moving Medicare away from a siloed fee-for-service payment system to one that better aligns incentives by adding an explicit policy to reduce Medicare fee-for-service post-discharge spending by 7.5 percent would yield Medicare savings of $100 billion over 10 years. The report finds that more innovative payment models are necessary to achieve optimal savings, where there is strong financial pressure on post-acute care providers collectively to reduce Medicare expenditures, increase efficiency and reduce episode complexity and length.

"The current Medicare program is not sustainable, so it is critical that we begin to adopt policies that reduce spending, while protecting Medicare and overall quality of care for current and future generations.  The CACEP project presents compelling data for restructuring post acute care with innovative payment models that have the potential to significantly reduce spending, increase efficiencies and facilitate improved patient care," said Allen Dobson, Ph.D., CACEP lead researcher and President of Dobson | DaVanzo & Associates, LLC.  

Researchers completed a comprehensive review of the research literature including studies of existing Medicare reform demonstrations. The review examined how shifting patients to the most clinically appropriate and cost-effective post-acute care setting can improve quality and efficiency, streamline care transitions and strengthen care coordination across care settings. The report also examines models for care coordination that demonstrate how provider incentives and increased access to lower-cost settings can lead to significant cost savings through improved chronic care management and reduced avoidable hospital admissions.

Other key findings of the final report include:

• Patient overlap across first settings in post-acute care is considerable.  Given that formal first settings have very different expenditure levels, reductions in Medicare spending can be achieved by shifting patients to more cost-effective settings, including home health.
• Medicare episode payments more than double when the beneficiary's care includes a hospital readmission.
• While the CACEP models are primarily based on post-acute care episodes, the implications of these findings can be applied across our nation's healthcare delivery system.

"With this research, we are identifying areas for strengthening the Medicare program, which we hope the health policy community will find useful for future policy-making decisions to ensure patients receive care in the setting that offers the most clinically-appropriate level of care at the lowest cost," stated Teresa Lee, Executive Director of the Alliance for Home Health Quality and Innovation.  "In releasing this report, we look forward to being part of further discussions on how post-acute care can be reformed to ensure that patients receive quality care in the least expensive setting."

Dobson | DaVanzo & Associates, LLC conducted the Clinically Appropriate and Cost-Effective Placement (CACEP) study. The purpose of CACEP was to determine how the Medicare home health benefit can better meet beneficiary needs and improve the quality and efficiency of care provided within the U.S. health care system. The CACEP project examines claims for a five percent sample of Medicare fee-for-service beneficiaries from 2007 to 2009 and analyzes opportunities for improving quality and efficiency of care and reducing Medicare spending. 

The Alliance for Home Health Quality and Innovation (the Alliance) is comprised of leaders in the home health care community – including several of the largest home health care providers in the United States and the largest national trade association representing home health care providers. The mission of the Alliance is to foster research and education on the value of home health care to patients and the overall U.S. health care system. The Alliance is dedicated to improving the nation's health care system through development of high quality and innovative solutions aimed at achieving optimal clinical outcomes.  To learn more, visit www.ahhqi.org.

SOURCE Alliance for Home Health Quality and Innovation

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Medicare Fraud prevention!

The recent news about Medicare fraud arrests further highlights why home health agencies committed to the highest standards of practice continue to choose Axxess. 

Axxess is the only ANCC accredited consulting and technology vendor in the industry. Our customers depend on us to keep them compliant...An important feature and benefit that Axxess’ Agencycore software offers is that it helps ensure compliance and eliminate errors. Organizations that want to be fraudulent will definitely not choose Axxess because we have built in tools into the software that promote best practice and supports organizations that want to do the right thing. If an organization’s goal is to fraudulently submit claims and cheat the system, then Axxess is the wrong tool for them because we make that extremely difficult. We want the most successful and compliant organizations using Axxess because our software helps the home health agencies do the right thing in a cost-effective and compliant manner. For instance, before you can create claims in our software, there are essential items that must be in place. All visit documents submitted go through a Quality Assurance center where home health agency staff review the documents before they are certified as “billable”. Once the visits are certified as billable, our software takes users through additional steps where you have to indicate they the patients have actually had a face-to-face encounter with the physician and that there are signed orders and care plans in place for the duration of the care provided to the patients. We also have built-in tools that review the quality of the assessments performed on the patient to identify logical and clinical inconsistencies in the documentation. These are just some of the ways Axxess improves compliance for home health agencies. The best and most successful home health agencies continue to choose Axxess to grow their improve patient outcomes, ensure compliance and grow their business.
Here is the article -

http://www.texastribune.org/texas-health-resources/health-reform-and-texas/medicare-fraud-strike-force-indicts-28-texans/

US Healthcare Priority: Home Health

By C. Sam Smith

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"It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity; it was the season of Light, it was the season of Darkness; it was the spring of hope, it was the winter of despair; we had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way." ~ Charles Dickens

In these times of uncertainty, budget numbers are being discussed openly by candidates and cuts are being considered in many government programs. It appears certain that Medicare reimbursements will be cut, and, as always, insurance companies continue to tighten their belts and closely analyze every claim that home health agencies file. Every month, the US Justice Department seems to announce another major instance of fraud in the home health segment, in another part of the country. All these gloomy situations are currently buffeting the home health industry.

In many ways- it seems to be the worst of times.

But, there’s a bright silver lining to these seemingly dark, dark clouds.

Focusing on finding ways to reduce the spiraling Cost of Care has emerged as a single important driver of the dynamics that are changing the healthcare industry.

It is clear, since Home Health is the low cost provider in the healthcare continuum, amidst all the doom and gloom, there is a positive light shining from this one industry segment.

Following is a chart that tells much of the story.

Chart: Per Day Costs for health services: Comparing Hospitals, SNF, and Home Health ¹

This graphic illustrates the reason why Home Health Care as an industry segment is beginning to attract the attention of investors and the larger players in the healthcare industry, even the federal government.

Home Health Costs are lower per day than for any of the other patient care models. That was a fact from 2000-2007, and it is even more accurate today than then.

So home health pros, take heart. Not all the news coming out of health care is bad news. For many of you, who operate and work for cost conscious, quick learning home health agencies, the news is not ‘doom or gloom’ oriented, in fact - it is brightening.

The healthcare industry and its investors are beginning to take notice on this long neglected and undervalued segment, Home Health, and for good reasons. Let’s consider some specific reasons.

1.       Low cost provider: Home Health - With cost based analysis of healthcare delivery taking place within the private and public sectors, home health as an industry segment which includes hospice,  due to its lower cost of care delivery, has become pre-eminent, and has gained increased emphasis, respect and priority in the Overall Healthcare Industry. Home Health Care is not only the Patient’s preferred healthcare delivery method, but is the Low Cost Provider of the Overall Healthcare Industry Continuum, which includes Hospitals, Physician’s Clinics, & Skilled Nursing Facilities.

•    Home Health Agencies do not have the high and escalating cost of maintaining costly buildings and equipment to house their patients, meaning their costs of operations are naturally much lower.
• o   Home Health Agencies are guided by Skilled Nursing Care and Licensed Therapist Care as opposed to hospitals and clinics being guided and driven by Physician Based Care.
• o   The cost of Physicians salaries is naturally higher than the cost of degreed Nurses salaries, due to the amount of time it takes to achieve their educational requirements.
• o   Nurse Practitioners have become more highly valued and utilized across the industry, which enables more patients to receive preventive care at a lower incremental cost.
• o   Many observers are predicting that soon Home Health will soon be driven by NP orders, not solely by doctor’s orders. While it is true that now in 2012, Home Health Agencies require orders from Physicians in order to receive reimbursement from insurers, these orders are carried out primarily by nurses, therapists and aides, who visit in the patient’s home, which dramatically reduces the overall cost of reimbursement vis-a-vis SNF’s and hospitals where the cost of overhead is dramatically higher.
• o   Hospitals daily cost of care in 2007 was 43X higher than that of home health, a tremendously high magnitude. All insurance providers will continue to make certain that patients will be sent home from the hospital almost immediately.
• o   Hospital re-admission rates are already a driving measure that providers are mandated to reduce. Patient outcomes are universally considered to be a top priority of the continuum, emphasizing priority on The Most Important Player in all the healthcare industry—the Patient.
• o   Awareness of healthcare costs overall are receiving increased focus by all segments of the federal government, not just Congress, the Media and the General Public, but also the supreme court has gotten into the healthcare cost analysis business!

2.       Medicare and Medicaid are large drivers of the Federal budget and have a dramatic effect on the US economy, composing 18.2% of GDP and 10.8% of all employment in the USA. Cost savings in healthcare has become a very important topic—for both parties, and for a large segment of the population. Home Health, being the low cost provider, is more and more an important voice at the table.

3.       25% of the overall healthcare patient population base is absorbing 83% of the overall costs in healthcare. ²This causes a disproportionate amount of spending on a minority of the population, the chronically ill. This smaller percentage of patients absorbing a great percentage of the cost is causing more and more home health providers to narrow their focus on this chronically ill patient base. These forward thinking HHA’s are looking to focus their efforts on the patients who require the greatest amount of care. Resources naturally will follow the reimbursement payments.

4.       Home Health Agencies must remained focused on their cost containment because the climate for reimbursement is one where future reductions are almost assured.

5.       Truly only the strongest of home health agencies will survive. Advanced Home Health Agency Management Technology is the only way for HHA’s to effectively manage changes in the regulatory and financial cost containment realms. The strength of a HHA is determined by their effective use of advanced technology to deliver their services.

6.       Home health is the segment that is now the most needed by the overall healthcare vertical in order to reduce overall costs yet, historically, it has been the segment that is most underserved by advanced technology

Of all the software platforms approaching the market today, AXXESS Agencycore is the most recommended³, fastest growing, most comprehensive platform available to the home health industry segment. Axxess takes its role as a thought leader in the home health industry quite seriously. Although some may view the status of home health as being in the worst of times, the future is quite bright, especially for Axxess - which is a fast growing, healthy ecosystem, composed of literally hundreds of highly effective home health agencies, and this number is growing by large increments, monthly. These agencies are forging with confidence into the future with their patient charts well documented in compliance with regulations. Their billing reimbursement rates are ever improving and their costs of doing business are going down. These agencies actually look forward to and enthusiastically welcome surveyors. They use their survey visits as their chance to share with others their ever growing operational confidence and efficiency. Axxess Agencycore⁴ enables them to do this.

Home health is indeed a strong growth industry, for those agencies who operate with strength and confidence and the right mix of technological tools, a culture focused on learning, and a razor sharp focus on the most strategically sound business model with which to thrive in this dynamic industry.

Sources:

¹ Wyatt Matas and Associates, NAHC data analysis, 2001-2007.

^{2 “}Choosing a Successful Post-Acute Business Strategy in Today's Changing Healthcare Environment. Washington, DC: Wyatt Matas. 2012.”

³ http://www.softwareadvice.com/home-health; http://www.homehealthsoftwareguide.com

⁴ http://axxessweb.com

Pasco County Home Healthcare Agency is prepared for the future

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Pasco County mother-daughter pioneering entrepreneur s have established health services business over the past two decades with agility, innovation and commitment to business ethics

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By: C. Sam Smith

 

(New Port Richey, FL,  June, 2012) What was considered sound, ethical, open ended business strategy by woman-owned Mobile Personal Services, Inc. of New Port Richey, FL. has positioned the 22 year old home health agency for the possible effects of the Federal “Patient Protection and Affordable Care Act of 2010” structural health insurance payment reforms, as they may occur.

 

MPS Home Office Location in New Port Richey

Owners Clara Ward and her daughter Lisa Ward Tabbert opened their now highly successful Pasco County home care agency in 1991 driven by a desire to ethically serve the health needs of the populations of a three county area.  

New Port Richey is located in Pasco County, FL, approximately 30 miles north of Metropolitan Tampa, FL. and is a coastal city, population 20,000 and is considered by many an ideal place to either raise a family and an even more attractive place to retire. Lisa and Clara were pioneers in many ways. The two woman team had very little capital and very little knowledge of the home healthcare industry when they launched the agency.

These ladies have no fear.

What’s more, their timing was right.

Capital requirements have changed.  In 1991 it was possible to start a home healthcare agency with as little as $2000 in start-up capital. Initially, MPS was licensed solely through Florida’s Agency for Health Care Administration. They hold a license to serve Medicare clients now, after obtaining a license from the Center for Medicare Services in Washington, D.C. Currently, due to the increased complexity of the regulations, and the costs of licensing, hiring, marketing and advertising, the barriers to entry into the home health market are much higher and more expensive. Today, according to Lisa, starting a licensed home health agency accredited by the State and the Federal authorities, can cost anywhere from $100k $200k.

MPS’ founding based on ethics.  Lisa remembers the ethical issue that led to the startup of their agency. Lisa remarked, “When I graduated from college, I secured a job as a social worker for a Medicare certified home healthcare agency,” Lisa remembered. “In those days, my job was to set up community resources for senior patients. Many of the companies I would refer to were good honest companies, however, some were not,” she stated. She observed that some agencies would intentionally overbill a slightly forgetful client. She would repeatedly have to call to correct these ‘oversights’. As she continued to observe these unethical practices, she approached her mother about creating a new business which would succeed by providing excellent, reliable, dependable and ethical care for area seniors, all of whom deserve honest professional care.

Naysayers did not deter their will to succeed. Lisa’s acquaintances told her that she and her mother never should even attempt to open a home healthcare agency. This advice did not deter them. After six months they had Mobile Personal Services licensed as a home healthcare agency and after one year they were able to give up their other jobs and work full-time in the agency. They began with two small rooms, two desks and two phones in a rented office space. All of referrals at the beginning before Medicare licensing had been secured were private pay patients that needed home healthcare. Lisa exclaimed, “My mother and I were literally on call 24 hours a day seven days a week for 10 years!”

Hard work is a prerequisite. They were determined to start a home healthcare agency that serves patients with reliability, dependability, and honesty. “It took a year of work and saving for us to buy our first copy machine,” remembered Clara. “Our first fax machine was bought by my husband, who was always very supportive,” Clara continued. “Sometimes it felt like we were skating up a hill of ice”, explained Lisa, “… but we were always grateful to be working at it together, which made the hard times quite bearable”.  Adaptation is one of their strengths. The agency has changed from a non-Medicare to a Medicare Certified Home Healthcare Agency to diversify and expand their business. They have always believed in diversification. Having a private pay, non-skilled healthcare service offering as well as offering skilled nursing services has enabled the agency to achieve good stability in the recent turbulent economic times. 

Employee Attrition is an issue for HHA’s - One of the biggest challenges of home health agency operation is attrition in staff, which brings about continuing re-orientation and retraining, both quiet costly in terms of productivity. Due to their open, listening philosophy towards their team, MPS has reduced the negative effects of attrition. Maintenance of excellence in the retention of professional staff is a key factor in a successful home healthcare agency. Clara and her daughter Lisa agree that they have finally achieved a very good balance of competency amongst their nursing staff and their administrative office employees. Lisa quipped, “I always look at it like building a house. If the foundation is not good the structure is going to fall”. She added, “Once we obtain a competent professional employee, in order to assure that he or she is happy, we try to think out-of-the-box”.  

For example, Maribeth, the Director of Nursing for MPS, is a fitness buff. She maintains a very fit lifestyle and was unhappy with sitting at her desk all day doing paperwork, so she suggested to Lisa that she look into getting a treadmill desk!  Lisa quickly agreed to accommodate this request. The DON’s job satisfaction has increased tremendously.

Maribeth works and walks at her treadmill/desk

The agency has also rotated many interoffice staff to four ten-hour workdays which is also increased job satisfaction and allows the agency to stay open longer hours to serve the prospects and patients. 

The mother-daughter team have long ascribed to an ongoing philosophical formula: Honesty + Dreams + Plan + Faith + Hard Work = Success

Sharing the vision - “We are believers in everyone sharing the vision for the agency, and buying into the goals and objectives we as an agency have strategically decided to set as our operating vision”, stated Tabbert. After years of operation with a state and a federal Medicare license, the agency had an open mind regarding the varied ways that our clients may want to obtain and pay for services from us. Their strategy was to be agile and adaptable, and not to lean on just one payment source for their revenue stream. MPS accepts managed care insurance, HMO insurance, private duty clients and clients who reside in skilled nursing and assisted living facilities. MPS also has contracted with therapists of all disciplines so that their services are broad and applicable to patient’s needs.

Using technology to manage the increasing complexity

. In 2011, MPS had grown to the point of needing a tool to assist management and nursing care services in overseeing so many patients and maintaining compliance with the myriads of government and insurer regulations and standards. “In order to accept all the types of payment, and to be able to cope with the increasing complexity of home health agency operations, we needed an agile software platform to continue to expand and operate successfully”, Lisa stated.

Axxess is the choice

After what Lisa considers “extensive due diligence”, which included compiling a list of requirements, ,performing an internet search, and attending conferences to view and seek demonstrations of the varied vendors in the marketplace, MPS chose Axxess’ Agencycore^® platform, over the many competitive offerings in the marketplace. Lisa is enthusiastic in her appreciation of this innovative technology, and quipped, “Axxess has been a great fit for our agency. They do not charge you for every little feature (like the other software companies she previewed)- they provide all these features at no additional charge”. She continued, “The training was easy and ongoing support has been exemplary. Axxess support staff have always been competent and friendly.  The most important feature for me is that they listen to your feedback and constantly improve their product to meet our needs. I am a very happy customer.”

 

Staying true to the course

 

MPS’ mission remains a constant; providing honest, professional, caring home health services to Florida’s Pinellas, Pasco and Hillsborough counties. Additionally, the move to state-of-the-art technology promises to aid the company in achieving even greater success in today’s turbulent home health market. The strategic and philosophical decisions made at the outset at the founding of Mobile Personal Services, Inc. appear to have “passed the test of time” over the two decades they have been in operation.

“Due to our excellent technology platform, we are operating at a productivity level and volume that we could not have dreamed of in 1991”, beamed Lisa. “Our hope is that as we follow our business philosophy which is to provide the ultimate in care as we serve our patients, we will continue to drive our agency into the future. Strategically, we trust that our technologies, our ethics and our market will continue to afford us the opportunity to operate profitably and productively for years to come”.

She concluded, “As we reflect on our years in business, we can truly say that we are blessed.”

 

Knowing these ladies successful ways and determined approach, it’s a safe bet that MPS’ patients are blessed as well.

Wisdom in the Workplace: Developing Emotional Intelligence to achieve Personal Mastery

By: C. Sam Smith, Editor, Axxess News and Updates


(Dallas, TX, June, 2012)  How can an awareness of brain chemistry enable us to be productive team members? We can begin to understand how to become more focused on natural impulse-responses to negative workplace events. This will enable us to respond with more appropriate responses to reduce conflict in our day-to-day work environment. The end result is the cultivation of “Emotional Intelligence”, which is defined as the ability to identify, assess, and control the emotions of oneself, of others, and of groups.
This topic is of critical importance as we seek to develop the Learning Organization culture in our workplace environments.
Two-time Pulitzer Prize winning author and psychological researcher Dr. Daniel Goleman, in his 2011 book, “The Brain and Emotional Intelligence: New Insights”  has outlined the way to one of the critical outcomes of the Learning Organization, Personal Mastery, by highlighting the stimuli which cause us to enter into a “fight-flight-or-freeze” response triggered by our natural brain chemistry.  Goleman calls these events “emotional triggers” causing an unnaturally severe response because of the way these events can trigger the “fight-flight-or-freeze” reaction. Our internally produced stress hormones, cortisol and adrenaline—kick into gear when our brains perceive a “threat”. Most of the time--there’s a big problem with all this: our brain often makes mistakes.  Particularly these mistakes occur in modern workplace life, where the “dangers” are symbolic, not physical threats. So we overreact in ways we often regret later.

Is there a practical methodology for avoiding workplace misunderstanding and conflict?
What causes our overreactions? Goleman outlines symbolic workplace occurrences which our brain perceives as threats—that cause us to get an emotional hijack overload.

Here are the 5 top “emotional triggers” in the workplace: 

1. Condescension and lack of respect. 
2. Being treated unfairly. 
3. Being unappreciated. 
4. Feeling that you're not being listened to or heard. 
5. Being held to unrealistic deadlines.

We all can very easily relate to these issues as having the capacity to cause our egos to rise up and want to defend ourselves. All but the most emotionally intelligent of us will naturally defensively react to these stimuli.
Goleman states that in an economic atmosphere with great uncertainty (like the current state of home health agency operations) there’s lots of “free-floating fear” in the air. Many people fear for their jobs, for their family’s financial security, and all the other problems that a bad economy brings. And this anxiety causes hijacks in workers who have to do more with less. So in such a climate there are many people operating day-to-day in what amounts to a chronic, low-grade “emotional hijack”.
It behooves us to become more educated regarding the chemical brain functions. This knowledge enables us to become more aware of our own reactions.
If these emotional hijacks are part of our workplace existence, then, in order to truly become emotionally intelligent, how can we minimize these hijacks?
• First of all, we must pay attention. 

• It’s better to realize what’s going on and disengage from the potential emotional trap into which you’ve realized you could be heading!
• This requires some practice but, start with monitoring what’s going on in your own mind and brain, and noticing, “I'm really over-reacting,” or “I'm really upset now,” or “I’m starting to get upset.” 

• Notice familiar feelings.

• It’s much better if you can notice familiar feelings that a hijack is beginning – like butterflies in your stomach, or a flushed face--whatever signals that might reveal you're about to have an episode. It’s easier to short-circuit it the earlier you are in the cycle of the hijack. Best is to head it off at the bare beginning.

What can you do if you are caught in the grip of an emotional hijack? 

• First, you have to realize you're in it at all. Hijacks can last for seconds or minutes or hours or days or weeks. 
• For some people it may seem their “normal” – people who have gotten used to always being angry or always being fearful. 

 But we’re talking about normal here.
There are lots of ways to get out of a hijack if we first can realize we’re caught, and also have the intention to cool down.

• One is a cognitive approach: "Talk yourself out of” the hijack. Reason with yourself, and challenge what you are telling yourself in the hijack –“This guy isn't always an S.O.B. I can remember times when he was actually very thoughtful and even kind, and maybe I should give him another chance”. 
• Apply some empathy, and imagine yourself in that person’s position. This might work in those very common instances where the hijack trigger was something someone else did or said to us. You might have an empathic thought: “Maybe he treated me that way because he is under such great pressure”. 
• Another is a biological approach…like meditation or relaxation to calm down our body.
•  My mother used to suggest that I count to ten before I responded to an offensive remark.
•  This is a very simplified kind of relaxation or meditation technique.
•  Practice makes perfect. Unless these methods have become a strong habit of the mind, you can't just invoke them out of the blue. But a strong habit of calming the body with a well-practiced method can make a huge difference when you're emotionally hijacked and need it the most.

Understanding and working through these “emotional hijacks” are important considerations as we seek to consider becoming more emotionally intelligent in the workplace…and that is a goal to which all effective agency managers and staffers can aspire. 


Remember, becoming emotionally intelligent is the only way to achieve true Personal Mastery, a worthy goal of all home health professionals.
___________________________________________________________________________________________________________


Goleman, Daniel (2011-04-12). "The Brain and Emotional Intelligence: New Insights", pp.297-304. More Than Sound LLC. 

Is Your Agency Becoming a Learning Organization?

Author: Sam Smith; originally published at http://axxessweb.com/newsandupdates

Date: February 23, 2012

Does your agency team always work together as a team as they operate and compete in the marketplace?
When Home Health Agency (HHA) management encourages team participation to do the agency’s work, encourages the open exchange of knowledge and information- and also places its emphasis on becoming an adherent to this principle, it is thereby accepting the challenge of becoming one of the brightest and best–a Highly Effective Home Health Agency. This aim is to accept and continuously improve upon adoption of the positive virtues of ‘shared vision’, systems thinking’, ‘personal mastery’ and ‘team learning’, all principles of a “Learning Organization”, a concept first introduced by Dr. Peter Senge at MIT in 1991. ¹
Knowledge Sharing is a competitive advantage
By sharing knowledge, the home health team gets stronger and better decisions are made because there is a wealth of collective intelligence and experience on the team. Operating a HHA is a complex enterprise, requiring practical experience and specialized knowledge. There are many specialized bits of information that must be mastered in order to become a Highly Effective Home Health Agency. The areas and specialties of HHA knowledge are varied and have great depth and skill involved.
The knowledge and skills necessary to achieving mastery as a HHA MVP include:

• The peculiarities of all variations of Medicare coding, requiring a thorough knowledge and understanding of HCPC and all other types of governmental specialized code
• Skilled nurses and therapists charting—ICD 9-10 and all the skills of nurses
• Scheduling for efficient work across the agency
• Quality, caring patient relationship building and maintenance
• Accurate and precise Medicare billing and the general regulatory and insurers framework
• The ways that patient episodes can be documented and can completed so as to properly bill Medicare for the optimum billing and regulatory standard
• Proper and compliant workflow methodology
• Specialized and highly skilled mastery of the particular software platform being utilized to accomplish the work in the agency (yes, Axxess Agencycore is the best software platform in the US for the management of a HHA!)

Knowledge is your most valuable asset
Shared, facilitative learning helps promote the growth and business continuity of the organization, so when a team member is unavailable for any reason, other members can easily step in and function effectively and in the proper context. The shared knowledge of the varied disciplines represents expertise that can increase in value when shared among all members of the organization, members of all levels in the agency. Knowledge may be your most valuable asset to your HHA. In fact, technical and HHA specific knowledge in the minds of those who hold the greatest amount of knowledge in the agency, when openly and freely taught/shared with all the staff, is a great leap forward towards becoming highly effective as an agency in the competitive marketplace.
Axxess practices the principles and attests to their value
Axxess Healthcare Consult, as an organization believes that there is great wisdom in adoption of “Learning Organization” principles. A primary value of learning organizations—is that all its members actively pursue “Personal Mastery” in their field, whether it be as an administrator, a biller, an aide, a nurse or a therapist. It is a principle of “Continuous Improvement”. This is how we become ‘craftsmen’ or ‘artisans’ with mastery in our chosen profession. In fact, those who are intentional about training and guiding their staffers of all the disciplines to learn, learn and learn some more, with the goal of becoming Masters and promoting the achievement of Mastery for all employees in their fields of endeavor themselves, are actually taking positive steps toward achieving the worthy goal of becoming a Highly Effective Home Health Agency. This is why we at Axxess actively practice the standards of a “Learning Organization” and stress that our clients adapt this methodology of operation as well.
These agencies are compelling workplaces
The Highly Effective Home Health Agencies that are the winners in their marketplace are compelling places to work. Attrition is lowered. People want to grow and learn within a cohesive team—and thus will tend to be admired and respected in their communities and in their marketplace. These agencies are those that adopt and promote a shared vision and a standard operating model of repeated and systematic corporate learning, and over time they become a true “Learning Organization”. Our advice is to seek to eliminate withholding of valuable knowledge, and adopt the tenets of a “Learning Organization”.
The benefits are many and include the following:

• Eventual reduction of the attrition –the dreaded high turnover of employees
• Improvements in your agency’s profitability
• The quality of its regulatory compliance
• Excellence of care in all its services to its patients

Axxess will be sharing more information about becoming a Highly Effective Home Health Agency over the next few months as we move towards our upcoming Administrator Seminar Series, being offered in four locations across the country: in McAllen, Houston, and Dallas, TX. and Ontario,CA. Potentially, in early summer/late spring-we may be presenting the teaching series in the Chicago area. Go to http://axxessconsult.com/seminars for more information.
¹Citing: “The Fifth Discipline: The Art & Practice of The Learning Organization”, Dr. Peter Senge, 1991.

Home Health Agencies as Learning Organizations

According to Peter Senge, a learning organization exhibits five main characteristics: systems thinking, personal mastery, mental models, a shared vision, and team learning. 

All these characteristics are achievable in agencies that are seeking to become "Highly Effective". This is a process, not an immediate absolute. An agency needs to ascribe to the process, and adopt a patient attitude towards achieving the full benefits of the principles.

Systems thinking. The idea of the learning organization developed from a body of work called systems thinking. This is a conceptual framework that allows people to study businesses as bounded objects, such as as Home health agency. Learning organizations use this method of thinking when assessing their agency and have information systems that measure the performance of the organization as a whole and of its various components. Systems thinking states that all the characteristics must be apparent at once in an organization for it to be a learning organization. If some of these characteristics is missing then the organization will fall short of its goal. The characteristics of a learning organization are factors that are gradually acquired, rather than developed simultaneously.

Personal mastery. The commitment by an individual to the process of learning is known as personal mastery. There is a competitive advantage for an organization whose workforce can learn more quickly than the workforce of other organizations. Individual learning is acquired through staff training and development, however learning cannot be forced upon an individual who is not receptive to learning. Research shows that most learning in the workplace is incidental, rather than the product of formal training. therefore it is important to develop a culture where personal mastery is practiced in daily life.^. A learning organization has been described as the sum of individual learning, but there must be mechanisms for individual learning to be transferred into organizational learning.^[1]

Mental models. The assumptions held by individuals and organizations are called mental models.^[2] To become a learning organization, these models must be challenged. Individuals tend to espouse theories, which are what they intend to follow, and theories-in-use, which are what they actually do..Similarly, organisations tend to have ‘memories’ which preserve certain behaviours, norms and values. In creating a learning environment it is important to replace confrontational attitudes with an open culture that promotes inquiry and trust. To achieve this, the learning organization needs mechanisms for locating and assessing organizational theories of action. Unwanted values need to be discarded in a process called ‘unlearning’. 

Shared vision. The development of a shared vision is important in motivating the staff to learn, as it creates a common identity that provides focus and energy for learning.^[3] The most successful visions build on the individual visions of the employees at all levels of the organization, thus the creation of a shared vision can be hindered by traditional structures where the company vision is imposed from above. Therefore, learning organizations tend to have flat, decentralized organizational structures. The shared vision is often to succeed against a competitor, however Senge^[3] states that these are transitory goals and suggests that there should also be long term goals that are intrinsic within the company.

Team learning. The accumulation of individual learning constitutes Team learning.^[2] The benefit of team or shared learning is that staff grow to mastery more quickly and the problem solving capacity of the organization is improved through better access to knowledge and expertise. Learning organizations have structures that facilitate team learning with features such as boundary crossing and openness. Team learning requires individuals to engage in dialogue and discussion; therefore team members must develop open communication, shared meaning, and shared understanding. Learning organizations typically have excellent knowledge management structures, allowing creation, acquisition, dissemination, and implementation of this knowledge in the organization.

Benefits to Home Health Agencies

The main benefits are;

• Maintaining levels of innovation and remaining competitive
• Being better placed to respond to external pressures
• Having the knowledge to better link resources to patient needs
• Improving quality of outputs at all levels
• Improving Corporate image by becoming more people oriented
• Increasing the pace of change within the organization

Barriers to progress as a Learning Organization

Even within a learning organization, problems can stall the process of learning or cause it to regress. Most of them arise from an organization not fully embracing all the necessary facets. 

Once these problems can be identified, work can begin on improving them.

Some organizations find it hard to embrace personal mastery because as a concept it is intangible and the benefits cannot be quantified; personal mastery can even be seen as a threat to the organization. This threat can be real, as Senge points out, that “to empower people in an unaligned organization can be counterproductive”. In other words, if individuals do not engage with a shared vision, personal mastery could be used to advance their own personal visions. In some organisations a lack of a learning culture can be a barrier to learning. An environment must be created where individuals can share learning without it being devalued and ignored, so more people can benefit from their knowledge and the individuals becomes empowered. 

A learning organization needs to fully accept the process needed for removal of traditional hierarchical structures.

Resistance to learning can occur within a learning organization if there is not sufficient buy-in at an individual level. This is often encountered with people who feel threatened by change or believe that they have the most to lose. They are likely to have closed mind sets, and are not willing to engage with positive mental models. 

Unless implemented coherently across the organization, learning can be viewed as elitist and restricted to senior levels. In that case, learning will not be viewed as a shared vision. If training and development is compulsory, it can be viewed as a form of control, rather than as personal development. Learning and the pursuit of personal mastery needs to be an individual choice, therefore enforced take-up will not work.

Thanks goes out to the reference shown in the Wikipedia article shown under: http://en.wikipedia.org/wiki/Learning_organization.

10 Reasons Why Home Health Agencies are Choosing Axxess

Author: Sam Smith

Date: January 18, 2012

Among web based home health platforms, Axxess is preeminent – Charles Sam Smith
Why are leading agencies subscribing to Axxess’ Agencycore, when there are more well- known platforms that have been in the market for years?
The 10 reasons are simple, but the context of the decision itself involves a series of very complex issues, clinical tasks, regulatory processes, administrative intelligence. An intelligently conceived, organized, workflow based platform must be chosen in order to master these complex tasks and processes in a cost-effective manner. Let’s face it…using Excel spreadsheets and paper forms to keep up with agency business is no longer viable to achieve high performance and regulatory compliance. An operating platform run by intelligent software is a key element for the highly effective home health agency
I. Ease of use promotes cost efficiencies– Once an agency has migrated to Axxess Agencycore, the marketers, point of care skilled nurses, therapists, caregivers, administrators, and billers immediately begin to master the platform. Aided by the cost neutral, unlimited training and support provided through Axxess’ subscription based model, coupled with true intuitive ease of use, end user mastery quickly ensues, and the agency begins to reap the cost savings of platform deployment. Agencycore home health software enables the accurate, consistent submission of thoroughly analyzed, scrubbed OASIS assessments, Care plans (485) and claims and this means less time to reimbursement, and more time to serve patients. Agencycore creates a workflow environment that is increasingly efficient and effective!
II. Reasonable pricing is, for Axxess, a competitive advantage – Agencycore is the most reasonably priced, client-friendly home health software platform in the industry. Axxess has a flat fee structure for setup, implementation and migration. With sliding scale pricing ranging from a low cost fee structure for start-ups and smaller agencies, to a unlimited user subscription rate for larger organizations. Axxess has enabled agencies a critical path which enables them to afford to grow continuously, and as they adapt and become more efficient, and enabled to accept more referrals and referral sources without acquiring additional exorbitant user upgrades masked by “per seat” costs of software deployment. Axxess is uniquely positioned to be very sensitive to the needs of “the little guys” and also accommodate the needs of the “big guys”. Start-ups who are anticipating receipt of a new license can begin to acquire training and skill in Agencycore operations prior to license receipt, for a reduced rate. Pricing is graduated as you grow the agency from 1-5 users, with a lower monthly cost, to a 5-10, 11-20, 21 to 40, then to the most cost effective “Unlimited” user level. What is admirable is that there are no additional hidden charges for any additional features or functionality. Although an annual subscription renewal is preferred, the company allows clients to vacate their services platform with a thirty day notice, yet allows clients databases to remain accessible. This unequalled and genuine generosity with its clients is a display of the confidence Axxess has regarding its product, and its service to its clients.
III. Agencycore is all inclusive - Familiar with ongoing contracted OASIS Analysis providers? Yes, they normally cost agencies from $400- $500/month which are billed as extra costs beyond the agency platform subscription. Not with Axxess. OASIS analysis services are all part of the platform subscription. So is additional training. So is access to Medicare Number Eligibility Verification, NPI and PECOS databases. It is truly an all-inclusive platform. Axxess culturally maintains a holistic viewpoint towards its client base, so that a standard subscription is all encompassing; including training, implementation, and continuously improving operational effectiveness through upgrades. As one Axxess client, Lisa Tabbert of Mobile Personal Services, Inc. in Florida, recently exclaimed – “I love Axxess cause they don’t ‘nickel and dime you’ to death!”
IV. Workflow orientation – Axxess developed the features and functionality of Agencycore in concert with actual licensed, operating home health agencies. These agency collaborators, along with Axxess’ experienced team of home health consultants, guided the original formative development of the platform. And Axxess still listens to its agency clients. Agencycore home health software is designed with effective workflow in mind, and provides its users with efficiencies in point of care, billing and productivity heretofore unachievable in the industry. Axxess enables timely and productive workflows by providing Integrated Clinical Teaching Guides, Integrated Drug & Allergy Interactions, integrated Visit Notes and Clinical Documentation, and a comprehensive Patient Relationship Manager…all included at no additional cost within Agencycore.
V. Excellence in Agencycore User Training and Support – Axxess believes in continuous improvement as part of its mission, and focuses its customer services operations on “the golden rule”, treating clients like they themselves want to be treated. The customer support queues huddle daily, and maintain in close communication and receive constant training. The support teams have rotating schedules to accommodate client’s needs from all parts of the US. Recently, Axxess completed an Online Training Manual which serves as a training tool to agencies who experience turnover (and don’t we all experience turnover?). This ever growing, ever improving compilation of key training topics, comes directly from past queries offered Axxess clients and can use to give a preliminary training model for new trainees so that they can gain an immediate resource, allowing them to get up to speed on the platform. More training resources are in the works, so continuous improvement is being applied in this arena as well. Calling or going online to the Training Manual for support means receiving the most friendly and knowledgeable assistance available from any provider in the industry. Period.
VI. Axxess’ cultural intelligence exudes confidence – Axxess is an organic, ideological company which believes in a set of philosophical values called The Axxess Way. This drives the way the company manages it business, creates its solutions, interacts with its staff and client base, and markets its products. Axxess truly hires and maintains a staff that consists of “Knowledgeable Experts“ who, as a team, care for the HHA client and the end-user recipient of services, “the patient”. The reason Agencycore was created was because Axxess saw the need for a cost effective web based alternative in the market, a home care software platform that reflects the firm’s focus on customer care. Axxess remains doggedly focused upon the direct and indirect customer, both the Home Health Agency, and the end user service recipient, the HHA’s patients. The Axxess Way is the standard at Axxess, and this is a primary reason why Agencycore is the preeminent platform for HHA operations in the industry.
VII. Expert software conception and development: a state of the art, .Net platform – One cursory overview of the Agencycore platform reveals that the development team at Axxess uses the latest code base for web page development, not Cold Fusion. Axxess utilized the latest commercial software platform, .Net which fuses perfectly with not only your Windows operating system and every browser out there (Internet Explorer, Firefox, Chrome, Opera, and the latest Apple browser (Safari)). This browser based delivery enables Agencycore clients to utilize Android based tablets as well as iPads, along with smartphones, laptops and desktops running either the Apple OS or Windows XP, Vista or Windows 7. Agencycore also enables the setting of specific roles and permissions for all your users including Physicians, Marketers, aides, therapists, administrators and billers. Security and privacy is built in. Another feature of Agencycore is the use of an Operations Dashboard which facilitates a rapid jump start of a team member’s workflow, directly from the home page.
VIII. The Point of Care (POC) system enables precise Regulatory Compliance – As the clinician or aide completes his or her assessment of the admitted patient, the completion of the POC serves to accurately document the encounter with the accepted, comprehensive, complete OASIS or Non-OASIS assessment, Face to Face encounter, and Plan of Care (485) standard, required reports, for rapid, error free digital transmission to Medicare or to the private pay/managed care insurer utilized by the patient. Axxess’ expert consultants made sure the system gets it right. The Quality Assurance module is a key step in the workflow of Agencycore, providing an ongoing process which assures quality care and compliance and provides a conduit for timely receipts of billed reimbursements. As a built in bonus, Axxess provides an OASIS analysis “scrubber” to capture logical and clinical inconsistencies in the OASIS assessment before it is completed and sent to CMS. This is an included service in Axxess, whereas, as an add-on, this service can cost over $500 per month with other web based providers. This enables Axxess clients to gain ever improving billing processes and reimbursement management while providing excellent, flawless regulatory compliance. Axxess is HIPAA 5010 compliant and has been confirmed by financial intermediaries that the platform is ready when the new standards are made mandatory. The platform conforms to all governmental regulations, including HIPAA, JCAHO, CHAP & ACHC. Axxess is fully compliant.
IX. Thoughtful scheduling and planning – The scheduling module in Agencycore is revolutionary. DONs, Case Managers, Schedulers and Administrators are able to create nurses, therapists and aides work schedules to optimize patient care and to eliminate over-booking of the visiting caregivers. Administrators are permitted to have direct vision into the schedules of all its on-site caregivers, creating balance in assignments and assuring timely service provision in regard to workloads and the general quality of patient care delivery.
X. A focus on revenue-improving billing methodology – Agencycore streamlines the process for billing Medicare, and other primary or secondary insurances in which all requirements of documentation for RAP’s, EOE’s and Recertifications are analyzed and scrubbed. After the scrubbing and analysis, then the billing can be submitted which means that collection of Medicare, Managed Care, and Private Insurance reimbursements can be drilled down to an exact science. With Agencycore you can achieve continuous improvement in your billing and collection workflow processes. Axxess enables and encourages your mastery in the art of efficient home health operations.
Axxess realizes there are providers who claim to provide everything needed to help agencies succeed in the home health marketplace. Perhaps, but can they deliver their solutions in as up-to-date, client friendly, regulatory comprehensive and as cost effective a manner as Axxess? The drive to improve, listen and improve more and more sharpens and heightens the internal urgency within the Axxess team to provide unequalled customer care. High performance agencies are choosing Axxess every day. The opportunity remains for your agency to become one of them.

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