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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Game Changers

‘Game Changers’

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The 7 Secrets of Highly Effective Home Health Agencies

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A focused, visionary, ideological culture drives effective organizations. The licensed Home Health Agency (HHA) is not simply an organization with an owner, some skilled nurses, an administrator, a corporate charter from the state and a Medicare license. The employees, nurses, billers, and owners/management, are members of the particular HHA “tribe”, and are members which function within the agency team. Since prehistoric times, the basic human organic structure is tribal**. An HHA which operates as a tribe is a well led organism which exudes confidence, competence and proficiency in its behavior. Highly effective HHA’s have these cultural components present in order to thrive in technical nursing, point of care skill and professionalism, administrative competence, and in communication of a shared vision.  Many of the same or similar characteristics of tribes are inherent in what is known as “a learning organization”. These concepts, when strategically applied can yield highly effective practices that result in successful, effective home health agency operations. The characteristics of learning organizations in this essay are presented first, but not in order of priority.  The Learning Organization framework gives meaning to all aspects of effective HHA’s. 

The 7 secrets:

1. Effective Home Health Agencies are Learning Organizations*

Agencies which teach and encourage shared vision and corporate learning, over time become true “learning organizations”. The learning organization concept was introduced by Dr. Peter Senge, of M.I.T.’s Center for Organizational Learning in Cambridge, MA, and author of “The Fifth Discipline, The Art and Practice of the Learning Organization”.  Dr. Senge identified that a learning organization exhibits five main characteristics: Systems Thinking, Personal Mastery, understanding Mental Models, a Shared Vision, and Team Learning.

• 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 (home health agencies are businesses) as bounded objects, like cellular organisms. Learning organizations use this method of thinking when assessing their company and have information systems that measure the performance of the organization as a whole and of its various components (metrics). Systems thinking involves all the characteristics that must be appear in an organization for it to be a learning organization.  If some of these characteristics are missing, then the organization will fall short of its goal of being fully effective. 

• An individual’s commitment to the process of learning and professional proficiency is known as Personal Mastery.  There is a competitive advantage for a Home Health Agency organization whose workforce learns and implements quicker than the workforce of other organizations. Individual learning is acquired through staff training and development, and credentialed formal education. However eventual learning cannot be forced upon an individual who is not receptive to learning. Effective agencies know the importance of the development of a culture where personal mastery is encouraged and practiced in each member’s daily work-life. The effective HHA must employ agreed upon mechanisms to encourage individual learning to be transferred into organizational learning. 

•  The assumptions held by individuals and organizations are called Mental Models. To become an effective agency which is growing as 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, organizations tend to have ‘memories’ which preserve certain behaviors, norms and values.  In creating a learning environment for the effective Home Health Agency, it is important to replace confrontational attitudes with an open culture that promotes inquiry and trust. Unwanted assumptions, norms and misaligned values need to be discarded in a process called ‘unlearning’. It is the responsibility of each agency to identify the flawed mental models of its members. These should be dealt with discretion and in a considerate, humble manner. 

•  The development of a Shared Vision is important in motivating the HHA staff to understand the shared vision of excellent, quality patient care as being the overriding cultural value can energize the tribe. In some agencies the agreed upon shared vision is often to succeed against a competitor; however, these are transitory goals.  The shared vision should reflect a long term goal that is intrinsic within the company, such as the vision of excellent patient care. 

• The benefit of Team Learning is that staff members grow more quickly and the problem solving capacity and agility of the organization is improved through better access to knowledge and expertise.  Team learning requires individuals to engage in dialogue and discussion; therefore team members must develop open communication, shared meaning, and shared understanding.  (Tribunals aid in developing this capacity.) 

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 *For more in-depth information on the theory and practice of Learning Organizations, please refer to the work of Dr. Peter Senge and the Society for Organizational Learning www.solonline.org

**Many of the ideas that are contained in this essay have their root in Tribes, a book by Seth Godin, published in 2003.

2. Effective agencies know the “why” behind their agency—an authentic desire to care for their patients, and their members

In the effective HHA, patient care must be the top priority. If all other characteristics are present, yet the agency is not patient focused, the agency will be less than highly effective. Care for patients is the “why” behind everything that is done. The effective agency’s “lifeblood” is quality patient care, and in that highly effective agencies share a common cultural ideology. Together HHA staff members believe that care for patients is something we are called to do.

Helping others should come naturally to us as individuals, and together we aspire to this cultural norm as a living company, an organism, a tribe. No members of our agency staff are to be hired unless they can agree and agree to learn to espouse the agency’s shared cultural operational vision. Owners and managers who are unable and unwilling to be open and to submit to this shared vision/teamwork oriented concept and agree to grow towards operating in this way are acknowledging that they will accept something less than becoming highly effective as an agency. Leaders are very aware that they must constantly praise and encourage the members of the tribe to continue learning, initiating and growing in personal mastery. The agency without a focus primarily on quality patient and member care, empowering its employees/members to act as “care agents” in the field, are not able to achieve anything similar to the effectiveness of those HHA’s that do.

3. Effective agencies are proficient in skilled nursing and therapeutic care

Skilled Nursing Proficiency is also a non-negotiable cultural norm of the effective HHA. Highly effective agencies know that skilled staff members working in the areas of patient admissions, charting, case management, therapy deployment, regulatory/billing & compliance, and RN accreditation are necessary in order to become more and more effective in operation. The highest professional standards for skilled nursing care, nursing licensing, and knowledgeable, well-designed workflows and well-trained administrative staff are high return targets for each HHA. Decisions regarding software platforms and operating systems for the agency should include methodologies for tracking and maintaining the necessary ongoing training necessary for always current professional nursing licensing.  Effective tribal agency leaders have a constant eye on the professional standards maintained by the nursing staff.

4. Effective agencies achieve a growing competence in Regulatory Compliance

The most important reason for choosing a software platform is to provide a methodology for maintenance of regulatory compliance in skilled care of patients, and billing & reporting those patient episodes. In the current environment the home health industry is regulated by our primary payment source, the Center for Medicare Services. The effectiveness of the agency in billing and overall compliance is directly attributable to the accuracy achieved in preparation of the Outcome and Assessment Set documentation (the OASIS). Also the 485 summary report to be signed by the Physician in charge of the patients care must be accurate and in compliance. The technologically superior and constantly improving updated software platform* is the driver for this accuracy and completeness in the effective HHA.  Because of the sophistication of operational platforms maintaining the home health agency on paper forms, while still possible, is now impractical and counterproductive. The time required in generating paper charts and billing submission documents in order to maintain regulatory standards for OASIS and 485 submissions is clearly cost prohibitive.

If you still utilize paper docs to run your agency.   Your results will not be as effective.

*Note: Axxess’ Agencycore® is the leading state-of-the-art Point-of-Care and Operations based software platform in the US. A rapidly growing number of prominent and effective Home Health Agencies utilize Agencycore® to enhance their ability to achieve highly effective and productive operations. To the writer’s knowledge, no other platform available in the marketplace today can compare to Axxess in the enablement of highly effective agency operations.

5. Effective agencies act with wisdom regarding expenditures

Are the agency’s costs and expenditures aligned with the agency’s shared vision of excellent patient care?

Generosity with patients and with staff brings about the joy of working, of having fun with one’s co-workers and the patients in the field. Cost containment managed wisely means being generous with patients and the pay scale for agency staff, because these factors drive greater returns, more referral generation and more expansive revenues. Cost containment is non-negotiable; however, the effective HHA is wise in strategically deciding on how costs are linked to productivity. Additionally, effective agencies utilize productivity and performance metrics as motivational drivers towards greater productivity. Personal productivity and team productivity can effectively be managed in an open facilitative manner, appropriate to the adaptive, learning organization based tribal culture.

6. Effective agencies are Ideological and Visionary in Nature

Tribes are a prehistoric way of organic alignment of like-minded people working together collaboratively for a common goal or shared vision. An authentic desire to provide quality patient care is an excellent example of a shared vision. The effective agency is a living organism, a tribe, whose culture must be guided and disciplined by its shared vision and its collaboration. Each member is expected to seek Personal Mastery of his or her role in the tribal organism. This recognizes the skilled nurse, the aide, the social worker, the billing and administration personnel, the ownership and management, as being highly proficient and ever-learning, ever-growing-in-knowledge and proficient in their assigned duties. The age old “guild” interrelationship between the master and the apprentice is a guiding principle in an effective home health agency. Knowledge is not hoarded for personal advantage. Teaching and learning is encouraged between team members and between care givers and patients.

7. The effective tribal/organic agency is protective of its collaborative culture

Tribes have strong, visionary, focused and competent leadership.  Effective “Tribal HHA’s” are focused on ‘the why’ behind what they do, so that every member acts in accomplishment of the shared vision of the tribe.  For effective HHA’s it has to do with excellence in patient care. Tribal organisms are quick to identify the mental models (or flawed assumptions) that are not aligned with the agency’s vision. Left unattended, flawed mental models can harm an agency’s shared culture, and can in turn do harm to its ongoing business success.  The effective HHA acts and initiates based on its best knowledge and shared learning.  The effective agency is always creating, initiating, evolving. This creative action and initiation has the effect of causing others in the market to react. Most HHA’s are not aware of tribal organic operational culture, so tribal cultures can move stealthily within their local markets, to quietly and forthrightly accomplish their goals and objectives, and move closer to their shared vision. In doing so, they are lethal competitors.

Because effective agencies are learning organizations, and every member is encouraged to act in accordance with a shared vision, creative solutions and methods are constantly being tried and implemented. Like a tribe in the wilderness, it constantly adapts and is agile as a team.

An effective HHA recognizes its organic nature, in that tribal culture is the fundamental unit of human activity. Everyone knows and understands his or her role and is expected to do his or her job because each member is committed to achieving an ever growing sense of personal mastery and is fulfilled in his or her role. He or she is being encouraged to grow in their role, and is praised when they achieve new attributes. This mastery and the encouragement of leaders can assist each member in making their assigned work become “fun”.

Let’s have fun! “Having fun” and achieving positive feedback at work creates a work environment in which members enjoy participating. Once organic concepts and learning organization cultural standards are implemented in the HHA, more effective workflows in operations result, because the team members are enjoying their work and working together towards a common goal. Why not try these concepts? You might become more effective! Not only that, you might begin to have fun at work.