What is Telephony?

I believe Telephony is one of the greatest inventions since sliced bread. It works for everyone involved. It saves time and money and it is easy to use. Best of all it prevents a lot of problems.
For those who don’t understand what it is; with telephony, a caregiver arrives at a client’s home, uses the clients phone to dial an 800 number, which tells the office they have arrived for their visit. They can pick up voice messages or just hang up and begin their visit. When it is time to leave they dial the number, check messages and type in codes for the tasks that were done on the visit. They can also leave a message for the office, if needed. So in essence, when they leave the home they have completed their visit, charted and verified their time sheet. It is now already back in your office ready for QA and payroll.
Of course you hear objections at first.
“The clients don’t like us to use their phone.” Once they understand it costs them nothing and ensures that they are getting the appropriate care, very few really object. One company uses telephony as a marketing tool, promising clients they are never charged for extra time.
“The clients don’t have phones.” Really? How often is that, and how safe? There may be an exception and in that case the clinician can call from their own cell phone. Exceptions can always be handled from the office
Once your staff gets used to it, they will appreciate the time savings it has for them. Maybe it saves them a trip to the office every week or helps them be more concise and on time with their charting. Payroll is more accurate.
For the office, the saving is great. First, you know when your staff is at a client’s home. You know if they arrived on time. You know they got your message about the meeting next week. You get an alert if they don’t arrive on time, even if it is after regular office hours. Instead of waiting for everyone to trickle in with paperwork a few days before payday, you have it as it is completed, and it is ready to process.
Fraud prevention is another area where telephony really helps. We all have had experience with a caregiver who was “sloppy” about her record keeping and always in her favor. Maybe she is running late but writes she was there on time, or she slipped out a little early to stop and do some shopping. The client doesn’t notice, so who gets hurt? Well you for one, and the client. “Padding” of time sheets costs agencies countless dollars. And when you get into Medicaid and Medicare it becomes fraud and can get the entire agency in trouble. If knowing that you have a strict telephony policy in place keeps someone from even applying, you might never know how much you have saved. One of our clients told us recently that he saved $1200 the first month he used ClockWork!
I once worked in an agency back in the days before PPS and OASIS, where a nurse had convinced the owner she could do 21 visits a day! I knew it wasn’t possible but it took weeks to come up with enough proof to convince the owner. Eventually she slipped up enough to prove she wasn’t where she charted she was and we found patients who were able to recall that she was not there when she said she was. It ended badly for all involved when it turned out the owner was supportive of the fraud.
The point of the story is that it would never have taken place in an agency using telephony. She would have been foolish to try a scam where she could not falsify her documents. If you think stories like that don’t happen anymore, take a look at an OIG website or your state Board of Nursing’s disciplinary list.
So why doesn’t everyone use telephony? Good question. Maybe you think it costs a lot, maybe it seems too complicated. Boy have I got a deal for you!
August Systems recently went through some big changes to make our company more efficient and state of the art. As a result we are able to really lower the price of some of our programs especially for small and new companies. We have taken our telephony program to a new hosted level, which means you don’t have any hardware or extra phone lines to deal with. If you qualify for our Home Care Essentials product you can add our telephony, Clockwork for just $99.
Better yet, we have also lowered our pricing on Visit Wizard Home Care Essentials! This program is designed for companies with less than 5 users, who need Scheduling, Staff tracking (HR), and a way to extract payroll to QuickBooks, .csv file or a report. It gives you the foundation to grow your business and build on when you are ready. We give you options to start small and become whatever you want to be. Staffing, Private Duty, Medicare certified or Hospice. We do it all. You choose between web based or self-hosted.
Contact me when you are ready to experience the magic of Visit Wizard!

Update on F2F

      20 years ago this month, when I decided I had done my dues as a night shift nurse, had a new daughter that would need daycare and wanted to see the light of day on a regular basis, I took my first real position as a home health nurse. I started learning the rules which were pretty simple at the time. We did skilled care, we tried to prevent hospitalizations and we kept some people on service a long time as long as they were homebound. We had 485s, but not OASIS or HIPPA, and agencies were paid per visit. I lived in a large rural county and drove a lot of miles to see my patients. There was only one other agency in the county so we didn’t worry much about competition. We were usually glad to find someone was no longer homebound so we could discharge and free up the schedule a bit.
One day the state surveyor came. She wasn’t happy with our director and told her some things to take care of. A few weeks later she was back and telling us she was closing us down. Apparently the Director had not taken her seriously. We went to the CEO of the hospital. He negotiated, fired the director and brought in consultants to teach us the real rules and we went through the first real intensive training for home health I ever saw.

 

The Homebound rule was made abundantly clear at that time and, of course, we often debated the nuances of it. There always were, and will be, the challenge of balancing the real need and the care in those who fall into grey areas. But most honest home health agencies have a pretty clear idea after 20 years what constitutes homebound status. And most honest HHAs will have clinicians document homebound status regularly and discharge patients when they no longer meet the criteria.
Enter 2011 and the new Face to Face requirement, where physicians who have been signing 485s for years suddenly have to be the ones to state why the client is homebound. It is like jumping back 20 years. I put the question on a forum and responses are amazing. These are some of the examples I have seen.
“Just got a F2F form back from a physician and on the homebound status he wrote “N/A” …… unbelievable “
“My favorite so far was “because he’s old” patient was 90+”
“When we first started using the form, one of our physicians wrote under the homebound status: no footprints in the snow…”
If this were the worst of it we could laugh and move on but the sad truth is that the F2F rule which requires the physician actually see a patient and write out a reasonable reason for homecare and homebound status seems to be a final straw for many physcians. But it is also having a huge administrative impact on home health agencies. One responder on the forum wrote,

“Oh My , F-2-F is not going well I am sure with most agencies, We have had to dedicate one employee who spends at least 80% of her time tracking and attempting to get the documentation as well as getting the documentation filled out correctly. CMS has gone overboard on this one.”
A survey done in February 2011 by NAHC yielded a 381 page document of the difficulties HHAs were already encountering.

http://www.nahc.org/Regulatory/home.html#comments
What is supposed to be curbing fraud and abuse is angering physicians who do not want to deal with it. They are not completing the forms; they are threatening or actually dropping home health patients rather than write a short statement validating what they have been signing all these years. Agencies are scrambling to placate them, some committing more of what will be considered fraud by attempting to assist the physician with check box or prewriting the homebound reason.
From a clinical stand point, I don’t really object to the Face to Face rule. I don’t think it is unreasonable to expect a physician to evaluate a patient before or soon after ordering Home Health. I recognize that it can be a logistical burden in some cases. But a good percentage of initial referrals come from a hospitalization or MD appointment. The encounter itself does not seem to be the major issue. I believe that physicians don’t want to be held more accountable for trying to determine the wording for why someone is homebound when they have already signed a statement that they are on the 485.
Should HHAs be deprived payments if a physician doesn’t do their job according to CMS standards? Should they have to add additional administrative hours to educate and police physicians? Should deserving patients lose an important healthcare benefit because their doctor doesn’t want to deal with additional paperwork? Of course not!
But, the sad truth is they will, unless there is a change in the requirements. So what can you do as a new agency to minimize the impact on your company? The best answer seems to be to attempt to have the F2F documentation done prior to your acceptance of the patient. Educate discharge planners and physician offices that this is the requirement and make the appropriate form easy for them to access with appropriate samples. Remember you cannot use check box reasons or complete it for the Physician to sign, neither can the discharge planner. If you can’t get it before you take on the patient, be sure you make it clear that you need it ASAP and keep on it so offices know you follow through. Document every contact until you get what you need. It may mean more time initially but it will become common practice eventually.
Use forms and educational material as part of your marketing. Be sympathetic, but firm with the additional paperwork burden of the physician. It will do you no good to try and get around the regs by doing it wrong so you get the client over someone else. Those companies will end up losing money and having more issues. If CMS is looking for ways to bankrupt agencies they will go after them.
As usual, I would welcome your comments or even just a brief update on how your agency is doing. If you don’t want to receive this newsletter, just reply with unsubscribe as the subject and I will remove you from my contact list. If you are ready for great software to run your agency, let me know.

Should your Software Be In The Clouds?

Many people I talk to these days want to know whether their software should be internet based or self hosted. It is a valid question because you need to make this decision at some point. Rather than just assume that one way or another is right for you, because someone tells you so, why not make that decision based on what works best for you.

You will see terms such as “Cloud computing” and SaaS, “Software as a Service”. These terms refer to resources which are accessed via the internet. Many of us use these services all the time with our applications such as Facebook, email programs, music and game sites.

The alternative route is software which resides on your own network system. This can vary from a single computer to a server based system sharing the information over multiple computers. You own the rights to the data and have strong control over access to the data from both a physical and access standpoint. This is not to say you cannot treat these programs as internet based. With VPNs (Virtual Private Networks) and such programs as Go To My PC, you can set them up as internet accessed programs as well.

Having access via the internet is clearly an advantage to anyone who wants to be able to work away from the office, so why would you not choose cloud computing every time? There are issues to consider:

1. Cost. Whether your data resides on your server or someone else’s, it has to reside somewhere and be managed by someone. There are going to be costs associated and consumers will pay for those costs whether they see it spelled out or not. As a new agency you may not want to be paying for IT costs that you really don’t need. If you can manage a small peer to peer network, it may be worth waiting until you grow to pay for that service. On the other side if you are at a size that a network is becoming a necessity, it may be worth sharing that cost with other groups and paying for offsite IT support. The savings on hardware and staff to manage it may be substantial.

2. Accessibility. In the cities, we may take internet access for granted. We assume we can always hop on the internet and find what we need. But not all areas are that reliable. If you only have dial up access or have frequent random failures at the provider level, you are going to have issues with getting to your data. You may be frustrated with your software, when it is the internet carrier having issues. You will need to determine if you are located where you can count on reliable access.

 

3. Privacy. Having easy access to Medical records via the internet requires stringent privacy policies. It is very easy to work on charting from home or the coffee shop via the internet. It is also easy to step away or forget that unauthorized people can be watching over your shoulder.  Of course, this is a training issue that should be a constant focus regardless of where your staff access medical records. HIPPA compliance can not be ignored. Lapses in security can have huge consequences no matter where they take place. Stolen laptops and hacked passwords may leave people who trust you extremely vulnerable.

 

4. Ownership versus Renting. There are tax advantages to owning your software. Using Section 179 of the tax code may save you as much as 25% of the price of the software in one year if you qualify. Paying for support and updates is typically much less than ongoing rent. Explore your options before paying rent forever.

August Systems is a unique company in that we are able to provide our software in the way that works best for you. And we can adjust when you need to. As a new start you may only need a single user on one computer. You certainly should not pay for cloud computing at this point, especially if it is a laptop you can take with you. But if it is on a computer in your office and you need to access it from home or the field, or next year, when you have 6 users and would need to invest in additional hardware to set up a network, it might be cost effective to move to net hosted so you don’t have to hire an IT person and buy a server. In a few years, you can buy the software and take advantage of both our purchase credit and Section 179 and save close to 50%.  You will still have state of the art software and make use of the latest technology.

When you are ready to automate your business, take a look at our field proven software and talk to one of us about how the Visit Wizard will work for your company.

April Brings Spring with some Stings to Home Care

April is proving to be a challenging month in the home health world. With not one, but two new CMS regulations to track, the forums are buzzing on how to manage these issues.

If you are new and trying to get a handle on all the other regulations as well, it might be even more of a challenge to grasp the details, and how to capture the required information. Let’s take a look at the new rules.

First is the face-to-face rule. F2F says that the certifying physician is required to document that he or she, or a non-physician practitioner working with the physician, has seen the patient. The encounter must occur within the 90 days prior to the start of care, or within the 30 days after the start of care. Documentation of such an encounter must include a summary of the patient’s condition, and why home health is necessary.

For a lot of detail straight from the horse’s mouth go to http://www.cms.gov/center/hha.asp. On the surface, this rule sounds somewhat reasonable. The doctor ordering home care should know what is going on with the patient. Moreover, they should not order home health for people who just do not meet homebound requirements. This assumes the doctor has a good understanding and appreciation for home care.

Of course, this is not always the case. Some of the neediest patients are so homebound that they can only see a physician if they are transported by ambulance or if the physician comes to them. This can be a major hurdle. Few doctors are willing to make house calls. An ambulance transport is expensive. The concern is that some of the neediest clients will not get the homecare they need when they can’t be seen.

Even if the physician sees the patient, getting correct documentation is also a problem. One forum writer reports “I can’t even get a face to face back that remotely meets the requirements! Even when we send a dummy copy to follow! I got the best one ever this week! All the physician wrote was ‘pt requested services’. And that’s it!!!!!!!!!!!!”
The real world knows how difficult it is to get the physician to sign a 485, where it is presumed to have been read, and agreed to. Adding another page requiring them to WRITE a summary of the patient’s condition, why they need home health and which services they need, may be a nightmare for many agencies. Of course, the company who figures out how make it easy to gain the compliance of physicians may have a new great marketing tool.

If you need sample letters related to F2F, go to the NAHC site. http://www.nahc.org/regulatory/home.html

The second challenge taking effect on April 1, 2011 is the Therapy assessments regulation. This is summarized on the CMS site, http://www.cms.gov/HomeHealthPPS/Downloads/Therapy_Requirements_Fact_Sheet.pdf

It basically encompasses Assessments at Start of Care, 30 days and 13th and 19th therapy visit timepoints.

This is a real challenge as the 13th and 19th visits are the sum total of all disciplines. This makes it a moving target on the schedule as the visit must be done by a qualified Therapist not a PTA or COTA. Small companies may not find it too difficult to keep up with on paper but I can see it becoming a very difficult challenge for even medium size companies, or companies who contract for Therapy visits.

Some quick Q and A’s I found on the HCAF web site:

The National Association for Home Care & Hospice (NAHC) received responses from CMS to the following questions.

Q: If a patient is reassessed by a therapy discipline based on the 13th or 19th reassessment requirement prior to reaching the “at least every 30 days” [point], would the 30 day reassessment count begin again with the 13th/19th visit assessment? (In other words, whenever the patient is reassessed, does the every-30-days clock start over?)
A: Yes, the 30-day clock restarts with every qualified therapist visit during which the therapist conducts an assessment and measurement and completes documentation.
Q. If a patient is receiving multiple therapy services, must one of the qualified therapists’ actually conduct a reassessment visit on the 13th/19th, or may all of the disciplines conduct their qualified therapist reassessments on the visit closest, but prior to, the 13th/19th? In other words, if PT is 10th, OT is 11th, SLP is 12th, may the PTA visit on the 13th therapy visit as long as the qualified PT assessed the patient on the 10th visit?
A: The visit close to (but before the 13th and 19th) is fine for all disciplines, when there are multiple disciplines.
Q. When we count visits to determine when the next therapy assessment is due, do we count all visits or just billable visits?
A: Count billable visits. (http://hcaf.wordpress.com/2011/02/08/cms-responds-to-therapy-assessment-and-other-questions/)
It is not hard to see why this ruling has come into effect. When you look at the government’s goal; spend fewer healthcare dollars, and the general rule for agencies, maximize care for patients and still make a little profit, it is not hard to see where this rule will push the trend. In general, I predict many agencies will settle for 12 Therapy visits or less on average. This will keep them from spending more for assessment visits and justifying more visits. Some will do it out of fear that they won’t do something right and will not get paid even though they did the visits. Some will be lost in the nightmare of trying to keep up with those 13th and 19th visit dates. Those that try to meet the challenge will have to keep it in the front of their mind with every schedule change.

This will be one more question to ask your software company. It will be interesting to see what innovative ideas will be developed. Early reports are showing that some vendors are not providing any assistance in this area, opting to leave it to the client. August Systems has two viable ways to assist you in keeping on target. We have introduced an added line to our hover hint section. When you hover over a name on the schedule, Not only will you see who is seeing the client, but you will see the Therapy visit count. It will self adjust as visits are made or cancelled. Since it is built into the system, you won’t be doing redundant work as you would a 3rd party tracking system.

The second way we have people using our system, especially where they use contract therapy for visits, is using our telephony, ClockWork. Because the telephony actually shows when visits are done, you can keep track up to the hour of which visit you are on.

I would be interested in hearing what problems and solutions you are finding relating to these new regulations. If you don’t mind sharing, just hit reply and tell me.

Bumps, Bruises and Growing Pains

I learned a new word this week, Calcific Tendonitis. What it means is that some calcium deposit in your rotator cuff breaks down into toothpaste like substance and irritates everything around it. It feels like…. Number 10 on the pain scale. Bad enough that I wasn’t sure it wasn’t my heart so I went to the ER. They gave me pain pills and sent me to more doctors who gave me more pills and said to see more doctors. My chiropractor told me to cut out my Diet Pepsi and get acupuncture. Oh Joy, take away my one big vice and stick needles in me.

The Home Care business can be like that. You are going along fine, thinking you have it figured out, when BOOM! Out of nowhere comes something that knocks you off balance. It hurts like crazy. First, you don’t even care if you get it fixed, you just want the pain to go away. Think OASIS, your first customer complaint or implementing software.

Then you want to know what the problem is exactly, and how you got to that point. Did you do something wrong? Did you forget to do something? Was there a big gap in your learning process? As you move forward, you start thinking about how to prevent a recurrence of the problem.

Pain is usually a symptom of an underlying problem. It acts as a motivator to force us to action to correct that problem. If we wait for it to go away without changing anything, we often find it comes back to bite us harder the next time. Problems in our business act the same way.

Suppose we have a client complaint. If we ignore the complaint, it may go away. However, so will the client and any future clients that person may have referred. A quick response to allow the client to express their concern will validate you are concerned. An honest effort to rectify the situation will always be better received than a quick dismissal. This is not to say that the client is always in the right. However, an honest look at the situation and a timely response to the client will often be effective. It can also be an early warning sign of a deeper underlying problem related to employee training, agency processes or some other issue.

As with most things, it is better to prevent a problem than to experience the results. How do we prevent things we don’t know about? By anticipating and learning. I don’t know anyone who will tell you they know all there is to know in the home care business. Nevertheless, we are accountable to meet all the requirements and standards. Owners, Directors and Managers need to know as much about the current and upcoming standards as possible. If you wait until the implementation dates, you are probably way behind. If you take a shortcut in hiring and get a bad egg in your agency, you may find they cost you far more than their salary.

There is also a trickle down effect with your staff. If you train and expect your staff to look at the whole picture of your industry standards, you will have a wiser group of people supporting your agency. They might hold you to be more accountable. They might catch things you have missed, or turn out to be the “guru” of a particular agency task. Imagine if one of your office people suddenly turns out to have a talent and lust for coding because you sent her to an inservice. A clinician decides the new software is the best thing since sliced bread and masters it quickly and shares her enthusiasm with everyone. By opening up, you may find that something that is an acute growing pain to you is the opportunity for someone else to go for the gold.

Just as pain is not always preventable, bumps, bruises, and growing pains are part of the daily life of a growing agency. If we use them to direct us to healthier, smarter behavior, our agencies can thrive and mature. We are better prepared to deal with problems when they do come.

Home Care vs. Auto Sales: Marketing your business

One of my girls recently started dating a car salesman. He is delightful and loves to talk about his job so I am learning a lot about the sales business. They have a completely strange vocabulary that customers never hear. I have realized that I do not ever want to buy a car again! However, if I do I will take him with me. There is a reason they are known as the least trusted profession. We may not trust car salesmen, but we do buy cars and there is no doubt they have very effective sales techniques. Perhaps we in home care can learn a little from them when it comes to promoting our business. Stay with me and I will share a couple insider secrets about car dealerships too.

 

 We buy cars because we need them and we want the best we can afford. It is the same with Home Care. People need it but they don’t always know how to get the best value for their dollar and they don’t always know what they are looking for. If we want to be the home care dealership of choice in our area, we have to find ways to draw people to our agency and keep them as our choice customers.

 

First, we need to be known. You need to have a visible presence. We may be a national franchise or the homegrown dealer down the street. I am still amazed at how many agencies don’t have web sites. Even a free, one page, information site is better than none and will start being found. As soon as feasible, move to a better format. Spend a little time looking at your competitors and find ideas that you like and develop your own unique presence. Don’t be naïve and think that the elderly don’t use the internet. Even if they don’t, their children and their doctor’s staff probably do. It is one of the lowest cost of advertising there is.

 

Use free internet sites to promote your agency. Places like BBB, Yellow Pages, Caring.com and Manta allow you to submit information to them. There are many local information sites as well. Be sure to include your web site so people can find you.

 

Use brochures, public activities and logo tagged freebies to promote your business around your local area. Get local newspapers to promote you or write articles about you. Be involved in your local community activities as an organization.

 

The next phase is to get known personally. Get to know your referral sources. Doctors, and more importantly their office staff, Discharge Planners, Social Workers, and Community Service providers. When people attach your agency name with a person they trust, they will think of you when they need to refer. Never underestimate your staff. They are the face of your agency in the community. I have seen individual caregivers bring in lots of referrals because they were competent and loved by clients. I have also seen an individual bring an agency to its knees by creating an air of distrust. While car salesmen may get away with less than honest practices, It is NOT acceptable in the health care arena.

 

Develop trust and relationship with your clients and referrals. This is where nurses have a natural advantage. We are perceived as trustworthy. We gain trust by professional, compassionate care of our clients. Your staff is trained to provide quality care, protect privacy and support healthy decisions by your clients. You know that clients will talk about their caregivers with family, friends and their physicians. That is either the best, or worst, advertising you can get.

 

Strive for repeat business. I was surprised that dealerships really strive for this but it does explain all those friendly letters I get and throw in the trash.  If your perception is that, someone went out of their way to be friendly and give you their best effort, you generally prefer to deal with them instead of someone new. There is a huge amount of trust in the home care business. Your referral sources and physicians need to trust your agency; your clients need to trust you. You must have caregivers you can trust to be excellent in serving the people they care for.

 

OK, for those who stuck it through, here is what I have learned about car sales.

To Crack someone is to over charge you when you think you are getting a great deal. They can do this on the front end by charging you more for the vehicle than you realize or on the back end by charging more interest than the bank requires or selling you an extended warranty at a ridiculous price. If you are not careful, they will get you on both ends.

MSRP means nothing to them. I thought it was the top price but they see it as the low end of price. When I asked is that illegal, he said it is only a suggested price. If they can get you to pay or a bank to finance, they think it is fine.

They will bait and switch you in a heartbeat.

Repeat customers are the best to crack, if they trust you, you can sell them anything.

 

If we ran our home care businesses like that, we would be in jail. So let’s keep our integrity and take the good we can learn and leave the rest.

Resolutions and Goals

Welcome to 2011! This is the time of year we spend time looking back and measuring what we have accomplished. Then we look forward to plan what we want to accomplish.

We may plan to lose 10 pounds, as soon as we finish off the last of the Christmas fudge, or to clean the garage as soon as it gets warm. I have this vision of finally getting organized. The nice ones in my family just roll their eyes. The rest are rolling on the floor.

Let’s look at business goals. Mine are relatively simple: sell Visit Wizard software and help make your lives easier. Y’all feel free to help me out with my goals. Tell me what you need and want in our newsletter and, certainly, let me assist you to get where you need to be with managing your agency.

Your Business goals are going to be a lot more complex. For some, you still have state or certification surveys looming on the horizon. Others have passed that step and are wondering how to proceed in growing the business. Some are moving out of the realm of “new kids on the block” to being established businesses. Wherever you fit, it is important that you keep moving toward new goals. A stagnant agency dies. A thriving agency is constantly finding better solutions to problems and better ways to meet the needs of their clients.

2011 promises to be another year of uncertainty. Healthcare is caught in a tug of war at the highest levels. We know that the people who lose are those who need services most and, often the companies who serve them directly. We saw that in 2010 as well, when cuts were looming and the outlook was grim. I spoke with one client who looked around her area and realized she could plan to be in a position to succeed rather than fail with the others. We looked at how automation would allow her to be more efficient and she invested. A year later, she is still thriving and people listen to her when she talks about how to succeed.

I would enjoy compiling a list of your goals if you will contribute just one or two apiece. It would be great to see this community of young agencies become more interactive. Don’t spend a lot of time. Just hit reply and type the first things that come to mind. It will benefit others who may be struggling with their own goals. It will certainly help me focus on the areas most helpful to you.

Thank you and have a wonderful and successful New Year!

What goes into a Personnel File in Home Health?

I recently watched a webinar that listed the top ten reasons home health companies get citations on their surveys. Number One of those is that the personnel records fail to capture critical data assuring employees have all they need to be legally employed.

After discussing it with some Home Health friends, I realized that this is a very difficult area for many administrators.

Some things are obvious, and they go into the file one time, such as applications for employment and reference checks. Other items must be renewed periodically, so the person in charge of human resources must be able to track that these are done consistently and on time.

So where do you start? The logical answer in my mind is to build a checklist and use it consistently with each employee file to be sure it is completed during the hiring and orientation process.  Then develop a system for updating documentation in a timely manner.

We can start with a basic checklist but you will also want to check with your state and Fiscal Intermediaries to be sure they don’t have additional requirements. As part of your personalized checklist, I would suggest including contact information for any third party resources you use or have contractual agreements with in your area, such as fingerprinting agencies, drug testing companies, etc.

Be sure all forms are correctly completed, signed and dated before they go into a file. And be sure files are secured to prevent any risk of HIPPA violation or Identity Theft.

Sample Personnel Folder Checklist

___ Application for employment

___ Documentation of reference checks

___ Statement of Employability (this is a standardized form in TX which outlines the specific convictions that would bar an employee from working in Home Care) It is often part of the application form.

___ Criminal History Background Check

___ I-9, Employment Eligibility Verification

___ Copy of Social Security Card

___ W-4 Tax withholding form

___ Signed Job Description

___ Competency Skills Checklist

___ Competency Test (if used)

___ Orientation Checklist (we will address this in an upcoming newsletter)

___ Employee Acknowledgment of receiving and reviewing required documents, (P&P, Orientation Checklists, etc)

___ Copy of Professional Licensure, Certification related to profession or

___ Verification of Professional Licensure, as required by State

___ Current CPR

___ Current Vehicle license

___ Current Vehicle Insurance

___ Non-Solicitation or Non-Competition agreements

___ Performance Evaluations, Annual or as required

___ Counseling Forms

___ Commendations

___ Inservice Records

___ Hepatitis B Consent/ Declination form

___ Hepatitis B Vaccination Tracking Form

___ TB test verification

___ HBV/HIV exposure and follow up forms, as applicable

___ Other exposure reports and Follow up, as applicable

___ Medical Leave of Absence records

___ Family Leave of Absence records

___ Reliability reports

___ Medical reports as related to accommodation for disability

___ Documentation as required for illness.

Feel free to let me know if there are other requirements either in general or state specific, that you would add.

Getting everything checked off at the time of hire is one thing. Keeping up with numerous employees year after year is often the real challenge.  You can either divide your staff up and focus on those who have anniversary dates each month, or have an annual competency week and get it all done for everyone at once. Of course you will still have those who have bi-annual vehicle insurance cards or for whatever reason they are out of sync with everyone else. I hope that you will have software that can easily track the annual items due for renewal and allow you to remind your staff without taking large chunks of time. (Yes, of course, our Visit Wizard software does.)

Have a wondrous Holiday season and Blessings on you in the coming Year!

Educating Your Staff and Yourself

Whether you have a staff of one or a thousand, your agency’s success depends upon you AND your staff knowing what they are doing. All too frequent changes in Medicare, coding, billing and all the other nuances of home care mean that you must constantly keep yourself and your staff educated. If you are new in the Home Care or Hospice arena yourself, how do you accomplish that?

Let’s see, you could hire only seasoned professionals who already are up to speed and can do their visits and chart perfectly on time, every time. Good luck with that. You could provide weekly inservices and every one will come just for the donuts. Sure they will. You could threaten them with demanding they attend or you will take their firstborn child and they would throw in the second one free.

So how can you be sure education is a priority? First it must be YOUR priority. If you don’t care enough to make information available, you can’t expect your staff to rush out and find it. Worse yet, your seasoned clinicians will lose motivation and your less trained staff will not even comprehend what they do wrong. If you take the lead in education and share with enthusiasm, you invite discussion and can show the value to your agency.

How can you make staff education a priority? Make it worthwhile. Pay for their time. Make it as painless as possible if not outright enjoyable. Here are some ideas I have seen used.

Involve your staff in the training. Find clinicians or office staff who enjoy teaching and let them research and present new ideas.
Make games of it. Play “What is wrong with this picture?” Take real mistakes and include them into a practice 485 and see who can find the most errors. Make some errors ridiculous to keep them smiling.
Reward staff with CE classes, then have them share what they learned
Share the information. If you subscribe to newsletters and journals, place them where staff can browse on their downtime. Post important articles.
Watch for potential “gurus” and encourage them. Maybe the quiet clinician who has mastered the clinical charting software is a better one on one mentor for a struggling learner than the dynamic class instructor who gets frustrated with slow learners.
Teach the right people the right stuff. Although it would be nice if all clinicians could code, the likelihood is small. For many clinicians it is mind numbingly boring. Find the right clinical person, pair them with the right office person, send them to an annual Coding for Home Care class*, and you will find it a worthwhile investment.
Involve your staff in the news. If you have weekly meetings, spend a moment or two telling them what is going on in the world of Home Care. Make the world real by talking about the issues and problems across the country. It is easier to discuss fraud and abuse by discussing what happened to someone else than to have OIG knocking on your door. Encourage questions. Talk about your own practices. Discuss how they stand up to the test of integrity. Discuss how your agency meets CoPs and what surveyors look for when they come.
Find good teaching resources. Budget for staff education. There are excellent resources out there these days. A few examples are listed below.
Make education an ongoing function of your agency. Set the expectation from the hiring process that all staff members are responsible for knowing more than just their own job functions. Home Care is a dynamic, ever evolving industry and that requires keeping up.

Resources:

Home Care Institute www.homecareinstitute.com. Online learning by subscription at a reasonable price. Eligible for Continuing Education. Teaching modules are excellently done. Has some free demo classes on the site.

Decision Health http://www.decisionhealth.com/HomeHealth/homeHealth.aspx

Industry leader in newsletters and seminars.

Home Health Aide Digest http://www.hhadigest.com/

NAHC http://www.nahc.org/education/home.htm

Looking Back and Aiming For the Future

It is hard to believe I have been writing articles for a year now. And what a year this has been! It has been full of hopes and dreams, and fears and trials. I have been in the presence of great men and held a 2-pound baby in my arms. I have seen the miracle of her growing up to an eight-pound, 4-month-old grandbaby. I have even managed to accomplish a few things on my “bucket list”. I have been challenged and I have come out stronger.

I know it has been a ride for all of you who are starting and growing agencies. For some, your business has grown wildly beyond what you imagined. For some it has been a painfully slow process.

I would love to hear from you about how your agency has done this year. What are the challenges and victories you have faced? If you have a few moments to share, please let me know your story.

I had the privilege of attending NAHC in Dallas last week. As a vendor, I enjoyed meeting our clients who were so positive about their experiences with our Visit Wizard software. I spoke with people who were looking for solutions. I also took some time to see what resources were out there for you. I met a few new consultants and found some interesting products. There were informational seminars and plenty of opportunities for networking. The Keynote Speaker was George W Bush, who was delightful. I came away from NAHC feeling encouraged and hopeful for our great industry.

One of the useful tools used at NAHC is session handouts. These are posted on their website before the conference and for a while after. Even if you do not get the full benefit of the classes, you may find some interesting data and some links for further study. I find it a relatively quick way to spot trends and learn the new buzzwords for the industry.

http://www.nahc.org/Tango/Mtg/AM/sessinfo.taf?function=handout&mtg_code=10AM

If you see one you really wish you could have attended, you can order audio or videos of the sessions from NAHC.

Again, I would welcome hearing your stories of growth this year. Please feel free to share.