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| Welcome to the latest edition of the Simione Solutions
E-Newsletter. This informational newsletter will be
e-mailed to you on a monthly basis containing articles
and information on up to date industry issues. |
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2010 BRINGS PROMISE TO THE M&A ARENA
by Shelly Berman, CPA, CVA, Principal,
Simione Consultants
M&A activity during the first half of 2009 was a challenge for most buyers. The economy was at its lowest level in years. Both strategic and investment buyers felt the pain of the Credit Crunch. However, as 2010 kicks off, it appears funding has loosened up making equity investments and other types of funding available for growth and acquisition. Private Equity Groups and other investment buyers are again looking to make investments in the Home Care and Hospice space. Strategic buyers will be looking to increase their revenue base in order to keep unit costs down. So does that mean bigger is better? The traditional safe answer is "That Depends". Horizontal integration or horizontal expansion is not for everyone. Every company needs to define its own objectives and where they want to be in the future.
There are over 10,000 home care and hospice agencies in the country and many of them are looking to sell. Buyers will assess the agency's value depending on their needs. Strategic buyers have different needs than investment buyers. Finding a company with a strong platform and infrastructure may not be as important as compared to market share and relationships. Other elements to be considered are profitability, compliance and operational risks. Whether you are merging or buying, a strong due diligence should always be performed.
Due diligence has many facets including financial, operational/clinical, regulatory, technology systems and legal. Also, post-closing integration should be recognized and planned for well in advance so that a smooth transition can be accomplished.
Along with M&A transactions, the Centers for Medicare & Medicaid Services (CMS) issued a rule which was part of the 2010 Home Health Prospective Payment system rate rulemaking. This rule requires a party that acquires a home health agency (HHA) with less than 36 months of current ownership to undergo a full survey or accreditation. This process is the equivalent of a start-up HHA. This is in contrast with the previous rule where there was a "change in ownership". We are working with the National Association for Home Care and Hospice (NAHC) together with CMS in assessing all the implications of this rule.
To learn more about our Mergers and Acquisitions Consulting Services, click here
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ARE YOU OPTIMIZING THE USE OF YOUR CURRENT SYSTEM?
By Suzanne Sblendorio, RN, BSN, MA, Director, Simione Consultants
In step 1 of the utilization self assessment presented in last month's newsletter, you walked through the key work processes with your employees and noted their interaction with the system.
In step 2 you begin to analyze your findings from that process review. You will look for signs of:
- User knowledge deficits such as not knowing how to execute core functionality, the use of a large number of custom reports or staff believing "it can't be done in the system".
- General mistrust of the system such as using tracking tools rather than relying on the system, or verifying outputs manually.
- Work done outside of the system such as with spreadsheets, logs, whiteboards, etc.
- Reliance on a large number of custom reports.
- Tasks taking longer than anticipated or than before the system was implemented.
Note also if:
- Complaints are consistent among users.
- Users access system documentation and other user guides.
- You are using the most current release of the software.
- Your hardware and network are compliant with the vendor's current specifications
In the coming issues, we will outline additional steps to help you refine your analysis and identify potential sources of the problems that may be affecting your ability to obtain maximum benefit from your solution. If you would like more information about our IT Division Consulting Services, click here |
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USING ORGANIZATIONAL DASHBOARDS TO
IMPROVE PERFORMANCE
By Julia Maroney, RN, MHSA CHCE, Senior Manager, Simione Consultants
Organizational dashboards are essential tools for senior
executives to measure agency performance. Key performance measures can be monitored on a
one page dashboard, with comparisons to targets, budgets and benchmarks. Each organization's dashboard is based on the
measures that are key to its performance. Using dashboards is an effective and
time saving way for home care and hospice executives to monitor performance and
to prioritize those measures that are critical to operations.
While many organizations are using dashboards at the senior
level, very few have chosen to use dashboards at all levels of management and
staff. Those who use dashboards or
"report cards" have found that staff and management are more engaged in the organization's
performance. Tying compensation to
performance is also a practice that many high functioning organizations utilize
to assist in meeting or exceeding targets.
Effective use of dashboards begins with its development. Determine what measures will give a
"snapshot" of agency performance. Think
"wallet-sized" rather than an "8x10"!
Keep it simple, and customize the dashboard to the management or staff
level of accountability. Carefully consider how both clinical and
business operations impact the overall performance of each measure. Clinical managers can have financial measures
and business managers can have clinical measures.
For example if an
organization has determined that a measure is "Days of Cash on Hand", this
would be appropriate for a CFO to monitor, but a Billing Manager may have "days
in AR" or "days to RAP". In addition a
Clinical Manager may also have "Days to RAP" as this is a direct reflection of
the timeliness of clinical documentation processes.
To learn more about our Clinical & Operations Consulting Services, click here |
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 COMPLIANCE TIP .....
AVOID THE "TECHNICAL" DENIAL
By Robin Seidman, RN, BSN, MSN, MBA, LNCC, HCS-D, Director, Simione Consultants
Dates, Dates, and more Dates! Stop Medicare from taking your money back because of a simple error... like missing dates or signatures on clinical documentation. Although the mistake is considered a technical error, "missing, incomplete or untimely....orders/certifications/consents, etc." is still one of the top denial reasons for home health and hospice claims.
In Home Health, the biggest "date" compliance issue continually identified in audits is the lack of or unreadable date in CMS Form-485: Locators (Loc) 23 and 25. Do not put multiple dates (i.e. "the date the 485 was reviewed") in Loc 23 - the most recent date documented will be the date used for verbal start of care. If your computer system stamps a date in Loc 23 and that date is accurate, sign (but do not date again) Loc 23. It is good practice to enter a date in Loc 25 regardless of whether or not the MD dated their signature (in Loc 27.)
In Hospice, the biggest "date" compliance issue continually identified in audits is lack of clear certification dates on the CTI and/or the date both physicians (Attending and Hospice) signed. If the date span for which the physician is certifying cannot be identified, your claim may be denied.
STEPS TO SOLUTIONS:
- Buy a date ink stamp (with identifying attribute specific to your agency- i.e. company logo or initials).
- Implement a process that ensures every document requiring a date signed/received is clearly dated (preferably with a date stamper).
- Conduct a random review of final claims to evaluate process vulnerabilities ( e.g. does a hospice (re)certification form have a place to document the exact certification period dates).
- Review your Compliance Plan & make sure it stipulates monitoring & auditing of potential "technical" errors as well as any identified government risk areas.
To learn more about our Compliance Consulting Services, click here |
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ALL REFERRALS ARE ADMISSIONS UNTIL PROVEN OTHERWISE!
By Mike Ferris, Director, Simione Consultants
Our research over the last ten years has shown that both home health and hospice agencies are losing admissions due to poor referral management. Many referral centers (or "intake") we've studied are staffed by burnt out field nurses who screen OUT referrals as they come in.
As we've seen time and time again, if we make it about THEM (possible patients and referral partners) and not about US (our agency and its employees), referrals and patient satisfaction show significant increases.
It is with that in mind that we created a philosophy that says that ALL CALLS are referrals and ALL REFERRALS are admissions - until proven otherwise. Since no one has a crystal ball, the goal should be to see each referral and assess it in person. Over the last 10 years this philosophy has proven itself with every single agency who implemented it. They saw jumps in every category - including referrals, admissions, conversions, and patient satisfaction.
Hiring the right people to manage your phones and training them to AdmitRight will increase your admissions, on average, by 20%. And this is accomplished WITHOUT any additional sales or marketing efforts.
The referral center (admissions, customer service center, etc.) is the most important hub for being a truly customer centric organization.With the amount of competition in many markets today, a focus on making the referral center the leading department for customer service will pay big dividends. Contact us to discuss an evaluation and assessment of your intake department.
To learn more about Marketing, Sales and Customer Service,
click here
To sign up for the Legendary Sales Leadership e-newsletter,
click here
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FINANCIAL MONITORTM TIP OF THE MONTH.....
2009 BENCHMARKS
By Rob Simione, Senior Consultant, Simione Consultants
In today's environment it is important for Home Health Agencies to compare themselves to national and state benchmarks. Using benchmarking practices allows you to determine areas where your agency can become more profitable or cost efficient. Through the Financial Monitor from Simione Consultants and OCS we would like to present the following 4th quarter 2009 benchmarks:
- Did you know that the median quarterly revenue for a Home Health Agency is $1.91 million? As a result for every 1% saved on Gross Margin an agency would earn an additional $19,100 of net income each quarter.
- Did you know that Private Insurance makes up 26% of an agency's patients but only 14% of their revenue?
This is important information not only for your agency but also for the industry as a whole.
To learn more about participating in the Financial Monitor,
click here
To sign up for a free Webinar on the Financial
Monitor....click one of the links below:
Wednesday, March 17, 2010
1:00 PM EDT, 12:00 PM CDT, 11:00 AM MDT, 10:00 AM PDT
Click here to register
For New
Jersey State Association
Wednesday, March 24, 2010 1:00
PM - 2:00 PM EDT
Click here to register
For Connecticut
State Association
Thursday, March 25, 2010 1:00 PM
- 2:00 PM EDT
Click here to register
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