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Home Healthcare Whitepaper


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12 Ways Gps Reduces Home Health Agency Costs And Improves Operations

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Home Healthcare Whitepaper

  1. 1. Sponsored by 12 Ways GPS Reduces Home Health Agency CostsWritten by and Improves OperationsDecisionHealth White Paper Services Nurse visits to patients’ homes have been the foundation of home careContents since the days when horseback sometimes was the only way to get there. Today, visits still are the key to patient care, but they’re also a• Traditional tools: Labor major cost for every home health agency. intensive .............................. 1• Technologies emerge that fit with HHA business structure .... 2 Ensuring the quality of care delivered in the home is of prime• GPS/cell phone/software offer importance, of course. But successfully managing travel time and costs benefits in field and HQ ........... 3• Advantages for home health gives HHAs the opportunity to increase the number of visits and time field staff ............................... 3 with patients while trimming the high costs of travel.• Advantages for home health agency executives .................. 4• ROI table ............................... 6 Fortunately, several newer technologies offer better methods for• Case Study: Swedish Medical managing the travel and visit schedules of agency field staff providing Center Home Care Division ...... 7 skilled nursing care, social work services, physical, occupational and• Final thoughts ........................ 8• About the Sponsor .................. 8 speech-language therapy, and aide services. These technologies include global positioning satellites (GPS), the Web and handheld devices such as cell phones. This white paper explores those alternatives and theirExecutive Summary pros and cons.Home health agency use of cellphones equipped with GPS navi-gation and linked to a powerful Web- Traditional tools: Labor intensivebased application helps HHAs bettermanage their field staff of nurses, First, let’s benchmark the way most home health agencies havetherapists and aides. Turn-by-turn managed their mobile workforce. Technologies at play are theGPS directions on cell phonesprovide the shortest/quickest route telephone, voice mail and pen and paper. Upwards of 70% of HHAsfor visits to patients’ homes, saving may fall into this category, indicates an informal November 2007fuel costs and driving time. A GPS- survey of 379 HHAs by Home Health Line, the leading independentbased application that tracks cellphone travel shows where all staff newsletter in the industry.are at any moment, generates datafor automated timecard and mileage Visit scheduling and schedule changes rely on time-consuming andreimbursement calculations, providesadditional documentation of patient labor-intensive phone calls (and leaving voice mail messages) betweenvisits, and sends safety alerts to the the agency and field staff. More phone calls follow to report thehome health agency when a nurse conclusion of a visit so office staff have some idea how the visitmay have encountered a problematicsituation. schedule is progressing. When there’s a change during the day, the scheduler checks the board or screen to find a nurse whose location and visit load can accommodate the added visit. White Paper Program During much of the day, the agency won’t have an idea where its staff homehealthwhitepapers are at any given moment. .decisionhealth.comPosting of this white paper on any Generally speaking, agencies assign field staff to a geographic area;Web site or intranet without prior staff decide the order in which they make their visits. Agencies maywritten permission by DecisionHealthis prohibited. provide driving directions based on Internet mapping services (such as © 2008 DecisionHealth © 2008 UCG Page 1
  2. 2. White Paper: 12 Ways HHAs Can Leverage GPS MapQuest, Yahoo Maps and Google Maps), which takes time to do. Or the nurses or other field staff can do the mapping program look- ups and printing at home themselves. For four to five visits in a day (see on left), it’s time consuming no matter whether the agency scheduler or the field staff member does it. For tracking mileage driven, field staff use pen and paper to record their vehicle’s odometer settings from home to visit to visit, etc. Staff who are paid on an hourly or per-visit basis also manually track their work performed using time or visit sheets. That’s a lot of administrative work (and cost).As miles add up,so do costs Technologies emerge that fitHome health nurses make an with HHA business structureaverage of four to five visits a day,according to a June 2008 HomeHealth Line productivity survey There are better uses of the time of agency managers and field staff.receiving 160 agency responses. There are more effective ways to manage home health clinicians andWhat was the average number of aides in the age of wireless communications and GPS-aided devices.miles driven between visits? The Alternatives include:mean was 13 miles a day and themedian 11 miles, 138 of theagencies reported. Equip clinicians’ laptops or tablet PCs with an aircard for wireless communication.For an agency with 30 field • Pros: Aircards provide wireless communication for field staffclinicians, you get something like$1,900 week or nearly $60,000 a who carry laptops. Laptops have bigger screens and keyboards,year in mileage costs at the IRS rate can work with a point-of-care system and handle collection ofof 58.5 cents/mile (July-Dec. 2008). answers to the lengthy OASIS form.Industries outside of home health • Cons: Laptops must be powered up for GPS navigation andhave been able to lower such costs wireless communications to work. Laptops are more expensivethrough use of “location-basedsolutions” such as GPS-enabled cell and bulkier than cell phones and provide more functionalityphones. An average 13.2% savings than is necessary in many situations. Laptops also fail toin fuel costs and a 19.2% reduction provide a truly effective solution for GPS navigation – they arein miles driven were reported in a2007 survey of 330 enterprises in similar to reading printed directions and maps.service industries with field staffsuch as telecom and utilities. Give field staff a portable GPS device such as TomTom, Garmin or MagellanSource: “The Impact of Location onField Service,” December 2007, consumer brands.Aberdeen Group, Boston. • Pros: They supply driving directions, are portable and sold widely. • Cons: Mapping features and directions become out of date unless you pay an extra charge for updates. These devices don’t communicate back to the home health agency to provide location, route and time and duration of stops. Another tool has emerged that combines the Web, wireless© 2008 UCG Page 2
  3. 3. White Paper: 12 Ways HHAs Can Leverage GPS communication and GPS technology to enable home health agencies to locate and manage their field staff in near real time. Almost 91% of home health nurses and other clinicians already carry a cell phone during the work day for various professional purposes (see on left) so it’s already a familiar work tool. The key to turning a GPS-equipped cell phone into a true management tool lies in special mobile workforce management software added to the phone and tied to a Web-based platform accessed by the agency to enable work flow, communications, and collection and analysis of data from field staff. GPS satellites GPS/cell phone/software offer benefits encircle the Earth for both field staff and managers Here’s how the marriage of cell phone wireless, GPS and Web tech- nologies can help field staff and their managers at the agency office: Advantages for home health field staff 1. Turn-by-turn driving directions: This function is built into the phone. GPS specifies the phone’s location and software provides voice and onscreen directions for the best (shortest/quickest) available route to the patient’s home or other destination. If there’s a traffic jam along the way, the software calculates an alternate route. It gives new directions when the driver misses a turn. Extra benefits: Safety – not driving distracted with map reading and direction finding; but instead eyes on the road and hands on the wheel. The clinician or aide arrives at the patient’s home lessCell phones get wide use stressed and ready to focus on patient care. Also, the field staffin home health member receives the perk of using the GPS directions outside ofAnswering questions posed by HHA work hours at no extra cost to the staff and mangers constitutesthe top use of cell phones by the 2. Improve safety: A “stop alert” goes to an HHA dispatcher or91% of clinicians who carry cellphones during the work day. That’s manager if the phone of a nurse or aide remains at a visit locationwhat 224 home health agencies longer than a predetermined length of time. The agency officereported when they responded to an receives the alert and someone can call, text or e-mail the fieldAugust 2008 Home Health Linesurvey. Job-related cell uses: staff member to determine whether he or she has encountered an unsafe situation. Many industries and organizations use this feature • 95% − answer questions to monitor the safety of mobile workers. Example: During a • 89% − contact physicians • 88% − contact patients winter storm, a worker’s phone was stationary more than 10 • 74% − arrange patient visits. minutes. Alerted dispatchers sent help; the worker had suffered a heart attack and was saved. In addition, a “hot key” alert can be configured on the phone so© 2008 UCG Page 3
  4. 4. White Paper: 12 Ways HHAs Can Leverage GPS field staff can alert management quickly when they need assistance. Also, the phone can be programmed to send an alert when it moves outside of a designated geographic area (called a “geofence”). Imagine this feature’s benefit in the case of a possible carjacking or kidnapping. 3. Cut fuel costs: Finding the cheapest gasoline when nurses need to fill up can reduce their out-of-pocket expenses. Special software makes that possible by listing gas stations near the cell phone’s GPS location in descending order of price (updated daily). Select a gas station and its address and driving directions from the GPS location appear on the cell phone screen. In a similar manner, field staff can cut miles driven to find health care-related providers such as pharmacies, assisted living facilities, nursing homes and hospitals. Agencies can add information on these local facilities to their GPS information, allowing field staff to quickly find them and generate driving directions, saving time and money. 4. Ease mileage reporting paperwork: GPS tracking software is ideal for mileage reporting. Equipped phones, after they’re turnedCell phones mesh on at the beginning of the day, accurately record the distance towith timecard needs patient home A, then to patient home B, and so on until the endMany home health agencies pay of the staff member’s work day. That means the field staff memberhome health nurses on an hourly no longer has to write down vehicle odometer settings andbasis, making use of a cell phone as manually fill out mileage sheets.a timecard a cost-saving benefit forthe agency and the nurse (whodoesn’t have to maintain a manual 5. Automate timecard paperwork: For nurses or aides paid by thetime sheet). hour – which many agencies do (see on left) – the right softwareAbout 160 respondents to a June can turn the cell phone into a time clock. When the phone comes2008 Home Health Line productivity on, the nurse “clocks in” – the phone sends the start time andsurvey reported paying: GPS location to the agency; the same process occurs when the • 33% of field nurses on an staff member clocks out. (There’s also a way to turn off the clock hourly basis when on personal time.) As with mileage reporting above, the field • 40% by salary staff no longer faces the chore of filling out time sheets. Nurses • 23% per visit • 4% on a contract basis. also can indicate specific codes for services performed and any products used during the visit.An analysis of 120 agencies byconsulting firm Fazzi & Associates,North Hampton, Mass., found that Advantages for home health agency executives51% of home health nurses werepaid on an hourly basis, 34% bysalary and 15% per visit, the firm 6. Expedite visit scheduling: The agency can push out the nextreported in March 2008. day’s schedule to field staff members’ cell phones. (In other words, no more labor and time intensive manual telephone scheduling!) When they turn on their phones in the morning, field staff will© 2008 UCG Page 4
  5. 5. White Paper: 12 Ways HHAs Can Leverage GPS have their schedules for that day, with the order of visits and driving routes optimized (thanks to GPS and special software) to save time on the road. In some cases, that could make more time to spend with patients or time for an additional visit that day. 7. Cut fuel costs: Nearly all home health and private duty agencies cover mileage costs of field staff (see on left). With gasoline costs remaining high, “route optimization” through GPS and built-in cell phone driving-direction software can achieve significant reduction in agency fuel costs. It’s simple: Give field staff the shortest (or quickest) routes between patient visits – which themselves are placed in the order that requires the least amount of driving – and they burn less gasoline. Example: Such technology allowed one home health agency to capture enoughGasoline prices savings over a year to add two staff members and two vehicles tohit home health its field staff of 50.The vast majority of Medicare home 8. Cut agency paperwork: By integrating cell phone/GPS data intohealth agencies reimburse their their accounting and payroll systems, home health agencies canclinicians for mileage, an April 2008Home Health Line survey indicated. slash paperwork and costs substantially. The mileage data for visitsThe results: referred to in Point 4 can be transmitted to the agency’s back- office accounting systems to calculate the field staff member’s • 95% of 73 respondents said they reimburse for mileage reimbursement and cut a check. Similarly, the time card data (see • 42% have increased mileage Item 5) go to the agency where payroll systems (such as ADP, reimbursement Kronos or SAP) can figure compensation for field staff paid on an • 18% lost clinicians who couldn’t afford the higher gas hourly or per visit basis. Benefits: Accurate mileage and timecards prices from GPS data, elimination of the work and data entry errors • 15% refused to accept associated with manual rekeying of mileage sheet and timecard patients who clinicians wouldn’t drive to data, and elimination of the need to cut manual checks. • 12% raised clinicians’ rates. 9. Improve documentation of visits: The health care axiom “NotPrivate duty home care agencies alsofeel the crunch. documented, not done” isn’t cause for worry. That’s because HHA officials can generate what’s called a “breadcrumb report” showing • 83% of 69 respondents in an the routes and precise location, times and duration of stops of August 2008 poll said they reimburse caregivers for gas home health clinician and/or aide visits for any time period. Think mileage what it would be like to show this report to a Medicaid auditor • 47% reported hiking mileage seeking proof that visits were made and your reimbursement is reimbursement • 42% had to decline taking on justified. You have an audit trail ready to go at any time. clients because of driving distance 10. Manage field staff more effectively: Visualize a computer map • 39% raised client rates • 27% raised caregivers’ hourly of your HHA service area displaying pushpin icons showing where rates. all of your field nurses, therapists and aides are at any given time. (The system also allows you to group field staff in many ways, for example by branch, or by supervisor so a manager sees only those staff for whom he or she is responsible.)© 2008 UCG Page 5
  6. 6. White Paper: 12 Ways HHAs Can Leverage GPS Think how much more effective it would be to manage your field staff if you could see where they are whenever necessary, including in relation to a landmark such as a hospital? Example: Say you unexpectedly need to send a nurse to a patient’s home within hours. This technology now allows you to type the patient’s address into a Web site that receives data from your field staff cell phones. Immediately, you see the 10 nearest nurses to the address. Such data will ease your decision-making about who is in the best position to perform the unexpected visit. 11. Communicate to field staff more effectively: Reach all field staff without making dozens and dozens of calls – and know who received the message and who didn’t. You can expect such efficiency from these systems whether it’s for a notice of a routine meeting or an urgent situation affecting everyone. Example: A big storm approaches. You not only can send a text message to all staff in your geographical area telling them what to do, but the system can tell you (1) who received the message, (2) who read it, and (3) whether the recipient responded. If the message was read, there’s no need to waste time with a follow-up call. If it wasn’t received or read, you know who needs a call. 12. Decrease turnover: The more you can relieve clinical staff frustration over paperwork and other administrative burdens, the greater their job satisfaction. For example, GPS directions makeHHAs report existing their life less stressful: Getting directions and schedules via theinvestment in cell phones phone eliminates wasted trips back to the office. With nationalHome health agencies already spend turnover estimated at as much as 20%, use of the abovesignificantly on cell phones, technologies could pay off by reducing the thousands of dollars inaccording to a Home Health Line costs of replacing field staff.August 2008 survey: • 44% of HHA officials reported A survey of more than 120 organizations providing home health care their agencies provide cell and services found an ROI for use of all types of wireless devices in phones for clinicians • 36% help cover costs of home health care of up to $15,000 per full-time-equivalent per year. personal cell phone use Wireless handhelds and cell phones showed particularly positive ROIs. • Only 11% said they provide no financial support. Wireless Handheld/BlackBerry Smartphone Phone ROI66% said their agencies spend $20 Field Admin Productivity Smartphone/ Smartphone/ Payback Staff Staff Enhancement BlackBerry BlackBerry Periodto $50 a month per clinician for cell Savings Total Cost of Return onphone coverage or reimbursement. Ownership Investment RN $1,150 $13,505 $1,557 964% 38 days LPN $1,150 $9,990 $1,557 739% 40 days Home Care Aide $1,150 $2,840 $1,557 345% 106 days Source: Venture Development Corp., Natick, Mass., 8/2007 report “Wireless Home Care Solutions: Addressing the Quality of Service and Performance Gap”© 2008 UCG Page 6
  7. 7. White Paper: 12 Ways HHAs Can Leverage GPS Case Study: Swedish Medical Center Home Care Division Fiddling with maps while driving was just one of the concerns that the Swedish Medical Center Home Care Division had about the way its 200-strong field staff traveled to homes and facilities where patients lived in the Seattle metropolitan area. Reading maps or calling the office for directions while driving was a safety concern as well as an efficiency issue. Further inefficiencies occurred when the home care office called staff on wireless phones, paged them or even sent text messages to provide schedules and destinations. Such communications interrupted clinical staff and aides during their patient visits, and sometimes compromised patient confidentialityField staff for this Washington state when the home office had to give details of the next case to someonehome health agency no longer relyon the agency office for directions to visiting with another patient. It was not the best use of Swedish’s non-patients homes. Instead they use profit resources to have mobile field health care workers rely heavilytheir TeleNav-equipped cell phones on the office for directions.for GPS directions and navigation,eliminating wasted trips back to theoffice. Facing shrinking Medicare and Medicaid dollars, escalating costs and a nationwide nursing shortage, the Home Care Division turned to TeleNav Track for a cell phone-based solution using GPS navigation enhanced by a Web-based software application. “Providing directions to get around Seattle and the surrounding counties was problematic,” reports Debby Ramundo, Senior Project Manager, Home Care. “Our people were too tied to the office for getting directions. Because patient appointments change often and on-the-fly, it was a significant waste of time for employees just to come into the office to get directions, only to go right back out again. Also, the safety of our mobile healthcare employees is an important issue, not just for us, but also for them.” Using TeleNav Track’s GPS turn-by-turn directions for the shortest or quickest route knocked down travel time considerably and greatly reduced the number of trips into the home office, thus allowing mobile healthcare workers more time for patient calls and to do what they do best—take care of patients. “With TeleNav Track, we can respond to patient needs faster and with more flexibility,” Ms. Ramundo adds.© 2008 UCG Page 7
  8. 8. White Paper: 12 Ways HHAs Can Leverage GPS Final thoughts Adding the power of GPS tracking to the convenience of wireless cell phone technology gives home health agencies a combination perfectly suited for their needs. Cell phones are supremely portable and already In Summary familiar to field staff. Smart cell phones can transmit GPS data – a rich source of information which the right software turns into productivity- Top home health agency benefits of a GPS-aided cell phone enhanced enhancing and cost-saving tools for the agency. Not just a manage- with a Web-based application: ment benefit, the technology combination also makes life easier – and safer – for home health clinical service providers and aides in the field. • Cut field staff fuel costs • Cut driving time. • Obtain accurate mileage, While the initial home health patient visit may require use of a laptop timecard data. for recording answers from the more than 90-question OASIS form, • Track location of field staff to facilitate visit schedule most visits don’t require such heavy equipment. Other times, the cell changes. phone/GPS/software advantage has a proven record of: • Enhance safety of field staff. • And much more. 1. Cutting fuel costs by giving field staff more efficient driving routes 2. Giving staff less time on the road and more time to spend with patients 3. Sending accurate time card and time sheet data to the agency for automated calculation of mileage reimbursement and hourly-based pay 4. Automated generation of paychecks when tied to the agency’s payroll system 5. Displaying a map so agency mangers can see where their field staff are at any moment 6. Issuing a safety alert to the agency when a nurse or aide may be in danger in the field 7. Providing a means to send text messages to all staff and know whether they received and read them. 8. Documenting performance of field staff members’ patient visit schedule, creating an audit trail showing compliance with Medicare, Medicaid and private payer requirements. The technology that delivers these benefits isn’t something that’s promised to be just around the corner. It is here for you to use now. About the White Paper sponsor TeleNav, based in Sunnyvale, Calif., is the global leader in location- based applications delivered via a cell phone. The first to launch a GPS navigation and mobile workforce management service on a cell phone in North America, TeleNav is partnered with every significant wireless carrier and device manufacturer. TeleNav provides two solutions for© 2008 UCG Page 8
  9. 9. White Paper: 12 Ways HHAs Can Leverage GPS home health agency clinical and nonclinical field staff: TeleNav GPS Navigator provides voice and onscreen driving directions on mobile phones and cell phones. Its ability surpasses in- car and stand-alone GPS systems with features that include easy portability, local business listings, voice-activated directions, and free updates to maps and points of interest – all at a fraction of the price of stand-alone systems. TeleNav Track is a Web-based application (no hardware or software to install at your agency), using GPS data from field staff cell phones so managers can see the locations of their staff at any time. TeleNav Track helps cut fuel and time costs by optimizing driving routes and reduce operation costs by collecting mileage and time card data from the field. Tracking enhances the safety of field staff, automatically alerting managers when a potential security problem exists. TeleNav Track is complementary to and integrates with information systems of home health vendors including Homecare Homebase, McKesson and Misys. For more information, go to or call 1-88-TeleNav-2 (1-888-353-6282).© 2008 UCG Page 9