Download to read offline
Uploaded byBlackTree Healthcare Consulting
Home Health Business Improvements Part 1 from 2018 NAHC Financial Managers Conferences
The document outlines key performance indicators (KPIs) essential for improving home health businesses, detailing how to prioritize and organize them into actionable dashboards. It emphasizes the importance of data transparency and monitoring to facilitate informed decision-making and set realistic goals within the agency's operations. Additionally, the text discusses strategies for effective KPI management, performance analysis, and operational improvement to enhance clinical and financial outcomes.
More Related Content
Similar to Home Health Business Improvements Part 1 from 2018 NAHC Financial Managers Conferences
Home Health Business Improvements Part 1 from 2018 NAHC Financial Managers Conferences
- 1. Home Health Business Improvements:Part 1 Wanda Coley, President & COO Nick Seabrook, Managing Director
- 2. Learning Objectives • Prioritizedata to identify the key performance indicators that drive success in home health • Organize the key performance indicators into a daily dashboard to effectively monitor your performance • Strategies for sharing key performance indicators across the agency
- 3. Overview • Key PerformanceIndicator Overview • Building an Agency Dashboard • Keys to Managing KPIs • Strategies for Success – Well Care
- 4. Key Performance Indicator(KPI) • Definition “The selected measures that provide visibility into the performance of a business and enable decision makers to take action in achieving the desired outcomes.”
- 5. Why are KPIsImportant? Performance Drivers Provide Insight Drive Decisions Goal Setting
- 6. “If you can’tmeasure it, you can’t manage it.” -Michael Bloomberg, former mayor of NYC “If you can’t measure it, you can’t improve it.” -Peter Drucker, “The Founder of Modern Management”
- 7. Operations KPI • Census •Referrals (By Referral Source, Marketer) • Payor Mix – 57% Medicare* • Productivity • Days to Admission • Outstanding Orders • Turnover • Employee Satisfaction • Re-hospitalization within 30 days – 12.4%** *Source - Simione Financial Monitor **Source - SHP
- 8. Financial KPI • AccountsReceivable (A/R) Balance • Days Sales Outstanding (DSO) • Days to Final Claim – 10-15 days • Bad Debt – 1-2% • Days Cash on Hand – 45 days* • Profit Margin – 40%* • Unbilled A/R • Revenue vs. Billed vs. Paid *Source - Simione Financial Monitor
- 9. Financial KPI • CostPer Visit* • SN - $95 • PT - $98 • OT - $94 • ST - $123 • MSW - $193 • HHA - $52 • Administrative and General Cost* • Clinical Supervision/QI – 8.3% • Executive Team – 4.1% • Office Support – 3.0% • Intake – 2.7% • Revenue Cycle – 1.3% • IT - 1.3% • Finance - 0.9% • Medical Records - 0.6% • Human Resources - 0.8% • Fundraising - 0.3% *Source - Simione Financial Monitor
- 10. Clinical KPI • Productivity– 5-6 visits/day • Case Mix – 1.074* • Days to RAP – 5-7 days • LUPA Percentage – 9.1%* • Outlier Percentage – 2.9%* • Therapy Utilization – 8.6 visits/ep* • Average Visits Per Episode – 17.6* • Average Length of Stay – 45 days • Recertification Rate • Supply/Drug/DME Utilization • Outcomes • Patient Satisfaction • Star Rating • Value Based Purchasing *Source - SHP
- 11. Building an AgencyDashboard • What Data? • Frequency • Daily • Weekly • Monthly • Quarterly • Annually • Distribution • Who?
- 12.
- 13. Keys to ManagingKPI Establish Goals •Realistic goals •Realistic timelines •Trend Data •Prioritize
- 14. Keys to ManagingKPI Identify Source • EMR Reports • Dashboards • Third Party Reporting • Home Health Compare • VBP Interim Payment Reports • CASPER Reports • PEPPER Reports
- 15. Keys to ManagingKPI Monitor •Who is reviewing what? •How often? •Who gets it? •What manages?
- 16. Keys to ManagingKPI Analyze Drill Down! • Clinician • Team • Biller/Collector • Agency/Service Area • Referral Source • Case Mix • Day • Time • Write Offs
- 17. Keys to ManagingKPI Analyze Drill Down! • Case Mix • Clinical Domain • Functional Domain • Service Domain Score Average Case Mix Difference C1 1.11 C2 1.17 5.2% C3 1.31 12.6% F1 1.14 F2 1.20 5.0% F3 1.24 3.7% Therapy Visits 0-5 6 7-9 10 11-13 14-15 16-17 18-19 20+ Case Mix 0.63 0.78 0.92 1.07 1.21 1.36 1.54 1.72 1.90 Difference 15% 15% 15% 15% 15% 18% 18% 18%
- 18. Keys to ManagingKPI • Action • Develop department scorecards • Develop employee scorecards • Monthly meetings with employees on variances from goals • Create action plan
- 19. Well Care Health,INC Agency Overview • Headquartered Wilmington, NC • Serving the Carolinas • Privately Held for over 30 Years • Clinically Integrated Network ~Medicare Certified and Private Duty Services • 11 Offices (3 Medicare Certified) • 1,000+ Employees • 5,000 Average Daily Census • JCAHO Accredited and Deemed Status
- 20. Strategies for Success •Strategic Planning • 4 Disciplines of Execution • Average vs Top 10% • Financial, Clinical, Operational Benchmarks
- 21.
- 22. 4DX Philosophy Focus onWildly Important Goals Act on Lead Measures Keep a Competing Scoreboard Create a Cadence of Accountability
- 23. More Goals =More Success NUMBER OF GOALS (In addition to the whirlwhind) 2-3 4-10 11-20 GOALS ACHIEVED WITH EXCELLENCE 2-3 1-2 0 Your chances of achieving 2 or 3 goals with excellence are high, but the more goals you try to juggle at once, the less likely you will be to reach them.
- 24. CONVENTIONAL THINKING 4DXPRINCIPLE All of our goals are Priority 1. We can successfully multitask and succeed at five, ten, or fifteen important goals. All we need to do is work harder and longer…… Many or our goals ae important, but only one or two are wildly important. We call them WIGs. They are the goals we must achieve. Our finest effort can only be given to one or two wildly important goals at a time.
- 25. Key Performance Indicators •Data Transparency • Accuracy • Actionable • Timely • Trends • Why?
- 26. Sales •Goals • Admits perMarketer • Conversion Rate • Payor mix % • Face-to-Face • Achieve Goal 2 out of 3 Months •Expectation • 35-40 MCA Admits / Month • 85% Referrals to Admission • 75/25 PPS vs Non PPS • <10% > 30 Days Post SOC
- 27. Sales Weekly Dashboard Daysin Month 8 of 31 MTD Name June MCR Actual July MCR Goal July MCR Actual Variance Projected MCR Projected Variance Total Admits MCR % Pending Non-Admits MCR Non-Admits Total Outstanding F2F Acct Exec A 28 32 8 -24 31 -1 10 80.0% -- 5 10 Acct Exec B 20 35 11 -24 43 8 16 68.8% 3 -- -- 5 Acct Exec C 33 40 18 -22 70 30 24 75.0% 6 2 5 Acct Exec D 17 28 3 -25 12 -16 14 21.4% 8 3 8 5 Acct Exec E 20 28 6 -22 23 -5 10 60.0% 3 -- -- 3 Acct Exec F 22 22 4 -18 16 -6 6 66.7% 9 -- -- 1 TOTAL 140 185 50 -135 195 10 80 62.5% 29 10 23 14 % Goal --> 70.0%
- 28. Competing Scoreboards • MonthlyFinancial Review • Senior Leadership • Director of Operations at Branch Level • Staff Meetings • Distribute Weekly Dashboard • Sales Activity • Cash Collections vs Cash Goals by Payor • Readmission %
- 29. Competing Scoreboards • Marketing/ClinicalCollaboration • Pending > 24 Hours • Trend Non-Admits • Customer Relationship Manager - Playmaker CRM • 20% Increase in Admissions • Market Analysis
- 30. Intake • Productivity • StaffingModel • RN, LPN 12-15 per day • Administrative 15-17 per day • Access to Hospital Portals and HIE • Standard Office Hours vs. Flex Schedules • Extended Intake Hours • Cutoff Time
- 31. Intake • Weekend Intake/AfterHours Scheduling • Same Day Insurance Verifications • Timely Authorizations • Monthly Report Write-Offs Due to Missing Authorization • Currently centralized considering decentralizing to branch • Face to Face Tracking • Weekly Tracking Report by Liaison –Marketing Team and Operations Leadership • Weekly Cadence with Intake, Marketing and Clinical
- 32. Clinical Care TeamDesign *400 ADC Clinical Assistant LPN
- 33. Productivity • Pay PerVisit Model • Skilled Nursing • RN = 5.5 • LPN = 6.5 • Therapy • PT/OT = 5.5 • PTA/OTA = 6.5 • Staffing Model • Discipline Mix 55/45
- 34. Bi-Weekly Productivity Report PersonnelHire Date Goal Avg Visits Avg Miles Wgt Miles Variance Capacity PT PT, Tom 06/12/2017 5.50 5.07 75.54 5.08 (0.42) 92% PT, Dave 03/26/2018 5.50 3.14 27.88 2.43 (3.07) 44% PT, Alex 03/20/2017 5.50 3.50 25.86 2.75 0.02 50% PT, Susan 03/27/2017 5.50 7.95 68.34 7.85 2.35 143% PT, April 12/14/2015 5.50 5.79 51.22 5.43 (0.07) 99% PT, Jaimee 06/20/2016 5.50 6.73 34.87 6.13 0.63 111% PT, Daniel 08/22/2016 5.50 6.83 44.66 6.37 0.87 116% PT, Robin 01/29/2018 5.50 6.25 87.52 6.44 0.94 117% PT, Traci 06/20/2016 5.50 8.18 102.09 8.59 3.09 156% Average for PT : 5.50 5.94 57.55 5.67 0.48 103%
- 35. Episode Management • UtilizeEpisodic Tool • Admission and Recert Review • Patient Name • HHRG • Utilization • Projected Revenue, Cost, Profit per Episode • Weekly IDC • Center for Clinical Excellence • Code Record within 48 Hours of SOC • Monthly Coding Scorecard
- 36. Clinical Benchmarks • AverageRevenue Per Episode • Average Visits Per Episode • Average Cost Per Visit • Profit Per Episode • Utilization • Recertification Rate
- 37. OASIS Accuracy • OASISExpertise Clinical and Performance Improvement Teams • OASIS Walk • Utilize SHP OASIS Alerts • Clinicians Manage Alerts • 98% Alert Resolution • Monthly SHP Scorecard by Team by Clinician • Distributed Clinical and Sr. Leadership by 10th of Month • Monthly PIP – Team and Clinician • Monthly Outcomes and HHCAHPS Review by Sr. Leadership
- 38. LUPA Management • LUPAs=10% • Educate Clinicians and Marketing • Weekly LUPA Meeting • 7 or Less Visits Projected • Premature Discharge • Therapy Down Codes • Make Up Missed Visits • Hospitalizations • Diagnosis Driven
- 39. Avoidable Readmissions How importantare Quality Star Ratings? What’s your readmission rate? Days to SOC from Referral Date? Direct Admit to SNF *Population Health & Clinical Integration Team
- 40. All-Acute Readmission Rate(SHP) - Team Rankings Rank Team Clinical Manager Mar-2018 Apr-2018 May 2018 1 A CM A 9.0% 8.9% 8.0% 2 C CM C 10.3% 9.0% 8.2% 3 D CM D 10.0% 11.8% 12.0% 4 F CM F 11.9% 15.0% 12.8% 5 G CM G 12.8% 12.0% 13.0% 6 B CM B 12.0% 10.9% 13.3% 7 Goal - 14.0% 14.0% 14.0% 8 E CM E 15.8% 18.0% 19.2% 9 I CM I 18.7% 19.0% 19.5% 10 H CM H 19.0% 18.5% 19.8%
- 41. Operational • Days SalesOutstanding • Monthly AR Aging Review • Cash goals • Weekly Revenue Cycle Stand Up • Revenue Cycle Calendar • Clinical and Billing Collaboration
- 42. Operational • OASIS submittedprior to billing final claim • Submit RAPs and Final Claims Daily • Claims Billed vs. Unbilled • Orders Management • Claim Denial Management • Timely Visit Completion- Weekly Report Incomplete Visit Documentation • Electronic MD Signatures • Pre Claim Review Proposed Illinois, Ohio, NC, Florida, Texas • MBI
- 43. PEOPLE •Turnover Goal =25% • Chief People Officer • Recruitment & Retention Strategy • Nursing Challenge 4 Day Work Week Salaried On Call Nurses LPN Clinical Assistants
- 44. Human Capital Scoreboard CurrentMonth Jun-2018 Fill Rate (Total) percentage of open positions Rank Recruiter Goal Apr-2018 May-2018 Jun-2018 1 A 10.0% 9.4% 9.4% 6.1% 2 B 10.0% 16.5% 16.9% 9.5% 3 C 10.0% 0.0% 0.0% 12.3% 4 D 10.0% 20.0% 15.8% 12.4% 5 E 10.0% 23.3% 23.8% 21.6% Fill Rate (31+ Days) percentage of open positions over 30 days Rank Recruiter Goal Apr-2018 May-2018 Jun-2018 1 A 8.0% 6.8% 3.6% 4.2% 2 B 8.0% 13.5% 20.8% 4.7% 3 C 8.0% 0.0% 0.0% 9.2% 4 D 8.0% 17.9% 12.7% 10.3% 5 E 8.0% 22.6% 13.1% 17.9%
- 45. Offers Extended Rank RecruiterApr-2018 May-2018 Jun-2018 1 A 9 13 23 2 B - - 12 3 C 16 13 11 4 D 13 15 9 5 E 8 6 8 Offers Accepted Rank Recruiter Apr-2018 May-2018 Jun-2018 1 A 7 11 19 2 B 11 15 8 3 C 9 12 7 4 D 3 4 6 5 B - - 5
- 46. Monitor, Measure, ACT Measure Trend DrillDown PIP- Agency, Team, Staff Member Establish Agency Goals
- 47.
- 48. Contact Info: Nick Seabrook ManagingDirector, BlackTree Healthcare Consulting NickSeabrook@BlackTreeHealthcare.com Wanda Coley, MBA President & COO, Well Care Health, Inc. WColey@wellcarehealth.com