Using Benchmarks to Drive Home health Success

Transcription

1 Introductory announcements: This provider-directed continuing nursing education activity was approved by the Maryland Nurses Association (MNA) to award contact hours. The MNA is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center (ANCC) Commission on Accreditation and refers only to continuing education activities, and does not imply endorsement of any product, service, or company referred to in this activity. Attendance for the full session is required to receive continuing education credits Please complete an online evaluation for each session you attend CE certificates will be available through within a few days Please silence your phone Using Benchmarks to Drive Home health Success Wanda Coley, COO Nick Seabrook, Managing Director 1

2 Objectives Identify the key performance indicators that drive success in home health List the sources for financial, operations and clinical outcome benchmarks in home health Outline the process for benchmarking your agency s performance Implement performance improvement initiatives using benchmarking efforts Overview Key Performance Indicator Overview Understanding Benchmarks Managing Benchmarks and KPIs Strategies for Success 2

3 Key Performance Indicator 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. Operations KPI Census Referrals By Referral Source By Marketer Payor Mix Productivity Outstanding Orders Turnover Employee Satisfaction 3

4 Financial KPI Accounts Receivable (A/R) Balance Days Sales Outstanding Cost Per Visit Days to Final Claim Bad Debt Days Cash on Hand Profit Margin Unbilled A/R Clinical KPI Productivity Case Mix Days to RAP LUPA/Outlier Percentage Therapy Utilization Average Visits Per Episode Average Length of Stay Recertification Rate Supply Utilization Outcomes Patient Satisfaction 4

5 Benchmark Definition: A point of reference from which measurements may be made Something that serves as a standard by which others may be measured or judged Why are Benchmarks Important? Measuring Stick Provide Insight Drive Decisions Goal Setting 5

6 If you can t measure 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 Benchmarks in home health Operations Productivity Performance Financial Revenue Cost Clinical Productivity Quality 6

7 Financial Benchmarks Revenue Case Mix* Average Reimbursement/Episode $3,109 Gross Margin** 38% LUPA percentage* 9.9% Outlier percentage 3.0% Days in AR Medicare 30 days Non Medicare 60 days Payor Mix** Medicare 56% Medicare Advantage 19% Medicaid 3% Other 12% *Source SHP **Source Simione Financial Monitor Cost Benchmarks Cost Per Visit* SN $96 PT $95 OT $99 ST $114 MSW $162 HHA $42 Administrative and General Cost* Clinical Supervision/QI 9.03% Executive Team 3.43% Office Support 3.03% Intake 2.70% Revenue Cycle 1.38% IT 1.17% Finance 0.96% Medical Records 0.63% Human Resources 0.46% Fundraising 0.46% *Source Simione Financial Monitor 7

8 Clinical Benchmarks Productivity Visits per day 5 6 (weighted) Days to RAP 5 7 days Days to Final Claim days Visits per episode* SN 7.79 HHA 1.27 PT 5.94 OT 1.94 ST 0.43 MSW 0.16 Total *Source: SHP Clinical Benchmarks - Quality 8

9 Clinical Benchmarks - Quality Clinical Benchmarks - Quality 9

10 Operations Benchmarks Star Rating: stars Re hospitalization* Within 30 days 13.0% Within 60 days 16.9% Value Based Purchasing *Source: SHP Achievement Points HHA Current Data Period 12 Operations Measures Benchmarks - VBP Month Ending Performance Achievement Benchmark Threshold Score Achievement Points Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care Influenza Immunization Received for Current Flu Season Pneumococcal Polysaccharide Vaccine Ever Received Improvement in Bathing Improvement in Bed Transferring Improvement in Ambulation- Locomotion Improvement in Management of Oral Medications Improvement in Dyspnea Improvement in Pain Interfering with Activity Discharged to Community Claims-Based Measures Emergency Department Use Without Hospitalization Acute Care Hospitalizations HHCAHPS Measures Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care Willingness to Recommend the Agency

11 Data Period 12 Month Ending Improvement Points HHA Performance Score Baseline Period Score Current Improvement Points Measures Benchmark Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care Influenza Immunization Received for Current Flu Season Pneumococcal Polysaccharide Vaccine Ever Received Improvement in Bathing Improvement in Bed Transferring Improvement in Ambulation- Locomotion Improvement in Management of Oral Medications Improvement in Dyspnea Improvement in Pain Interfering with Activity Discharged to Community Claims-Based Measures Emergency Department Use Without Hospitalization Acute Care Hospitalizations HHCAHPS Measures Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care Willingness to Recommend the Agency State Benchmarks Source: 2017 HH Final Rule 11

12 Calculation of Applicable Measures Total Performance Score Total Applicable Applicable Measures Applicable Measures Raw Total Classifications Measure Points Weight Final Weighted Score (AM) Points (RTP) (RTP/AM)*10 (AMFWS) Points % Cumulative Applicable Measures Score Calculation of New Measures Classifications Available Points (AP) Raw New Total New Measure Measure Points Points (RNMP) (RNMP/AP)*100 Weight New Measures Final Weighted Score (NMFWS) Points % 10 Cumulative New Measure Score 10 Percentile Ranking within Cohort 75 Total Performance Score Summary Percentile Classifications Final Weighted Score Ranking within (FWS) Cohort Applicable Measure Final Weighted Score (AMFWS) New Measure Final Weighted Score (NMFWS) 10 Total Performance Score (TPS) Operations Benchmarks Productivity Intake Clinical Staff 8 10 referrals/day Clerical Staff referrals/day Authorization 150 non Medicare patient census/fte Insurance Verification 50 referrals per day/fte Orders tracking 30 physician calls/day 12

13 Operations Benchmarks Productivity Scheduling Staff entering own schedule 1 staff to 400 patients Staff not entering schedules 1 staff to 200 patients Coding/OASIS QA reviews/day Billing/Collections Medicare manage between $20 25M in revenue Non Medicare 30 phone calls/day 600 accounts aged over 60 days Benchmarks Internal or external Not necessarily a goal 13

14 Building an Agency Dashboard What Data? Frequency Daily Weekly Monthly Quarterly Annually Distribution Who? Keys to Managing KPI Establish goals Action Identify source Analyze Monitor 14

15 Keys to Managing KPI Establish Goals Realistic goals Realistic timelines Trend Data Prioritize Keys to Managing KPI Identify Source EMR Reports Dashboards Third Party Reporting Home Health Compare VBP Interim Payment Reports CASPER Reports PEPPER Reports 15

16 Keys to Managing KPI Monitor Who is reviewing what? How often? Who gets it? What manages? Keys to Managing KPI Analyze Drill Down! Clinician Team Biller/Collector Agency/Service Area Referral Source Case Mix Day Time Write Offs 16

17 Keys to Managing KPI Analyze Drill Down! Case Mix Clinical Domain Functional Domain Service Domain Score Average Case Difference Mix C C % C % F F % F % Therapy Visits Case Mix Difference 22.0% 18.0% 15.3% 13.2% 11.7% 14.2% 12.4% 11.0% Keys to Managing KPI Analyze Scorecards Outcomes by Clinician Each VBP Outcome and 5 Star Average outcome score for discharges for month by clinician case manager Patient Satisfaction Set goals Trend data Monthly discussion with clinician on variances from goals Create action plan 17

18 Keys to Managing KPI Analyze Scorecards Financial Outcomes by Clinician Productivity PPS Revenue per patient discharge Cost per patient discharge Profitability per patient discharge Monthly discussion with clinician on variances from benchmark Develop action plan Keys to Managing KPI Action Develop Improvement Plan Monthly meetings with team to discuss goals 18

19 Agency Overview Well Care Home Health, INC Headquartered Wilmington, NC Privately Held Celebrating 30 Years Medicare Certified and Private Duty 8 Offices (3 Medicare Certified) 800+ Employees 4,200 Average Daily Census Strategies for Success Strategic Planning Current and Future Planning SMART vs DUMB goals Average vs Top 10% Financial, Clinical, Operational Benchmarks 19

20 Strategies for Success Benchmarks Data Transparency Accuracy Actionable Timely Trends Why? 20

21 Goals Sales Expectation Admits per Marketer Conversion Rate Payor mix % Face to Face Achieve Goal 2 out of 3 Months MCA Admits / Month 85% Referrals to Admission 75/25 PPS vs Non PPS <10% > 30 Days Post SOC Data Transparency Distribute Weekly Sales Dashboard Marketing and Sr. Leadership Marketing/Clinical Collaboration Pending > 24 Hours Trend Non Admits Customer Relationship Manager Playmaker CRM 20% Increase in Admissions Market Analysis 21

22 Sales Weekly Dashboard Days in Month 15 of 30 MTD June 2017 Market A Name May MCR Actual June MCR Goal June MCR Actual Variance Projected MCR Projected Variance to Goal Total Admits MCR % Outstanding F2F Liaison A % 0 Liaison B % 11 Liaison C % 15 Liaison D % 10 Liaison E % 10 Total % 46 % Goal --> 75.0% Intake Productivity Staffing Model RN, LPN per day Administrative per day Access to Hospital Portals and HIE Standard Office Hours vs Flex Schedules Extended Intake Hours Cutoff Time Weekend Intake After Hours Scheduling Same Day Insurance Verifications Timely Authorizations Monthly Report Write Offs Due to Missing Authorization Face to Face Tracking Weekly Tracking Report by Liaison Marketing Team and Operations Leadership 22

23 Clinical Care Team Design *400 ADC Clinical Manager 1 RN Clinical Coordinator 1 RN Team Assistant 2 FTE s Medical Record Specialist 2 FTE s Multi Disciplinary Team 55 Clinicians Productivity Pay Per Visit Model Skilled Nursing RN = 5.5 LPN = 6.5 Therapy PT/OT = 5.5 PTA/OTA = 6.5 Staffing Model Discipline Mix 55/45 23

24 Bi-Weekly Productivity Report PRODUCTIVITY 6/4/17-6/17/17 Personnel Hire Date Goal Avg Visits Avg Miles Wgt Miles Variance Capacity RN NURSE BETTY, RN 09/09/ % NURSE SUE, RN 08/26/ % NURSE, TOM, RN 10/31/ (0.22) 96% NURSE, NANCY RN 07/06/ % NURSE, ANN, RN 08/08/ (0.72) 87% Episode Management Utilize Episodic Tool Admission and Recert Review Patient Name HHRG Utilization Projected Revenue, Cost, Profit per Episode Weekly IDC Outsource Coding to Fazzi Code Record within 48 Hours of SOC Monthly Coding Scorecard 24

25 Clinical Benchmarks Average Revenue Per Episode Average Visits Per Episode Average Cost Per Visit Recertification Rate OASIS Accuracy OASIS Expertise 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 10 th of Month Monthly PIP Team and Clinician Monthly Outcomes and HHCAHPS Review by Sr. Leadership 25

26 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 Quality Outcomes & HHCAHPS Quality Star Ratings 2 Agencies = 5 Stars 1 Agency = 4.5 Stars HHCAHPS Star Ratings 2 Agencies = 4 Stars 1 Agency = 3 Stars 26

27 Operational DSO Cash goals Weekly Revenue Cycle Stand Up Revenue Cycle Calendar Claims Denial Management Submit RAPs and Final Claims Daily Claims Billed vs. Unbilled Order Management Timely Visit Completion Weekly Report Incomplete Visit Documentation Utilize Suture Sign for Electronic MD Signatures PEOPLE Predictive Staffing Model Nursing and Therapy Ratios Recruitment & Retention Strategy Turnover Goal = 25% Nursing Challenge Millennial and Generation Z Eliminate Annual Performance Evals Quarterly Feedback Semi Annual Employee Engagement Survey Contented Cows 80% Employee Engagement 27

28 Monitor, Measure, ACT Establish Agency Goals Measure PIP- Agency, Team, Staff Member Trend Drill Down 28

29 Summary Benchmarks serve as a guideline when reviewing agency KPI It is crucial to monitor dashboards on a consistent basis to establish attainable, timely goals Having a team approach is the best method for developing action plan and achieving success Questions? 29

30 Contact: Nick Seabrook Managing Director, BlackTree Healthcare Consulting Wanda Coley COO, Well Care Home Health 30