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 www.nahc.org within a few days Please silence your phone Using Benchmarks to Drive Home health Success Wanda Coley, COO Nick Seabrook, Managing Director 1
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
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
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
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
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
Financial Benchmarks Revenue Case Mix* 1.073 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
Clinical Benchmarks Productivity Visits per day 5 6 (weighted) Days to RAP 5 7 days Days to Final Claim 10 14 days Visits per episode* SN 7.79 HHA 1.27 PT 5.94 OT 1.94 ST 0.43 MSW 0.16 Total 17.53 *Source: SHP Clinical Benchmarks - Quality 8
Clinical Benchmarks - Quality Clinical Benchmarks - Quality 9
Operations Benchmarks Star Rating: 3 3.5 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 2016-09-30 99.573 96.083 99.728 9.117 Episodes of Care Influenza Immunization Received for Current Flu Season 2016-09-30 78.673 74.831 88.236 3.079 Pneumococcal Polysaccharide Vaccine Ever Received 2016-09-30 85.248 79.372 93.389 4.273 Improvement in Bathing 2016-09-30 72.574 65.593 78.883 5.228 Improvement in Bed Transferring 2016-09-30 74.646 61.3 74.551 10 Improvement in Ambulation- Locomotion 2016-09-30 71.7 64.699 75.276 6.457 Improvement in Management of Oral Medications 2016-09-30 54.381 51.487 64.208 2.547 Improvement in Dyspnea 2016-09-30 75.425 70.714 85.934 3.286 Improvement in Pain Interfering with Activity 2016-09-30 73.776 67.231 81.53 4.62 Discharged to Community 2016-09-30 72.988 70.679 78.229 3.252 Claims-Based Measures Emergency Department Use Without Hospitalization 2016-06-30 15.046 14.395 9.272 0 Acute Care Hospitalizations 2016-06-30 15.359 16 11.447 1.767 HHCAHPS Measures Care of Patients 2016-06-30 92.33 90.405 94 5.319 Communications Between Providers and Patients 2016-06-30 91.982 88.032 92.386 8.665 Specific Care Issues 2016-06-30 88.739 84.672 90.836 6.438 Overall Rating of Home Health Care 2016-06-30 87.759 87.153 93.431 1.369 Willingness to Recommend the Agency 2016-06-30 84.701 82.703 90.235 2.887 10
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 2016-09-30 99.573 98.821 99.728 7.791 Episodes of Care Influenza Immunization Received for Current Flu Season 2016-09-30 78.673 80.738 88.236 0 Pneumococcal Polysaccharide Vaccine Ever Received 2016-09-30 85.248 81.516 93.389 2.643 Improvement in Bathing 2016-09-30 72.574 62.101 78.883 5.741 Improvement in Bed Transferring 2016-09-30 74.646 59.166 74.551 9.562 Improvement in Ambulation- Locomotion 2016-09-30 71.7 63.08 75.276 6.568 Improvement in Management of Oral Medications 2016-09-30 54.381 47.697 64.208 3.548 Improvement in Dyspnea 2016-09-30 75.425 58.606 85.934 5.654 Improvement in Pain Interfering with Activity 2016-09-30 73.776 60.996 81.53 5.724 Discharged to Community 2016-09-30 72.988 72.204 78.229 0.801 Claims-Based Measures Emergency Department Use Without Hospitalization 2016-06-30 15.046 16.994 9.272 2.023 Acute Care Hospitalizations 2016-06-30 15.359 15.242 11.447 0 HHCAHPS Measures Care of Patients 2016-06-30 92.33 90.695 94 4.447 Communications Between Providers and Patients 2016-06-30 91.982 89.986 92.386 7.817 Specific Care Issues 2016-06-30 88.739 89.585 90.836 0 Overall Rating of Home Health Care 2016-06-30 87.759 85.329 93.431 2.499 Willingness to Recommend the Agency 2016-06-30 84.701 82.589 90.235 2.262 2015 State Benchmarks Source: 2017 HH Final Rule 11
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 17 86.554 50.914 90% 45.823 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 45.823 New Measures Final Weighted Score (NMFWS) Points 30 30 100 10% 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) 45.823 New Measure Final Weighted Score (NMFWS) 10 Total Performance Score (TPS) 55.823 75 Operations Benchmarks Productivity Intake Clinical Staff 8 10 referrals/day Clerical Staff 15 20 referrals/day Authorization 150 non Medicare patient census/fte Insurance Verification 50 referrals per day/fte Orders tracking 30 physician calls/day 12
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 10 12 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
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
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
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
Keys to Managing KPI Analyze Drill Down! Case Mix Clinical Domain Functional Domain Service Domain Score Average Case Difference Mix C1 1.136 C2 1.187 4.6% C3 1.345 13.3% F1 1.171 F2 1.216 3.8% F3 1.281 5.4% Therapy Visits 0 5 6 7 9 10 11 13 14 15 16 17 18 19 20+ Case Mix 0.654 0.798 0.942 1.085 1.230 1.373 1.568 1.763 1.958 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
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
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
Strategies for Success Benchmarks Data Transparency Accuracy Actionable Timely Trends Why? 20
Goals Sales Expectation Admits per Marketer Conversion Rate Payor mix % Face to Face Achieve Goal 2 out of 3 Months 35 40 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
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 35 35 15-20 30-5 20 75.0% 0 Liaison B 32 35 16-19 32-3 19 84.2% 11 Liaison C 29 40 20-20 40 0 25 80.0% 15 Liaison D 25 32 18-14 36 4 28 64.3% 10 Liaison E 10 15 10-5 20 5 13 76.9% 10 Total 131 157 79-78 158 1 105 75.2% 46 % Goal --> 75.0% Intake Productivity Staffing Model 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 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
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
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 09/09/2013 5.50 9.44 119.56 10.11 4.61 184% NURSE SUE, RN 08/26/2014 5.50 10.08 161.02 11.37 5.87 207% NURSE, TOM, RN 10/31/2016 5.50 5.57 55.85 5.28 (0.22) 96% NURSE, NANCY RN 07/06/2015 5.50 9.38 73.72 9.36 3.86 170% NURSE, ANN, RN 08/08/2016 5.50 5.42 32.22 4.78 (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
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
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
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
Monitor, Measure, ACT Establish Agency Goals Measure PIP- Agency, Team, Staff Member Trend Drill Down 28
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
Contact: Nick Seabrook Managing Director, BlackTree Healthcare Consulting NickSeabrook@BlackTreeHealthcare.com Wanda Coley COO, Well Care Home Health WColey@wellcarehealth.com 30