In this second installment of Rehospitalizations in the VBP area, the obvious must be stated: agencies would be remiss in their path to success if they do not objectively investigate their pre-VBP levels of leadership control. Throughout the history of our industry, multiple areas of operations, currently under leadership management, have hampered HH agencies in their pursuit of success. Working with Providers all over the country, we see outdated operations managed by leadership preventing success. These are regularly seen in current PDGM programming, and they will certainly block success under VBP, resulting in agency closures across the industry.
Progressive, successful HH agencies that achieve 4.5 stars or higher, and 90th Percentile in total performance scoring (TPS) in VBP, have addressed and rewired these items in terms of leadership and operations:
Leadership areas that prevent success:
- Lack of regulatory understanding and compliance with all state, federal and accreditation standards among all staff
- Lack of Home Health experience in leadership – if you never did it, how do you lead it?
- Silos among departments – it is one patient, why are there disconnects among the team??
- Subjectivity based clinical direction versus objective, accurate data and metrics to guide practice/operations
- Lack of transparency
- Acceptance of current culture and clinical practice
- Pushing ownership and accountability in terms of accurate data and documentation, to avoid leaving patient care delivery quality on the front-line clinical staff
- Chasing timely documentation
- SOC Admissions that take over 2 days to complete audit/coding, and submission
- Lack of standardized operational practices among all departments
- HH Orientations that are void of regulatory training
- The misconception that front line clinicians are all equal in past experiences and understanding of diagnosis, treatment plans, equipment use and changes in condition
- The use of front line clinicians to determine what to do next – versus managing care delivery and changes under a Plan of Care signed and directed by an MD
- Lack of daily metric driven huddles with all operations staff to recognize and resolve in real time any problems/changes/issues
- Lack of daily documentation review for compliance and goal achievement
- Lack of utilization control – think volume approach over value
- Clinician centered versus patient centered approach
- A fear of staff retention that prevents high-level clinical outcomes and regulatory adherence through documentation
- Still holding Case conferences with multi discipline involvement – not patient centered
- Supervisory staff that don’t directly manage the patient through the clinicians assigned to staff the case
- Surprise at audits, outcomes, and below par Star rating and TPS results
- Who do we blame? The staff? This requires full leadership control
- Failure to address Missed visits
- Independent front-line clinician decisions on whether to admit a patient or not resulting in lower referral volumes based on opinions
- Lack of immediate, real time objective audits and follow up meetings in relation to any ER visit or rehospitalization
- how it could have been done different/better?
- Ongoing Staff education from audits – they all don’t have the same expertise – so why do we expect them to manage care delivery independently???
In presenting nationally, the use of the list above is a very successful tool for a HH agency to rate their current practice. Longevity in the industry is dependent on leadership/operations adapting to the latest regulatory changes. A real time, objective approach to these areas is key for understanding how to win in outcomes in Star ratings and VBP terms. A complete analysis of operations and metrics are the drivers of success. Are your ready for a 5% cut? How will the agency survive that? Why wouldn’t you want to be on the winning side of 5% increase?