TCG QuickTip: #3
Our final post of the series gives tips on making your organization a contributor to the care transitions and rehospitalization conversation.
3. Reserve a Seat at the Table
Ensure your team has the knowledge and resources to ‘sit at the table’ with an ACO or health system.
Ask to have a seat at the table and be prepared to demonstrate why your organization should be part of their solution.
Did you miss our other posts? Click to read part one and part two.
TCG QuickTip: #2
In part two of our QuickTips series we want to introduce the key factors in creating a best practice model and introduce how to begin.
2. Establish and Monitor Your Care Transition Best Practice Model
- Promote specialty programs that show evidence of success in reducing unnecessary re-hospitalizations and improving coordination across care settings.
- If your organization does not have such programs, identify what programs would be of most value to your local health system; collaborate with teams from the hospital, nursing homes and physicians to develop and implement a transitions of care program to assist the health system reduce re-hospitalizations.
- Prepare to cover the cost of non-reimbursable services.
- Be sure to check back for the final post in our three part QuickTips series to learn your organization’s role and see exactly where to focus.
Did you miss the first post? Click here to read it!
TCG QuickTip: #1
Since October 1, 2012, the Hospital Readmission Reduction Program (HRRP) that penalizes hospitals with high readmission rates for certain conditions within 30 days of discharge has been in effect. For the first two years, acute myocardial infarction, pneumonia and heart failure will be the only applicable conditions on which readmission rates will be calculated. Beginning in 2015, however, CMS will add additional conditions or procedures it believes represent high costs and high volumes of readmission.
As post-acute providers, you have a vital role in ensuring appropriate care transitions to and from acute care settings.
Follow our three part QuickTips series to learn your organization’s role and see exactly where to focus.
1. Track and Measure Key Metrics
Use key metrics to show your acute care partners that your organization is at or above industry standards, such as: Patient outcomes related to hospital admissions and ED visits, and HH-CAHPS scores. Establish other measures and value points that demonstrate your success as a solution partner.
Check back on our blog for our next piece of advice!
TCG QuickTips: Evaluate Your Rehospitalization and Care Transitions Know-How
Since October 1, 2012, the Hospital Readmission Reduction Program (HRRP) that penalizes hospitals with high readmission rates for certain conditions within 30 days of discharge has been in effect. For the first two years, acute myocardial infarction, pneumonia and heart failure will be the only applicable conditions on which readmission rates will be calculated. Beginning in 2015, however, CMS will add additional conditions or procedures it believes represent high costs and high volumes of readmission.
As post-acute providers, you have a vital role in ensuring appropriate care transitions to and from acute care settings.
Track and Measure Key Metrics.
- Use key metrics to show your acute care partners that your organization is at or above industry standards, such as: Patient outcomes related to hospital admissions and ED visits, and HH-CAHPS scores.
- Establish other measures and value points that demonstrate your success as a solution partner.
Establish and Monitor Your Care Transition Best Practice Model.
- Promote specialty programs that show evidence of success in reducing unnecessary re-hospitalizations and improving coordination across care settings.
- If your organization does not have such programs, identify what programs would be of most value to your local health system; collaborate with teams from the hospital, nursing homes and physicians to develop and implement a transitions of care program to assist the health system reduce re-hospitalizations.
- Prepare to cover the cost of non-reimbursable services.
Reserve a Seat at the Table.
- Ensure your team has the knowledge and resources to ‘sit at the table’ with an ACO or health system.
- Ask to have a seat at the table and be prepared to demonstrate why your organization should be part of their solution.
Downloads/Links
Download TCG QuickTips: Evaluate Your Rehospitalization and Care Transitions Know-How
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Are you HRRP Ready? Embrace Your Unique Position.
The October 1st implementation of the Hospital Readmissions Reduction Program (HRRP) is quickly approaching and for the best outcome, home care and hospice organizations need to be fully prepared. It is important that providers embrace their unique position in the care continuum to ensure appropriate care transitions. Leading providers are instituting interdisciplinary team assessments, interventions, and care coordination across the continuum of care (e.g., Acute, Skilled Nursing, Home Care and Hospice) by reviewing rehospitalizations and Emergency Department visits on a regular basis. Most importantly, they have integrated a quality focus process and outcome measurements to track patient care. Is your organization ready for the HRRP challenge? Learn more by reading TCG QuickTips©: Care Transitions Collaboration—Your Role in Reducing Avoidable Rehospitalization or contact a TCG Consulting Services expert.
Are you ready for the HRRP kick-off? Strategic Partner Relationships Count.
With the October 1st “kick-off” to the Hospital Readmissions Reduction Program (HRRP), providers across the care continuum will begin to see the impact of certain hospital readmissions within 30 days of discharge. Home care and hospice providers play a vital role in ensuring appropriate care transitions under health care reform. Savvy providers are identifying key strategic referral and care coordination partners who demonstrate performance strength and value in the care continuum. Most importantly, they are solidifying relationships with partners who can assist in the development and integration of a comprehensive approach and build upon their hospital and referral strategy. Does your organization have a plan to get in front of C-suite executives who are making partnering decisions for appropriate care transitions? Learn more by reading TCG QuickTips©: Care Transitions Collaboration—Your Role in Reducing Avoidable Rehospitalization or contact a TCG Consulting Services expert here.
TCG QuickTips: Care Transitions Collaboration – Your Role in Reducing Avoidable Rehospitalization
On October 1, 2012, the Hospital Readmissions Reduction Program (HRRP) will become effective as part of the March 2010 Patient Protection and Affordable Care Act (PPACA). This program requires the Center for Medicare and Medicaid Services (CMS) to reduce payments to hospitals with excess readmissions for unnecessary readmissions within 30 days of discharge if the patient has acute myocardial infarction (AMI), pneumonia (PN) and heart failure (HF). CMS views three stages related to readmissions:
- Inpatient care processes
- Effective discharge (soon to be termed transitional level planning)
- Post discharge or transitional care
This is just another step the Federal Government and CMS are taking to appropriately manage a patient’s care and the associated cost across the care continuum.
In the new era of Healthcare Reform, home care and hospice leaders play a vital role to ensure the appropriateness of care, in the right setting.
Solidify Strategic Partner Relationships.
- Identify key strategic referral and care coordination partners who demonstrate performance strength and value in the care continuum.
- Solidify relationships with physicians who are aligned with the hospitals you serve.
- Align with strategic “partners” (e.g., hospitals, subacute facilities, therapy organizations, physicians, consultants, pharmacy providers, software vendors, medical supply companies, etc.) who can assist in the development and integration of a comprehensive approach, including clinical, operational and financial performance.
- Build upon your hospital and referral strategy. Have a plan to get in front of C-suite executives who are making partnering decisions now.
Create Your Best Practice Model for Collaboration and Coordination of Care.
- Develop a best practice approach to disease state management to support ACOs, hospitals, physicians, payers and community-based providers who will be sharing the risk for payment.
- Track and monitor outcomes for continuous improvement of your hospital transfer/readmissions rates by top diagnosis. Have this data readily available when meeting with key referral sources.
- Align care delivery protocols to complement hospitals and physicians in the care continuum.
Embrace Your Unique Position to Ensure Appropriate Care Transitions.
- Implement OASIS + holistic assessments (e.g., depression, health literacy, rehospitalization risks, etc).
- Implement consistent identification of signs and symptoms that may lead to hospitalization and identify ongoing disease and symptom management protocols.
- Institute interdisciplinary team assessments, interventions, and care coordination across the continuum of care (e.g., Acute, Skilled Nursing, Home Care and Hospice). Review rehospitalizations and Emergency Department visits at weekly team meeting.
- Invest in technology that can assist in seamless review of data in order to showcase ongoing quality focus process and outcome measures.
Downloads/Links
TCG Quicktips: Lead or Be Led
“We cannot predict the future. But we can create it.” – Jim Collins
As we consider the continual changes that surround us–in the world, in our country, and in home care and hospice–no one could have predicted how these events could alter our way of thinking and leading. Some have chosen to lead through the unknown. Others will take a “wait and see” attitude and be led.
Leading organizations reject the idea that forces outside their control determine their success. They accept full responsibility for their own fate and take action.
Develop a plan and create discipline surrounding its execution.
- In times of chaos, leading organizations have a specific, methodological, and consistent (SMaC) plan. The more uncertain your environment, the more SMaC you need to be.
- Plan and rapidly implement. An average plan that is executed can be better than a brilliant plan that never comes to life.
Reinvent partner and referral source relationships.
- Identify partners with whom you can collaborate across the post–acute continuum and successfully prevent readmissions.
- Build upon your hospital strategy. Have a plan to get in front of the C–suite where partnering decisions are being made now.
- Solidify relationships with physicians who are aligned with the hospitals or with partner hospitals on your radar.
Invest in a solid technology roadmap and data analysis.
- Ensure your organization has outcomes data you can trust that provides insight regarding costs, especially for the top three conditions targeted for hospital readmission penalties beginning 2012 (CHF, pneumonia, and AMI).
- Have data–driven proof of your outcomes for cost, quality, and readmissions analyses.
Create an agile business model to meet the care continuum for the 21st century.
- Know the changing paradigms, such as, Enterprise Care Management vs. Silos; Coordination of Care vs. Episodes; Transition of Care vs. Discharge; Keeping People Well vs. Caring for the Sick.
- Prepare to transition from volume–based to value–based care.
- Have a mindset of continuous improvement to realize greater efficiency and quality.
- Identify industry experts you can trust for guidance.
Downloads/Links
TCG QuickTips: Successful Positioning for Industry Consolidation
Future scenarios for home care and hospice point to consolidation as a key element across all healthcare sectors. Providers need to be ready for some form of affiliation. Whether you hope to be the consolidator or expect to be consolidated, it’s important to know and understand how an organization can best prepare itself to become an attractive partner of other entities.
Envision your organization’s position in the future of healthcare delivery.
- Do you already own a major share of a niche or major service line at a local or regional level?
- Do you have solid relationships with major health systems, free-standing hospitals, health plans, physician groups, and/or long-term care and senior living communities?
- If so, will those relationships be sufficient to ensure that you are a key player in affiliations that will shape the future of healthcare?
- If not, is selling or merging your best option to reach critical market share?
- Do you have the ability to be the consolidator or is your best option to consolidate with one or more other organizations?
- What is a realistic target role and position for your organization?
Assess your organization’s strengths and value proposition to take advantage of opportunities.
- Culture and leadership team bench strength
- Clinical expertise and patient care services, including Home Health Compare, QAPI outcomes and data demonstrating strength of care delivery
- Effective cost structure with respect to projected reimbursement, including productivity and models of care
- Compliance with Medicare CoPs (low risk of condition or standard-level deficiencies under survey)
- Compliance with reimbursement requirements (low risk of recoupment under ADR or government audit)
- Information technology capacity for clinical and business management
Invest in initiatives that will address weaknesses and improve your value proposition.
- Infrastructure investments, especially in human capital and technology
- Corrective actions to improve compliance with Medicare CoPs and reimbursement requirements
- Staff recruitment, training and retention
- Business development activities
- Optimal contractual obligations to employees and vendors
Prepare for a comprehensive organizational review and be prepared with answers before questions are asked.
- Ready a comprehensive prospectus containing company-wide and supporting data that a potential buyer or partner will want to evaluate
- Organize source documents to support the prospectus
- Identify key contact person and team who would be involved in the process
- Know your value
If you want to sell, work with an experienced broker who can who can provide professional advice to maximize your organization’s value and/or goals.
Downloads/Links
TCG Quicktips: Working Smarter, Not Harder
As home care and hospice have become ever more complex, volatile and demanding, several key ideas can help make the difference between feeling overwhelmed and thriving. Use these tips to help your organization operate at peak effectiveness.
Maximize your existing resources.
- Engage your employees and volunteers in order to increase enthusiasm and commitment to improving outcomes:
- Interact with staff and volunteers regularly and foster their engagement by connecting their work to the difference it makes for patients, families, co-workers and the community
- Ask what is going well, what needs improvement, and how you can help them be successful
- Leverage existing tools, computer applications and vendors:
- Ensure tools are kept up-to-date and that you have upgraded software to the most recent version
- Assess whether there are modules you aren’t using that could improve efficiency or effectiveness
- Enlist your vendors to help you address the key issues – those 20% of problems that cause 80% of the headaches
- Invest in coaching skills for your managers and supervisors so that they can help tap and build employees’ passion for doing a good job
Simplify processes.
- Make things simple for front-line workers, as opposed to management or corporate support functions
- Enlist your engaged employees and vendors (see previous section) to ensure that information, tools, and processes support efficiency and quality
- Use the TCG Simplification Checklist to assess key processes
Increase workforce flexibility.
- Extend work hours beyond the traditional 8am to 5pm work day – institute afternoon and evening shifts which optimize coverage when patients and referral sources want it
- Extend the work week by including weekend days in a “normal” work week
- Check whether your task assignments are overly RN-centric – ask what tasks your RNs are doing that could be performed equally well by other team members
Downloads/Links
TCG Quicktips: Positioning for Success
Recognizing emerging trends, let alone being at the leading edge, can be daunting to even the most experienced leader in today’s health care environment. Identifying the trends, determining which are key to your organization’s future, and deciding whether and how you should respond – are critical questions as you plan for future success in a rapidly evolving environment.
Here are some tips on how to identify and stay on top of trends that are shaping healthcare, and how to determine what your response will be.
Talk.
- Ask your leadership team and your board what success will look like in 2020 for your organization given the trends you’ve identified and the likely changes in your strategic environment.
- Ask your colleagues, locally and nationally, what strategies they are implementing and why.
- Meet with leadership of health systems, hospitals, and physician groups; take responsibility for leading robust discussions to develop initiatives that will be beneficial for all those involved in the conversation.
Look and Listen.
- Stay abreast of new healthcare models (ACO, TCM, CCM, AIM, etc); which will be the best strategic fit(s) with your organizational culture, your service area, and your population base.
- Include all staff in the conversation to help define approaches and best practices with respect to emerging models.
- Develop business plans that take advantage of key trends and reduce potential risks.
Read.
- See below for key strategies that leading-edge home care and hospice providers are focusing on in response to emerging healthcare trends.
- See TCG’s recommended reading list for how to position your organization for success.
Execute.
- Experiment now with pilot programs–don’t wait for someone to tell you what you must do.
- Don’t become paralyzed by the risks or uncertainties, but add resources, contingency plans, and exit criteria to mitigate them.
- Try, and try again; no one is yet an expert in these new models – it could be your organization who is the trend-setter.
Downloads/Links
TCG QuickTips: Leadership
Visionary leadership is the key to success or failure. Yesterday’s solutions and strategies may not work for today’s challenges. Practical tips for home care and hospice leaders to think and act differently in 2012 and beyond.
- Leadership at the executive level alone is not enough. It is not just a cliché that people are your most valued resource. Invest in and cultivate the diverse talent you have. Energize leadership qualities up, down and across your organization.
- Adopt a “beginners mind.” Be curious. Ask questions, listen and be open to possibilities. Don’t accept the first idea as the answer. Always look for more and don’t assume it can’t be done! Notice the obvious.
- Change before you have to. Focus on what you can do to help things go right, rather than correcting them when they go wrong. Focus not on what others should be doing, but on what you can do to help them.
- Harness the power of progress. Despite the fact that most managers believe that employees are motivated by recognition, recent studies show that the top motivator is progress—whether real or perceived. Set clear and achievable goals. Provide resources and encouragement. Celebrate progress and make it visible.
Downloads/Links
TCG QuickTips: Financial Performance
Financial success today means thinking beyond cutting costs. To thrive, organizations must work intentionally to implement a range of integrated actions in a systematic, disciplined way to achieve positive, sustainable fiscal results.
- Ensure basic operational processes are functioning effectively. Efficient, cost-effective operational practices result in the right discipline, the right delivery mechanism, at the right time, for the best patient outcomes. Effective hiring, scheduling, case management, productivity, technology deployment, staff development and back office functions must be in place.
- Create a culture of performance excellence and accountability. Leadership’s capacity to model accountability and execute a plan to achieve performance goals is critical to take an organization to the next level. All employees need to perform at or above expectations. When employees underperform, the costs are significant: additional staff to compensate for poor performers, inefficiencies in work processes, lowered morale or turnover of high performers.
- Reduce the number of part-time employees. Employees who work less than forty hours per week are typically the most expensive employees in the organization. Part-timers may be less productive, require the same supervision, and their employment costs (recruitment, training and benefits) are proportionately more than for full time staff. Consider a ratio of 75:25 full-time to part-time or per diem staff to improve your bottom line.
- Change up your work week. Patients need to be seen and visiting staff/referral sources need to be supported seven days a week, not just on Monday through Friday. Design your work week to include at least one Saturday or Sunday (e.g., Wednesday – Sunday, Thursday – Monday, Friday – Tuesday, Saturday – Wednesday, or Sunday – Thursday). Change the work week schedules for both visiting and administrative employees. The revised schedules will reduce overtime and the need to hire additional staff for weekends.
Downloads/Links
TCG QuickTips: Ensuring Continuity of Executive Leadership
It’s never too soon to plan for transition in executive leadership. To expand on a quote from Benjamin Franklin, “Nothing is certain but death and taxes”…and executive transition. Whether planned or unplanned, an organization that has established policies and processes will ensure a smooth continuity of executive leadership. Although continuity of executive leadership, frequently referred to as “succession planning,” most often focuses on the chief executive, organizations would do well to consider how these tips apply to other executive staff and key board members as well.
- Build trust between board and chief executive and between chief executive and his/her executive team to allow for robust discussion of potential transitions and leadership development needs on an ongoing basis. Recognize that a number of barriers can prevent this from happening.
- Replace reliance on individuals with reliance on systems. Develop policies to respond to planned and unplanned vacancies and create systems to ensure that important information and contacts are systematically recorded and monitored rather than kept “in someone’s head.”
- Develop a system for identifying needed skills and personal attributes for executives, assess performance regularly and plan for opportunities to build leadership bench strength. Integrate career planning discussions into the performance evaluation process so that intentions and desires are clear and not assumed.
- Begin the planning for a permanent transition by confirming the core essence of the organization – its vision and values – and then tailor your search to a current strategic direction. Selecting an executive for your organization is one of the most important tasks in ensuring its long-term success. Start with a firm foundation by confirming the context in which your next leader will be operating so that you can select the best person possible to lead within that context. Recognize that the skills that have led to success in the past may not be the skills most important for the future.
- Move quickly, but methodically, when there is a hint of an upcoming vacancy. Today’s reality is that external searches can take six to nine months. Being able to immediately implement a pre-existing plan will give you a jump start, but expect that a thorough and successful process will take time, energy and resources.
- Assess your readiness for executive transition.
Downloads/Links
TCG QuickTips: Reinforcing a Culture of Compliance
Compliance is an increasingly critical element of home care and hospice programs. Good leaders recognize that training and formal compliance plans are only as strong as the culture in which they exist. These three tips will help you ensure that your organization’s culture supports compliance with state and federal regulations.
- Set a strong compliance example at the board and senior leadership levels.
- Demonstrate through actions and attitudes that regulatory compliance is a top priority.
- Demystify how the organization deals with compliance lapses by responding in an open and forthright manner.
- Encourage the reporting of “bad” news sooner rather than later by exhibiting an openness to learning from failures or mistakes.
- Provide opportunities for learning and discussing compliance expectations.
- Interweave ethics and compliance training into all training and relate it to everyday issues.
- Focus training on how to deal with situations with increased potential for compliance problems.
- Use lapses as learning opportunities. Convene crossfunctional teams to determine what can be done to educate staff in order to increase awareness of the issue and prevent reoccurrence.
- Understand your organization’s current culture by assessing it regularly using questions such as these:
- If you were to observe what you think is a clear compliance issue, are you confident that you know what to do?
- In the last three months, how frequently have you observed compliance lapses?
- During the last three months, how frequently have you observed open discussion of gray areas related to compliance?
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