As a consultant, I have the opportunity to spend time with agencies and clinicians all over the country. I get to work with small privately-owned agencies, large regional groups, venture capital companies, and publicly traded corporations. I enjoy interacting with different disciplines and discussing the benefits of our trade and the challenges we face as an industry with all levels associates, from field clinicians to owners. One of the issues I have identified in my time with these companies is the general lack of understanding by the associates on how home care is set up and functions. They do not have a knowledge of the history of home care, the regulatory requirements we operate under, the hard timelines we must meet, the role the OASIS plays in the episode (operational, reimbursement, compliance, audit triggers, and outcomes), reimbursement methodologies, differentiation of payor policies (Medicare, advantage plans, private insurance, etc..), and outcome measures to name a few.
I have long advocated that associates that understand the rationale behind directives are much more likely to buy into the expectations and direction of the agency. Asking someone to blindly follow instructions with no explanation of the logic behind them leads to mistrust, misunderstandings, and frustration. Home health, in particular, tends to operate in this manner. With ever-changing policies and regulations as well as the coordination of multiple bodies of compliance (federal, state, TPA, accrediting body, and agency policy and procedures), it can be a daunting task to keep staff informed.
What we must remember as an industry is that the staff we employ are college graduates, board certified, state licensed professionals trained in their clinical field and aware of ethical standards and healthcare challenges. An agency would do well to acknowledge these truths and spend the time needed to help clinicians understand and accept the parameters we operate under and the agencies policies to achieve targets. Incorporating a “HOMECARE 101” presentation into your orientation process will assist in avoiding the pitfalls discussed above. At a minimum, your presentation should include:
- Historical review of homecare
- Explanation of regulatory requirements
- Explanation of different regulatory bodies
- Explanation of reimbursement methodology (by payor type)
- Explanation of OASIS purpose and effect on all aspects of the episode
- Review and explanation of the rationale behind agency goals and benchmarks
- Education regarding the challenges our industry faces (PFP, VBP, F2F, audits, etc…)
I have personally presented our “Homecare 101” presentation to hundreds of clinicians, and I can confidently state that 99% of the time attendees report they have never been educated on these topics. We get feedback such as:
“I have been in home care for years, and that is the first time I have ever heard that information.”
“If I had known this before, it would have much easier for me to understand directives.”
“I had no idea how much the agency had to deal with.”
“I never knew the OASIS was so impactful.”
Close your eyes and reflect back to your first year in home care…. How much easier would it have been for you to buy into agency goals and meet expectations had you known what you now know about the inner workings of home care!
Chad Whitefield is a founding partner of several rehabilitation companies and currently serves as the CEO of Advance Rehabilitation Management Group, a national consulting and staffing company specializing in home care. Chad is a member of the Georgia Board of Physical Therapy and is actively involved in the APTA, HCAF, and PTAG. He can be reached at Chad@advancemgt.com.