Kenyon HomeCare ConsultingGinny Kenyon, Author at Kenyon HomeCare Consulting (206) 721-5091

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The Veteran At Home: Does You Homecare Have What It Takes To Properly Serve This Demographic?

Veteran at homeYou may read this and immediately want to say yes. This is really the time to think of the veteran at home. At different times, this blog has focused on different patient demographics and how to specialize in them. However, the veteran at home is a demographic often not considered. The needs are different. The experiences are different than others in your community. It is time to consider how to be the provider of choice for these special men and women.  

What Does The Veteran At Home Look Like? 

Often, agencies will see the elderly veteran who was in Vietnam or a discharged soldier with physical limitations. What about your local pharmacist who was activated for the first Iraq war? When that pharmacist has cardiac surgery, should his care plan look the same as someone who hasn’t served? If the answer is yes, then it is time to rethink the care plan. The military comes with a whole different mindset. They are trained to think differently than those of us in a private sector. The experiences of our veterans may mean that illness reminds them of soldiers lost in battle. It may trigger PTSD previously under control. When assessing the veteran, ask about the experience to help guide care planning.  

What About Your Staff? 

Do you have military spouses or veterans on staff? You can learn so much about the mindset, lifestyle, and what it is like for the family unit of a soldier. Take the time to sit down and see where you can train staff on proper assessment and care of the veteran at home. We can specifically target things that aren’t necessary the primary reason for homecare, but absolutely affect the patient’s return to prior level of function. As we in the healthcare industry better understand the effects of mental illness, we can better treat those that suffer from it. If you have never had a panic attack, do you understand how paralyzing it is? Maybe the anxiety has been present, but not to the extent that your heart feels as though it is beating out of its chest and you are sweating profusely. Uncontrolled anxiety alone can be a huge issue for the veteran at home.  

Opportunities: 

Many of you may already service VA patients under contract. If you don’t specialize care, then you won’t achieve goals for this soldier. On the other hand, care of the veteran at home can become a niche’ like no other. Considering the years at war, the demographic will continue to increase. Teach clinicians sensitivity to soldier interaction. Imagine your nurse or aide outwardly opposes something in government or from the military. That individual may have been overseas with his or her life on the line. This is where our personal opinions need to stay that way. How offensive to someone having been in active combat or potentially lost those who were.  

Kenyon Homecare Consulting:

At Kenyon Homecare Consulting, we focus on strong educational and operational planning for agencies. If you need help with either or would like to discuss an educational plan for your agency, then please call us today at 206-721-5091 or contact us online. 

 

Continuing Education: What’s Your Gameplan? Are You Looking To Blow The Competition Away? Start With Nurses And Make Them The Quarterbacks..

teamThe concept of a great team begins with great leadership. This is the way we think of our businesses. Yes? Take it one step further now. In homecare, the leadership of your care team begins with nursing. This should be your approach for continuing education as well. Let’s look at why promoting the leadership in education to nurses converts to the care team that wins. 

How Do Your Nurses See Themselves In The Clinical Picture? 

Do your RNs really manage your care plans? Do they see themselves as management of care planning or just the ones creating the plan? There is a big difference. Challenge your agency to review care plans at the beginning of the cert and at the time of DC. How many things changed? Managing the care plans should show an evolution throughout as the patient situation changes. Is the start of care the same as 3 weeks later? As we move into the world of PDGM,the first 30 days in care planning is more important than ever. 

Changing The Mindset: 

Before you approach clinical education attached to a new payment system, approach your nursing staff. True chronic disease care and clinical success won’t happen without care management. Not in the same sense of the last several years, but a progressive move to give nurses the ability to coordinate and manage care in the sense it is intended. Get them on board with the vision of a successful care management model. This is back to bedside nursing at its finest. 

Continuing Education Moving Forward: 

Consider the last paragraph. You have worked to set the minds of the nursing staff. They are your quarterbacks. They are on board. Now, how do you educated all clinical staff moving forward? Your agency needs to choose chronic disease education that encompasses all clinical staff. You need agency specific and discipline specific. This will guide your agency to continuing education that makes sense in a care management model. It is the step towards a medical home model still missing. If you don’t see your agency as a prime mover in the patient care world, then home health won’t make it there. This model includes hands-on care and frontloading like you own the position of prime mover. The continuing education must be something that promotes a care team and forgets the care plans that don’t work! 

We Can Help Get You There:

At Kenyon Homecare Consulting, we have the chronic disease education for individuals and agencies. Call us today at 206-721-5091 or contact us online today. Let’s talk about how online and additional support for your agency from Kenyon can prep you for success today and tomorrow! 

 

Oasis And Coding Are More Important Than Ever. What Are You Doing To Make Sure Every Oasis Counts? Or, Are You Just Sitting Back Hoping For The Best?

ICD-10 CodingWith the approach of PDGM, homecare agencies work to understand and fit in a new payment system. If this is where your thought process ends, then it is time to go back to basics. Oasis and coding are the basis and the beginning of everything from your care plan to reimbursement. If you do not optimize both, then you miss the mark moving into PDGM. 

OASIS Accuracy: 

Many agencies dismiss Oasis training with the thought process that “nurses are sick of Oasis training”. This may be true. However, training and evaluation of Oasis accuracy are key to care planning and proper coding. You may be a small agency that does more Medicaid than Medicare. This should not decrease your effort to train and evaluate accuracy. With PDGM, it reality that certain agencies will not survive. This may increase your Medicare census. As the Oasis tool changes, it’s frustrating for long-term clinicians. The way a question was answered 5 years ago is not the way it is answered today. This causes a need for some de-programming of that previous knowledge. Don’t assume staff is answering things correctly. Now, this doesn’t minimize the value of long-term staff in any way. You know the invaluable leadership and experience these staff bring to the table. It just means you must evaluate the accuracy regardless the years of experience. 

Coding Appropriately: 

Coding needs to be evaluated on several levels. Whether you code in-house or outsource, make sure your coding system optimizes the dollars you deserve. A good way to determine whether you are on the right track is by doing a side-by-side comparison. If your current in-house provider evaluated the same for OASIS and coding as an outside source, then you can feel good about what is in place. You may also find out from the outside source that you do not have the documents you need to justify codes that could lead to higher reimbursement. Let me explain this. Many times, it may be clear to the clinical reviewer of Oasis and coding that the patient qualifies for certain specific codes, but the agency has not sought out the documents from outside agencies to prove it. This leaves you agency at risk for losing hundreds or up to a thousand dollars for an episode of care.  It is worth the time and effort to make sure you are on the right track.

Let Kenyon Homecare Consulting Be Your Side-By-Side Comparison:

At Kenyon Homecare Consulting, we always offer 5 free re-codes to work as a check-and-balance to your current system. Whether you need someone to cover your in-house coding during times of high census or medical leave, we can help. Maybe you have been a provider that outsources but haven’t seen improvements in accuracy or coding specificity. Call us today at 206-721-5091 or contact us online to see if we can help with education, coding, or evaluate your current system. 

Have A Happy Fourth Of July!

July 4thAs we celebrate with family and friends today, Kenyon Homecare Consulting would like to wish you a safe and happy Independence Day. We thank the men and women out there serving to keep our country the home of the free and the brave.  Enjoy today and God bless the USA!

 

 

Clinical Documentation: Keeping Your Agency Out Of Hot Water And The Courtroom!

courtroomLet’s talk about the real issues with clinical documentation. In today’s home health and hospice world it is much more than regulations. It is also much more than taking care of the patient. We live in a very litigious society. As an agency owner or administrator, it is important to make sure documentation can stand up in a courtroom. 

4 Tips To Clinical Documentation: 

Nurses and therapists go into the field to take care of people. If your documentation process does not leave a clear and consistent path from admission to discharge, then change workflow. Here are 4 things to help you streamline the process. 

  • Clear Care Plans: Any clinician in that discipline should be able to interpret the interventions regardless of whether the clinician has a homecare background. If this is not the case, then you can’t really show your care plans are effective treating disease process or patient care. 
  • Don’t Omit Important Data: Every licensed professional has heard “If you didn’t document it, then you didn’t do it”. In the healthcare world there is no truer statement. If deposed on patient care, then your documentation is your only guide. You can’t defend your agency or the individual clinician if there is no record of a phone call made or intervention completed. 
  • Consistency: Documentation should be completed in a consistent pattern. Provide clear education to clinicians as to the flow of documentation. Vague documentation is a nightmare. It will always favor the person taking action against the agency. Clearly state interventions and make a clear consistent way for clinicians to document them. 
  • Policies Matching Clinical Practice: If your clinicians document care that is contrary to policy, then the clinician sets herself up for potential malpractice and your agency can’t it. Best practices need maintained and that means your employees need to know how to follow your policies. In addition, review your policies and procedures to ensure it is not so strict that clinicians cannot possible comply. A beautiful policy manual is no good if clinical documentation can’t comply with it. 

Let Us Be Your Guide To Clinical Documentation:

At Kenyon Homecare Consulting, we specialize in clinical and operational processes with senior associates who can streamline and teach documentation. Call us today at 206-721-5091 or contact us online to see how we can put all the pieces of the documentation puzzle fit. 

 

Who Checks The Oasis Assessments In Your Agency? What Are You Doing With The Data You Receive? Doing Nothing Is Like Having A Brain Unattached From The Rest Of The Body.

Oasis TrainingOk,  it’s time to focus on Oasis assessments. The Oasis is clearly a data collection tool for CMS, but most agencies do not use it properly. Today, incorrect assessments can mean a big difference financially. So, we need to discuss the work flow in your office and how to maximize use the assessment tool.

Reviewing Your Oasis:

Do you have someone reviewing the assessment tool? Is that individual Oasis certified? It may be that you utilize a vendor to sweep for discrepancies. Ultimately, someone needs to review that tool for accuracy. The person needs to be Oasis certified and capable of comparing clinical information with what is contained in the assessment tool.  This is not only for clinical accuracy, but the difference in Oasis mistakes can mean so much money left on the table for every episode.

Maximize Educational Opportunities:

This one is big. If you don’t analyze the data you receive from the reviews, then it makes no sense. You will continue to see the same consistent mistakes from the same clinicians. This costs you more money in the long run. Take the Oasis errors and work with the individual clinicians as well as with entire clinical staff.  When Oasis teaching is consistent there is improvement in accuracy. Accuracy declines can lead to increases in ADRs or other types of audits.

Once your staff has consistent levels of accuracy, then focus on linking the Oasis to proper care planning. Often times, the assessment tool is filled out, but never looked at throughout the episode of care. It should be key in writing interventions and goals based upon what the tool should look like at discharge. Too often, this is not the case. If this sounds familiar to you, then educate staff to use the tool as an ongoing guide to care plan management.

Let Kenyon Homecare Consulting Be Your Guide:

At Kenyon Homecare Consulting, we have senior consultants who are certified in Oasis as well as coding to guide clinicians through the documentation process. Allow Kenyon to complete 5 free reviews on current assessments and codes in your system. You may see you are missing out on reimbursement and accuracy. Contact us today at 206-721-5091 or contact us online to see how we can help!

ICD 10 Coding: Understand How Coding And Documentation Can Keep Your Agency Out Of Hot Water At Audit Time!

ICD 10 CodingSometimes, home health agencies don’t give ICD-10 coding much thought. Maybe you are a home care that provides mainly Medicaid services, so you don’t focus on Medicare specifics. Either way, we are coming up on big changes to payment reform. It is important on both a compliance and financial standpoint to get it right to thrive in a PDGM world. Let’s look at why you should code confidently and not dismiss its role in the auditing process.

Are You “Just Being Safe”?

Often times, agencies will avoid code specificity for multiple reasons. It can be a lack of knowledge, lack of supporting documentation, or fear of the dreaded “upcoding”. Let’s address each of these and what needs changed.

  • Lack Of Knowledge: Who is your coder? Many smaller agencies have office staff or the nurses coding. Nurses have so many responsibilities. It is unrealistic to think that the nurses can spend the time to properly code along with everything else. An office manager who also works to code isn’t a good option either. There is no question a certified coder needs to do your codes.
  • Lack Of Supporting Documentation: In the previous bullet point, think about whether or not your nurses or office staff would be able to take the time and follow through to hunt down extra documents. The answer is no. Those individuals already have other specific job roles. What takes precedence for them? The difference in hunting down the documentation could mean the difference in hundreds to a thousand dollars an episode.
  • Fear Of “Upcoding”: Many agencies fear code specificity for fear of “upcoding” or getting in trouble for picking a code with higher reimbursement. This does an injustice for your agency. If you have the documentation, there is no upcoding. As Medicare uses the data derived from agencies to determine ongoing reimbursement rules, you must show the level of care by the diagnosis you address.

How Does ICD 10 Coding Affect Me At Audit?

If CMS sees ongoing uses of non-specific codes, it may trigger audit. It could be that there is an ongoing number of therapy visits attached to a certain non-specific diagnosis that doesn’t support it. As an agency, you don’t want to trigger an audit. Maybe you didn’t trigger one, but an audit demonstration hits your state. Ultimately, use of non-specific codes is often unsupported by face to face documentation and can immediately have your episode denied. Without certified coders, you don’t really know if your charts have the documentation needed to even get past the first part of your audit.

Let Us Help!

At Kenyon Homecare Consulting we have ICD-10 coding available along with billing programs if you need the assistance. If you are unsure, then let us do a free side-by-side code demonstration and see what the potential difference in revenue and compliance is for your agency. Call us today at 206-721-5091 or contact us online to see if our coding program is the solution for your agency moving forward.

Chronic Disease Education: How Do You Invest The Time And Money When You Haven’t Seen The Outcomes From It? It Starts Here And Now!

education and successChronic Disease Education continues to be a hot topic as homecare moves into further payment reform. In the past, you have probably done it on hire and maybe something at a yearly competency, right? Well, today, we need to talk about it being an effective part of transition and change within your agency. Here are the steps to make your chronic disease program successful and cost-effective.  

5 Steps To An Effective Chronic Disease Education Program: 

If your program is giving employees a self-study with a test, then you probably haven’t seen changes because of your investment. Maybe you teach it once and that’s where it ends. The bottom line is there must be something to follow-up the teaching to make it work. Here are the steps to make sure your education dollars make a difference.  

Alter Work Flow Of Clinical Staff:  

If you want to make a difference in outcomes, then how the clinical function in the fields and out of it are crucial. Without changing job roles or case conferencing objectives, you really haven’t changed a thing.  

Clinical Documentation Needs To Reflect Chronic Disease Management Collectively:  

We want to see a one patient one care plan methodology. If your nursing, aide, and therapy EMR do not address these items as part of routine visits, then it won’t happen. Examine your EMR for what is currently there. Most therapy notes do not have anything specific to address chronic disease management. This means every individual must remember to document certain things that are not part of what is routine. The same exists for aide staff.  The care plan should address specific chronic disease items within the scope of practice. Make chronic disease management present for all disciplines in a meaningful way that can lead to real-world practice changes.  

Educate Staff Before You Provide Chronic Disease Education:  

This means let your staff know the endgame. Explain the changes to communication and work flow. Instruct as to how the documentation will flow between disciplines to show a collective effort towards chronic disease management. If you don’t make it clear what you expect the difference to be, then don’t expect staff to achieve it. 

Pick Your Program:

Consider something online to allow the training to remain consistent and relevant over time. Many excellent programs allow agencies a certain number of uses over time. This allows the agency to have any clinician complete or repeat the training. Online access allows clinicians the flexibility to access the information around client visits.  If you want to consider onsite, then have a way to obtain a copy of the face-to-face education so it can be used in the future. 

Let Your QI Program Show What Needs To Change:  

As with any clinical process, you will measure this for efficacy. Your agency needs to track items related to chronic disease management. Consider Emergent Care/ Hospital Admissions related to chronic disease exacerbation. It also means looking at specific clinical items such as shortness of breath. Check your congestive heart failure and COPD patients. Did staff initiate effective intervention at times according to your disease management program? Or, if it wasn’t addressed properly, determine why. If it is a lack of knowledge, then train again on your protocols.  

Kenyon Homecare Consulting Has The Online Programs You Need:

At Kenyon Homecare Consulting, we have online chronic disease education programs for both the individual and the organization. Call us today at 206-721-5091 or contact us online for your free 30-minute consultation and see how our program and be the change you need.   

 

Starting A Homecare Agency? Don’t Fall Into Quicksand Before You See Your First Patient. Get The Help To Do It Right!

how to stare a home care agencyThere is a lot to know when starting a homecare agency. Whether you want to provide skilled, non-skilled, or hospice care it is a process. The ultimate goal of every start-up business is to do it correctly and spend the least amount of money to make it happen. Right? Of course. Let’s look at why it makes sense financially to spend the money on a start-up consultant now to save you time and money in the overall process. 

Using A Start-Up Consultant:

Bottom line is that regulation speak is complicated. Making sure you have all the boxes checked to be ready to begin is time consuming and tough. Here are 5 reasons a start-up consultant can make starting a homecare agency a whole lot quicker.  

  • Knows The Regs: You don’t have to wonder or guess if you understand the interpretive guidelines. You have someone who knows the background of the reg and how to comply with it. 
  • Knows Clinical Practice: The start-up consultant can help with clinical flow and documentation. This will move you to clinical efficiency and patient outcomes.  
  • Knows Finance: The consultant can help to manage costs associated with clinical and operational processes. Starting a home health agency is expensive, so you need to have a hold on the costs you can control.  
  • Knows Hiring Needs: When starting a homecare agency, you need to make sure the team members can be successful for the team. Your consultant can help hire and train staff to become knowledgeable and efficient in the roles they work. This may include hiring your admin and training them. 
  • Knows Accreditation: Most agencies begin with accreditation at this point to avoid long wait times associated with state surveys. The consultant can provide mock surveys and give you the feedback you need to pass survey when it is time for the real one.  

Starting a Homecare Agency With Kenyon:

At Kenyon Homecare Consulting, we have senior consultants with decades of experience in start-ups. Call us at 206-721-5091 or contact us online for your free consultation and see how we can become your start-up or diversification lifeline.  

 

Utilizing Interim Management: Why This Can Put Your Agency Back On The Map Instead Of Struggling To Survive!

Interim Management HelpingInterim Management isn’t always something most agencies consider. However, maybe it is time to look a little closer at what an interim can do for your agency. You work every day trying to put together the pieces of the homecare puzzle between financial, clinical, and organizational. If you need to refocus efforts and streamline processes, now us the time.  

Changes With Home Health: 

Ok, so we had new COP’s. We have a new payment system rolling into next year. You may need a new administrator. Maybe, you just took over a home health or hospice agency. There are so many moving pieces that anyone can get stuck. On top of everything, you may see that efforts to comply with new regulations have meant outcome management doesn’t look the way it should. Maybe, compliance with regs has meant you can’t be as focused on marketing efforts and have lost market share. Many admins with nursing backgrounds still see patients on a routine basis. You must remember that no one can fill all these roles and expect to thrive even if it is a small agency. Admins working 20-hour days aren’t doing themselves any favors.  

If you are one of those people, then it is time to talk to employees. Are you available to “run” the agency? Is the impression that you are completely exhausted and really not available when they need you. Maybe you have historically been too available, and it keeps you from moving forward in a meaningful way. Administrators are often so concerned with employee burnout that they forget to check themselves. The way to do that is interim management. 

How Can Interim Management Help Me? 

Consider all the items we spoke of in the last section. If you begin to run off the rails, then it is so hard to get back on track. You may need someone to help with other parts of operation while you dig into something and give it your full effort. Also, you may need someone to completely fill a spot in your agency while you look to hire someone new. If an admin has resigned or will be gone for an extended period, you can’t afford to let pieces fall. We live in a world audits. If you don’t have all the pieces in place, something will give and normally that means someone isn’t monitoring compliance with regulation. This sets you up for more auditing. Interim Management can jump into whatever administrative function is necessary to keep the ship running smoothly.  

Kenyon Homecare Consulting Can Work For You: 

At Kenyon Homecare Consulting, we have senior consultants who specialize in interim management. These individuals have worked in multiple states and have decades of administrative experience. The team works together to provide your agency the tools and leadership you need. Whether it’s a goal-oriented operational process, working with a new administrator, or being the administrator in the absence of another, we can help. Call us at 206-721-5091 or contact us online for your free consultation.