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

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Moving Into 2020: Wrapping Your Head Around Evolving Clinical Staff Into The New PDGM Model Of Care. By The Way, This Includes Every Person Who Sees The Patient.

changeThis is a big time for transition in homecare. This industry just came off a year with the first changes to the Conditions of Participation in decades. It is a big deal. Now, you are faced with new a payment model for 2020. If you think this is just about payment, then you need to research more about the PDGM model. 

Bye Bye Therapy Thresholds: 

The industry knew this was coming. No longer will there be additional reimbursement related to the number of therapy visits. This is a good change. In order to “see” all members of the homecare team working together, there should not be incongruence in reimbursement for one over the other. Many providers continue to struggle with therapy providers not willing to comply with coordination of care or working towards shared care plan goals. This can’t happen in the PDGM model. 

Working As A True Team: 

This is huge too.  For years, healthcare has pushed to eliminate the silos of care between providers. However, the focus has been from hospital to SNF or SNF to homecare. It has not been focused on homecare discipline to homecare discipline. It is always the assumption that all clinicians within a realm of healthcare already work as a tight knit unit. Reality is, this isn’t the case in so many agencies. If you don’t have true interdisciplinary care and care planning, then it is unrealistic to think it will be successful with outside providers. So, this means fix the issues in your own house before the PDGM model hits and 30-day payments are in place. 

Begin With Education: 

Chronic disease care is the key to a true medical home model. It requires clinicians to be laser-focused on a shared patient care plan. All caregivers need educated about working in this type of model. It means more than nurses rattling off signs and symptoms of a CHF exacerbation. It is more than the aide documenting blood sugar readings. The COPD patient with pulse ox readings from the therapist doesn’t manage chronic disease. These items are all task-related and not about management of the disease. A comprehensive chronic disease management program gives you the paradigm shift you need in a PDGM model. It sets you up to be efficient and profitable. 

Call Us For Help: 

At Kenyon Homecare Consulting, we have comprehensive online disease management programs on the clinician and agency level. Call us at 206-721-5091 or contact us online for more into how chronic disease management is the key to future success.

So, You Want To Start A Homecare Agency. Do You Know What Kind Of Homework To Do? Check This Out To Make Sure All Your Ducks Are In A Row First!

Ducks in a rowIf you want to start a homecare agency, then you need to take some steps before you jump in with both feet. Let’s look at some things to consider in a start-up. 

Top 5 Things To Consider To Start A Homecare Agency: 

Moving forward successfully means you must research ahead of time to have your ducks in a row.  Here are the top 5 things to evaluate first. 

  • Location, Location LocationHave you checked out where you want to hang a shingle? Does that location make sense for your agency? Are you in an area where the population needs the services? What about competition. You need to look further than the mission. If the market is already saturated in the area, then you need to consider a different location. 
  • Marketing: This is often overlooked prior to opening. It shouldn’t be. If you want to start a homecare agency, the community should know about it way before you open doors. 
  • Secure Funds: You need significant capital on hand to start a homecare agency. You need to hire and train staff who will be providing care long before you can bill for services. 
  • Join An Industry Association: Whether it be on a state level or a national one, a homecare association opens you to resources and education. While the association provides advocacy for the industry, it is also a huge reference point for members. 
  • Work With An Industry Expert: Starting a homecare agency is like speaking a new language, even if you have previous experience in healthcare. Whether you want to start up services or diversify what you currently provide, an expert in the industry is huge to help you move forward. 

Finding Your Expert To Help Start A Homecare Agency: 

At Kenyon Homecare Consulting, we know what it takes to start a homecare agency today. Call us at 206-721-5091 or contact us online for your free 30-minute consultation with a senior consultant today! Whether you need help from beginning to end or just specific parts of the process, we have the expertise you need.  


Are You Abusing Your Policy And Procedure Manual? Read This to Understand Why Misuse Can Abuse Your Policy. Make Your Policy An Asset Instead Of A Hindrance!

decisionLet’s face it. This is a litigious world. You run your agency the best way you know how. If you make the patient the focus, then you should be good. Right? Unfortunately, it is not that simple. Let’s look at ways to make sure you unknowingly don’t “abuse” your policy and procedure manual.  

The “Do Not” Of The Policy And Procedure Manual: 

It is important to avoid landmines in use of your policy and procedure manual. Here are some mistakes agencies make. 

  • Do Not Have A Manual In Pieces: All policies should be together in one place and easily accessable for all employees. Regardless of what type of policy, everyone need to know where to see every policy.  
  • Do Not Make Changes To Suit Every Situation Differently: This is a big one when it comes to employees. You put a policy in place for a reason. So, do not make changes to how you run your agency based on one employee. An employer can get into trouble if one employee is treated differently than another. Consider the employee who has been stellar and makes a policy infraction worthy of termination. If you terminate one and don’t another, you can get yourself into trouble.   
  • Do Not Make Changes Contrary To State And Federal Regulation: This is a common agency mistake. Sometimes, operational changes may make sense for your agency, but make sure regulations don’t get violated in the process.  
  • Do Not Put Your Manual On A Shelf To Collect Dust: The manual needs to be a tool that allows you to run your agency properly. If you don’t use it, then it isn’t a good tool.  The “fly by the seat of your pants” method is stressful and risky for you as an owner. You also need to keep it up to date. This means it needs to be evaluated for efficacy and compliance regularly.  

Ok, My Manual Needs Help: 

At Kenyon Homecare Consulting, we have manuals for all types of home care services. Please call us at 206-721-5091 or contact us online to see if we can help you get the manual you need. All our manuals can be downloaded online and are fully customizable.  

The Year Of The CERT: What CMS Learned And How You Need To Cover Yourself To Get Paid!

regulatory complianceMany of you will read this and know exactly what CMS learned. The home health industry has been dealing with lots of changes in the last several years.  However, recent audits have alerted CMS to some issues with plan of care compliance. 

Changes In The Conditions Of Participation: 

If agencies focused on only the big changes to the COP’s, then others probably got missed.  It makes sense that while you try to comply with emergency preparedness, clinical management, and proper governance that something can be missed elsewhere. This is the issue for agencies now. The plan of care condition of participation is now a condition for payment. In order to be compliant for payment purposes, advanced directives info must be present. 

CERT Testing: 

Bill Dombi, President of the National Association of Homecare and Hospice communicated January 9th that Medicare home health agencies need to determine compliance with COP 42 CFR 484.60. This includes proper advanced directive documentation. If proper advanced directive information does not flow to your plan of care properly, then your agency is at risk of retroactive claim denials. This means more than just a DNR notation on a plan of care. Through Comprehensive Error Rate Testing (CERT), CMS evaluates proper coding, coverage and billing rules. This is done with random sampling yearly. The most recent data available is a 9.51% error rate totaling over 36 billion dollars in recoupment for Medicare home health payments from 2017. 

Avoiding Recoupment: 

Does your EMR have the proper information included for staff to input all the needed information? If not, then you need to make changes in operations to make sure a check and balance of the POC or 485 has the information present. Does Oasis contain detailed information on advanced directives? If your agency determines there is information not included on the plan of care, then initiate protocol for an addendum from the MD that includes the information you need for proper payment. You can submit corrected claims accordingly after speaking directly with the MAC about the process. Ultimately, it makes sense to make the changes now prior to massive audits that put your agency on administrative overload. 

Let Us Help You: 

Regulatory compliance can get tough. It can feel like you just keep your head above water in daily operations. At Kenyon Homecare Consulting, senior consultants help with operational flow or education regarding regulations and compliance. Call us today at 206-721-5091 or contact us online. 

Do You Want To Start-Up Your Home Care Agency With Accreditation? Here Is What You Need To Know To Start Off On The Right Foot.

Well, you may be at the stage of your home care start-up where you have an NPI and Tax ID. Now, you decide whether you want a home care agency with accreditation or not. Let’s look at why agencies often do choose to accredit. 

Advantages Of A Home Care Agency With Accreditation: 

There are many reasons an owner would choose to start a home care agency with accreditation. Let’s look at 3 reasons this is a great way to go. 

  • Quality: This is a big one. With accreditation, you adhere to Medicare Conditions of Participation as well as additional standards of care. The quality measures lead to a higher standard of care. 
  • Timing: As a start-up, accreditation leads to a quicker timeframe for survey. When the state completes the start-up survey, agencies can wait for extended periods of time. Considering the agency is incurring costs providing care without reimbursement waiting for survey, this can be very expensive. 
  • Education/ Resources: Although there are costs associated with accreditation, there is additional education and account experts available for you to use as resources. It is a big deal starting an agency. Having experts to call to help you wade through regulation is a big plus. 

How To Choose The Accrediting Body: 

Accrediting can come from CHAP, JCO, or ACHC. Ultimately, it will be your choice which agency makes the most sense for you. The industry currently sees Joint Commission in home health agencies that are part of hospital or nursing home based systems that already use JCO. If you are free-standing, the standards from CHAP or ACHC apply specifically to home health. If you are unsure, then look at the standards for each to help you decide.

Let Us Help You Through The Process: 

At Kenyon Homecare Consulting, we can help you through the start-up process from beginning to end. This means we help you understand the regulations and get you through the accreditation process by helping from A to Z. We include start-up packages that include mock surveys to get you ready for the real thing. If you need some help, then call us at 206-721-5091 or contact us online for your free 30-minute consultation with a senior consultant who can help you succeed.

To Purchase Or Not To Purchase? That Is The Million Dollar Policy Manual Question. Now, You Just Need To Make The Decision.

QuestionWhether you are starting a brand-new agency or have been in business for years, you need an up-to-date policy manual. It needs to be useful and effective to help run your business. If you can’t say it is either, you need to look at a new one. 

Do You Write The Policy Manual Yourself? 

If your manual has been kept up-to-date and ultimately just needs a few things added, then doing it yourself may be your best bet. This may be a very easy process if you have been in the industry for a long time. If regulatory compliance is old hat for you, then it may seem easier. In order to make this decision, you may need to “grade” your current manual first. Ask yourself a few things: 

  • Do you clearly communicate with staff? 
  • How often do you review and update? 
  • Is your manual easy to access and update? 
  • How organized are you? 
  • How easy is your policy manual to follow for someone who didn’t write it? 

These affect how well you can write a manual. You can’t be unorganized and unable to communicate well but put out an easy to understand and follow manual. Unfortunately, this happens more than you think. 

Benefits To Purchasing A New Manual: 

Benefits to purchasing an updated manual often outweigh the alternative for business owners. Here are some of the bigger ones. 

  • Saves time 
  • Saves money 
  • Easy to update 
  • Compliance Ready 
  • Can be customized to include state and agency operations 

Now, You Need To Decide: 

If your policy manual is in great shape and you don’t need to consider a new one, then you are good to go. If you aren’t sure, then the answer is to talk with someone about it. At Kenyon Homecare Consulting, we can evaluate your current manual, help you update it, or get you an up-to-date customizable one. Call us at 206-721-5091 or contact us online for your free 30-minute consultation with a senior associate.

Combing Through The 2019/2020 Home Health Payment Rule Changes Without Pulling Your Hair Out!

healthcare reformWhenever CMS drops payment changes, home health agencies want to cringe. Over the years, agencies become better at completing documentation and filling out Oasis properly. In response, CMS hits us with terms like case mix creep and then  changes payment for services. It can be overwhelming to jump multiple hurdles and not feel like you reach the finish line. Let’s look at payment and policy reform and how it changes care planning. 

Per CMS: 

CMS states policy changes for 2019 are based upon empowering patients, increasing competition, and fostering innovation.  The goal here is that the changes are supposed to be less about paperwork and more about patient focus. Focus on the condition/needs of the patient and not on the amount of care provided. This is the continued evolution of a value-based purchasing model with advancement of quality reporting. 

30-Day Periods In A 60 Day POC: 

This is a huge stand out for providers. Ultimately, instead of the 60-day episode of care, CMS will begin paying according to 30-day periods. This is a budget neutral plan from CMS to begin calendar year 2020. The therapy thresholds will be gone then as well. If you follow the rationale from CMS, then it makes sense. Value-based purchasing and episodic care are not meant to be based on the volume of visits. However, therapy thresholds are. So, your efforts to push therapy providers to work together in an interdisciplinary manner is not in vain. It is necessity. 

What Does PDGM Ultimately Mean: 

It means you must see each discipline working collectively. Weekly goals are discussed between disciplines and all members know exactly what to work on in the patient care plan that week. Then, progression of care is a systematic effort focused on joint goals. Now, this does not mean everything is going to be easy. If you thought so, you wouldn’t be in home health right now. Correct? Well, in all honestly, this is absolutely the time to advance home health into the next realm of care. This is front-loading of care from all disciplines. It is making the Oasis something you learn from as opposed to a form that must be filled out for payment. It is making the medical home model reality for all home care providers.

Kenyon Homecare Consulting Can Help: 

At Kenyon Homecare Consulting, we are working through these changes with agencies along with you. The senior consulting staff can help you move through operational changes to match the industry standard of care. As we continue to focus on aspects of payment reform, please call us at 206-721-5091 or contact us online to see if we can help you meet your goals.

You Want To Start A Homecare Agency. Sounds Great! What Next?

start a homecare agencyHomecare is a complex industry. Those in it know it all too well. If you want to start a homecare agency, then do your homework first. In addition, having help to navigate the playing field can make your journey a whole lot easier.

What Kind Of “Homecare” Do You Want:

Homecare tends to be the cookie cutter term for providing care within the home.  However, there are multiple types of service lines. The type of service you want to provide determines your road map to start.

  • Private Duty/ Homecare Services: These services are generally considered non-skilled. These are private pay services as well as those covered by certain contracts. Your local Area on Aging as well as the VA will provide home and community based services that are more for custodial care or maintenance care. Payment for services is normally an hourly or per-unit rate
  • Skilled Home Health: These services are provided when a patient has recently been hospitalized or has had an exacerbation of illness. The patient requires the skill of professional services such as skilled nursing or physical/occupational therapy. A home health aide can provide personal care during this time, but skilled care is generally short-term. If your agency wants to bill Medicare for services, then you will need to become certified to do so. Payment for services is by episode of care or a per visit rate.
  • Hospice: If your mission is the terminally ill, then hospice may be the type of homecare you want to provide. Payment for services is an all-inclusive daily rate. This is different than other homecare services.

You Know What Kind, But Don’t Know What Next:

This is where it can be really beneficial to invest in consultant services. You may need state licensure. You may not. And, you also need to adhere to both state and federal regulations. When you jump into a whole new realm like homecare, having someone who has done it all before can make each step of the way a whole lot easier.  Consultants can get you through all your steps leading up to and through your survey and accreditation process. You need to hire and train staff, develop policy and procedures, admit and manage patient care. The thing is, you don’t need to start a homecare agency alone.

Let Us Help:

At Kenyon Homecare Consulting, we have senior consultants who can help you start a homecare agency successfully. Call us at 206-721-5091 or contact us online for your free 30 minute consultation.

We Purchased A New Policy And Procedure Manual? Now What? What Is Next In The Road Map?

EditIn home care and hospice, having an updated policy and procedure manual is necessary. Whether you are considering a purchase or have already done so, there are some steps to finish the process. Let’s look at what still needs done. 

Add Your State Rules: 

Even though customized manuals have updated regulations for Medicare and accreditation, it doesn’t have your state regs. Unless you buy a manual that has your state accounted for, you must add what is necessary for compliance. You may be able to find manuals specific to your state regs through state associations or consulting agencies contracted to provide them to your state. 

What’s In Your Manual: 

If you purchase a manual, print it and sit it on a shelf, then you miss what you gain. The manual is customizeable for a reason. It allows for easy updates and changes specific to your workflow. You still want to make it easy and clear to follow how your agency complies with specific regulations. This doesn’t mean you need to update everthing in your new policy and procedure manual. It means you will want to customize some. An updated manual saves time and money, but still requires you to add specificity. 

Operation Manuals: 

Customizing your manual is huge in operations. You should have HR involved in what relates to employee procedure. This helps erase ambiguity handling employee benefits and personnel issues. Ambiguity can be difficult to defend in times of both. Workflow, chain of command, job descriptions, and evaluations are all part of a functional manual. Add or subtract what is specific to you from your purchased manual. 

Do You Need To Update Or Customize? 

At Kenyon Homecare Consulting, we offer online policy and procedure manuals for purchase. A senior consultant can also help you customize for your state or agency dependent upon your needs. Call us at 206-721-5091 or contact us online today for a free consultation with a senior consultant. 

As An Employer, Do You Feel Like You Have The Right People In The Wrong Places? Now Is The Time To Make The Change!

organizational restructuringThat first sentence is a handful, isn’t it? Organizational restructuring is tough, but often necessary.  If now isn’t the time, then when? Let’s look at what some of the big hurdles are and how to overcome them.  

“We Have The Best Team” 

That’s fantastic. Not all agencies can make that statement. Long-term employees and bright new talent are a great mix. These are the teams that seem to go with the flow and work efficiently through bumps in the road. If you think you have that mix but aren’t working like a well-oiled machine, then it deserves another glance. Maybe you have all the talent in the world, but employees don’t function in roles that suit individual strengths. This is very common in agencies. It is the adage of putting a square peg in a round whole. Employees cannot function at optimal levels in every role within your agency. Employees can become discouraged and overwhelmed when given job roles that don’t fit them.  

“We Can’t Keep Staff” 

This is another big reason that employees get discouraged. You have your dedicated staff filling so many roles because new employees do not stay. You may have your core team, but for how long? Don’t take for granted that employees are ok with playing multiple roles long-term. This ultimately hurts your process too. Your core and dedicated staff can’t function at 100% at any of roles they are given.  

Organizational Restructuring: 

At Kenyon Homecare Consulting, we have senior associates that can help provide objectivity on workflow. A senior associate will look at staffing and how functioning on clinical and non-clinical levels affect your day-to-day and bottom dollar. Sometimes it becomes difficult to see staff objectively. You have worked with these people for years. You have seen them through good times and bad. An outside source can see things differently than someone deep in the daily routine. Call us at 206-721-5091 or contact us online to see how we can help with organizational restructuring.