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

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Positive Clinical And Financial Outcomes: Do You Realize How Clinical Education Is The Most Important Cog In The Wheel? Let’s Put It First And Foremost In Your Head And Strategic Plan!

chronic disease educationToday, positive and clinical outcomes are crucial for long-term survival in homecare.  However, often we don’t see how the basis for success with both begins with clinical education. Now, you may not see the connection at first. So, let’s look at how you need to visualize the future of your agency. 

Clinical Education: 

Even the most skilled clinical staff needs education. No one will disagree that homecare is different than any other type of institutional care. Only those who live in the world of home and community-based care understand the complexity of putting all the pieces of patient care together. You may have clinical staff who are excellent in the acute care setting, but struggle with all that must be considered in a successful care plan at home. It takes programming specific to our industry. If you miss this step, your clinical staff won’t be comprehensive and set the patient and your agency up for success. This will be despite best efforts by all concerned. There must a training into homecare that deals with more than computer documentation or Medicare regulations. It is about the paradigm shift to a true integration of care. 

Now, that may seem like an impossible undertaking, but it isn’t. Consider the interdisciplinary team functioning in hospice. There is more communication and collaboration in hospice than with skilled care. However, it shouldn’t be that way. None of us know what the payment system will be down the road, but is it so hard to believe that agencies may be responsible for all aspects of covering patient cost much as hospice does now? Imagine your plan for care if this was the case and let’s look how that effects clinical and financial. 

Clinical And Financial Outcomes: 

Hospice nurses manage patients at home. Whether the visits are at 2:00 am or noon. Symptoms are managed by working closely with physicians to keep the patients at home. The home health side does not always approach the proactive nature of care the same way. But, if the mindset was different going into care and care planning, it could be. If you consider the same hospice type approach to finance, then outcomes would also improve. Hospice nurses often have a better understanding of costs related to visits, treatments, medications, and dressing supplies since it all comes out of a per diem.

Other members of the clinical team such as physicians work differently with orders when the patient is under a hospice program too. Ordering IM Lasix for a patient at home at the beginning of a CHF exacerbation with an additional nursing visit to administer it can easily avoid a hospitalization. This type of treatment would be ordered in a heartbeat for a hospice patient. Let’s get there on the skilled side collectively. It begins with chronic disease education and a paradigm shift to care planning. 

Start With Your Clinical Education Process:

At Kenyon Homecare Consulting, we have chronic disease education for clinicians as well as facilities. It helps to train staff individually and the agency to work towards competency and organizational change. Call us today at 206-721-5091 or contact us online for your consultation today. Let us help you meet your clinical and financial goals. 

Management Consultant Versus Interim Management: Do You Know And Understand The Difference? Know How Both Function To Put Your Homecare On The Right Path With One Foot In Front Of The Other!

interim management You hire good people. If the whole of a homecare agency is only good as the sum of its parts, then make sure staff fit the roles they play. Often, interim management or a management consultant helps make the wheels of the homecare cog function well. To determine which is best for your agency, ask yourself a few questions about how you function now. 

Where Do You Need Help? 

This is a very loaded question. You may see issues in more than one department. Maybe you have great nurses you promoted to management, but things aren’t going so well. Or, maybe you can’t figure out why you aren’t more financially successful. If this is the case, then take a step back and analyze where you really need to start. Sometimes, that objective organizational assessment can get you pushed in the direction of meaningful organizational change. Look at someone to come in and analyze your agency objectively. Then, decide what step is next.  

Interim Management Versus Managing Consultants: 

There are many ways that these terms can be interchangeable. But, when it comes to the function within your agency, you need to know the difference. When you have lost a key administrator and need to look for a new one, interim management is your focus. This senior level consultant will help to keep your agency running while helping to hire and train a new administrator. This is especially helpful for smaller agencies where administrators often do not have the time to be all pieces in the puzzle daily. It is also key in vertically integrated systems where there is not another administrator in the department to fill that role.  

A Management Consultant works with current staff when you need help with training or changing operations. In homecare, we often promote our most skilled clinicians into management roles. Right? Of course. How many times have you discovered that the best nurse in the field isn’t a skilled manager? As administrators, we cannot assume that good clinicians do not need management training.This is an expensive process to continue to change clinical managers. It is also stressful for nursing staff if supervision is a revolving door. A management consultant helps you to train people into the role of clinical or administrative management. Too many times, we put someone into an administrative role without proper support to foster confident and correct decision-making. It is too hard to keep and retain staff to let someone slip through your agency’s fingers by not providing support they need.  

Kenyon Homecare Consulting Can Help! 

At Kenyon Homecare Consulting, our senior consultants can provide interim management and management consulting for your agency. Please call us today at 206-721-5091 or contact us online for your free 30-minute consultation and see how we can make a difference fo

ICD-10 Coding Moving Forward Into PDGM: Does Your Program Have What It Takes To Thrive Or Are You Setting Yourself Up For A Big Fall? You Can’t Build Your House On A Weak Foundation.

OutsourcingICD-10 coding is crucial for today’s home health world. However, agencies still do not accurately reflect patient care with the specificity of codes. This leaves money on the table and leaves CMS to wonder about things like case mix creep. In the world of PDGM, you cannot afford to miss out on proper coding and development of visit protocols to go with it.  

Common ICD-10 Coding Mistakes: 

Many agencies do code on-site. If you are one of those agencies, then make sure your coders have the skill to do justice to your coding. Here are common errors with ICD-10 coding: 

Knowledge: So many smaller agencies have someone code that is self-taught. You cannot afford this regardless of the number of Medicare admissions you do.  

Fear: Yes, that is exactly right. Sometimes, coders will stay away from higher specificity coding due to lack of the knowledge. This leaves money on the table. Ultimately, you do not need to fear repercussions from audits if things are properly completed. Upcoding is not ok but making sure you receive proper reimbursement is.  

Time: Many agencies have coders that fill multiple roles within the agency. Coding properly is a significant job. Often, coding properly can become secondary to other work functions at your office. If your coder is also an admin assistant, then does he or she really have the time to give coding its due? Or, will you see common non-specific codes because it is quicker and easier.  

Operations Based On Medicare Census: Your coding needs to be correct regardless of how much Medicare business you do. Many agencies that focus mainly on Medicaid do not worry as much about coding since it is not tied to reimbursement the say way. This is not the way to do things. CMS compiles this data and then “sees” a picture with less acute patients. So, filling out the Oasis and codes properly is more important than ever rolling into a PDGM world.  

PDGM and Beyond:

Along with correct Oasis, ICD-10 coding with be crucial in development of visit protocols to sustain you in a PDGM world. Business as usual will not work. You have probably heard that many times this year. But, if you are struggling with how to change things, then the time is now. Consider outsourcing your coding in small agencies. It is not fiscally sound to have someone trained and to maintain competency of coding skills in a small agency. Moving into PDGM is a great time to transition the coding outside. Choose coding only from certified coders that make sure you have the data needed in your chart to justify your codes. If you have proper documentation to justify your codes, then auditing may be cumbersome, but ut usn’t scary. 

Kenyon Homecare Consulting ICD-10 Coding Program:

At Kenyon Homecare Consulting, we can help with all your coding needs. Whether you just need the coding done or need assistance with billing, the services are here. We have certified coders who can help make sure you get the dollars you deserve for care of the patients you see.  Call us today at 206-721-5091 or contact us online to see how we can help you!  

Interim Management: Keeping The Pulse Of Your Homecare Beating During Extended Absences Of The Administrator.

interim managementRegardless the size of your home care, all pieces of the administration puzzle are key. The use of interim management during extended absences often overlooked. Let’s look at how interim management can help the ship continue running smoothly even with a large piece missing. 

UH-OH: 

It’s the call from a senior level administrator you never want to receive. There’s been an accident or sudden illness.  The anticipation is 3-6 months out or more. This is a good employee and you don’t want to lose him. Although you have worked at a cross-training program so everyone can fill in for each other, it has never been an issue. Maybe your agency is already spread so thin at the admin level that there aren’t enough hours in the day to cover the workload of the other. If you can already see yourself behind the 8-ball, then consider interim management before you are catching up from behind. This industry has too many changes on a yearly basis. You have to be in a constant forward motion and without an interim to keep things moving, your direction won’t be forward. 

Why Interim Management: 

The first reason people don’t consider interim management is the expense attached to it. If this has been your reason, then you need to reconsider. When administration is out, it usually means hourly employees are working longer to cover the holes. This means staff burnout, lots of overtime wage, and more chances for regulatory compliance to slump. The world of healthcare doesn’t have the luxury to let regulations slide. Ask anyone in their second or third round of probe and educate. Ask those in Illinois who have been through the pre-claim review process. Interim Management roles evolve with the needs of your specific agency. You may see that with interim management from the start, you may be able to utilize the service part-time to meet your needs effectively. 

Kenyon Homecare Consulting Has What You Need: 

Ay Kenyon Homecare Consulting, we have senior level interim managers with decades of experiences in all service lines. Whether you know exactly what you need or need to determine it, we can help. Call us at 206-721-5091 or contact us online for your free 30-minute consultation today. 

 

Starting A Home Health Agency: Make Sure Your Head Knows What It’s Doing Before Your Feet Start Running!

starting a home health agencyStarting a home health agency takes many steps. Whether you want to bill Medicare or not, state and federal regulations need to be followed before you ever see a patient. You must understand the rules and do it right. Let’s look at first steps and then ways to make it easier. 

Steps To Starting A Home Health Agency: 

If there is a way to complete this process smoothly, then why struggle? It is because the cart is usually before the horse. Here are 5 steps in the process of starting a home health that often end up bumpier than necessary. 

  • Service Area: Two mistakes are commonly made here. The first is taking on a huge service area that increases costs per visit to a level you can’t sustain without revenue. The other is the opposite. If you only take a very small area, then likely you do not have the ability to obtain the numbers of patients needed to stay in business.  Complete some form of feasibility for the target area. 
  • Hiring: In a perfect world, we would be at full capacity from the day we open our doors. Many start-ups begin hiring too many people and costs go through the roof. To begin, you need the core individuals to service your 10 clients for survey. Have contracts in place. These initial staff will help to train as you expand. 
  • Licensing/ Certification: You obviously need to obtain state licensure where required. You must have a tax ID and NPI for your business and you need to determine what type of legal entity you will be. It may be an LLC. or you may already have a company in place. 
  • Accreditation: When starting a home health agency, you may be waiting on your state for survey for a lot longer than expected. With an accrediting body like CHAP or ACHC, you will have guidance for survey, and it is typical to see them present in the agency within a month of  notification that you are ready. Without this, you must continue operations and paying staff with no reimbursement indefinitely. 
  • Policy/ Procedures: If you purchase a manual, you should have the ability to edit it to meet your agency needs. Make sure you do it. Manuals with no personalization are easy citations on survey. No surveyor expects things to be perfect for someone starting a home health agency, but there must be an effort to show true compliance. 

This is Just A Small Part Of The List:

Doing any of the items improperly or without an efficient timeline costs a lot of money. At Kenyon Homecare Consulting, we can help you move through the process effectively. We can get you ready for survey from A to Z. We have competitive start-up packages that work for you. Call 206-721-5091 or contact us online for your free 30-minute consultation. 

Education And Training: Maybe You Need To Start With A Day In The Life Of An Auditor To Make It Stick!

point of viewYou have completed all the education and training to your staff.  You struggle with seeing compliance in CQI results. If you just don’t know why the results don’t match the effort, then consider looking at things like an auditor. Let’s look at how education and training end up off the mark if you don’t connect the dots. 

Education And Training: 

There are so many approaches to educate staff and each agency tends to stick to a certain pattern. Here are several ways agencies use education and training opportunities: 

  • Staff Meetings: The supervisor gives direct education to staff as to standards or protocols set forth by the agency. 
  • Clinical Competencies: Many agencies still utilize a yearly competency to work on staff education collectively. 
  • Online Education: Many agencies find this to be a cost-effective way to train a lot of people. 
  • Seminars or Conferences: Although this is a more costly option, it allows for direct questions and interaction during the session. 

Education and training should improve your outcomes and documentation. Right? If you haven’t linked the clinical practice to the documentation, then you miss what you hope to achieve. 

Look Through The Eyes Of An Auditor: 

This is good advice for anyone in your clinical system. Whether you are a nursing supervisor or administrator, you often know things about patient care that don’t allow you to look objectively at documentation. Often, your clinical staff will do the same thing. Care plans and interventions need to be real for the patient. It isn’t about creating a beautiful care plan in your EMR that doesn’t make sense for the patient. Now, let’s look at this example. 

The documentation may seem complete because EVERYONE knows that patient doesn’t take blood sugar first thing in the morning as fasting. So, the AM reading is always up, right? The auditor sees AM blood sugar readings much higher than what is expected. The nurse is not notifying the MD because it’s a typical result, but it is not clearly documented. Your agency has seen this person off and on for years. The auditor will also see a care plan that doesn’t fit the patient. If the patient never does a fasting blood sugar, why isn’t there a range from the MD applicable to what the patient does? 

Change The Way You Teach:

ICD-10 Coding

How To Win In PDGM With Accurate Coding

At Kenyon Homecare Consulting, we can help with education and training to achieve the change you desire. Whether it is on-site teaching or operational coaching you need, we are here to help you through it. Call 206-721-5091 or contact us online to see how to make change happen for your agency. 

In The World Of Technology, Does Staff Think Home Care Has Lost The Personal Touch? Complete The Balancing Act Of Clinical Documentation And Hands-On Care!

computer documentationLet’s face it, technology makes life much easier in many ways. However, it can also complicate things for hands-on clinicians. If clinicians are struggling in the world of the electronic medical record, then consider your set up. As you think about what works well for your agency, also consider whether your documentation process needs a change. 

Common Technology Complaints: 

If clinicians could wave a magic wand, what would they change about your system? Do you know? Consider these 5 things that are typical to hear from those working with an EMR: 

  • Documentation Takes Too Long 
  • Program Isn’t Web Based, So Sync Times Hinder Productivity 
  • Takes Too Long To Document In The Homes 
  • Documentation Isn’t Consistent 
  • Reviewing Previous Visits Takes Too Long 

You have heard all of these, yes? Well, there are certain things about an EMR you are unable to change, but some you can. Let’s look to determine if work flow can change for the better. 

Potential Changes: 

All EMR system systems have capability of doing a ton. Therefore, streamline what needs to be completed based upon the needs to your client population. If you have not tweaked assessment flow since you started the system, then it is time to take another look. Many agencies will start with everything unlocked and staff ends up spending too much time documenting. Look at the flow from A to Z whether it is admission, discharge, or a routine visit. Do you have double documentation required? Or, do you still have clinicians who document the same thing several times. If so, then it is a process and a hard habit to break. 

Documenting in the homes is still the best way to capture the most accurate information and decrease overall documentation time. There are always going to be cases where it is not advisable to bring a computer into the home, but this should be the exception and not the rule. This gives more time for the clinicians to observe and evaluate the patient as well as make sure documentation is complete. Overall, documentation in the homes takes less time to complete because there are not the same distractions when the nurse is back in the office with phones and other staff interrupting. 

Kenyon Homecare Consulting: 

Let Kenyon Homecare Consulting help you streamline the documentation process. Whether you are documenting too much in the work flow or need to update your assessments, we can help. If you are considering what EMR to purchase, we have senior consultants with a focus on technology who can help you make the best choice. Call us today at 206-721-5091 or contact us online to see if we can help you! 

So, Your Administrator Needs To Go. But How Do You Keep Things Running Smoothly Until You Hire Someone New? Consider An Interim Manager As Your Saving Grace During A Tough Time.

businessThe world of homecare is a place where compliance is not an option. Having the right person in charge of your business is key. If you don’t have it, an interim manager can get you there. Consider these different ways you can use interim management to keep you on track when you have jumped the rails.  

Interim Manager? 

Seriously, there are so many things administration must account for today. And CMS requires it. Surveys are citing agencies who don’t have engaged administration. In these cases, compliance usually issues exist in many areas of operation. Even if you had not considered it in the past, it may be time. An interim manager knows federal regulations, accreditation and operations. And, knows how to achieve compliance with all of it. If you have tried to make operational changes unsuccessfully, then use an interim manager. An interim manager can work alongside current management to get the operational changes you need. Or, the interim manager can help you obtain and train a new administrator for your agency.  

Financial Constraints: 

Often, agencies dismiss the idea of an interim manager because of cost. If you have been struggling to get the results you need, then how much has it cost you already? Have you completed education unsuccessfully? What about all the time and effort from current staff trying to initiate change. It takes a toll on the engagement of staff members. As we jump into the PDGM world, you can’t afford employee burnout. Working through change with an objective set of fresh eyes can be huge for your agency growth.  

Kenyon Homecare Consulting Can Help: Webinar text

At Kenyon Homecare Consulting, we have senior consultants with decades of experience working through organizational changes with home care. Whether you need help with compliance, diversification, marketing, or organizational transition, we can help. Call us at 206-721-5091 or contact us online today to see if we are the solution for you. 

Starting Medicare Home Health: It’s Not As Easy As You Think. Make Sure You Know How To Swim Before You Decide To Take The Plunge!

start a home care agencyStarting a Medicare Home Health has a lot of steps and costs. It is important to know what the requirements are based upon federal and state guidelines. If you think you are ready to jump in, then dip your toes in the water first and make sure you have what it takes to get going successfully.  Let’s look at some things to consider in making your decision. 

Prior To Starting: 

Before you see your first patient, there are things that must be in place first. Here we will list items that are required and those to consider before you hang your shingle. 

  • Due Diligence Of Your Area 
  • Establish Corporate Structure Including Tax ID And NPI 
  • Accreditation 
  • Insurance (Professional And Liability) 
  • Licensing Fees 
  • Policy And Procedure Manuals (Operations And Clinical) 
  • Employee Handbook 
  • Forms 
  • Competency Testing Kit 
  • Software 
  • Advertising (Website, Logo, Business Cards And Brochures) 
  • Recruitment And Hiring 
  • Capital Per Federal And State Requirements 

Ok, we realize that this may seem overwhelming to you at first. If you don’t have experience in home health, then it may seem even worse. However, it is not something you have to conquer on your own. You may already have an agency and want to add additional service lines. For those who have non-skilled agencies, starting into Medicare is a whole new ballgame. Just understanding the regulations can be huge to make the process streamlined and set you up for success. 

What Is Your Next Step? 

Talk to a consulting company. This is a good first step to determining if you have the skill and capital to do this. Depending on your area, it may cost between $150,00-$300,000 to start your agency. In other cases, you may be able to defer costs by coming with the clinical and management background to fill clinical and operational roles yourself. A senior consultant can walk you through the steps and help you decide if the goal is a realistic one before you start to put a bunch of money into the process. 

Webinar textLet Us Be Your First Call: 

At Kenyon Homecare Consulting, we offer a free 30-minute consultation with a senior consultant who has been through starting a Medicare home health and diversifying services for existing providers. There are packages ranging from those that need some assistance and those who need help with everything. Ultimately, the consultant can help you with what package makes sense to start your agency. Don’t reinvent the wheel by spending time and dollars creating policy and procedure manuals for Medicare when this is already done. You can focus on what needs to get you survey ready and on to billing for services you provide. Call us today at 206-721-5091 or contact us online.

Not Getting The Results From Education And Training You Want? Make Every Penny Count To Get The Outcome You Need From The Money You Invest!

Game ChangerHomecare education is so important, and no one argues that point. Making sure all clinicians have the critical thinking and technical skills is vital to proper patient care. If you put the dollars into education and training without the seeing the benefit, then you need to change something. Let’s look at ways to transform your education and training. 

What’s Your Current Approach? 

Do you have an education and training program for staff above orientation or a typical yearly competency? Is there an educational fund in the agency and if so, is staff aware of it? Also, do you provide additional education based upon outcome data to determine clinical weaknesses? Is the training usually just for an individual discipline? Why do you think there was a lack of return on your investment? 

These are all good question to ask yourself, but also consider how the education and training is delivered. Is it all the same format? Online education, conference attendance, self-studies and internal programs are all good approaches. However, keeping your education and training fresh can be tough if the format is always the same. 

Change The Educational Paradigm: 

Make education and training dynamic by making it inclusive to all clinical disciplines. Now, this doesn’t mean the level of clinical education for the home care aide is the same as the nurse or therapist, but it doesn’t make sense to provide education that doesn’t span the clinical spectrum. If you want to improve chronic disease outcomes, then chronic disease education must be for all those clinicians who see the patient. So, start with your processes first and then seek education that is inclusive of all clinical disciplines functioning as one clinical unit. It is the key to making clinical education successful and not fragmented. It means fully integrated care plans that make sense to everyone providing care. 

Let Us Help: Webinar text

At Kenyon Homecare Consulting, we understand all that goes into having highly skilled staff to provide patient care. It is also important to spend money on education where it makes sense for your agency moving forward. Whether you need chronic disease education for individuals or for your facility clinicians, we can help. We also have the trained and seasoned consultants to help with organizational change to help make it happen. Call us at 206-721-5091 or contact us online for your free consultation with a senior consultant.