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Can running my agency be easier?

Interim Manager helps frustrated nusiness ownerChanging government regulations and industry transitions make administration more challenging than ever. As a result, the past 5 years have put business owners on administrative overload! Sometimes, all you need is interim management to put a fresh perspective on the issues you face.

Streamlining Administration with Interim Management

Fortunately for owners and managers, there’s a solution to administration conundrum. Whether you’re understaffed or overwhelmed, interim management is an effective option for to simplify the areas listed below.


Running a home care agency is a different ballgame than many other businesses. With home care, you must consider the well-being of your clients— they’re health is at least partially in your hands. An interim manager helps ensure caregivers and the organization are in compliance with regulations, etc. This is great news since keeping up with these ever-evolving requirements is especially difficult for the average owner.

Billing and Financial

Improper billing procedures leads to errors which potentially leaves money on the table. Unfortunately, finding these errors takes time and attention to detail. The good news? Interim management professionals can help streamline billing methods and what mistakes keep you from maximizing revenue.


Your agency’s success depends on how smoothly operations run. From client care to paperwork—and everything in-between—the way team members handle responsibilities can make or break your agency. With help from interim management, operations run more efficiently that what you thought. Why? These experts have been in the industry for years seeing agencies thrive or fail based on operations. So, they know what leads to success.


If your home care agency seems to be doing well, there’s always room for growth. Whether growth comes from diversification of services or branch expansion, interim management is a must. The right interim manager allows a smooth transition that leads to growth while maintaining daily operations. This way, you can operate with minimum interruptions.

Kenyon HomeCare and Interim Management

At Kenyon HomeCare Consulting, we know exactly what it takes to make running your home care agency easier. It doesn’t have to be a struggle every day, so reach out to us now to learn more.

Top 6 Ways to Begin Developing Strategic Partnerships

Developing strategic partnerships with other providers is not optional in the home health & hospice industry. Without them, you rely on “random” walk-ins and call-ups without any reliable source of new clients.

You might survive without strategic healthcare partnerships, but you will certainly not thrive. Partners help you improve care for patients, greatly boost referrals, and ultimately improve your community reputation and bottom line.

But how do you form these strategic partnerships, and what kind of partners are you looking to “team up with” anyway?

Selecting Partners (And Being Selected by Them!)

You first look for a wide variety of other providers as potential partners, from hospitals to doctor’s offices to assisted living facilities to outpatient clinics. Sometimes, which ones you seek partnerships with depends on your staff’s skill sets, as when you team up with wound care clinics when you have wound care nurses and a wound care program at your agency.

Other times, mere geographic proximity is a key factor in selecting a partner, depending on how many healthcare organizations (and of various types) are located in the area.

But otherwise, look for providers as a partner that are reputable, willing to work closely with you to improve care levels, and especially if you are accepted as a “preferred providers.”

In the past, for example, hospitals would just hand people a list of post-acute care options; but today, more and more hospitals choose a smaller number of preferred partners to work with. You need partners whose services you can complement, not duplicate. And remember, partners will affect each other’s reputation and bottom line, so choose wisely.

And don’t neglect to join an ACO, which might lead to referrals and partnerships!

Tips on Making the Partnership Work Well for All Involved

To gain new partnerships, as well as to manage them well and thus maintain them, you will want to follow these six strategic partnership development tips:

  1. Assign a “designated relationship coordinator” to be your official contact person for all your partners, and prospective new partners.
  2. Set up data exchange protocols with partners to facilitate efficient and accurate communication/billing.
  3. Ensure partners are aware of your capacity and capabilities, and can quickly get updated on the current situation.
  4. Establish transition-of-care milestones, and work to eliminate any glitches in inter-agency work flow issues.
  5. Have issue escalation procedures already in place to deal with emergencies. Know how/where/when to get help with critical conditions that go beyond your on-staff expertise.
  6. Make specific service level commitments with partners so they can count on you for such and such number/types of services.

Finally, let your managers and coordinators focus on their specific tasks and not get bogged down in other duties. And consider outsourcing your ICD coding rather than to tie down managers/clinicians with coding assignments.

To learn more about forming/managing key strategic partnerships for your home health organization, contact Kenyon HomeCare Consulting by calling us at 206-721-5091 or by filling out our online contact form.


Meta Description:

Strategic partnerships are key to home health growth. Find out how to form and develop optimal partnerships.

Social Media Posts:

1. Have a plan for establishing and developing your home health strategic partnerships.

2. Learn how to develop new strategic partnerships that will help your agency grow.

3. Learn what kinds of homecare partnerships to seek and 6 ways to develop them!

4. Don’t neglect homecare partnerships: they’re key to quality patient care and referrals.

Abandonment Or Termination Of Homecare Services For Violence?

Today’s article, written by Elizabeth Hogue, a well-known health care attorney provides guidance about how to terminate services to patients in the face of violence or threatened violence against field staff members. Homecare field staff who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies and home medical equipment (HME) companies are extremely vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff members certainly need as much protection as possible.

In Part 1 of this series, exposure to workplace violence was reviewed from the point of view of requirements of the Occupational Safety and Health Administration (OSHA). Also, the previous article addressed the potential liability of all types of home care providers for negligence when employees are injured as a result of violence. This article provides guidance about how to terminate services to patients in the face of violence or threatened violence. Providers are at risk for legal liability of abandonment when they terminate services to patients. Violence or threatened violence, however, likely warrants immediate termination of services. Providers show concern understandably about the possibility of legal liability associated with the termination of beneficial services.Abandonment

Liability for Abandonment

Specifically, providers remain concerned about the possibility of liability for abandonment of patients. Practitioners often speak of abandonment as though it is equivalent to termination of services. On the contrary, patients who want to hold case managers liable for abandonment must show that:

  1. Providers unilaterally terminate the provider/patient relationship
  2. Without reasonable notice
  3. When further action was needed

Patients who fail to prove any one of these requirements are likely to lose their lawsuits against providers.

As indicated above, abandonment requires unilateral termination of the relationship between the patient and the provider by the provider. In instances of violence or threatened violence, this requirement of proof of abandonment may be met when providers decide unilaterally to discontinue services.

Requirements of Abandonment

The second requirement of abandonment means that providers who give patients reasonable notice prior to termination of services will not be liable for abandonment. The key question is: what is “reasonable” notice? Providers should view what is reasonable on a continuum. That is, on one extreme end of the spectrum are patients who are violent or threaten violence. Practitioners are likely justified in terminating services immediately to patients who fall into this category. Providers are also likely justified in ending services to patients whose family members threaten violence or are actually violent.

Statutes and/or regulations in some states govern how much notice must be given to patients prior to termination of services. Some of these statutes address the issues of violence or threatened violence and permit providers to terminate services to patients immediately under these circumstances. Providers must carefully review requirements for the state in which the patient resides before terminating services.

After staff members agree that immediate termination of services due to violence or threatened violence is reasonable, patients and attending physicians should receive notice verbally and in writing. Written notices should be hand-delivered to patients’ homes. Although it is desirable, it is unnecessary to obtain a signature verifying receipt. Written notices to physicians may be faxed or hand-delivered.

After giving notice, providers must terminate care as planned. Practitioners are sometimes tempted to continue services in the face of pleas from patients, physicians, and/or family members. Providers must bear in mind, however, that one of their most important responsibilities is to protect staff members from harm.

How Providers Defeat Claims of Abandonment

Finally, providers can defeat claims of abandonment if patients for whom services are discontinued need no further attention. How do providers know whether further attention is needed? Is this requirement as subjective as it appears? On the contrary, judges are likely to make retrospective determinations about whether further attention was needed. The basis for such determinations will probably be whether patients were injured as a result of termination. In other words, the law is likely to conclude that no further attention was needed, so long as patients are not injured as a result of termination of services.

What kind of injury must patients prove? Can patients who attempt to prove emotional damage only as a result of termination of services win lawsuits? The “good news” for providers is that courts generally require proof of physical injury or damage before they will find providers liable for abandonment. Providers must, therefore, take appropriate steps to make certain that patients are not physically injured as a result of termination of services.

In rare instances, appropriate action may include sending an ambulance to take a patient to the nearest hospital. Even if patients refuse transport by ambulance, providers may avoid liability because patients likely assumed the risk or were contributorily negligent when they refused transport via ambulance.

In Conclusion

It does not appear that the world is becoming a kinder, gentler place for anyone. Field staff members must face their vulnerability every day. Those who are behind the firing line must provide support by shielding them from threatened or actual violence whenever possible.

If you need to develop or implement a comprehensive program to prevent violence in the workplace, Kenyon HomeCare Consulting is here to help! Schedule an appointment to speak with one of our experts or give us a call at 206-721-5091.

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

©2017 Elizabeth E. Hogue, Esq. All rights reserved.


6 Ways to Increase Your Home Care Referrals

Tim Rowen and Home Care Technology Report (HCTR) are favorites of ours here at Ankota.  Tim and HCTR are invaluable resources for folks interested in keeping up with innovations in the home care space.  I subscribe to HCTR’s email list and receive regular informational emails from Tim that includes industry news, reviews, and thought pieces. A recent email I received from HCTR resonated with me as a marketer. In only a few sentences, Tim provided a number of ways to increase referrals for home care agencies. In his email, Tim thanked a home care agency for the excellent level of care that his mother is receiving.  He also relayed a personal story to illustrate why he felt they were worthy of notice.  This seems simple enough, so why did it resonate with me as a marketer?

Long story short:  It was a sincere and specific compliment based upon personal experience from an industry Thought Leader that was shared to an audience broader than the home care agency had already.  In other words, it was free promotion to a wide audience from a trusted source with direct experience of the service.

What agency wouldn’t want a recommendation from a trusted industry leader sent to an audience that is already requesting the information from that person?

Given that introduction, the question becomes, what can we learn from the story to help improve and grow our business?  As a start, here are 6 lessons that sprung to my mind thanks to Tim’s story:

Increase Referrals- Provide Exceptional ServiceReferrals

For the most part, the success of your agency begins and ends with providing exceptional personalized service to your clients and families.  Whether it’s general word of mouth or a “shout out” by an industry leader, no one is going to recommend your business if they don’t feel that you truly care about the client and their family’s well-being.  For veterans of the home care industry, you likely know this better than I.  Beyond that, it’s likely that providing excellent service and caring about each individual client’s well-being is not an issue for you.  Rather, the challenge is how to get the word out to prospects about all your great work caring for folks?

Glad you asked…

Grow Your Referrals-Request Online Reviews

An increasing number of us look to online review sites such as Yelp to inform us about a new service or product we are considering purchasing.  I know folks in home care are often busy caring for their clients to do anything more than the basics for their online presence.  But based upon how consumers decide to spend their money, having strong online reviews are important.  If for no other reason than it is likely that your competition is working on improving their reviews, it is important that your business does as well.

The easiest way to achieve this is to either ask clients that you feel are particularly happy with your service to write one. Also sending a mass email with your request can prove effective.

Beyond Yelp reviews, here are a few online review resources you should look at.  If you haven’t already looked, you may be surprised to find some reviews already posted!

  • Google Reviews (connected to your business’ Google search)
  • Facebook Page Reviews
  • Reviews Directly Posted onto Your Website

Build Trust with Influencers and Cohorts to Boost Referrals

There are a number of industry experts, Key Influencers, Thought Leaders, social media mavens part of every industry who have broad and loyal followers.  If you are active on social media, odds are that you’ve already connected with them in some way.

Getting an endorsement, Mention, Retweet, or similar can often increase your web traffic, engagement, and the feeling that you’re “in the mix”.  Ultimately though, if the goal is to increase revenue and create loyal customers, building trust with both Influencers and others “in your boat” is more important than a social media engagement metric.

That is, while consumers do tend to look at things like total followers, that’s a pretty small part of their decision-making process when choosing their home care agency.  What folks add into their process is outside opinions and Social Proof.  And often what it takes to move the needle is simply providing value, support, and generosity to folks involved in your industry.  Put simply, be a good online Citizen involved in your particular community.

Getting a glowing review by someone who you’ve built trust with (Key Influencer or otherwise) will be easy. You’ve already proven that you are someone they want to help succeed and that your offerings can bring value to their followers.

To Realize a Referral Upsurge, Get Involved in Local Business Associations

While being a good online Citizen and contributor to your online is important, I suggest that you do likewise in the real world as well.  I’ve noticed some folks join their Chamber of Commerce or small business organization, they read the newsletter, and that’s about it.  It’s unlikely that approach will create dividends for you.

Building trust is the name of the game and that can only happen if you “show up”.  So get involved, volunteer to help out on events or committees, get to know the business people both related to your field and outside of it…provide value.

Often the folks that are already involved in these organizations continually meet a lot of other folks in the community or industry, and have built a wide network.  If you do get involved, you might be surprised how often your name is the first one folks mention when others come to them for recommendations in your industry.

Connect with Folks in Your Industry from Outside Your Area

Here’s a bit of a confusing mantra for you: “You don’t know who you know knows.”  That is, folks you are connected to, who you wouldn’t assume could help build your business, could possibly be connected to a treasure trove of prospects.

Beyond that, if you do build trust with other businesses in your field but who operate out of your area (or those parallel to your business), they will often be more likely to refer folks to you over your competition.  They get to feel that they are bringing value to prospects who are outside of their expertise or local area. And the assumption is that you will do the same for them when a prospect in the opposite situation comes to your attention.

Build Your Email List to Multiply Referrals

The story behind this blog article began when I received an email from Tim.  Or did it?  Another way to look at it is that this article began when Tim continually provided value to the home care industry to the point where I noticed him as an industry expert.  More to the point, this article would not have been written if A.) Tim hadn’t built trust with me to the point where I felt is was valuable for me to be on his e-mail list and if B.) the home care agency that he mentioned in his article hadn’t built trust with both him and his Mother.


To tie this all together:

In whatever fashion you can muster time for, build trust through your level of care and your industry/community involvement, ask those who you’ve built trust with to provide reviews and recommendations, and finally, build your email list so that you can promote all your new glowing reviews! How do you build your email list?  That will be a blog topic for another day.

On a related note, download Ankota’s new e-book called, Winning with the Home Health Value-Based Purchasing Program.

We are here to help! Call 206-721-5091 or contact Kenyon HomeCare Consulting if you need advice on marketing including increasing referrals.

This article”6 Ways to Increase Referrals for Your Home Care Agency” by Jed Hammel, first appeared on Jan. 30, 2016 on the Ankota blog. Mr. Hammel is the marketing director at Ankota LLC. Ankota’s mission is to improve the efficiency and coordination of care outside of the hospital. Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination.  


New Study Shows RNs Vital to Home Care Technology Success

As home care technology continues to develop, becomes increasingly powerful and more practical, we may be seeing glimpses of what our industry may look like in 100 years. A recent, first-of-its-kind study by the University of California San Francisco is proof. The data demonstrates how cutting-edge home care technology and remote monitoring improves patient outcomes and bottom lines simultaneously.

While the study shows the workability of general remote health care and the need for full staff training for successful implementation, the registered nurses (RNs) were the key. The report highlights the need for RNs who have not only solid basic training and varying experiences but who also receive adequate additional telehealth training.

The Critical Role of RNs in Upgrading Home Care TechnologyHome Care Technology

Remote health monitoring is taking the medical world by storm! And causing a surge in the demand for technology equipped home care organizations. Consequently those agencies employing RNs with telehealth training are able to admit patients who might otherwise require hospital or a nursing home care.

Therefore, these nurses are front and central interpreting remote monitoring data and then moving on-site to verify conclusions and to administer treatments. Oftentimes non-nurses can review data and look for “red flags” before passing this information to the RN. But despite the fact that to a degree all staff members need to adjust to remote monitoring, it’s the RNs who bear the brunt of this transition.

However, RNs need time to adapt and to complete telehealth specific training. Much of this training is on-the-job and program-specific. Most home care technology manufacturers supply training on their products. Some education involves shadowing another RN already experienced in remote monitoring techniques. And there are also modules and online, distance education classes that address this need.

Remote Monitoring, One Piece of the Home Care Puzzle

Many RNs who are familiar with in-home, face to face patient assessments may be uncomfortable with remote monitoring at first. But RNs quickly adapt when given the right tools. However, the second major conclusion of the UC San Francisco study indicates that telehealth care will never fully replace human contact.

The study results show that preventing first-time hospitalizations and reducing readmission rates, were far better when using both remote monitoring and in-home care rather than using just one or the other being exclusively.

It is undeniable!  Advanced home care monitoring, think telehealth, is a useful tool to reduce costs and compliments home visits. Furthermore, there are already moves to incorporate video-conferencing in the near future allowing for remote visual patient assessments. Yet, home visits will always be essential, and RNs with hands-on clinical experience will continue to be the best candidates for remote monitoring training.

Thus, it is no surprise that the UC San Francisco study found the success rates of remote monitoring programs were directly correlated to the provision of supplemental education for RNs.

Patient Reaction to New Home Care Technology

One surprising study finding was that patients were not generally apprehensive or resistant to participating in remote monitoring assessments. Although it had been expected that most patients, especially the elderly would be against the benefits of this technology.

The equipment—highly accurate, reliable, and easy to use—and training participating home care clients, remote monitoring was very well received. And there are other positive facts clients appreciate. Field installers are available to answer follow-up questions and are consistently accessible for troubleshooting and technical support.

In fact, it is providers who worry the most, fearing an unmanageable overload of patient phone calls and follow-up visits. Instead, the most common problem was that many remote monitoring patients were slow to communicate or were unable to adhere to self-management requirements. On the whole, training RNs and patients alike will prevent most bumps in the road and lead to success.


The recent UC San Francisco study only confirms what many of us already know! RN training is a major key to the success of any remote monitoring program. And in-home care will never be 100% replaced.

At Kenyon HomeCare Consulting, we offer homecare staff training, coding outsourcing, and consulting assistance. Let us help you maximize your reimbursements, improve your service delivery and meet your success goals.

To learn more, call us today at 206-721-5091 or complete our online contact form for 30 minutes of free consultation.


3 Approaches Home Care Uses To Help Clients Avoid Financial Scams

As the American population grows older and more of its wealth becomes controlled by senior citizens, home care agencies must be able to help their clients both recognize and avoid instances of financial scams and fraud.

Unfortunately, financial scams targeting older adults remain one of the most common forms of fraudulent criminal activity. Elderly individuals are frequent targets, due to the effects of age on memory, cognition and social participation. And that situation can be exacerbated by a revolving door of strangers entering an elderly person’s home. But, it’s also an opportunity for care agencies to provide safety measures to ensure clients aren’t taken advantage of.

“As it is with any employed position, caregivers will come and go,” said Joy Loverde, author of The Complete Eldercare Planner and the upcoming Who Will Take Care Of Me When I’m Old? “Caregiver burnout is a significant industry problem with high rates of annual staff turnover — between 40 and 60% in home care agencies, according to research conducted by the Paraprofessional Healthcare Institute.”

The only steady relationship most clients have with the home care agency is with the owner and their care manager. That’s why an extra layer of “scam security” is necessary to safeguard both your staff and clients.

Loverde suggested the following best practices for home care agencies to help their elderly clients avoid financial scams like those noted by the Federal Bureau of Investigation:

Avoid Financial Scams: Safeguard Finances, Correspondence & Valuables

Financial Scams

During the initial home visit, ask clients specific questions about their financial-management and mail-management systems.

“Ask clients: Who manages your finances and your incoming mail? Who is directly responsible for paying your bills? Importantly, the goal is to find out if clients have an existing system in place for averting financial abuse,” Loverde said.

Ascertaining such details as who is responsible for paying credit cards and other bills or who balances the checkbook can help determine not only if the client has already been a victim of fraud (like debt collection scams) and if they are still at risk.

“Experts say most people don’t realize they’ve been scammed right away. It’s only later they feel something ‘wasn’t right,’  Loverde said. Intelligent, well-read and accomplished people succumb to slick sales pitches, fearing exposure of the incident might bring their competence into question.” “Some victims choose to forget about the loss and keep it a secret.”

Also during the initial home visit, “put the topic of valuables on the table,” Loverde said. “It is not uncommon for home care workers to be unjustly accused of stealing. Discuss with clients and family members the importance of putting away private papers, cash, and valuables in a safe place.”

Avoid Financial Scams: Provide Documentation of Caregiver Vetting Process

“Among other questions, clients deserve to know: Why are you recommending this particular person for this job?” Loverde said. “What kind of background check did you conduct on this person?”

You can obtain forms online that will help identify and organize the documents providing proof of a potential caregiver’s skill set. A personal care agreement, or contract between the individual who agrees to provide caregiver services and the person receiving care, can serve to protect your loved one should they need a legal advocate.

Avoid Financial Scams: Provide Training for Designated Managers and Caregivers

Loverde suggests providing certain staff members with sensitivity training around financial scams. Also providing clients with written documentation of part of this training.

“Care managers and caregivers should be aware of how the client manages their incoming mail, unexpected visitors who pose as healthcare or home repair representatives, use of internet, and incoming telemarketing phone calls, among other scam tactics,” she said.

Determining if elder clients have already been victimized can be difficult.  But, Loverde recommends observing their behavior when the subject is brought up. Do they clam up? Become standoffish?  She suggests watching for other clues such as:

  • Overdue bill notices and bounced checks
  • Unusual activity in bank accounts and cash withdrawal machines
  • Withdrawals of large amounts of cash
  • Unrecognizable signatures on financial documents
  • Conflicting accounts of incidents
  • Forgetfulness regarding the whereabouts of checkbooks, bank and credit card statements
  • Frequent trips to gambling casinos
  • Recent changes in wills or the creation of a new will
  • Increased frequency of incoming telephone calls
  • Large volume of mail that promotes prizes or free trips
  • Valuables such as artwork, silverware, and jewelry going missing

By putting these measures in place, you can help ensure that clients, family members, staff and your agency are all scam-aware and, hopefully, scam-free.


If you’re looking for additional ways to expand your knowledge-base or business, download Ankota’s free white paper, Why Care Transitions Is The Next Big Thing for the Home Care Industry.  Just click the link to download.

Writer of this post, Constance Brinkley-Badgett is an editor and writer at In the past she was as an editor for, senior digital producer for CNBC, and digital producer for NBC Nightly News. Constance is a graduate of the International Culinary Center in New York. She has worked for chefs such as April Bloomfield and Jean Georges Vongerichten, and is the founder of Crave Personal Chef Services in Austin, Texas.

This article first appeared as “3 Ways Home Care Agencies Can Help Clients Avoid Financial Scams” on the Ankota blog on December 14, 2016. Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination.  Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.

Will Home Health Star Ratings Suffer Same Fate As Insurance?

Five-star ratings are a familiar tool in general. Although they are not new to many providers receiving CMS funds, such as skilled nursing homes and hospitals, home health star ratings are relatively new. And, be aware, hospice star ratings are coming in 2017.

Below, we introduce the basics of what home health star ratings are, as well as some potential problems home health agencies may encounter.

What Are Home Health Star Ratings?

Currently, there are two types of home health star ratings or tools helping customers make the best decisions about their health care.home health star ratings

1. Quality of care ratings, first introduced in July of 2105 are based on OASIS and Medicare claims data. Quality score calculations use 9 quality-of-outcome metrics and, in general, reflect how much patient conditions improve and how often they make a hospital visit.

2. Patient perception ratings. First available on the CMS website for home health in January of 2016, this rating category bases outcomes on patient surveys. Survey questions examine areas such as:

  • Agency education with patients on how to care for themselves
  • Patient understanding of how to take their medications
  • Reasons why medications are necessary
  • How thoroughly clinicians probe for possible medication side effects

Both sets of home health star ratings are available on Home Health Compare, a subsidiary website of The quality stars are meant to summarize or rate care providers. On the website, consumers are able to compare up to three agencies at a time. Like the data they summarize, the website gets quarterly updates.

Agencies receive a preview report before the newest home health star ratings are seen by the public. Agencies have a 3 month window to check the “star” data to be sure it is complete and accurate. During this time-frame, agencies may also request a data revision from CMS.

October Surprise to Health Insurance Companies

On October 12, 2016, the formula CMS uses to rate health insurance providers was adjusted. And it is big change! Now, companies previously receiving 4 and 5 star ratings, are a rarity. For example, Humana with 3/4 of its plans receiving 4 or 5 stars last year, estimates that level at about 37% today. As a result, Humana stock prices took at immediate and spectacular hit. Although the prices are a bit more stable now, the “ride” was rather unpleasant for the stockholders and plan customers.

Many in the home health industry are now wondering if a similar fate awaits them. For health insurers, the CMS 3 star rating is now the equivalent of what 4 stars used to be. And striving for a 5-star rating now seems as futile as “reaching for the stars.”

Problems With Home Health Star Ratings

Similar to the recent health insurance plan fiasco, consumer confusion will occur if the value of the home health stars suddenly change. However, currently there is other confusion plaguing home heath star ratings.

First, there is a major difference in the number of stars received for quality of care vs. from patient surveys. Patients rate agencies at 4 or 5 stars about 75% of the time, but only about 25% of homecare organizations got as many stars on the quality of care score. Nor does this difference stem from patients being over-generous on the surveys, but from the fact that Medicare purposefully uses a different formula to make 3 stars the norm on quality scores. This results in the two scores differing by one or even two stars.

The second cause of potential confusion arises due to the lack of sufficient surveys. There “should be” 100 surveys to base patient perception star ratings on, but there are often fewer. And if less than 40 surveys to calculate, no rating will appear for that agency.

Finally, quality star ratings can give false impressions due to the patient population home health cares for. Many conditions, such as CHF or diabetes, are not likely to be reversed even with the best possible care. And, if patients happen to live in a region lacking certain services, hospital visits will increase and lower the star rating.


Only by understanding the home health star ratings calculations can you hope to improve both your quality and patient-survey scores. Be sure to review your agency’s preview data and contact CMS if adjustments are needed. Getting your OASIS and claims submissions right the first and every time is a big part of this equation. Remember, your quality score calculations use OASIS quality-of-outcome metrics reflecting how much patient conditions improve.

Kenyon HomeCare Consulting is here to help! To learn more, contact us today at 206-721-5091 or schedule an appointment online.

How To Decide What To Charge For Home Care Services

One of my current hobbies that will perhaps later be a career, is to teach in business school and to mentor start-up businesses.  Earlier this spring, I taught business strategy at the University of Massachusetts.  I’d like to now bring some of the techniques taught in business school to the topic of pricing for your home care services.home care services

The question of “what rate should I charge?” is an important one for every agency. To answer that question we need to look at two things.  First, we need to look at what the competition in your area charges.  Second, we need to understand your strategy for creating and sustaining competitive advantage.

What are Competitors Charging in My Area?

There are two resources that we’ve come across for you to use when bench marking home care services rates in your area.

  • Genworth: The first resource is a free website provided by the long term care insurance provider
    Genworth.  You can access it here. Since they are paying claims they have accurate statistics on the rates that are charged in each geography. Two things you should know about this survey are as follows:

    1. In addition to home care you can see rates for adult day care, assisted living and nursing home care
    2. The math is based on an annual rate where there are 44 hours of care per week over a 52 week year. So in order to find the hourly rate, you need to divide the annual rate by 2,288 (44 hours time 52 weeks). The depicted example is for the Phoenix Arizona area.  By dividing to get the hourly rate, we get a rate of $20 for homemaker and around $21.30 for home health aide services.
  • Home Care Pulse: There is a private duty benchmark and quality improvement company called Home Care Pulse. We’ve featured content from them on our blog many times such as this article.  Their benchmark study, which is available here, breaks down rates by geographic area and also give the low, medium and high rates.

Where Should I Price My Home Care Services Relative to My Competition?

Once you understand the pricing in your area, you need to determine where you should price your home care services and that pricing should correspond to your strategy.  The easiest explanation I can give for strategy is that it is that way that your business creates and sustains a competitive advantage.  The authority on strategy is a Harvard Business School professor named Michael Porter and he describes four generic strategies based on two dimensions.  The first dimension is whether you are differentiating via a “low-cost” strategy or “differentiation” strategy. By means of comparison, are you Timex or Rolex?  Second, do you serve the broad market or focus on a narrow market such as memory care or pediatrics?

Based on Your Strategy, Pick Your Home Care Services Price Point

If you’re going to provide a highly differentiated service to the broad market, you should be able to charge on the high enHome_Care_Rates_AZ_-_2016.pngd of the range for your area, whereas if you go for low cost then set your pricing that way.  By focusing on a niche you can likely charge a higher rate but you’ll have a smaller potential market. There’s room for successful companies with any of these strategies, so choose your course and succeed!

For more Best Practices, you can download a free eBook Seven Habits of Highly Effective Home Care Agencies.  If you’re interested in scheduling a live demo of the Ankota software solutions, click here.

Today’s post is by Ken Accardi, who is sometimes referred to as the “Home Care Software Geek.”  Ken founded Ankota LLC to improve the efficiency and coordination of care outside of the hospital.  Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination. Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.

This article first appeared as “What Rate Should You Charge for Your Home Care Services?” on Aug 6, 2016 via the Ankota blog

Can You Pay Home Care Caregivers $15/hour or More?

There’s been a lot of talk and press about getting home care caregivers to a $15/hour wage, which equates to an annual income of roughly $30,000 per year. There’s even a movement called Fight for $15 that is organizing strikes and lobbying efforts to raise the minimum wage. According to this page on payscalecom, home care caregivers present median hourly wage is $10. The Silicon Valley darling home care company Honor is paying wages in this range and they’re able to do it because they charge more and justify their higher wage with a tech-enabled better experience.

But as long-time home care expert Stephen Tweed points out in this article, a rate increase of this nature would not be affordable to seniors or to Medicaid waiver programs and would likely put home care companies out of business.  I agree that home care caregivers should be able to receive a living wage, but I don’t think that many people will be able to afford Honor, and I agree with Stephen that if we do home care the way that we’ve always done it and raise the wage to $15, that it won’t work.Lunch At Retirement Home

Maybe We Shouldn’t Pay Home Care Caregivers the Way We’ve Always Done It?

As a comparison, let’s look at the movie rental industry…  There was a time not long ago when we went to Blockbuster to rent videos.  We would go there and browse through shelves of VHS tapes, and later DVDs to see what movie we might want to watch.  There were Blockbusters pretty much everywhere and I’d imagine that the leadership in Blockbuster thought that their business model would live forever. It didn’t work out that way and Blockbuster is now gone, replaced by Redbox, Netflix and other on-demand services.  We didn’t stop renting videos, we just do it in a different way.

Can We Do Home Care a Different Way?

First of all I believe that home care is a fantastic industry that needs to grow and not die, and I would go as far as to say that there is no way that the home care industry can fail.  But by the same token, the movie rental industry didn’t fail either – only the video rental store model failed. Skeptics at this point might argue that the failure of Blockbuster and video stores occurred because technology was able to replace people, and that in home care there is no technology that is going to sufficiently help grandma with her bath and toileting.  You’d be right, there is not a way to care for fragile people in their mid-80s and above without people, but I do believe that there’s a different way.

How Can We Pay Home Care Caregivers $15/Hour?

One way to be able to pay caregivers $15/hour is to change the model of home care from a 1-on-1 experience to shared caregiver experience.  As I’ve shared a few times, I had knee surgery last summer and was in the hospital for two days.  Over that period of time I had 24-hour care, but the care providers were not in my room for 24 hours. I would hazard a guess that my 24-hour care required less than 2-hours of 1-on-1 care time.  The rest of the time, the care team was helping other patients.

To make this work in home care the concept would be different that it is today.  Instead of sending a caregiver to an individual client’s home, what if you sent them to a suburban neighborhood where they could care for numerous clients in a one-mile radius, or in a city to care for multiple elderly clients in the same building.  With a model like this, clients could pay less for their care because other neighbors are paying too, and caregivers can be paid more because there’s more money coming in to pay them.  Making this model work would involve a lot of technology because you’d have to look at proximity for emergency support, making sure that caregivers have sufficient breaks, clients are charged fairly based on their acuity and other factors.

Tying back to the Blockbuster saga, the movies are still the main attraction and what we’re paying for.  In this new home care model, the caregivers are still the star of the show and they’ll need to do more work during their shift, but ultimately they’ll be able to get paid more and have a life outside of work, and we can have an affordable and sustainable care model.

Will Your Home Care Software Take you into the Next Generation?

Is your home care software company thinking about and talking about how you can compete in an age with more clients but fewer caregivers? If they’re thinking that the new models of payment for post-acute care won’t affect you, it might be time for new software.  Please contact us if you’re ready for next generation home care software or want to learn about our Care Transitions solutions.

If you’re interested in learning more ways to improve revenue, check out our free white paper, Why Care Transitions Is The Next Big Thing for the Home Care Industry.

Today’s guest post is by Ken Accardi, who is sometimes referred to as the “Home Care Software Geek.”  Ken founded Ankota LLC to improve the efficiency and coordination of care outside of the hospital.  Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination. Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.

This article first appeared as “The Right Path to Paying Home Care Caregivers $15/hour or More” on July 21, 2016 via the Ankota blog.

Bundled Payments are NOW! Time for Home Care to Act!

Today’s guest post is by Ken Accardi. Ken, who is sometimes referred to as the “Home Care Software Geek,” founded Ankota LLC to improve the efficiency and coordination of care outside of the hospital. Enjoy his post and feel free to comment below.

We’ve done several very popular articles about bundled payments.  If you’d like to get caught up, please read this article How Will Bundled Payments Effect Home Care?” and this articleWhat’s A Bundled Payment? Will It Influence Home Care?”  The difference between those articles and today’s offering are that the prior articles were written in future tense.  This one is talking about NOW.

Bundled Payments for Join Replacements went into effect 4/1/16

The Wall Street Journal published an article on April 1st entitled Hospitals Brace for new Medicare Payment Rules.  The article mostly focuses on payment reform at a high level with the joint replacement bundle as an example.  Note that the joint replacement bundle is now in effect for 800 US hospitals. This picture (below) from the article is a great representation of what’s going on.


How Do I Interpret These Bundled Payments?

Here’s how to understand it.  Until very recently, hospitals billed for knee and hip replacements and then discharged patients mostly to skilled nursing facilities (SNFs) and home healthcare agencies (HHAs). The SNF or HHA would then bill Medicare separately for their services.  If there was a readmission, the hospital would bill Medicare for the readmission (but might pay a penalty of around $250).bundled payments

With the bundle, the hospital gets a fixed fee of around $28,000 and needs to pay for everything.  So, referring to the diagram above, if they send the patient to a SNF they’ll lose money and if the send the patient to home health they’re likely to be profitable.  You might be thinking that since you’re home health, you’re all set and in fact you’re likely to get even more referrals. But wait, if the hospital discharges a patient who used to go to a nursing home to home health, it’s very likely that the patient is going to need help with meals, toileting, and more. Sending a nurse for 30 minutes a week and a PT for 2 hours a week won’t get it done.  Plus, the hospital doesn’t need to pay the OASIS rate, they’re going to shop for the best provider at the lowest cost, and since they’re losing money on SNF discharges, they’re going to be looking to make it up on their discharges to home.

This Post-Acute Care Picture Paints 1,000 Words

The diagram below, courtesy of Dr. Josh Luke, sums it up.  The hospital (meaning a readmission) is the last resort because the hospital won’t be reimbursed for the readmission and will likely lose $8,000.  SNFs are the second to last resort because they’re a guaranteed loss for the hospital.  Home Health is viable but CMS is trying to reduce the number of home health agencies (read our ebook on Home Health Value Based Payments).


 What Do Bundled Payments Mean for Home Care?

Seeing the glass half-full, this represents a great opportunity for non-medical home care providers to participate in the reimbursed continuum of care.  Our expectation at Ankota is that the historical divide between home health and non-medical home care will break down and that organizations will merge.  The real leaders will also use call centers to drive patient adherence and behavior change and will use automation like our product Foresight Care to get early warnings to prevent hospitalizations.

Here’s Your Homework:

If you read this article and smiled because this is the direction your agency is moving in, then I applaud you.  For the rest of you, here’s what to do:

One of Ankota’s recent whitepapers, entitled “Selling Care Transition Services to Hospitals” is available for download and we think you’ll find it useful.

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.

This article first appeared as “Bundled Payments are NOW – Time for Home Care to Act” on May 26, 2016 via the Ankota blog.