Not Excited About Policies And Procedures? When Your Business Road Map Works, It Makes For A Much Smoother Ride.
Kenyon HomeCare Consulting • March 3, 2021
In consulting throughout different agencies within the US, we have seen so many different ways home health and hospice agencies operate. The thing that remains consistent and clear in all of them is that when policies and procedures do not match operations, there is always an issue. Let’s look at common things we see and where they can be landmines for agencies on a day-to-day basis.
7 Operational Landmines:
When we talk about landmines, we could mean with personnel issues, financial success, clinical practice, legal compliance, or at survey time. Having solid policy and procedures and operating manuals should be a sure guide to running your agency. In some cases, policies are not even considered as a tool. Here are 7 of the big landmines we see in agencies:
Complaint Follow Up: When the state or accrediting body follow up on a complaint, will you be able to show adequate follow up and follow thru? Does your agency all agree on what is written up as a complaint? Do staff know and understand your complaint policy. Do they follow it?
Personnel Issues: The biggest landmine here is if you don’t follow your own policy. You can’t provide 2 different kinds of disciplinary action to employees for the same offense in your manual. You may be on the hook for a lot more unemployment if you do.
Reimbursement/ Compensation: Same applies here. Wages and compensation must follow the same pattern for the employees. Your policies need to be clear as to what you will and won’t pay an employee for or you will end up paying for it all.
Labor Disputes: You have to know and follow labor laws. Make sure your policies match what is required on the federal and state levels.
Withholding Wages: This is a very slippery slope for us in the industry. In institutional settings, the employee finishes the shifts documentation before clocking out for the day. In home health, this may be best practice and what you want as a business owner, but it doesn’t always happen. Frustrated administration can say that if documentation isn’t turned in, then you don’t get paid. Be careful though, depending upon where you are, you may not be allowed to do so.
Continuity In Branches: Regardless the size of your agency, the way they run needs to match. You can’t have discrepancies between how office managers or nursing supervisors handle operating issues.
Hiring Practices: This one is huge. Not only are there legal components but also retention and financial implications as well. Your processes need to be swift and have continuity in the process of interviewing and onboarding. You already have to spend so much time and money to recruit and retain employees, but have you looked to see if you miss the mark from the minute you receive the application?
Keep Your Manuals Updated Routinely:
At Kenyon Homecare Consulting, we want to help you see policies and procedure as a tool and not a hindrance to smooth operations within your agency. We have fully customizable online manuals for all business lines and accrediting bodies. Call us today at 206-721-5091 or contact us online with any questions you may have about our services or online manuals. Please also consider joining us February 24th for our free webinar “Are You Afraid To Ask Who’s Minding The Store? Ensure Operational Efficiencies by Making Sure All Arms Of The Business are Efficient and in Compliance” at 10 am PST. Register today!
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HOPE Question and Answer Repository
Today, this article will look at little different than out typical articles. We all know the costs of losing employees and trying to hire and train new ones. It is exhausting and expensive. So, we think about our wages and benefit packages all the time. What can we do differently that makes people stay? We can’t change the job and we don’t want to keep people that don’t like the work itself. So, how do we acknowledge employees in a way that is valuable to them and that our businesses can afford to do? 5 Things To Consider About Employee Recognition At Your Christmas Party: 1. Years of Service: These can be based on milestone work anniversaries (5, 10, 15 yrs, etc.). If a person has been at your agency 11 years, you pull them up and acknowledge them in the group of employees who have been there at least 10 years up until the time they hit the 15 years landmark. This way longevity is recognized yearly. 2. Special Employee awards: Now, this may be difficult if your staff is very small, but acknowledge the employee who has gone the extra mile in the job they do. Tell the story. The employee needs to know when the employer is proud of the work that has been done. Consider a plaque or certificate. Don’t minimize the value of the employee having them to display. 3. Acknowledge all employees in the mix: Because we are a clinical industry, the administrative staff is often overlooked on day-to-day operations. Ultimately, don’t miss the chance to acknowledge the employee who was able to catch billing errors or collect on a large account. Staff doesn’t like to hear about money, but those types of collections keep Christmas bonuses in place! So, make sure the other staff knows the accomplishments of the finance department or the office manager that every caller loves to speak to. Don't ever forget the IT staff that is on call more than any clinical person in your agency! 4. Letters from the administration: Add a personal note to your staff either collectively or individually depending on the size of your agency. If you are larger, there are employees you don’t often see or get to talk to on a regular basis, so take the time so send a note with that Christmas bonus. 5. Consider the Christmas bonus: Listen, some of you can afford to do substantial monetary bonuses and that is fantastic. However, if you are not in that position, consider something in its place. Maybe small gas cards go with the letter from administration. With the cost of groceries, consider something that helps with the costs of daily living for employees. Big box gift cards in your area will always be used. You may do a lot of these things on a yearly basis to employees. All this being said, it doesn’t mean there aren’t reasons for acknowledgement throughout the year. However, your annual Christmas party is a good way to do it collectively. Between your annual party, write the individual cards to employees when you hear a patient interaction worthy of praise. Or, maybe you buy a gas card for the employee who has picked up extra shifts and always shows up on time. Ultimately, employees will feel valued. You will not regret the time, effort, and energy put into these efforts. Merry Christmas! If you want help with recruitment and retention strategies for your agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online today.
When you think in practical terms, what does your ICD 10 coding mean to the clinicians in your agency? It probably isn't as important as you would like. Realistically, your nursing staff cares about hands on patient care. If you want the code itself to be more meaningful, then you need to attach the concepts of patient care to the ICD coding. You may think the code itself goes hand-in-hand with the care, but this is not always true. As a clinician, there are concepts within the nursing care plan that are automatic and some that are instinctual based upon the body system causing the need for care. It's a given that medication, diet, and disease process teaching are going to be in the care plan (or should be). When you get to disease process, our experience shows the clinician doesn't always run deep into the specifics of the disease when it could lead to valuable interventions being included in care. For example, when clinicians do a care plan related to cardiac disease, are the interventions very broad to include all things related to any type of cardiac disease? If you have a patient with right sided heart failure versus left sided heart failure, how many nurses would assess the patient differently? Would your nurses change the frame of mind to look for distended neck veins or anorexia and nausea if the patient had right sided failure? Would they be in the head space of considering whether the patient's appetite changes are more about just having been in the hospital than about potential venous stasis in the abdomen? The point is that although there are certain interventions that would be the same regardless the type of heart failure, picking up on different symptoms and critically thinking through the cause is often missing in the hustle and bustle of the day-to-day. This is not a judgment on the capabilities of the nurses but more about how our nurses are trained to consider care planning and assessment. We have people for ICD 10 coding now. Most nurses are not in the ICD coding manual looking up their own codes anymore because of the specificity that wasn't the same 25 years ago. So, the nurses go out with an H&P from the hospital or doctors office and develop a care plan. It isn't necessarily with the coding in mind. So, we need to get back to basics when it comes to coding and clinical care. We need to train out staff to look harder at the coding. Our coding departments need to have open communication with clinicians and understand the concepts of care planning to understand if things are missing in the care plans. What about your clinical manager's role? Are these things considered when reviewing care plans? What about your record review process? Are your ICD 10 coders nurses that understand care planning and is it part of the coding process to review the care plan? These are things to consider when you look at your clinical practice as well as your coding solution. At Kenyon Homecare Consulting , we have a comprehensive ICD 10 coding department that can provide education to clinicians, accurate ICD 10 coding, care plan and Oasis review. Call us at 206-721-5091 or contact us online to see if we can help you merge the code with the clinical practice in a way to improve your outcomes and your bottom line. We will offer 5 free recodes to any agency that would like us to check the efficacy of their current coding system or talk about becoming your coding solution.
When your survey is done, is there a collective sigh of relief at your agency? Is it because it was successful and you can continue as usual? Is it because you have so much to do and now you don’t have to be at the surveyor’s beck and call? Or, maybe your policy and procedure manual just got annihilated and you are going to have a huge plan of correction with an overhaul of your manual? The latter means we need to talk about fixing your manual and what way to do it. Do I Buy An Online Manual Or Fix Mine? Well, that truly depends on you and your business. If you only have a policy or two that gets cited, updating your manual may be a quick fix for your agency. This is normally the case if someone is routinely updating it and the manual is used to run your business. Ultimately, your agency needs to keep the document a living breathing manual or it will not serve its purpose. If your policy and procedure manual is not typically updated other than for survey, then you need to consider buying a manual. Your rule of thumb should be if your agency has not updated the manual within the last 3 years, you should consider purchasing a new one. There are many benefits to purchasing on online manual: Customization: Pick a manual that allows you to fully customize policies to fit your operations. You should not buy a manual that doesn’t provide this option. You need to be able to prove to the surveyor how your agency complies with the regulation. If the policy is written a certain way and you don’t change it to meet how you operate, you will still be cited. Forms/ Documents: Certain online manuals also provide forms that coincide with the policies. This makes it easy for you to implement changes because forms are already generated. There is no reason to reinvent the wheel by making your own. Most of these forms allow you to place your logo and any specific personalization within the document. · State Rules: Several vendors have incorporated specific state rules into manuals. For instance, Kenyon Homecare Consulting offers skilled, non-skilled and hospice manuals as well as ones that have incorporated California and Washington state rules. This eliminates the individual business having to go back in and add state rules to the manual. Consulting Services: Pick a vendor that also has consulting available should you need assistance in customizing your manual to meet your state rules or specific program rules. This makes the process easier especially if you are new to the policy writing and editing. Up-to-date: This is the biggest advantage. These manuals have been updated to include the rules you need. We have seen so many agencies over the last several years not keep up with COP changes and it cost them at survey and with compliance. These manuals are routinely updated with changes so when you purchase your manual it will have the current federal regulations. Ultimately, you have to decide whether it makes sense to rewrite your manual with updates or purchase one that is currently up-to-date. At Kenyon Homecare Consulting , we offer customizable manuals for all service lines, accreditation, and incorporated with certain state rules. Please call at 206-721-5091 or contact us online before purchasing your manual so we can ensure you have chosen the correct one to meet your needs. We also offer consulting services to help incorporate your state rules should you need assistance.