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Surviving Your Home Health Agency Survey: Planning Ahead


Prepare for Survey In our previous post we provided a checklist of items to have handy if your home health agency is being surveyed by a state surveyor.  But in addition to the documentation listed there are a number of things you can do with your managers and staff prior to a survey to ensure your survey is a success.

3-6 months prior to your survey, I would begin working these items.

  • Focus audits on all wound care patients (especially those in close proximity to your office)- make sure interventions and notes mirror actual md orders, check wound vac orders, make sure nurse is using correct supplies, cg/ patient education is noted and understanding verbalized and cg/ patient are doing wound care on days SN not scheduled.
  • Look for Pressure Ulcer teaching  on patients with potential skin breakdown.  Make sure  Oasis questions are answered correctly for wounds and that teaching in place for intervention.
  • Look at Diabetic foot ulcer teaching - if this is a therapy only patient, then it should also be taught on all oasis points by that Physical Therapist.
  • Focus audit all IV and TPN  Patients - make sure the orders are correct, medications are listed correctly, flushes are on the med profile, PICC and Groshong measurements in place, arm circumference measured for PICC patients, CG and patient education in in place with understanding verbalized and possibly return demo if patient or cg doing care.
  • Review all patient charts that have foley or superpubic catheter, and especially if they are bedbound with Aide in home.  Typically a surveyor would pick one of these patients for an onsite visit.  Make sure the orders are correct, aide care plan reviewed, teach all foley patients / CG irrigation of foley with orders from physician and make sure CG verbalized understanding.  With superpubic cath patients make sure that CG or Patient is aware to call on call personnel immediately and that this documented in the chart.
  • Review your previous survey and address all issues that you previously had and make sure you are now in compliance.
  • Make sure all filing is up to date.
  • Proactively pick out a few patients that are close to the office that might be appropriate for IV or wound visits and get those charts ready for survey review.
  • Make sure all of your admission paperwork is correct and in place.
  • Make sure that your staff is utilizing the HHABN’s, BIPPA, etc and that they are on the charts.
  • Check your refrigerators in the office, make sure they are clean and defrosted, and thermometer setting is logged daily.
  • Do a bimonthly fire drill and document it.
  • Have your Professional advisory meeting and sign in sheets ready for review.
  • Have any performance improvement and QA efforts ready for review.  Create a QA project for wounds or IV’s, and use your “clean up” to get ready for survey as part of this QA effort.
  • Clean the supply room and make sure the MSDS books are updated.
  • Update all personnel records.
  • Make sure your business license, clia, delegation of authority, and PT therapy license on the wall and in clear sight.
  • Make a fun game and prep the staff with questions so that they know how to answer surveyor questions and teach the patients about appropriate hot line numbers, how to contact on call clinician, etc.

There are several G tags / defeciencies that surveyors always start out the survey process looking for.  Once they find a few of these items they will move on to other deficiency tags and extend the survey.  I wanted to make sure to list the most common G tag deficiency items that you should be aware of:

  1. G107 – Investigate & document complaints & resolutions (under patient rights)
  2. G109 – Particpate in planning of care & treatment (under patient rights)
  3. G123 – Identifiable line of authority (under organization, services, and administration)
  4. G133 – Organizes & directs the agency’s functions (administrator- under the organization, Services, and administration)
  5. G143 – Maintain liaison & support plan of care objectives (under coordination of patient care)
  6. G144 – Documentation shows effective care coordination (under coordination of patient care)
  7. G157 – All patient’s needs adequately met in residence (acceptance of patients, plan of care, And medical supervision)
  8. G158 – Care follows written plan/ reviewed by physician (medical supervision)
  9. G159 – Plan of care covers all pertinent diagnosis (plan of care)
  10. G164 – Alert physician of changes in condition (plan of care)
  11. G165 – Administer drugs/ treatments ordered by physician (conformance with MD orders)
  12. G166 – Verbal orders put in writing / signed/ dated
  13. G170 – In accordance with the plan of care (skilled nursing service)
  14. G172 – Regularly re-evaluates the patient’s nursing needs (skilled nursing service)
  15. G173 – Initiates the plan of care and necessary revisions (skilled nursing service)
  16. G174 – Services requiring  specialized nursing skill (skilled nursing service)
  17. G185 – Services that are performed by qualified therapist (therapy services)
  18. G186 – Assists physicians in evaluation/ developing plan of care (therapy services)
  19. G187 – Prepares clinical and progress notes (therapy services)
  20. G188 – Advises / consults with family and personnel (therapy services)
  21. G224 – Written instructions by the RN or Therapist (home health aide services)
  22. G236 – Maintain in accordance with professional standards (clinical records)
  23. G331 – RN nurse must conduct an initial assessment visit (initial assessment visit)
  24. G332 – Initial assessment within 48 hours or upon start of care date (initial assessment visit)
  25. G337 – Comprehensive assessment must include review of all meds the patient is currently Taking (drug regimen review)
  26. G338 – Comprehensive assessment must be updated and revised
  27. G340 – Within 48 hrs of the patient return home after 24 hrs or more hospital stay other than Diagnostic tests (update of comprehensive assessment)

Take a deep breath! You will survive the survey process.  And remember it is the surveyor’s job to try to find something wrong with the agency you work for, so don’t take it personal.  Be honest and truthful, but never offer any more information than what they ask for.  Be the most prepared that you can be using these key points.  If you found this article helpful please let us know and we can prepare other survey updates for you in the future!  Keep up the good work.

Surviving Your Home Health Agency Survey: Documentation


Surviving Your Home Health Agency SurveyWe are often asked by our customers for tips and information on how to handle a survey. HEALTHCAREfirst Enterprise Product Manager, Janel Manning, RN, BSN shares some valuable information on how you can be ready when that time comes. Following is the first in a series of articles regarding surveys.

Your receptionist is sitting at her computer enjoying her morning coffee, and suddenly a well-dressed gray haired woman walks through the door, with her rolling cart and notebook in hand.  The woman hands her a business card stating that she is from the state office here to do your survey.  A look of panic comes across the young receptionist’s face.  She leads the surveyor into the administrative conference room and offers the surveyor a drink.  She politely closes the door a little and runs into your office... in a high pitch whispering scream, she says “the surveyor is here!”

Panic then fills the room. You sound the alarm and set out giving the managers a task of setting up a call tree and notifying all field staff that there is a surveyor in house.  You catch your breath and casually stroll into the administrative conference room.  You are told that this is just your annual review.  You are given a list of a million items that the survey will be reviewing in the next 2-3 days, including doing onsite visits with your staff!  Panic is definitely starting to hit you now!  Here we go, you gather up the troops and get to work gathering up all the information that is needed, doing chart audits in between handing something off to the surveyor.

Have you ever been in this situation before?  Survey does not have to be this stressful.  I want to go over a few things that surveyor are looking for on a visit and create a checklist for you to get ready for your next state , CAHPS, or Joint Commission survey.  You will survive!

These items are always asked for when the surveyor arrives at your building.  If you know you are due for a survey, this is a great checklist to start from:

  1. Administrative appointment form
  2. Copy of Home Health Agency (state) license
  3. Liability Insurance Certificates
  4. Copy of CLIA license (for us and those places the agency takes labs)
  5. Copy of Occupational License (RN/ PT/ OT/ ST/ MSW, etc) & personnel files for selected employees.
  6. Limited English Proficient document (identifying your translator)
  7. P&P approval form
  8. P&P Transmittals
  9. Documentation of fire drill
  10. Documentation of Emergency Prep Drill and Review
  11. Hazard Vulnerability Assessment (HVA)
  12. Minutes of Professional Advisory Board Meeting (at minimum yearly)
  13. Copy of last State Survey Report
  14. Copy of last Joint Commission or CAHPS survey
  15. Measure of Success (MOS) from Evidence of Standards Compliance (ESC) and Periodic Performance Review (PPR)
  16. Copy of your PI quarterly reports
  17. Copy of your utilization review chart audit findings with improvement plan (action plan)
  18. Copy of your utilization review minutes with appropriate disciplines
  19. Copy of Casper (OBQM/ OBQI) reports with findings
  20. List of all employees with employment status
  21. Copy of budget
  22. Copy of unduplicated census
  23. Number of discharges and discharge reason in the last 12 months
  24. Will request full charts on any patients that they will selectively go out to visit with a clinician to evaluate care provided. Usually must print this copy or provide computer access.  They will also pull additional charts based on a percentage of total census
  25. Copy of organizational chart structure hanging in the office.
  26. Copy of administrative policy and procedures.
  27. Copy of clinical policy and procedures.

But wait there is more!  Watch for our next post where we identify some items that are always a good idea to review with your managers and staff prior to a survey.

Home Care Agencies Need to Plan First, Purchase Second - Part 3


The following article is the final part in a three-part series written by Tim Rowan, Founder & President of Rowan Consulting Associates.  In part 2, Tim goes deeper into The Business Planning Process.  In this exciting final installment, Tim breaks down the System Plan outline for you.

HEALTHCAREfirst offers Web-based home health software and hospice software, designed to enable agencies to focus on patient care and not paperwork. firstHOMECARE, our home health software solution, combines powerful functionality with intuitive, easy-to-use interfaces that think and work the way you do. firstHOSPICE, our hospice software solution, was developed with input from real hospice professionals all over the country and allows clinicians anywhere, anytime access to complete tasks at the ideal time and place – the point of care.

For more information about firstHOMECARE, firstHOSPICE or any of the other products and services we offer, visit, or click here today.

The Systems PlanBusiness plans drive systems plans.

Your critical technology needs are determined by the business direction you set for your organization. Linking your information systems plans to your business plans is the easiest way to minimize frustration and help you to avoid buying a system that does not support critical business functions or that has features that you do not need.

For example, if your business strategy over the next three years includes diversifying into hospice or private duty and increasing the percentage of revenue derived from non-Medicare sources, you need a system (or multiple systems) capable of supporting all of those business lines. You also need systems that can handle the variety of contracts you can expect to encounter working with a non-Medicare population.

“systems planning is a hierarchical process requiring formulation of strategies, goals, objectives, operating plans, etc.

On the other hand, if you operate a standalone agency serving the Medicare population, and your long-term plan is to remain independent and focused solely on this market segment, your challenge is to avoid the temptation to over-buy. You will have little use for features and functions associated with other business lines.

Like business planning, systems planning is a hierarchical process requiring formulation of strategies, goals, objectives, operating plans, etc. The product of this process will be the foundation for evaluating and ultimately selecting potential technology products and vendors.

The Challenge

We assume that most home care organizations have had some experience working with information technology. Our planning approach, however, addresses the needs of both first-time and experienced systems users.

If you are planning to replace an existing information system, you are doing so for one or more of the following reasons:

a)     your present system does not meet your needs,

b)    your vendor does not meet your needs,

c)     your system is too expensive to operate and maintain,

d)    the term of your license agreement is about to expire, or

e)     you need to begin using newer technology (your vendor may be withdrawing support for an old product).

Addressing perceived deficiencies is a key consideration when planning system changes. You want to benefit from your experience – good or bad. Consider this caution, however, particularly if your replacement decision is based on an assessment that your current system or vendor is not meeting your needs:

  • For every agency dissatisfied with one particular system, there are other users who think the same system and its vendor are “just wonderful.”
  • Focusing on current system deficiencies can blind one to the absence of features you rely on that are not present in some flashy new system.

In many situations, dissatisfaction may be warranted – the system is not adequate for any agency’s needs. Two customers seeing the same product’s capabilities differently may merely reflect one agency having taken the time to learn to use all of a system’s features and the other making an insufficient effort to do so.

Replacing an information system is a significant undertaking. Through the years, the best advice has always been to first assess the level of effort they have put into working with their current information system and its vendor. Replacement is warranted if you know you have “given it your best shot” and conclude that your system and/or vendor is not likely to meet your future needs regardless of any additional effort you may invest.

New agency exception: If this is the first time you are considering use of technology in your home care organization, you are most likely just entering the market. Your challenge is different. You must choose an information system that can accommodate a rapidly growing and changing enterprise. You should pay particular attention to vendor support and look for a clearly defined approach to accommodating your need for expanded capabilities over time. Approach “bells and whistles” cautiously, and avoid the temptation to over-buy.

There are many solutions available today that target startups with small budgets for technology purchases. Most of these deploy under the “Software-as-a Service” hosted model instead of installing software on servers located in your space. Many of them use pay-as-you-go pricing instead of requiring large, up-front deposits. While revenues may be tightening, affordable options for small agencies are actually expanding.


As the business of home care becomes more complex, your information system becomes an increasingly important strategic asset. In the strategic portions of your business plan you laid out broad goals and statements of long-term direction. As a starting point for your systems plan, you should develop similar statements of information system goals and direction to support your long-term business goals.

When considering your potential systems investment from a strategic perspective, think about ways to use technology to create competitive advantage. Ask yourself the following questions:

  • Can we use technology to differentiate ourselves from our competitors? Your information system may help you differentiate the cost or quality of your services. It should certainly help you to achieve efficiencies and improve service delivery.
  • Can we use technology to foster relationships with key entities (payers, other health care providers) in our marketplace? If your system can exchange data easily with other organizations, you may be able to develop unique relationships with key referral sources or contracting organizations. Once electronic linkages are established, they are difficult to do without. With federal dollars earmarked to encourage hospitals and physicians to deploy Electronic Medical Records, the ability to electronically interact with them is more crucial than ever from a competitive standpoint.
  • Can we use technology to create new services or revenue sources? Identify areas where use of technology can add value to your services (probably in clinical or telehealth applications). The added value may be sufficient to warrant charging payers a premium for these services (e.g. case management).

If these opportunities are consistent with your business direction, include them in your long-term systems strategy.


Your business plan should span three to five years. During this time, your system requirements will change to reflect changes in your organization or marketplace. Capacity planning, addressing your need for specific systems capabilities at appropriate points in time, should address critical business applications, hardware and communications requirements.

To begin capacity planning, first develop a timeline of significant events that you have forecast in your business plan. These should include major changes in business direction, expansion into new markets, etc., anticipated during the timeframe covered by your plan.

Next, develop a list of major system requirements based on these events. For example, if the third year of your plan includes establishing a hospice program, you will need hospice-specific software prior to starting operation. You may also need additional computing capacity, telecommunications capabilities, and perhaps additional software licenses. As you develop these plans, schedule sufficient lead time to acquire and install necessary systems, train staff, etc.

At this point, you will have developed only a general picture of additional system capabilities required. The next step is to review your plans in discussions with potential vendors to more accurately define your future requirements.

Attach cost estimates to the additional capabilities required to accommodate expected business changes. Your goal is to avoid major surprises that will impede your ability to follow through on your business plan or that will significantly add to total system cost.


Develop specific objectives that will help you meet long-term system goals. Objectives should have a more immediate focus, addressing major accomplishments you expect over the next one to two years. Include objectives directly related to the operational parts of your business plan and objectives developed specifically for your systems acquisition effort.

Operational objectives should focus on aspects of your operation that you want to improve through use of technology, a key consideration during what we have identified as PPS Phase Three, the continually falling payment rate phase. These could include, for example, increasing productivity with a point-of-care clinical system, extending clinical reach with remote electronic monitoring or reducing staff training costs through online education.

Objectives should be measurable and should identify the individuals accountable for their achievement. Then, evaluate performance continuously, because these objectives measure short-term return on your system investment.

We also suggest that you develop project-level objectives specifically related to the system acquisition and implementation process. At this level you are doing tactical planning – developing schedules and specifying deliverables.

Acquiring and implementing new technologies can be a significant undertaking – developing objectives will keep management’s attention appropriately focused.


The last component of our suggested planning process is assessing your organization’s capacity and readiness to accommodate new technologies. This assessment should include:

  • Risk tolerance. Acquisition of any new technology carries some risk. Many of the technology vendors serving home care are relatively small, young companies. Their products may have only been used in a few locations so far. The greater your agency’s aversion to risk, the fewer available options you have.
  • Staff skills/experience. Evaluate your staff’s attitude toward automation. Use a formal test to evaluate their experience with systems and their readiness to embark on vendor software training. When necessary, do not hesitate to provide a basic computer training course.
  • Computing capacity. Inventory your agency’s present hardware and software. Compatibility with newer applications may be an acquisition issue. When there are two or three Windows OS versions in use nationwide, as is the case as this article is written, compatibility and standardization efforts and policies are worth the trouble.
  • Financial resources. Determine what you can afford and how you want to finance your purchase. Prices and licensing arrangements vary widely and are often negotiable.

The breadth of your search for appropriate technologies will be based, in large measure, on your assessment of these factors.


You must determine your information system priorities in order to solicit proposals from vendors and ultimately evaluate proposed systems. The priority-setting process involves both your business and systems plans. It results in a clear statement of your application-level priorities and identifies other important considerations to which potential vendors should address their proposals.

You can use this process to acquire either a comprehensive management information system or specialized software or technology products addressing a specific application. For this discussion, we describe the methodology from the perspective of an agency acquiring a comprehensive system.

If you are using The Visible Home Care Technology Selection Guide to identify likely vendors online, it will help you think about and identify most common software features and functions. This is a team task. Distribute the list of features to get input from those who will be using them before making your final checkmarks and arriving at your final prospective vendor list.


Involve as many people in the priority-setting process as reasonable. Your objective at this point is twofold – to get staff insight and buy-in. Take into account the agency’s size and complexity. At a minimum, involve key administrative and clinical staff.

To begin, compile a list of your business and systems strategies. Review each one and make note of the applications and business processes you expect to have the greatest impact on your long term goals. Impact statements can be expressed both positively and negatively – positive statements describe an application’s contribution to accomplishment of a goal, and negative statements identify barriers created by the absence of a particular feature or function.

Once you have completed this process, we suggest that you repeat it, focusing on your shorter-term business and system objectives. What should emerge is a picture of the application features and functions that are most important to achievement of both your long-term goals and more immediate objectives. These represent your most critical application requirements.

As you go through this process, make note of features and functions that are “desirable” but, if pressed, you realize you can live without them. No software package or technology product will have everything you want. These desirable features will become points of potential compromise as you move through the evaluation process.


A number of other considerations must be addressed when establishing acquisition priorities and developing criteria to evaluate vendor proposals. They include:

  • Hardware (compatibility, expandability)
  • Software (operating system, navigation, security)
  • Support (training, operations manuals)
  • Business (contract terms)
  • Financial (cost, arrangements)
  • Vendor (reputation, stability)

Evaluate the relative importance of each of these to your selection decision. While these should have some weight in your product and vendor selection, they are seldom the key determinant of your technology investment.

As you can see, the process of selecting the right systems solution is detailed and involved, As home care reimbursement methodologies evolve, certainly for Medicare providers but also for those with other payer business relationships, planning before purchasing is not only our recommendation but may well determine if your agency goes through the coming home care “winter” as one of the secure ants or the starving, begging grasshopper.

Home Care Agencies Need to Plan First, Purchase Second - Part 2


The following article is the second part in a three-part series written by Tim Rowan, Founder & President of Rowan Consulting Associates.  In part 1, Tim describes the need for home care agencies to carefully plan their next technology purchase.  In this installment, Tim goes deeper into the Business Planning Process.

HEALTHCAREfirst offers Web-based home health software and hospice software, designed to enable agencies to focus on patient care and not paperwork. firstHOMECARE, our home health software solution, combines powerful functionality with intuitive, easy-to-use interfaces that think and work the way you do. firstHOSPICE, our hospice software solution, was developed with input from real hospice professionals all over the country and allows clinicians anywhere, anytime access to complete tasks at the ideal time and place – the point of care.

For more information about firstHOMECARE, firstHOSPICE or any of the other products and services we offer, visit, or click here today.

Plan First, Purchase SecondThe Business Planning Process

You do not need an elaborate planning process to develop the statements of direction and business objectives discussed below. Consider your agency’s size and needs. Step back from day-to-day activities. Determine your future business and systems direction and continuously assess your performance.

Though once it was possible to run a successful home care agency on intuition and common sense, the marketplace has matured. Formal business planning is crucial in today’s competitive home care environment. It requires that you:

  • evaluate the environment in which your organization operates,
  • define business goals and objectives,
  • monitor progress toward achievement of these goals and objectives and
  • review and revise plans to reflect performance or environmental changes.

Planning takes place on several levels. Strategic plans typically look three to five years forward and set forth broad statements of business direction. Shorter range operational plans usually cover a one- or two-year period and include specific performance objectives. Action plans routinely cover periods of less than a year and identify steps, activities and milestones associated with specific projects or initiatives undertaken to advance operational plans.

Presented below is a brief discussion of basic planning concepts and suggested steps to follow in developing a business plan, focusing on the elements that most directly influence systems planning and technology utilization.

Build A Foundation

To begin your business plan, have a picture of where your agency is and a vision of where you want it to go. You must identify and assess forces in your business environment that help or hinder progress toward your destination.

Define Your Business. Identify your starting point – define your current business. At a minimum, characterize your agency on two bases: business focus and corporate assets.

Business Focus. The business focus for most home care organizations can be described along three dimensions.

Populations: Populations served are most often defined in terms of patient demographics. For most traditional agencies, this is the elderly. Target populations are also defined by diagnoses or diseases.

Markets: Target markets are generally defined on a geographic basis. Market boundaries often reflect logistical, licensing or resource considerations.

Services: The identification of services offered includes core services (your specialty or primary revenue source) and ancillary services (other business lines).

Corporate Assets. These are the key attributes that differentiate your agency from others in your marketplace. They can include:

Reputation: A good reputation – a marketplace image of caring, reliability, a low hospital recidivism rate and cost-effectiveness – may be your organization’s primary asset, particularly if you enjoy longevity in your market.

Linkages: Linkages can be organizational or personal. They include relationships with referral sources, other healthcare providers, payers and suppliers or vendors.

Staff: Home care is a labor-intensive, service-oriented business. Staff skills and experience often determine business direction.

Financial Resources: Generally, home care is not capital-intensive. Access to financial resources, however, can be a significant consideration for organizations planning expansion.

If you have not already done so, take time to identify your business focus and inventory your key assets.

Evaluate The Environment. Next, assess your organization’s business environment. This assessment should take place on both macro (industry-wide) and micro (target market) levels. Your goal is to identify the environmental factors and industry or marketplace dynamics beyond your control which you expect will impact your business.

On a macro level, your challenge will be to identify the three or four market factors that will have the most direct impact on your business. A variety of resources is available to help you examine macro-level trends (e.g., changing demographics, managed care) and forecast their impact on home care. Look to government and trade association sources for much of this information – the Internet will be invaluable.

Micro-level assessment of your business environment requires that you identify and examine local factors. Focus primarily on competitors, other healthcare providers, local regulatory bodies and major payers in your market. Identify the factors that you expect will have the greatest impact on your business direction.

Develop A Plan

Business planning is an iterative process. It takes place first on a strategic level, where you formulate your vision of the future. Then, on an operational level, you develop increasingly specific plans, covering shorter time periods. Finally, you identify the near-term steps necessary to put your plan into action.

Formulate a Strategy. Begin by developing a picture of your business three to five years in the future. Then, using your business definition and environmental assessment, review your focus and key assets and specify the broad goals you hope to achieve over the next three to five years. Within the home care context, goals might include patient census growth, expansion in breadth of services (diversification) or extension of services to broader populations or geographic markets.

The product of this process should be a brief list of no more than three to five key organization goals on which management will focus attention over the longer term. Each goal should include a brief explanation of your reasons for pursuing it and the assumptions made regarding market factors and resource requirements that you expect to influence your ability to achieve that goal.

Re-visit your goals at least once per year. Assess progress toward achievement and identify any significant changes in market conditions or operating assumptions that may require change in strategic direction.

“Acquiring and implementing new technologies can be a significant undertaking – developing objectives will keep management’s attention appropriately focused.

Develop an Operational Plan.

This is where the action is – where you define your key objectives and develop specific plans to achieve them. Unlike planning at a strategic level, here you consider a horizon of no more than one to two years. Establish specific criteria for measuring accomplishments, and monitor performance continuously rather than periodically.

For each long-term goal, you should also develop a limited number of objectives related directly to achievement of that goal. The objectives should focus on what you hope will be key accomplishments in the next year or two. Each objective should specify a time period for achievement and criteria for measuring performance.

Operational planning can extend to increasingly specific levels, including detailed action plans and schedules developed for specific projects or individual objectives. The depth to which you pursue this planning process will be primarily a function of organization size and management interest in monitoring and controlling subordinates’ activities.

In the final installment of this three-part series, Tim discusses how business plans drive systems plans.


Home Care Agencies Need to Plan First, Purchase Second - Part 1


The following article is the first part in a three-part series written by Tim Rowan, Founder & President of Rowan Consulting Associates.  In it, he describes the need for home care agencies to carefully plan their next technology purchase. 

HEALTHCAREfirst offers Web-based home health software and hospice software, designed to enable agencies to focus on patient care and not paperwork. firstHOMECARE, our home health software solution, combines powerful functionality with intuitive, easy-to-use interfaces that think and work the way you do. firstHOSPICE, our hospice software solution, was developed with input from real hospice professionals all over the country and allows clinicians anywhere, anytime access to complete tasks at the ideal time and place – the point of care.

For more information about firstHOMECARE, firstHOSPICE or any of the other products and services we offer, visit, or click here today.

Plan First, Purchase Second
Successfully Navigating the Technology Selection Process

Tim RowenWhy do some technology purchase decisions lead to smooth, successful implementations while others seem destined for disaster? Is there a common denominator underlying every on-schedule, as-budgeted systems acquisition that is usually missing from the unsuccessful ones? There is. In our experience, that common denominator is careful, thorough planning. Rushing toward a purchase without taking the time to plan almost certainly guarantees at least headaches, at worst failure.

Over the course of the past two decades, home care practice has changed dramatically as provider organizations expand their use of technology in response to a changing regulatory, reimbursement and public health environment. It will have to expand again in an era of reform and federal encouragement of the universal use of Healthcare Information Technology (HIT).

“Involve as many people in the priority-setting process as reasonable, to get staff insight and buy-in. At a minimum, involve key administrative and clinical staff.”

Economists have been warning for some time now that Americans need to shed the idea they will always have whatever level of care they wish. Nor will healthcare providers be free to offer unlimited care, even if they want to. There is simply not enough money in the nation’s entire economy to continue to provide current care levels for a population that is increasing not only in age but also in its incidence of obesity, diabetes and other chronic health conditions.

Not only is there not enough money but there are not enough clinicians on whom to spend what money there is. If medical and nursing school graduation rates remain flat, as widely predicted, the unpleasant prospect of healthcare rationing looms as perhaps the only option to deal with an older, fatter and sweeter nation. Even the 2010 Patient Protection and Affordable Care Act can do little more than slow the expected effects of these conditions.

Home care must be ready

Caring for individuals in their homes is an economical alternative to other care locations and its importance will grow as the above-mentioned factors exacerbate. The question is whether home care providers will be ready when called upon. Though already substantially more efficient than institutional alternatives such as hospitals and skilled nursing facilities, home care nevertheless struggles with the same issues as its bricks-and-mortar cousins, shrinking dollars and too many patients for the number of available caregivers.

Efficient use of HIT to streamline agency operations and improve patient care can only grow in importance as public and private payment systems respond to demographic and economic realities. Border technologies, those available but not widely implemented, and future technologies, those on the drawing board but not yet on the market, have the potential to extend caregiver reach without drastically increasing provider costs. More importantly, they are also likely to be more readily available than additional staff nurses are.

While cost control has always been essential to home care operations, it is ascending from essential to urgent following recently announced PPS pay rate cuts for Calendar Year 2011 that are likely to continue to shrink every year for the foreseeable future. Add to this the prospect of payment bundling, set to begin as a pilot program in January, 2013, and stepped up state and federal fraud control efforts, which are already producing increased payment denials for fraudulent and honest agencies alike, and it is clear that home care and hospice providers must turn to technology to control costs and extend the reach and accuracy of their clinical workforce.

“ You must determine your information system priorities in order to solicit proposals from vendors and ultimately evaluate proposed systems.

Many providers, however, will find that this advice stretches them beyond their traditional high-touch, low-tech comfort-zone. They may resist; they may choose the comfort zone over technology as many actually have, operating their small agencies almost entirely on paper. These agencies, however, will not survive through the gauntlet of rate cuts, bundling, aging Baby Boomers, fewer nurses and national healthcare reform. They will either be acquired by a technologically sophisticated chain of agencies or close their doors.

For beyond that comfort-zone lies not only the world of electronic billing, point-of-care systems and home telehealth but that is also where one finds major league business and information systems planning. This is where too many agencies make their fatal mistake.

Uncomfortable in this unfamiliar world beyond, they go in halfway, quickly purchasing a little technology, perhaps based on the likeability of the first sales person they meet, in the process failing to take the time and effort to base that major purchase decision on mature business planning procedures.

Proper business and HIT planning establishes the prerequisites to assure that the technologies a provider selects are a “best fit” for its current and future needs.

Business plans and systems plans are not merely indispensable, they are interdependent. An excellent systems plan ignorant of or not based on a business plan will fail. A business plan alone is not sufficient to direct systems purchase. In this section, we identify key elements of business plan development. We then discuss systems planning, and establish the link between business plans and technology acquisition plans.

First, however, a word about the above-referenced Home Health Prospective Payment System (HHPPS) rate cuts. It is important to understand why the federal government is doing this in order to be able to construct both a business plan and systems plan that will carry you through the next five years.

Anyone who experienced the government’s imposition of Diagnosis Related Groups (DRG) in the early 80’s knew what to expect when CMS introduced prospective payment to home care. Medicare hospital payment rates started on the high side and gradually found their proper level as the government gathered more data and increased its understanding. Convinced such a plan worked 30 years ago with hospitals, they are replaying it today in home care, hoping to influence your clinical and operational behavior through rules, regulations and reimbursement.

CMS started home care’s PPS journey with generous reimbursement rates in what, looking back, was clearly recognizable as phase one. They most likely did this for two reasons.

First, they could not have been sure in advance exactly what the proper rates should be until they had time to observe their impact in a live environment. They chose to err on the high side rather than inadvertently put providers out of business.

Second, they wanted to provide agencies a period to adjust their clinical and business practices to PPS’s episodic reimbursement model and to begin streamlining operations. When industry pundits’ dire forecasts that there would be thousands of unserved patients as agencies across the nation shuttered their doors did not materialize, the feds had clear sailing to move into PPS phase two.

During this second phase, reimbursement rates have been routinely challenged by MedPAC to begin flattening inflationary increases permitted during PPS’s early years. Citing substantial profit margins as their rationale for putting downward pressure on reimbursement, the feds won most battles.

The Century’s second decade is clearly identifiable as PPS’s inevitable third phase. CMS believes agencies were given ample profit margins over a sufficient period of time to both adjust their practices and acquire the technology they need to gain efficiencies. PPS is a system designed to reward the most efficient providers. Those who squandered the money during phase one instead of investing in technology may find that it is too late to catch up now that profit margins are being squeezed.

Unfortunately, this phase is already placing strains on smaller, rural providers, many of whom began their PPS journey with modest margins and few resources to invest in technology. We are already seeing some of these agencies disappear, many gobbled up by large national chain organizations, just as we watched smaller rural and inner city hospitals shutter their doors or join the nearest city’s IDN in the late 1980s.

Among the bulk of agencies profiting under PPS, those that have already invested in efficiency-producing technologies and started to slow the rate at which their costs rise will be far better prepared than those who chose to spend their early-phase profits elsewhere. If this admonition sounds familiar, look up Aesop’s “The Grasshopper and the Ants.”

In part two of this three-part series, Tim goes deeper into the Business Planning Process.


Special CMS F2F Open Door Forum


Suggested Electronic Clinical TemplateCMS recently announced they are hosting a series of special Open Door forums to allow physicians and other interested parties to give feedback on data elements for a Suggested Electronic Clinical Template for Home Health.

In order to enhance physician understanding of medical documentation requirements to support orders for Home Health services, CMS has developed a list of clinical elements within a Suggested Electronic Clinical Template that would assist physicians when documenting the Home Health (HH) face-to-face encounter for Medicare purposes.

While not intended to be a data entry form, the template will describe the clinical elements that CMS believes would be useful in supporting the documentation requirements for coverage of Home Health services. CMS will work in collaboration with the DHHS Office of the National Coordinator for Health IT (ONC) and the electronic Determination of Coverage (eDoC) workgroup which are focused on giving practitioners access to payer approved tools for the electronic submission of medical documentation.

Comments on the document can be sent to Additional information is available on the HH Electronic Clinical Template web page.

The first in the series is scheduled for tomorrow, April 22 from 3-4pm ET and it is conference call only. The instructions for participating in the special Open Door Forum are as follows:

•    Participant Dial-In Number: 800-837-1935; Conference ID # 20361722

•    Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

The remaining forums in this series will be held on the following dates:

•    Thursday, May 8th

•    Thursday, June 19th

•    Wednesday, July 16th

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What Are Home Health Software Buyers Looking For?


Cloud ComputingChoosing a home health software vendor can be a pretty intimidating task. Many times, agencies will talk with other agencies, and refer to resources such as the internet or software referral companies.

Recently, Software Advice, a company that reviews home health and hospice software, released their 2014 Home Health Software BuyerView report that uncovers the top home health software buyer trends, including top reasons home health agencies are purchasing new software, deployment preferences and the most sought-after features. They spoke with more than 350 home health software buyers across the country, revealing some key findings including:

  • 97% of buyers prefer a cloud-based system over an on-premise solution.
  • 95% of buyers are looking to replace multiple software solutions into a single suite that will meet all of their needs.

HEALTHCAREfirst offers the software and services most buyers are looking for. We provide the most comprehensive and robust suite of Web-based home health and hospice solutions in the industry, enabling our customers to adapt quickly to changing requirements and needs as well as automate agency functions quickly. For more information about how we can help you put patients before paperwork, visit our website today!

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Effective Revenue Cycle Management for Home Care


Revenue Cycle Management (RCM)Revenue Cycle Management (RCM) consists of the steps required in claims processing to ensure you are paid for the services you provide.  A solid RCM process will allow you to achieve lower DSO, lower denial rates and better cash flow.

What are some key elements to good RCM?

The RCM process starts at intake.  Collecting good insurance information and verifying insurance prior to the first visit will help prevent lost revenue due to inaccurate insurance information.  It is equally important to build the checking of eligibility into your intake process.  By checking eligibility on the front end, you will see a significant drop in your denial rate. 

The process of gathering pertinent information at intake will allow claims to be released in billing much sooner and help decrease DSO.  The result of a good revenue cycle management process will allow the billing departments to focus on a lower number of problem claims ensuring a good payment process.

As Home Health agencies continue to experience growing financial pressures, you need a proven partner to help manage your revenue cycle, providing actionable insights that will allow you to make better and smarter business decisions.

HEALTHCAREfirst offers a comprehensive outsourced billing services program, allowing you to place your billing into the hands of experts, while receiving Web-based analysis and reporting of your claims data.  For more information, click here.

Legislation to Facilitate Access to Home Health Care Services Proposed


Home Health Care Planning Improvement Act of 2013Recently, Representatives Greg Walden (R-OR) and Allyson Schwartz (D-PA) along with 19 other co-sponsors introduced legislation that would facilitate easier and timelier access to home health services under Medicare.

The bill, entitled “Home Health Care Planning Improvement Act of 2013” would allow physician assistants (PA), nurse practitioners (NP), clinical nurse specialists and certified nurse midwives to order home health services for Medicare beneficiaries.  Currently, while these types of practitioners are generally able to order nursing home care and write prescriptions for Medicare patients, they are not able to order home health care.

Stated Schwartz, “We have a responsibility to provide America’s seniors with high quality, cost effective health care.  A key part of that is ensuring they have timely access to health care services in the privacy, comfort and security of their own homes.  These highly-skilled health care professionals play a central role in the delivery of primary care, particularly in medically underserved areas and are crucial to coordinating team-based care.”

Many older adults see PAs and NPs as their primary care professionals and are often required to make an extra office visit with a physician to get the in-home care they need.  As a result, many choose not to bother with the administrative and physical burden of making another visit, which can lead to the placement of patients in more expensive health care settings or could impede receiving care at all.

According to Val Halamandaris, President of NAHC, “Studies have shown that the expanded use of these professionals can result in dramatic decreases in expensive hospitalizations and nursing home stays.  We appreciate the outstanding leadership [Reps. Walden and Schwartz] have shown in helping make home and community based services more readily available to our nation’s elderly population and those with disabilities.”

In addition to increasing the accessibility of in-home health care to the nation’s senior citizens and others, this legislation could produce significant savings for Medicare.  In a 2011 study commissioned by the National Association for Home Care & Hospice (NAHC), it was estimated that in a five year period, Medicare savings would total around $91.9 million.  Savings would result from decreased administrative burden and costs for home health agencies as well as decreased administrative burden on physicians. 

To view a summary of the study, click here.

For the full text of the proposed bill, click here.

What do you think of this legislation? Share your thoughts below!

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Senator Susan Collins Voices Support for Home Health Care

CEO Bobby Robertson with U.S. Senator Susan Collins at NAHC

Recently, U.S. Senator Susan Collins [R-ME] wrote an article for the St. John Valley Times touting the importance of home care.

In her article, she points out the importance of shifting our health care focus from institutional care to home-based care.  She also discusses that not only is home care preferred by most patients, it’s also the most affordable means of care delivery. Senator Collins goes on to say, “It costs Medicare almost $2,000 per day for a typical hospital stay, and $559 per day for a typical nursing home stay.  How much does Medicare pay for home care?  Just $44 a day…slightly more than two percent of the cost of a typical hospital day.”

In the article, Senator Collins expresses her concern about the cuts that home health could see under the new health care law.  She says, “While home health represents just five percent of Medicare spending, it took a disproportionate 10 percent in Medicare payment cuts used to pay for the new health entitlement.  Moreover, these cuts are a ‘double whammy’ because they come on top of the more than $30 billion in cuts that have been imposed by the Centers for Medicare and Medicaid Services through regulation.”

We applaud Senator Collins’ stance against Medicare cuts for home health care and we stand firm in our belief that the future of health care is in the home. 

To read Senator Collins’ article in its entirety, click here.

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