Dancing with Your Data

Clinicians and Finance Hear Different Music and Dance To Different Drummers • Patient Outcomes vs. Bottom Line • Home Health Compare Scores vs. Unit Costs • HHRG Scores vs. Realized Revenue • Diagnosis (Disease Management) vs. Episode Costs

Not Exactly Fred and Ginger

Clinicians and Finance Not in Synch Clinicians learned financial language quicker than Finance is learning clinical operations because Clinicians already understand that: • HHRG scores translate into revenue • Fewer visits with good outcomes reduces costs • Productivity and efficiency result in lower unit costs • Better Home Health Compare scores mean better community image and more referrals

Clinicians and Finance Not in Synch How many CFOs really understand – Disease Management? – Positive Outcomes? – Patient Case Management? – Primary Nursing Model? – Staff Satisfaction?

Maybe CFOs don’t understand as much as they should!

Clinicians and Finance Not in Synch How much time has your finance staff spent – In the field with Clinicians making visits? – At patient staff meetings to learn and truly understand the ongoing care planning process? – Really trying to understand OASIS? It IS rocket science! – Understanding documentation requirements and time requirements? – Point of Care technology?

The Last Tango in Home Care

How Can They Dance Together Better? Clinicians and Finance have to listen to each other and understand what’s being said! – There must be a sincere willingness to learn – There must be a similar willingness to teach with patience and not be condescending – The knowledge levels will be different, but the improvement in the mutual levels of understanding is critical

Dance Steps Clinicians Must Learn The Clinicians generate the revenue and determine the related expense. They need to learn and understand: • What contributes to Direct Costs of their discipline • What comprises Indirect Costs, over which they have little control • How the Direct, Indirect and Total Cost per Visit by Discipline is calculated and what statistical factors cause it to vary, and why

Dance Steps Clinicians Must Learn – Compensation methodology – Incentives vs. “Productivity standards” – How revenue has been recognized

Dance Steps Finance Must Learn The Finance staff need to learn and understand: • Differences in visits and how they effect per visit costs – Admission – Follow-up – Recertification – Discharge • How different diagnoses effect the length of a visit and the documentation requirements

Dance Steps Finance Must Learn • How visit frequency factors and diagnostically specific standards of practice effect productivity, efficiency and costs per visit and episode of care • Whether their personnel cost classifications are correct • Whether revenue has been recognized with expense

Don’t Be Caught Doing A Tap Dance! • That’s what happens when someone doesn’t know the answers! • Clinicians and Finance should learn from each other and work together to find the answers • Knowledge IS the answer!

So….Shall We Dance? Clinicians and Finance are starting to dance – They are learning from each other – Conversations are constructive and positive – What they have learned has modified their approaches to practice and understanding

They are now starting to work together and become a team in rhythm!

The Revenue Recognition and Cost Per Visit Rumba Finance and the Clinicians have agreed on revenue recognition and established new costs per visit RN $ 125.75 PT $ 122.30 OT $ 123.50 ST $ 119.25 MSW $ 102.70 HHA $ 65.80 Tele-health per day (365 days) $ 5.30

Your Numbers Should Rock, But Not Rock Your World! CHF episode with telemonitoring $ 2,515.00

Revenue Costs of RN PT OT ST MSW HHA Telehealth Total Profit (Loss)

@ 125.75 122.30 123.50 119.25 102.70 65.80 5.30*

Visits/Days 6.58 2.84 0.61 0.06 0.20 3.05 13.34

827.44 347.33 75.34 7.16 20.54 200.69 190.80 1,669.30 $ 845.70

Your Numbers Should Rock, But Not Rock Your World CHF episode without Telehealth Revenue Costs of RN PT OT ST MSW HHA Total Profit (Loss)

@ 125.75 122.30 123.50 119.25 102.70 65.80

$ 2,515.00 Visits/Days 8.58 2.84 0.61 0.06 0.20 3.05 15.34

1,078.94 347.33 75.34 7.16 20.54 200.69 0.00 1,730.00 $ 785.00

Your Numbers Should Rock, But Not Rock Your World! COPD episode Revenue Costs of RN PT OT ST MSW HHA Telehealth Total Profit (Loss)

$ 2,461.00 @ 125.75 122.30 123.50 119.25 102.70 65.80 5.30

Visits/Days 8.01 2.73 0.63 0.04 0.25 2.97 0 14.63

1,007.26 338.88 77.81 7.16 4.77 195.43 0.00 1,631.31 $ 829.69

Your Numbers Should Rock, But Not Rock Your World! CVA episode Revenue Costs of RN PT OT ST MSW HHA Telehealth Total Profit (Loss)

$ 3,744.00 @ 125.75 122.30 123.50 119.25 102.70 65.80 5.30

Visits/Days 5.94 5.86 2.75 1.79 0.22 3.79 0 20.35

746.96 716.68 339.63 213.46 22.59 249.38 0.00 2,288.70 $ 1,455.30

Your Numbers Should Rock, But Not Rock Your World! Diabetes Mellitus episode Revenue Costs of @ Visits/Days RN 125.75 12.24 PT 122.30 2.47 OT 123.50 0.58 ST 119.25 0.09 MSW 102.70 0.23 HHA 65.80 3.19 Tele-Medicine 5.30 0 Total 18.79 Profit (Loss)

$ 2,744.00 1,539.18 302.08 71.61 10.73 23.62 209.90 0.00 2,157.12 $ 586.88

Now for The Lady’s Part

Dancing with Data Not Unlike Dancing with a Partner • Contrary to popular belief….you are quite intelligent • You’re not on data overload, you just need to learn new skills - no industry thrives on lack of info • P4P does not stand for pray for performance • Using quarter-old data or the wrong data is like dancing a quarter beat behind the music

Dancing with Data Not Unlike Dancing with a Partner • Real-time data allows you to respond to changes in rhythm and obstacles on the dance floor immediately, when it matters • The judges (CMS) use one standard to evaluate your clinical outcomes their own CMS risk-adjusted outcomes • Remember, it doesn’t matter how well you dance, it matters how well the judges think you dance

Dancing with Data Not Unlike Dancing with a Partner • Benchmark data tells you where you’ve been…… set your goals • Real-time data tells you where you are…...…set your strategy Data is one of your most • Trended data monitors your powerful tools. Learn all strategy…….track your the dance steps. progress monthly You can’t learn to dance • Predictive modeling alerts and the night OASIS edit data helps you of the ball. influence your outcomes

Benchmarks for Today • These are not your mother’s outcomes • Know where you stand with CMS at all times • Know where you stand in comparison to others, but focus more on what you can control August 2006. Source: SHP database

Benchmarks for Today • You generate the revenue • You control clinical outcomes • You influence costs

Benchmarks for Today • CMS focuses on management of disease • Clinical and financial benchmarks need to be disease-specific and must be looked at in context to one another

Tango with Trends Look for “bad months”, then drill down to determine contributing factors

Face-to-face with your performance

Clinical Outcomes Impact Profits • Under P4P, this is now a financial report! • Finance needs to understand outcomes and what impacts them, so they can allocate resources appropriately - this might include supplies • Finance and Clinical need to understand riskadjustment and how their score may impact revenue

SHP reference = 1,304 home health agencies

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Clinical Outcomes Impact Referrals

Diversify and show your data to referral sources!

Out of Breath or Out of Time? • Which clinical outcomes: – – – –

drive visits? drive other cost factors? are associated with hospitalizations? tend to decline faster than others? are tied to key diseases/conditions?

Good Outcomes Start with Good Data • Audit 100% of OASIS assessments • Audits within assessments and from one assessment to the next - that’s where declines occur • Audits must include disease-specific edits • Give immediate feedback to the clinician

Tiptoe with Telehealth • Decreased skilled visits • Improved outcomes • Enhanced profitability • Higher satisfaction rates

Hospitalization by disease - risk adjusted for telehealth patients

Paso Doble with Predictive Modeling •Take control of your outcomes proactively, before they’re calculated by CMS - the ultimate goal of P4P •Automate the process of identifying patients at risk for • falls • hospitalizations • declining outcomes

Samba with Satisfaction MedPAC and CMS placing heavy emphasis on patient self management . Data begs the questions: • is your agency spending enough time on patient training? • are staff being encouraged to shorten visits at expense of satisfaction? • is revenue at risk under P4P? 72%

“Teaching was adequate to……”

Swing with Staff Accountability

Compliments of At Home Care •% of assessments completed within 7 days Oneanta, NY •% Therapy down-coded episodes •Avg. case mix by clinician •% adverse events due to documentation error •Adherence to company policies

Understanding Visits In Perspective How do your visit rates compare to others in the competition? – – – – –

with LUPA’s without LUPA’s including all disciplines by discipline by diagnosis

Cha Cha with Case Weights Financial Data .

Copyright 2005 SHP,

Cha Cha with Case Weights Know how your case weights vary…... •by location? •by date? •compared to a current benchmark? •what are the contributing factors?

Compliments of Louisiana Home Care

Disco with Drill Downs • Which clinicians are leaving $ on the table? • Which documentation items are problematic? • Aim education at the right person at the right time

These two nurses are doing a different dance!

Viennese Waltz with Visits and Profitability

• Drill down to determine calculations • Under P4P, diseases will be managed, not HHRG’s • Visit benchmarks by disease help you determine how well you’re managing conditions

Flamenco with Financial Benchmarks Dashboards provide a quick glimpse of current performance. They should be provided with a benchmark and along with the ability to drill down to the patient level.

Partnering with Process • • • •

Process and efficiency will make or break your agency How does your efficiency compare to others? Poor process will be penalized in P4P! CMS wants to have minimal interaction with you

Dancing with the Stars • Waltz your way into P4P • Don’t tap dance around the issues • Be flexible and bend over backwards for quality • Get in step with finance and clinical • Perform like a champion • Get into the Quality Pool and win the competition! Barbara Rosenblum & Nigel Clarke United States 9-Dance Champions 2005

Your Final Report Card Matters • DanceSport Superbowl Pro/Am Championships International Standard (Waltz, Tango, Viennese Waltz, Foxtrot, QuickStep) The Finals [December 11, 2005, Luxor Hotel, Las Vegas, Nevada] • 1 Nigel Clarke with Barbara Rosenblum • 2 Tibor Kerekes with Hiroko • 3 Igor Litvinov with Sibyl Yang • 4 Oleg Suvorov with Carol Shen • 5 Ken Liu with Erin Pick • 6 David Weise with Barbara Gore

Your Dance is Just Beginning!

Speaker Contact Info Pat Laff, CPA, Managing Principal Pat Laff Associates [email protected] 843-671-4170 Barbara Rosenblum, CEO Strategic Healthcare Programs www.SHPdata.com 805-963-9446