June 6, 2016 — Forcura was recently featured in the below article from DecisionHealth's weekly newsletter, Home Health Line. For over 20 years, every issue of Home Health Line has delivered regulatory news, proven best practices, and tools to help healthcare agencies provide excellent patient care and increase profitability. For more information on the newsletter, visit http://homehealthline.decisionhealth.com, or call 1-855-CALL-DH1.
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Agency evaluates, redesigns its revenue cycle after staff turnover, EMR change
Examine your processes when it comes to tracking physicians’ orders — and whether technology can help. Doing so as part of a deeper examination into its back office helped one agency achieve significant savings.
HomeHealth Visiting Nurses of Southern Maine used Verona, Wis.-based Epic for its electronic medical records (EMR) but didn’t understand the best way to use it, says Michael Freytag, managing director of Conshohocken, Pa.-based BlackTree Healthcare Consulting.
Data-wise, the agency only used to track whether unsigned orders had increased or decreased from one month to the next, Freytag says.
Blacktree showed the agency how to use Epic to examine, for instance, how many calls each individual employee made to physicians per day and how many orders each employee was able to get back signed. This led to greater accountability among employees and helped the agency identify where problems existed.
Taking drastic steps such as this to fix its back office helped the Saco, Maine-based agency improve its bottom line from a $1.4 million loss in 2013 to break even in 2014 and operate at a 2% margin in 2015, says Donna DeBlois, the agency’s president and CEO.
Among the other changes the agency made: It began using Jacksonville, Fla.-based Forcura, which helps health care providers with document management.
Forcura’s system serves as an add-on to Epic. It helps the agency track what information has been sent to physicians and what information needs to be received. Better use of technology has significantly increased the agency’s cash flow, Freytag says. The agency is able to get claims out the door faster.
Ultimately the changes HomeHealth Visiting Nurses made across several departments helped with employee engagement and overall workplace satisfaction, DeBlois contends.
And happier employees lead to happier patients, DeBlois says. The agency earned four stars in the latest HHCAHPS star ratings.
The changes also helped with employee productivity, too — clinicians now visit about five patients a day instead of four, DeBlois says.
Agency scrutinizes itself after shakeup
HomeHealth Visiting Nurses of Southern Maine determined in 2013 it needed to redesign all aspects of its revenue cycle after it switched its EMR vendor, transitioned to a new president and CEO, and experienced turnover in vital clinical management positions.
With BlackTree’s help, the agency worked to revamp intake, insurance verification/authorization, orders/ face-to-face management, scheduling and clinical management. Among the issues identified:
• The correct physician signing face-to-face documentation often wasn’t confirmed at the time referrals were received. And the number of referrals entered per staff member was not being tracked. Now, clerical employees are assigned the responsibility of following up with referral sources to confirm who the correct physician is, Freytag says. The agency also utilized an EMR report to track referral entry productivity per employee.
• Insurance verification/authorization was a paper-intensive process. Instead of using portals, the agency generally sent faxes to insurance. That has since changed; the agency now uses a clearinghouse.
• Employees used Excel to schedule visits. Now the agency relies on its EMR, and as a result more users are able to see clinicians’ schedules. Clinicians post schedules to the EMR, and schedulers assign visits through the EMR. Clinicians are now held responsible for communicating visits that need to be covered in a timely manner.
• Clinicians were not assigned a geographic region to cover. Now they are. This helps reduce mileage and clinicians’ travel time, and it promotes the continuity of car, Freytag and DeBlois say.
Ways to improve your back office
• Reexamine intake staffing. HomeHealth Visiting Nurses reduced the number of nurses it used in intake. It did so through attrition and by eliminating one position. Instead of having eight clinicians and one support staff member in intake, the agency now has four clinicians and four support staff members, DeBlois says. Since HomeHealth Visiting Nurses’ main referral source also uses Epic, the information the agency needs for referrals generally comes electronically. If orders are complete upon referral and there are no complexities, a nurse is not required at intake, DeBlois believes.
• Investigate clearinghouses. HomeHealth Visiting Nurses used to rely significantly on making phone calls and faxing information to insurance companies. But now it uses a clearinghouse to upload documents. Relying on this technology is allowing the agency to get paid days faster than it used to, Freytag says. — Josh Poltilove (jpoltilove@decisionhealth.com)
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