Transcript Let’s Review the Critical Role Managers Play In This Effort

Engaging Employees
through Functional
Leadership Strategies
Pennsylvania Homecare Association
Annual Meeting – May 2012
Cindy Campbell RN BSN
Associate Director Operational Consulting
Fazzi Associates, Inc.
©2012
It’s a Changing World!
In a world of change.....there is no standing still
©2012
The Future of Home Care
Begins with the History of Home Care
1980-1986:
Growth of Home Care
1987-1991:
Decline, Denials &
Staggers Law Suit
1991-1997:
Growth and FFS
1997-2000:
Decline and IPS
2000-2007:
Growth and PPS
What’s Next? Want to Guess?
©2012
Medicare-Certified Home Health Agencies
11,815
10,914
9,403
8,955
10,184
9,407
7,804
7,057
5,730
2,924
1980
1990
2002
2004
2006
2007
2008
2009
2010
©2012
Source: CMS/CSP, Table VI.3, Other Medicare Providers and Suppliers Selected Years, December
2011 and MedPAC, Report to the Congress: Medicare Payment Policy, March 2012
2011
Home Health Future
Industry Challenge – Do More With Less
● 2011: Standard 60-day episode rate was reduced by
2.5%.
● 2012 and 2013: Market basket update was reduced by
1%.
● 2014 to 2016: A phased rebasing was implemented to
lower payments to a level to reflect changes in average
visits per episode and other factors that may have
changed since rate was originally set.
©2012
● 2015 and following years: Market basket was reduced
by multifactor productivity for each year.
Growth of Hospices
3,389
3,533
3,258
3,073
2,870
2,643
2,464
2,349
2002
2003
2004
2005
2006
2007
2008
2011
©2012
Source: MedPAC, Report to the Congress: Medicare Payment Policy, March 2010 and NAHC, 2011
Hospice
● In 2010, more than 1.1 million Medicare beneficiaries
received hospice services from more than 3,500
providers, and Medicare expenditures totaled almost
$13 billion. (MedPAC)
● In 2010, an estimated 1.58 million patients received
services from hospice. (NHPCO)
©2012
● For 2010, 44% of all deaths in the U.S. were under the
care of a hospice program. (MedPAC)
Future Hospice Payment Reform
Recommendations
MedPac 1/2012 – “U-shaped” reimbursement:
● Increase payments per day at the beginning of the
episode & reduce payments per day as the length of
the episode increases
● Provide an additional end-of-episode payment to
reflect hospices’ higher level of effort at the end of
life.
©2012
MedPAC’s View of Home Health
2000
2010
Percent
Change
7,528
11,815
57%
Total Spending
$8.5 billion
$19.4 billion
129%
Users
2.5 million
3.4 million
37%
90.6
123.8
37%
Agencies
Number of Visits
©2012
Source: Changes in supply and utilization of home health care, 1997-2010, Table 8-1, MedPAC
Report to the Congress: Medicare Payment Policy, March 2012
©2012
“Medicare spending on home health increased 84%
from $8.5 billion in 2000 to $15.7 billion in 2007. The
rise of home health spending leads to concerns about
the potential for improper payments due to fraud and
abuse.”
-Department of Health and Human Services,
Office of Inspector General
Study on Documentation of Coverage Requirements
for Medicare Home Health Claims
©2012
Heightened Monitoring
● 1997: Office of Inspector General (OIG) found 40% of total services
in home health agency claims did not meet Medicare
reimbursement requirements. (Four state review, CA, IL, NY, and TX)
In 1999 review, found unallowable or highly questionable claims with
charges totaling about $675.4 million.
● 2009: Suspicious billing patterns (particularly in Florida’s MiamiDade county). More than 65% of the county’s claims were outliers,
much higher than the national average.
1 Source:
Committee on Finance United States Senate, Staff Report on Home Health and the
Medicare Therapy Threshold, September 2011
©2012
● 2011: U.S. Senate Committee on Finance initiates inquiry into home
health therapy practices at Amedisys, LHC Group, Gentiva, and
Almost Family after a Wall Street Journal analysis of therapy
utilization patterns. 1
Heightened Monitoring (continued…)
● Obama Administration: elimination of fraud, waste and abuse a top
priority.
● Health Care Fraud Prevention & Enforcement Action Team (HEAT).
● Affordable Care Act enhances screening and enrollment
requirements, increased data sharing across government, expanded
overpayment recovery, and greater oversight of private insurance
abuses.
● In 2011, Medicare Fraud Strike Force Teams charge 323 defendants
who allegedly billed Medicare more than $1 billion.
©2012
● Health care fraud prevention and enforcement efforts result in
record-breaking recoveries totaling nearly $4.1 billion (largest sum
Source: HHS,
News
Release, February
2012 year, 2011)
ever
recovered
in a14,
single
HH Office of Inspector General
Medicaid Integrity Program Report – FY 2011
Medicaid Projects in FY 2012 Work Plan
©2012
ECONOMIC RECESSION




©2012
Epic bust of credit bubble
Unsustainable debt and deficit burdens
Entitlement programs in hot debate
Medical bills contribute to > 50% of
bankruptcies (many among people who are
insured)
 Medical spending exceeds 16% of GDP
 Per capita spend is >50% higher than any other
developed country
 Healthcare Reform also debated with variable
levels of adoption
LOW QUALITY DESPITE THE SPEND
“Ranking 37th — Measuring the
Performance of the U.S. Health
Care System”
NEJM | January 6, 2010 | Topics: Health Care Delivery
Christopher J.L. Murray, M.D., D.Phil. and Julio Frenk, M.D., Ph.D., M.P.H.
©2011
©2012
Quality is a Problem
1. Institute of Medicine: Over 98,000 patients die each year due
to hospital errors.*
2. Health Affairs: 1of 3 hospitalized patients are harmed while in
the hospital.*
3. OIG: In October 2008 alone, 134,000 experienced at least one
adverse event.***
4. Health Affairs: In 1.5% of hospitalized Medicare patients, a
harm event contributed directly to the patient’s death.**
5. Health Affairs: 44% is clearly or likely preventable.**
Sources:
©2011
©2012
*To Err Is Human, Institute of Medicine, 1999
** Hospital Errors Ten Times More Than Thought, Health Affairs, April 7, 2011
***OIG, Adverse Events in Hospitals: National Incidence Among Medicare Patients, Nov. 2010
Incredibly High Hospitalization Rates
1. Medicare patients over age 65 are admitted to the
hospital over nine million times annually.
2. 19.6% of Medicare patients discharged from a
hospital are readmitted within 30 days.
3. 28.2% of Medicare patients are re-hospitalized
within 60 days.*
4. Home care’s re-hospitalization rate nationally is at
27%. One out of four patients are re-hospitalized.
©2011
©2012
Source: * New England Journal of Medicine, 2009, pages 1,418-1,428
High home care hospitalization
rates means…
$6,400,000,000
to take care of home care patients re-hospitalized.
Costs are Out of Control
©2012
Home Care’s 27%
hospitalization rate means…
891,000
home care patients are hospitalized every year.
©2012
High
Hundreds
and
thousands
Hospitalization
of patients
and
families
Rates
suffer the consequences.
Means…..
©2011
©2012
Options Being Considered and Their Goals
1. Value Based Contracting: Work together and lower
costs.
2. Patient Centered Medical Home: Improve quality, lower
costs, and be more patient focused.
3. Care Transition Programs: Improve quality and improve
patient experience. Chronic care or all patient focus.
4. Bundled Payments: One payment to cover the services
for the patient across health sectors.
©2011
©2012
5. Accountable Care Organizations (ACOs): Work
together, lower costs, and improve quality.
What are the
Goals of all These Initiatives?
1. Save money.
2. Improve quality outcomes.
3. Improve patient experience.
4. Address patients with chronic disease.
5. Reduce unplanned hospitalization.
©2011
©2012
6. Increase the use of technology, EMR, and
telehealth.
Projected Marketplace
● Agencies are anticipated to consolidate; too many
providers than desired at present.
● Proposed/new payment constructs will compel agencies to
compete on cost per visit, clinical outcomes achieved (acute
care hospitalization rate) and patient satisfaction.
● System-based alignment will be desired; optimally
collaborating within a continuum of care-through end of life.
● Care will move to the least expensive, least restrictive and
most desirable ‘space’ – on and around the patient’s body/in
the home and work setting when possible.
©2012
The Delta Study to
Reduce Hospitalizations:
A National Study to Reduce
Avoidable Hospitalizations
Through Home Care
Dr. Bob Fazzi, Co-Director
Eileen Freitag, Co-Director
Fazzi Associates
©2012
October 2011
Facts on the Delta Study
● Sponsor: Delta Health Technologies
● Co-sponsor: National Association for Home Care
& Hospice
©2012
● Affiliated Sponsors
• Home Health Quality Improvement (HHQI) National
Campaign
• NAHC Forum of State Associations
• Community Health Accreditation Program
• The Joint Commission
• American Physical Therapy Association
• Fazzi Associates, Inc.
Interesting Insights
● Twenty-two distinct strategies
were identified by the field.
● Most agencies we studied used
more than one strategy.
National average: ten.
● The top five strategies did not
cost money.
©2012
● Agencies who were successful
were also very “intentional” in
their efforts to reduce
hospitalizations.
The Problem and the Opportunity
Strategy
Fall Prevention
Agency Awareness & Support
Front Loading
Medication Management
24 Hour Availability/Response System
Staff Education
Care Management
One Person in Charge
Patient/Caregiver Education
Risk Assessment
% in Top 20% % in Top 20%
Lowest (Good) Highest (Bad)
95.7%
93.5%
90.3%
76.8%
77.8%
75.7%
77.8%
75.7%
70.8%
67.8%
93.9%
91.4%
87.6%
81.2%
79.3%
79.0%
75.2%
70.4%
70.4%
71.3%
©2012
What Does This All Mean?
● All practices can work… and can fail.
● The difference in success and failure is not the
practice, but the implementation of the practices.
● For most agencies, the answer will not cost money,
can be immediately implemented and will be
effective.
©2012
● It starts with the development of a new model,
one based on accountability and leadership.
Accountability Is Key
•
Accountability: An obligation or willingness to accept
responsibility for one’s actions. Webster Dictionary.
•
Accountability: The obligation of an individual or
organization to account for its activities, accept
responsibility for them, and to disclose the results in a
transparent manner. Business Dictionary
•
Accountability: Making a commitment and keeping
that commitment in a timely and quality manner. Fazzi
SafeSide Program
©2011
©2012
You Need a Leader… Not a Manager.
Leadership and Accountability Make a Difference
Management works in the system;
Leadership works on the system
Stephen R. Covey
©2012
Why Supervisory Management Training
Is So Critical to Retaining Staff in Home Care
● Focus: One million workers and eighty thousand managers
in four hundred agencies.
● Length of Study: Twenty-five years.
● One Goal: What leads to retention of staff?
● Finding: While there are many reasons why an employee
initially takes a job in an organization, how long that
employee stays with the company and how productive he
or she is while there is determined primarily “by his
relationship with his immediate supervisor.”
Source: Break All the Rules: What the World’s Greatest Managers Do Differently. Marcus
Buckingham & Curtis Cuffman
©2012
Reflecting on a Bad Experience
● Think of a specific situation - past or present - when
the way that your supervisor behaved discouraged
your growth:
oWhat was the situation?
oHow did you feel about it then?
oHow do you feel about it now?
©2012
Why Supervisors and
Managers Fail at Supervision
● They fail to make expectations and how success will be
measured clear to staff.
● They don’t provide staff with the training and support
they need to do the job.
● They assume all staff are the same and supervise them
all the same way.
● They don’t hold their staff accountable.
● They don’t provide consequences for staff who are not
accountable or staff who do not perform adequately.
©2012
Reflecting on a Good Experience
● Think of a specific situation - past or present - when
the way that your supervisor behaved encouraged
your growth.
oWhat was the situation?
oHow did you feel about it then?
oHow do you feel about it now?
©2012
Seven Goals of Supervision
1. To clarify job expectations, i.e. how success will be measured –
Measures of Success.
2. To assess the competency levels of your staff and train them to
meet job expectations.
3. To delegate responsibilities to your staff based on their proven
competency levels and hold them accountable.
4. To support your staff on the job.
5. To build the confidence of your staff.
6. To increase staff satisfaction and retention.
7. To help your staff grow personally and professionally.
©2012
Questions
1.
Who is your most
“challenging employee?”
2.
Why are they so
challenging?
3.
How have you tried to deal
with them?
©2012
Outcome Management System
How Does the Agency Make Their Goals?
● CEO must be held accountable for achieving the
agency’s measurable goals.
● Department leaders must be held accountable for
achieving the department’s operational goals that
support the organization’s goals.
● Supervisors, managers and staff must have
performance or measurable work outcomes that help
ensure their department meets their operational goals.
©2012
Do You Know What
Your Target Should Be?
Organizational Goals
Outcome Measure
Profitability
11.4% Profit/Medicare
Episode (MedPAC)
Exceptional Quality
Top 20% of Home Health
Compare
Satisfied Patients
Top 20% of Patient
Satisfaction Service
Satisfied Referrals
Satisfied Staff
5% Growth from Previous
Year
Turnover less than 15% for
all positions
©2012
For a Management System to Work,
You Need Three Types of Goals
1. Agency goals: Clear organizational and outcome goals for
your agency. You monitor and manage your agency by
managing your outcomes.
2. Department Goals: Each department must have clear
measurable goals that support agency goals, Department
goals support agency goals.
3. Employee Goals: Employee goals support the department
goals.
o
If employees are successful, your department will be successful.
o
If your departments are successful, your agency will be successful.
©2012
Outcome Management System
How Does the Agency Make Their Goals?
● Every staff person at every level must know what
measurable outcomes “Measures of Success” they
must achieve to be a success.
● Staff must have the skills and competencies to meet
their Measures of Success.
● Managers must hold staff accountable.
● Leaders must hold managers accountable.
©2012
Four Phases of the
Outcome Management System
1. Determine the “Measures of Success” for each staff
person.
2. Ensure each staff person understands their Measures
of Success.
3. Train and ensure they have competences to succeed.
4. Delegate and hold accountable.
Note: Using a collaborative process helps to
ensure buy-in and success of this effort.
©2012
General Rules About the
Measures of Success
1. Closer to service delivery, the
more specific the Measures of
Success.
2. The further from service
deliver, the more general the
Measures of Success.
3. Failure to achieve the
Measures of Success represent
failure of BOTH the employee
and his/her supervisor.
©2012
Measures of Success Example:
Professional Field Clinicians
Home Care and Hospice
1. Complete documentation and transfer data in a timely
and quality manner.
2. Meet or exceed productivity standards at “x” visits.
3. Strong people skills, i.e. proactive customer service with
all three customer groups – patient/family, referral
sources and colleagues.
4. Proven clinical quality as measured by????
5. Personally accountable and follow-through with
commitments – up, down, all around.
6. Sharing knowledge, professional experience, skills,
mentoring with colleagues.
©2012
Setting the Stage
Start With the Measures of Success
1. Job Expectation Rule: Make sure staff know what they
are expected to do. Measures of Success.
2. Skill Development Rule: Make sure staff person is
trained and has the skills to succeed.
3. Accountability Rule: Hold staff person accountable for
meeting the job expectations you know they can do.
©2012
The Ten Rules
of Supervisory Excellence
1. Job Expectation Rule. Measures of Success.
2. Skill Development Rule. Based on Rule 1.
3.
4.
5.
6.
Accountability Rule. Based on Rules 1 & 2.
Individual and Team Morale Rule.
Feedback Rule.
No Embarrassment Rule.
7. No Surprise Rule.
8. Chain of Command Rule.
9. Don’t Go It Alone/Protect Yourself Rule.
10. Personal Modeling Rule.
©2012
If Staff Are Not Supported and Not
Held Accountable, What Does It Mean?
● Staff learn that standards don’t matter. “Our managers
don’t mean what they say.”
● Staff have no idea what success is. “If the productivity
goals are not real, then what do I need to do to be a
success?”
● Morale and motivation is affected. Good performers
quickly realize that those who don’t perform are not
held accountable and good performance really doesn’t
matter.
● Department goals are not met. Agency goals are not
met.
©2012
The Three Major Premises of
Functional Management
1. There is not one, but a number
of supervisory approaches good managers can use
when supervising and motivating employees.
2. All employees are not the same. Different employees
function at different levels of skill and motivation.
3. Optimal supervision can be most effectively achieved
by adjusting the supervisory approach to the
functional level of each employee.
©2012
The Two Major Components
of Employee Functioning
● An employee’s level of functioning is determined by
how well they are functioning on the job.
● There are two key factors to measure:
oAbility: Does the employee have the skills and
knowledge to consistently do the job in a timely
and quality manner?
oMotivation: Does the employee have the
confidence and willingness to consistently do the
job in a quality and timely manner?
©2012
Clarifying Motivation
● Confidence: Is the employee self assured and believe
that he/she can do the job in the manner that is
expected?
● Willingness: Is the employee willing to do the job in
the manner that is expected.
● High Motivation: High Confidence and High Ability.
● Low Motivation: Either Low Confidence or Low
Willingness.
©2012
To Increase Quality Using the Outcome
Management Strategy, You Need:
● Management systems that track progress in your key
outcome areas.
● Management outcome reports that are
understandable and actionable.
● Supervisors who have skills to supervise and to hold
people accountable.
● Leadership who holds supervisors accountable.
©2012
The Supervisory Process
Clarify Job Expectations
+
Provide Training/Skill Development
+
Provide Direction and Support
+
Hold Staff Accountable
They Come
Through
They Don’t
Come Through
Rewards
Consequences
Praise
Recognition
Acknowledgement
Greater Authority/Control
Reprimand
Tighter Monitoring
Shorten Time Lines
Less Authority/Control
©2012
Attached to everything that you
do in your agency,
is the care of people in need.
©2012
LEADERS ARE
ACCOUNTABLE FOR ADVOCACY
©2012
fazzi.com
[email protected]
800 379 0361
●
●
©2012