How a Better Back Office Infrastructure Can Foster Growth

Over the course of the past year, the efforts of home health agencies have been primarily focused on adapting behaviors under the new PDGM stipulations. The stress of adhering to these new regulations was compounded by the advent of COVID-19, levying an onerous burden on home health and hospice agencies.

Despite these stressors, the reduction of red tape surrounding home care regulations, an initiative the industry has been advocating for decades, has accelerated due to COVID-19. Given this new reality, home care agencies can benefit greatly from recent rulings. Given the industry’s trademark flexibility, home care agencies are not hampered by the same limitations as their brick-and-mortar counterparts, but rather are primed to make investments in the necessary services and solutions designed to assist with active adjustment to the industry’s climate.

Read on to learn how to strategically position your organization’s back office and use of technology to springboard your success in this new reality.

Preparing for growth

As you prepare for growth, there are many areas to be evaluated and internal, organization-wide questions to ask. Not only are you assessing budget, volume and trends, but also people, processes and tools of your organization. These assessments determine what is sustainable under current operations, or where additional help is necessary.

• Assess budget, volumes, trends
• Determine the “Tipping Point”
• Internal evaluation of operations

Establishing vision

Positioning your back-office infrastructure to absorb growth comes with an established vision derived from your organization’s mission and goals. To identify, or perhaps reidentify, these goals, the successful organization will form three core teams:

• Governance: Executive sponsorship team whose mission is to guide new processes and deploy consistent messaging.
• Steering: a detail-oriented group, charged with carrying out project tasks, making specific decisions and monitoring progress by ensuring the established KPIs are tracked and monitored.
• Optimization: a multi-disciplinary team inclusive of the members of Governance and Steering, subject matter experts, line managers and champions of change. The team focuses on identifying operational inefficiencies and implementing solutions.

Developing an innovation roadmap

With an infrastructure that encourages organizational agility, you develop a strategy to respond to drivers of growth, which may, at times, look more like inhibitors of growth. Your optimization team can use the below infrastructure to initiate innovation.

Goals

• Establish SMART (specific, measurable, achievable, reasonable and time-bound)
• Alleviate operational inefficiencies

Tools

• Identify available technologies
• Utilize steering committee
• Utilize clinical expertise and both the internal resources as well as external counsel

Implement

• Communicate the innovative solution your optimization team has identified
• Communicate the strategy again
• Train and retrain on multiple platforms
• Develop quick reference guides

Optimization of infrastructure

The focus for optimization of infrastructure must be ongoing rather than a one-time goal. The Steering Committee and Optimization teams must continuously assess and reassess the current state of your organization for inefficiencies. Some areas that mandate ongoing assessment include:

• Staffing models
• Intake
• Medical records
• Revenue cycle operations
• Cost benefit analysis

Optimization of data

After you establish goals, you must optimize your data to reflect each goal. If your organizational goal is to increase volume and growth, you must identify and track specific metrics, including admission, non-admits by reason, recert rate, payor mix and productivity.

You must also track quality metrics to ensure organizational goals remain well-rounded. For instance, if admissions and rehospitalization rates increase, this should be a red flag. In this and similar instances, deploy your steering committee to investigate the reason behind the spike and assess the root cause.

Optimization of processes

• For intake: Position your team to absorb growth by dividing workload. The division of workload would be between clinical and non-clinical staff. The benefits of dividing the workload include reduced overhead costs and increased operational efficiencies.
• For medical records: Assign staff members targeted follow-up initiatives. By grouping your physicians and facilities together under one staff member, you are increasing their ability to send and retrieve more documents at a time. The benefits of assigning staff members to a physician or facility helps create rapport and increases cooperation when asking for missing documents or timely signatures.
• For revenue cycle: Assign your staff a specific payor or group of payors for complete follow up inclusive of insurance verification, authorization, billing and collections. This is a payor centric model that we like to call payor pods. In this set up, your staff will become subject matter experts for their assigned payors.

Optimization of tools

Your EMR and ancillary software are your biggest assets when absorbing growth; they hold much opportunity to streamline and standardize processes. Before you try to absorb growth, you must understand if your current system is able to grow with you and if your system has the capacity to interact with ancillary software.

• For intake: Utilize a documentation tracking software that interacts with your EMR system. Ideal systems are cloud-based, have e-signature and e-faxing functionalities and reporting/analytics capabilities.
• For medical records: Implement a document tracking system to help track outstanding orders and assist with initial and subsequent auto-faxing, a system that can send the initial request on day 1, a follow up on day 7 and alert you when escalation to other forms of communication is required.
• For revenue cycle: Employ a solution with operational efficiencies that comes in the form of clearinghouses. The more you can utilize clearinghouses to submit clean claims and assess denied claims, the better.

Armed with these assessment strategies, your organization is ready to self-examine. After an extensive examination of your back office and its current capabilities, you will be able to define clearly articulated goals, benchmarks that will not only help you survive amid COVID-19, but also thrive in its eventual wake.

Have additional questions about how your organization can position its back office for success? At McBee, we have a panel of home care and hospice experts that can assist in identifying strengths and weaknesses within your current back office, as well as helping you develop a plan for optimizing existing processes.