Revenue Cycle Redesign

 Bundles / Financing 
 Team 

Agency:
HomeHealth Visiting Nurses, Saco, Maine.
 
Agency Description:
For more than a century, HomeHealth Visiting Nurses has been at home with the people of southern Maine. Whether caring for a frail newborn infant, helping an elderly patient remain independent, or providing palliative care for a life-limiting illness, HomeHealth Visiting Nurses is committed to compassion and clinical excellence.

The professional team provides the care patients need to make the transition from hospital to home where friends and family can support recovery and ease the uncertainty of illness. HomeHealth Visiting Nurses provides nursing care, palliative care, home health aide services, rehabilitative therapies, counseling and emotional support, telehealth services, community health and wellness, diabetes education and support, patient and child health, as well as an emergency response system, Lifeline.
 
Population Impacted:
HomeHealth Visiting Nurses (HHVN) is a fully licensed nonprofit organization caring for patients of all ages. HHVN provides nursing, physical therapy, occupational therapy, speech therapy, home health aide, and counseling services throughout York, Cumberland, and southern Oxford Counties.
 
Strategic Partners:
BlackTree Healthcare was a strategic partner in this program.
 
Project Description:
With the challenging times currently faced by home health and hospice agencies throughout the country, even minimal interruptions can have a significant negative impact on operations. HomeHealth Visiting Nurses experienced significant changes in their operations after completing a change to their EMR system, transition of their president and CEO, and turnover in key clinical management positions within the agency over a two-year period. The results of which impacted the agency's financial stability and created a need to redesign all aspects of the revenue cycle.

This revenue cycle redesign focused on five key areas: intake, insurance verification/authorization, orders/face to face management, scheduling, and clinical management.

The purpose of the redesign was to provide agency management with different avenues and ideas that they can pursue to perform an internal assessment of agency operations to identify areas in which they can operate more efficiently. 
 
Results:
Results included positive financial outcomes for the agency with increased productivity metrics achieved in each department. Through better utilization of the electronic medical record and electronic payment submission, as well as common tools such as Outlook, positive results were found in both the back office functionality and efficiency. The same tools allowed for more efficiency in clinical visits and in record keeping by clinicians, thus reducing agency administrative expenses.
 
Outcome Measures:
There was improvement in a variety of areas. The financial bottom line had an improvement of $1.6M broken down as $1.2M in increased revenue and a decrease of $400,000 in operating expenses. Back office productivity was improved by implementing better systems and protocols. This included outstanding authorization requests, the reduction in volume of unsigned Face to Face documentation, and missing orders (reduction of 26 percent).

These efficiencies were carried through in clinical outcomes as well. The LUPA percentage was reduced from 15 percent of episodes of care to eight percent in three quarters and a reduction in therapy utilization from 58 percent to 53 percewnt in the same three quarters.
 
Barriers to Implementation:
One barrier faced was staff turnover caused by changes in assignments and a clarification of roles due to new protocols and methods. Another barrier was the lag in acceptance by the staff. However, with leadership buy-in and the increased productivity that came with the new protocols and utilization of technology, the staff embraced the changes.