Question:
I know that Fazzi Associates has an Operational
Review service where you review all the operations
of an agency and make very specific recommendations
for improvement. I also know that you are one of
the few firms to incorporate Lean Management techniques
in your recommendations. Within your Operational
Reviews, are there common problems that you see
among the agencies you work with?
Answer:
Before we respond, it is important to first understand
the reason an agency might choose to have an Operational
Review. In most cases, they are initiated by senior
agency directors who recognize their agencies are
underperforming or new directors who are anxious
to get a full review of the agencies they will be
managing. In both scenarios, the goal is to streamline
operations and ensure every department is focused
on high performance and improvement in three major
areas: quality outcomes, financial outcomes, and
OASIS performance. We review marketing, intake,
clinical performance and productivity standards,
quality assurance, medical records, IT, accounting,
finance, billing, human resources, and the Organizational
Structure/staffing patterns. We look at everything
from structure to process to practices to outcomes
and most importantly, we give very specific recommendations
for improvement.
The
answer to your question with regards to common problem
areas is yes… and no. Yes, there does tend to be
specific problems that consistently show up in most
agencies. However, each agency is different, which
means there are always operational, process, and
system problems unique to each agency.
With
that said, there are three problems that we do commonly
see:
-
Agency
staffing costs are too high or misaligned.
Agencies are not structured in a way that ensures
the highest possible operating and quality outcomes
at the most efficient cost. Additionally, the
clinical model that agencies are using does
not allow them to fully succeed in today's home
care environment. (The clinical model should
be built in order to fully meet the essence
of home care – providing the right services,
by the right discipline, at the right time in
order to meet the patient's needs and to achieve
the patient's quality goals.)
-
Agency
processes are inefficient. Agencies
have spent years responding to changes by creating
work-arounds and add-ons to their operating
workflows rather than continuously ensuring
that each process and workflow is efficient
and effective. This results in cumbersome and
inefficient operations where staff are frustrated
and outcomes are lower than targeted.
-
Agencies
are not maximizing their Medicare revenue.
Agencies are consistently underscoring their
patients on the OASIS data set and not coding
the episode properly - leaving revenue on the
table.
After
problem areas are discovered, we find that it often
takes an external source to come up with clear,
very specific recommendations with substantiation
and rationales for what changes need to be made.
It also makes it much easier for the leader to make
the changes when the recommendations are benchmarked
against national standards and are presented from
a highly respected outside source.
