Thank You from Bob Fazzi

Please note that since this article was published, Mediware has changed its name to WellSky.

As you probably know, this is a historic time for Fazzi. First, as you’ve heard, we have been acquired by Mediware, a leading supplier of software solutions that help health care and human services providers. This is a company with strong visionary leadership and the drive and resources we need to expand our reach, impact and value for all segments of home-based health care. You will be hearing a lot more about them in the days to come, but for now, let me simply say they are exceptional. We could not have found a better partner.

Second, we now have an official change in leadership at Fazzi. Tim Ashe has assumed the role of President. This should not be a surprise to anyone. Tim has served as Fazzi’s COO for the past two years. He not only knows and has lived the history and culture of Fazzi — he helped create it. He is a passionate leader with impeccable credentials, experience, knowledge. Fazzi is in great hands.

Then there is me. It is transition time. I would be less than honest if I didn’t say that this transition is bittersweet. It is the right time and the right thing to do, but I will miss serving as leader of Fazzi. I will miss the excitement of coming to work and being part of creating innovative programs and services. I will miss knowing and watching the impact we have on thousands of agencies and millions of patients and their families nationwide. And of course, I will miss the daily interaction I have with Fazzi staff, colleagues and friends who really care about what they do and how they do it.

And finally, I must say I will miss the interaction I have had with you and thousands of other people either in person or through our programs, newsletters, training and services. As hokey as this sounds, I honestly believe we are part of a community who truly makes a difference in our country and this world. I have been awed by watching your passion and work; I have been honored that many of you have used Fazzi for services or for information and I have been inspired to know that together, we have proven that home based health care can be the center of America’s health care system.

I will continue to be involved with Fazzi and our industry in a strategic role, but for now I want to express my sincere thanks to each of you. You really have made this part of my life’s journey one of the most exciting and meaningful. I may not know every one of you personally, but there is one thing I can tell you: If you are involved in our field — regardless of your position — you are special. You really are contributing to making this world a better place. My sincere thanks.

Bob Fazzi

Why Has the Demand for Supervisory Training Grown?

In an industry where it is critical that staff in all departments be knowledgeable about new developments and new demands, training is always a high priority. Some demands are new, i.e. new regulations or new clinical procedures and some demands have always been around, i.e. how to best supervise, motivate and ensure quality staff performance.

It is easy to understand why new trainings are always being developed for new changes and requirements. It is less obvious why age old requirements such as the qualifications to be a great supervisor have suddenly become much more in demand. But, the answer is simple. More and more agency leaders have come to realize that highly skilled and motivated supervisors impact more than the quality and performance of their staff. Strong well trained supervisors impact the bottom line of an organization… the financial bottom line.

Poor Supervision, Turnover and Cost

Here are some basic facts:

  • A study by Brad Gilbreath in the Journal of Work and Stress reported in Psychology Today, stated that the number one reason “for lower than expected work productivity is not workers, but bosses.” Steve Oppermann in an article in FedSmith went on to say “that poor boss performance may affect the long term health of company employees, and that will become a financial issue.”
  • A study by Gallup reported that “employees don’t leave companies, they leave managers and supervisors. The impact that a supervisor has in today’s workplace can be either very valuable or very costly to the organization and the people who work there.”
  • Combine these studies with a study by the Society for Human Resource Management that found employers will need to spend the equivalent of 50% to 75% of an employee’s salary in order to find and train their replacement.

Do the math. If you have an employee earning $80,000 salary and benefits, it will cost your organization an additional $40,000 (50%) to $60,000 (75%). That is just to replace one employee. Other studies would say this number is conservative. Continue reading “Why Has the Demand for Supervisory Training Grown?”

Fazzi Announces Leadership Transition

Bob Fazzi, Managing Partner

This has been an exciting time for Fazzi. We have grown, added a number of incredibly strong, seasoned and passionate staff and have added new programs and services, particularly those related to Value-Based Purchasing. With growth comes the need to strengthen our overall leadership structure. Within this context, I am pleased to announce that Tim Ashe, RN, MS, MBA has been promoted to Chief Operating Officer and is now responsible for the firm’s day to day leadership.

Tim Ashe, RN, MS, MBA

Tim joined Fazzi in 2006 and became a Partner in 2007. Since that time, he has led our Operational Consulting Division to provide organizational, operational, turn around, and change management services to home care and hospice agencies across the country. Under his leadership, Fazzi has helped hundreds of agencies improve outcomes and profitability through best practices in organizational structure, clinical and operational processes, and new models for staffing, supervision and care management. More recently, Tim also assumed responsibility for our Outsourced Billing, Finance and Information Technology divisions. A long-time leader in the field of home care and hospice, Tim’s expertise and career has included a unique blend of clinical, operational, fiscal and academic roles. He is a frequent presenter at national and state conferences and is often asked to contribute to industry forums. Tim is also the Co-Director of the 2016-2017 National Home Care and Hospice State of the Industry Study.

Continue reading “Fazzi Announces Leadership Transition”

Predictions in an Unpredictable Year – 2017

The Trump administration has yet to define their strategies on home care and hospice, let alone on the entire American healthcare system as a whole. What is clear is that they want significant changes. What is not clear is what this means. Stay tuned!

Within this framework, we do have thoughts. In the big arena, we believe that the core vision and components of Obama Care will stay. We do not believe that the Trump administration will drop 20 million Americans from insurance. They will not eliminate care for those with pre-existing conditions. And, they will not eliminate the right of children to stay on their parents’ plans until age 26. Neither the incoming President nor the new Congress are advocating these changes.

But, change is coming. We are moving into a time of uncertainty, major uncertainty. And, within the framework of uncertainty, there are a number of realities that meet our criteria of high probability and high impact. Here are five predictions with recommendations. Continue reading “Predictions in an Unpredictable Year – 2017”

Celebrating Two Retiring Home Care Icons

There are two people who have done more for home care and hospice than nearly anyone who has worked in our field. They are brothers. One retired a few years ago, the other will retire at the end of this year. They are Bill Simione and Bob Simione, two incredibly talented, dedicated, ethical and generous leaders from Simione Healthcare Consultants.

I have known Bill and Bob for nearly forty years. When I joined the field in 1978, both were generous with their time helping me to understand some of the unique idiosyncrasies of the field. When Fazzi got involved with the devastation from Hurricane Katrina, it was Bill and Bob who immediately offered to join with us in a fundraising webinar, one that raised over $60,000. They have been consistent maximum donors to the Home Care PAC. Both have been on the NAHC Board and various state Boards. Both have led the Financial Manager Association, the single most effective NAHC affiliated entity.

Bill and Bob have been important advocates for our industry, testifying numerous times on key home care bills. Both have provided insightful and comprehensive presentations to state and national associations. Both have provided invaluable services to agencies and have generously given their time to provide our trade publications with facts and insights that writers were able to share with readers throughout the country.

There is a tone in our field that is different than in most other industries. It is a tone where competitors, whether agency competitors or vendor competitors often come together to share insights that can be of benefit to others. Bill and Bob not only exemplify this type of support, I believe it was their early leadership in being open to helping others that set the standard for our industry, a standard that we continue to see today.

Bill Simioine and Bob Simione didn’t simply work in the home care and hospice field, they deeply cared about it. They are industry giants that represent the ethical and moral best of our industry. We all owe them our debt of gratitude for their decades of leadership and compassion. And, from all of us at Fazzi, our sincere thanks for helping to elevate the quality and esteem of our industry and of the thousands of home care and hospice agencies throughout the US. We are a better industry and better professionals because of all you’ve done.

Hospitals and Home Care: Both Moving in the Same Direction 

As most of you know, Fazzi has just completed our fourth bi-annual National State of the Home Care and Hospice Industry Study. It is the largest and most comprehensive study in our field and while we are just beginning the tedious but critical job of in-depth analysis, it is clear that major changes are happening.

Consider outsource coding. It is clearly following the path of other critical tools used by home health and hospice agencies: IT systems, point of care systems, telehealth and OASIS scrubbing. Agencies started slow and then accelerated their adoption of these critical systems. Same for outsourced coding. Five years ago, few agencies outsourced their coding. Two years ago, in Fazzi’s 2014 State of the Industry Study, only 6.3% of agencies reported that they used outsourced coding services.

In our most recent study, the 2016 State of the Industry Study, we discovered that there is a radical shift in the use of outsource coding especially by medium to large agencies. The percentage of agencies larger than $500,000 who are outsourcing has more than tripled to 29.4%. The study also found that of those respondents who are not currently using outsource coding services, 11.2% of them plan to explore using these services in the next twelve months.

The home care and hospice field is, without a doubt, following the lead of the hospital and health system sector. According to Black Book Market Research, one of the hospital and health industry’s leading research publications, “outsourced coding, transcription, health records management and clinical documentation managed services are on a meteoric rise. 69% of hospitals now outsource CDI, audit, review and programming, up from 25% in 2014.” Of those using outsourcing, “84% expressed satisfaction and experience outcomes that exceed expectations.”

Continue reading “Hospitals and Home Care: Both Moving in the Same Direction “

Final National OASIS Testing Results and What They Mean for The Future of our Industry

As you know, I love data.  It fuels understanding, learning and improvement.  Even when the data is not good, we need to know it.  And in this issue of our Benchmark newsletter, I have some eye opening data to share.

You may recall that earlier this year we provided preliminary results from the national OASIS testing project that we conducted.  This project tested agency staff competencies on OASIS across the country.  There were 57 questions covering all areas of OASIS including a special focus on Value Based Purchasing and Star Rating items.  Here are the results:

Average Score by Position











Top Problem Areas

Neuro-Emotional/ Behavioral

Therapy Need/

Plan of Care

Respiratory Status






Scores by Type of Impact

Average Score on Items with Impact on

Average Score on Items with Financial

Average Score on Items Impacting Value-Based
Purchasing Measures

& Star Ratings





The Concern

I find this data eye opening and also concerning, because OASIS is the foundation of home care.  It is the single most important tool used by clinicians to assess the clinical status of every home care patient in the country.  OASIS is used to determine reimbursement.  It is the heart of compliance reviews.  It is the foundation for Home Health Compare public reports including Star Ratings.  It is the source for comparing agencies in the new CMS Value-Based Purchasing Program.  In short, OASIS is the foundation for the entire clinical, operational, quality and reimbursement process in home care.  Given the critical nature of OASIS, these scores should be higher. Continue reading “Final National OASIS Testing Results and What They Mean for The Future of our Industry”

It’s Time to Answer the Phone!

The phone calls are about to begin! By that I mean the phone survey calls for the 2016 National Home Care and Hospice State of the Industry Study.

With over 1,700 suggestions from you and your colleagues across the country, the questionnaire is now complete and we are about to begin making the survey calls. Every agency that participates will receive an advance copy of the findings to be released this fall. If you would like to volunteer to participate, you may do so by clicking this link.

This is our fourth biannual State of the Industry Study. Given the new world of Value-Based Purchasing and the inevitable Pay-For-Performance model that will be mandated nationwide, there is no question it will be the most important. Everything about this project is designed to help agencies improve quality and lower costs, because we know that the Invincible agencies will be those who embrace “who we were yesterday cannot be who we are tomorrow.”

I am so pleased and thankful for all of the input we received from the industry in designing this study.  A sampling of topics includes:

Continue reading “It’s Time to Answer the Phone!”

Fazzi’s National OASIS Testing Project Preliminary Results

8e908b30-d157-4786-80f5-e543854dfdd0Well, we made it, at least season-wise.  Spring!  It is absolutely my favorite time of the year.  It always feels like a new beginning.  It is not just the more pleasant temperatures, it is the excitement of seeing buds emerging on trees, birds returning to New England and the first signs of flowers.  Longer days and more sun makes it especially exciting for our colleagues in northern states.

Unfortunately, what hasn’t changed are the demands on our agencies, especially data demands.  This month I’d like to touch on a few different topics that share a common thread – research, data and the importance of continuous learning (the fun part!).

Our industry is flooded with data demands.  Data that must be reported.  Data that affects STAR ratings.  Data that impacts reimbursement and quite frankly could possibly threaten the existence of some agencies (especially in the Value-Based Purchasing pilot states).  That’s exactly why we’re so intent on providing research and data that fuels insight, learning, and improvement.

Let’s take a look at some research that we feel is important and telling.  First, as you may recall, we are currently conducting a national OASIS testing project to test agency staff competencies around OASIS across the country, and we have some preliminary results to share.  (Note that if you haven’t participated in this testing, please see the next article.)

Fazzi’s National OASIS Testing Project Preliminary Results:

Average score by position:

  • Manager 71%
  • PT 75%
  • RN 73%
  • Auditor 81%

Average score for those items impacting Value-Based Purchasing (VBP) and STAR Rating: 77%

Biggest problem areas are those that impact VBP/STAR scores:

  • ADL/IADL average score: 62%
  • Respiratory Status (specifically M1400) score: 54%

Continue reading “Fazzi’s National OASIS Testing Project Preliminary Results”

National State of the Industry Study: Fazzi Needs Your Help

Fazzi puts out a lot of information, studies, data, and other material that we hope is helpful to you and others in our field. We rarely ask for help. However, this is one of those occasions.

Fazzi is once again sponsoring The National Home Care and Hospice State of the Industry Study which focuses on the present and future of home care and hospice. This is our fourth. There is a National Steering Committee made up of leaders from all three accreditation groups, leaders of state and national associations, and leaders from agencies in every region. Like the three previous Fazzi State of the Industry studies, the results will be made available free to every agency in the country.

Here is What We Need…

To ensure the Study includes responses that you and others in our field are most interested in, a pre-survey request for suggested questions on specific topics is now online. The Online State of the Industry Input Survey is open to anyone involved with home care and hospice. The survey should take less than ten minutes.

Complete the Input Survey

I am hopeful that you can help with two things: 1) Participate in the online survey to provide input, and 2) Reach out and get others to do the same. Suggestions can be made on one, two, or all the themes that will ultimately be in the final survey.

In the past, our best questions have come from those who are closest to us, particularly you and others on the Fazzi Benchmark Email list. Please forward this email to your contacts. The Online State of the Industry Input Survey is available today through Friday, March 4, 2016. Your input will be very much appreciated. If you have any questions, please contact Kelly Dwight,

Thanks again,

Bob signature
Bob Fazzi,
Managing Partner