Why is Compliance Important in Home Health and Hospice?
“More Money, More Problems.”
Except in home health, it’s, “More Patients, More Staff, More Referral Sources, More Regulations, More Documentation, More Clinician Turnover, More Problems,” and not always “More Money”. Sound familiar?
Everyday home health and hospice owners and Administrators ask us to help them solve their operational, cash flow, and survey preparedness challenges. As a top national home health and hospice consulting company, our answer is usually “More Compliance”.
After helping hundreds of agencies, we believe compliance neglect is the top cause of failed surveys, health department walk-ins, referral source turnover, patient adverse events, legal complications, and provider terminations. While the type of compliance strategies agencies employ can differ, there is no question that compliance-focused agencies have a longer lifespan, fewer problems, and yes, “More Money.”
In this article we will explain what compliance means and why it’s important to home health agency and hospice agency owners, giving you more clarity around issues with your business's operations, profitability, and longevity.
What is compliance in home health and hospice?
Compliance means you are following the law. That’s it. Sounds simple BUT it’s not. During the Medicare enrollment process, it’s much easier to maintain regulatory compliance due to the small census and short timeframes between the first patient and the survey.
Once agencies are active, it’s much harder to maintain proper compliance because of the increased complexity surrounding a growing census, such as additional and rotating staff members, limited time and money, demanding referral sources, cutthroat competition, unreliable vendors and contractors, and general healthcare related urgencies, such as the need to quickly onboard an RN who can see a patient 20 miles away tomorrow morning. In these day-to-day problems, many home health and hospice agencies start to cut corners just to stay afloat.
Why is a compliance program important in home health and hospice?
Because settling for less than minimal compliance is a very slippery slope. Depending on the level of regulatory neglect, a common event like the health department walking in unannounced due to a complaint, can turn into an Immediate Jeopardy situation, on a provider termination track.
A fall can quickly become a legal situation if skilled nurses or therapists didn’t educate a high fall- risk patient on home safety and fall precautions. A survey can easily become conditional if major elements of disaster planning were ignored. Even a Board & Care’s negligent practices can lead to a hospice agency shutting down. And they’re not wrong.
Home health and hospice agencies are heavily regulated for several very good reasons:
Healthcare is a heavily regulated industry
Just like the airline industry, the primary goal in healthcare is to ensure no harm to the patient, caregivers, staff, vendors, and other participants. In other words, the patient should not be worse off because of your service.
The secondary goal in healthcare is to stabilize and improve outcomes. Laws are in place to help agencies improve the health and safety of patients while avoiding negative outcomes, adverse events, fraud, and abuse. This is achieved through prevention and mitigation practices, as well as a large emphasis on data-based quality improvement.
4 reasons home care settings create unique challenges
Unlike facility-based healthcare settings such as Hospitals and Skilled Nursing Facilities (SNF), home health and hospice agencies face unique challenges due to services being performed at the patients’ homes.
Limited control over the patient’s environment: Certain aspects of facility-based healthcare are easier to manage because staff have control over the patient’s environment. For example, it’s much easier to ensure that the patient doesn’t fall if you can control home hazards like loose wires and slip rugs. In the home setting, clinicians can provide education to patients and caregivers, but ultimately can’t control the furniture layout or floor clutter. In a facility-based setting, safety best practices are automatically applied, leaving fewer variables to account for.
Problems are harder to identify: In-patient providers can find problems easier since the patients, caregivers, clinicians, staff, and healthcare all exist under their roof. Besides being visually accessible, documentation is readily available since charting is factored into the staff’s time. Staff and patient interviews are easier since everyone is onsite. Home health and hospice providers rely heavily on patient or caregiver self-reporting for information. This requires vigorous and proactive open communication between the agency’s office staff and their patients. Otherwise, the only information received about patients and their care comes from their service providers, who rarely submit visit documentation within allowable timeframes and obviously can have conflicts of interest in reporting problems.
Supervision and staff support are not immediately available when needed: Facilities and other in-patient practices have onsite supervisors and support staff. For example, if a staff member is identified as not following protocol, supervisors are on location to provide direct and immediate hands-on guidance, training, and assistance. In home health and hospice, clinicians are alone at the patient’s home. The only way to observe their work is by scheduling a tandem supervisory visit. The only way to understand the quality of care and ability to follow procedure on a day-to-day basis is through documentation review, or patient reporting and feedback. This makes identifying problems harder.
Resources are not readily available if needed: In-home health settings also make unexpected situations harder to deal with. Since home health and hospice clinicians are alone in the patient’s home, if an emergency, health crisis or other unexpected situation arises, the clinician doesn’t have access to policy/procedure manuals, medical supplies, equipment, medications, other staff members, and managing physicians. Facilities have all these resources onsite; thus they are more prepared to respond to random problems.
Regulations address health and safety issues
Skilled home health agencies and in-home hospice agencies aren’t today’s innovations. These company types have been around for decades. As with any system, complexity increases with additional actors, factors, and time. Over the decades, regulations have been added as preventative measures to previously problematic situations. For example, Emergency Preparedness became conditional in 2018, as a reaction to the healthcare system failings in New Orleans after Hurricane Katrina in 2005.
6 ways compliance ensures business longevity and profitability
Maintaining daily compliance is transformative to home health and hospice agencies for the following reasons:
Patients are healthier and safer
Staff are more educated and safer
Operations are less chaotic, leading to decreased staff turnover
The agency is less susceptible to complaint surveys, ADR’s, and other financially devastating circumstances
Business longevity is ensured by passing surveys and other audits
Profitability improves by avoiding costly mistakes, lawsuits, and inefficiencies
Why do home health and hospice agencies neglect compliance?
On paper, it’s shocking that so many agencies wing their regulatory compliance. If you’ve ever worked in a home health or hospice agency, however, this is common practice, and understandably so. If you have to do a committee meeting or staff a patient; which will you choose? If you have to run payroll or do your 3-year budget; which gets priority?
Many agencies snooze on compliance until they are approaching their 3-year Medicare deemed surveys. Then they “clean house” just in time for their inspections, spending thousands of dollars in the process, sometimes even pausing their patient intake for days, weeks or months. The minute the surveyor walks out, they are back to their old ways and vulnerabilities.
But there is another way.
First Steps Towards Implementing a Compliance Program
Now that you understand what compliance means and why it’s important to your agency, you may be ready to take the first steps towards less stress, healthier patients, happier staff, longer business life, and higher profits.
If you are considering implementing a compliance program, a good place to start is evaluating the types of compliance structures that might be a good fit for your home health or hospice agency.