Home Health & Hospice Week

Follow this agency's lead to keep your business humming. If you're swimming in a sea of financial and operational data, you're not alone.

That's where the Visiting Nurse Association of Boston found itself after the transition to the prospective payment system in 2000, VNA officials said in a session at the National Association for Home Care and Hospice's 2004 National Policy Conference in Washington, DC.

The VNA's clinical, financial and information system departments had to learn to work closely together to keep the agency afloat under PPS, said VNA vice president for finance Ken McNulty in the March 31 seminar, "Blending Clinical and Financial Management Under PPS -- The Next Steps."

The trick was not just pulling data out of their systems, said VNA chief information officer Francis Lorion, but putting it in a form useful for management. VNA managers were drowning in hundreds of different reports, but "it was horribly frustrating" to synthesize and make meaning out of the data, Lorion said.

In response to the CEO's request, the IS team came up with a "Dashboard Indicators" report comprising the key "business driver" data points needed for management oversight.

"In one sheet of paper, it gives us the ability to see what's happening in the agency," Lorion told attendees of the conference, which drew 480 participants and 85 exhibitors -- up almost 25 percent over last year.

Here's what VNAB includes in its monthly report that covers the previous 12 months:

Number and type of episodes.
Average daily RAPs.
Visits per episode, minus LUPAs.
Percentage of LUPAs.
RAP timeline.
Total number of visits.
Total number of referrals.
Case mix weight.
Productivity.
Net operating income.

Case mix weights have been an especially important component, McNulty related. Every 0.01 in case mix weight costs the agency $250,000, he told a surprised audience. For example, moving the agency's average case mix weight from 1.05 to 1.06 means a quarter-of-a-million dollar increase, based on its volume.

That figure "really resonated with a lot of people," McNulty said, and helped clinicians understand why their OASIS had to be as accurate as possible.

By tightening up OASIS procedures, the VNA increased its case mix weights from 0.02 to 0.07 points in the last year, McNulty said. A large contributor to the "dramatic increase" were chart reviews by outside consultants to find OASIS inaccuracies, he added.