Home Health & Hospice Week

Efficient visit scheduling most popular weapon against increasing fuel prices.

High gas prices are once again dogging home health agencies, but here are ideas to contain the pain.

1) Geographic scheduling. It's time to get deadly serious about scheduling visits as efficiently as possible, experts agree. Larger agencies that can assign whole teams to a geographic region will fare better with scheduling visits efficiently, notes consultant Betty Gordon with Simione Consultants in Westborough, MA.

"I have always seen a lot of back-tracking and sending someone across town and back again on one day to see patients that are in the same geographic area," observes consultant Jim Hamilton with David-James in Baltimore. HHAs "need to have well defined areas and manage the schedules instead of allowing the employees to manage them."

When visits are scheduled geographically, some employees can carpool to patients' homes, notes Karen Hinkle with the Kentucky Home Health Association. Staff can also take mass transit, notes Kathleen Anderson with the Ohio Council for Home Care.

2) Keep visit times, staff flexible. The best way to make scheduling most efficient is to allow for variations in visit times and staffing. However, that can be difficult when patients prefer certain staff and visit times, notes Dan Hull with the Utah Association for Home Care.

Clients sometimes don't understand the reasons for the adjustments, Hinkle agrees.

HHAs should reiterate they have never been able to promise a patient a certain visit time, unless it is a time-sensitive treatment, Hamilton urges.

4) Cut down on unnecessary visits. Review care plans and schedules to identify and eliminate unnecessary trips to patients' homes, recommends consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT.

3) Use telehealth. A prime way to avoid unnecessary visits is to implement a telehealth program. "High gas prices make clear that payment for telemedicine is past due," notes Peter Cobb with the Vermont Assembly of Home Health Agencies.

But there are some serious obstacles to telehealth implementation. Many agencies don't have the money for the initial investment telehealth systems require, notes Casey Blumenthal with MHA...An Association of Montana Healthcare Providers.

Plus many agencies don't like that Medicare doesn't recognize their telehealth costs on the cost report, even if the prospective payment amount for a patient served by telehealth remains the same. And for HHAs with significant managed care contracts, often managed care organizations pay for home care by the visit and don't reimburse anything for telehealth, Gordon notes.

4) Give the gift of gas. HHAs who don't want to raise mileage reimbursement rates but want to ease employees' gas-related burdens often are turning to gas gift cards, reports Marcia Tetterton with the Virginia Association for Home Care.

"Although this doesn't fully compensate for the huge jump in prices, it demonstrates that the agency is concerned about [employees'] increased costs and is willing to share the burden," Hamilton says. "If gas prices come down to reason, then the agency may decide to no longer issue the gas cards."

Agencies can give the cards when prices hit certain levels, or they can hand them out as gifts and prizes at events, Anderson offers.

5) Review mileage records. You can help economize on gas prices by reviewing the mileage records of those staff who incur the most miles, Hamilton suggests. "Look carefully at their itineraries to see if efficiencies can be obtained."

6) Pay up to the limit. If your budget can swing it, reimbursing up to the IRS limit is the simplest way to ease employees' fuel burdens without adding to their taxable income, notes consultant Tom Boyd with Rohnert Park, CA-based Boyd & Nicholas.

7) Offer extra payment. If you already pay up to the IRS limit, you can still offer extra reimbursement. HHAs are offering per-visit add-ons of $1 to $3 when gas prices skyrocket, Boyd notes. Ohio agencies are offering an additional "energy expense" for each visit, Anderson adds. And one of Hamilton's clients offers a $250 per year stipend to help offset the cost of operating a vehicle.

However, be aware that such payments are counted as employee compensation and thus are taxed, labor law experts warn.

8) Use company cars. After last year's gas spike, HHAs started using more company cars for employees to drive, Hinkle notes. Being thus prepared has helped some agencies when this year's gas hike hit.

This strategy can be a valuable recruitment and retention tool, Gordon notes. And a fuel-efficient fleet may achieve significant savings over employees' own gas guzzlers.

HHAs that use agency-owned cars should also be "very specific about the caseload and productivity expectations for their staff," McNamara advises.

9) Educate staff. Saving on gas can be a team effort. Munson Home Care and Home Services in Traverse City, MI includes gas conservation ideas in its employee bulletin, says director Linda Rutman. You can find such tips on Web sites like www.fueleconomy.gov,gasbuddy.com and www.howtoadvice.com/SavingGas.

10) Avoid unnecessary travel. In addition to cutting out extraneous visits to patients' homes, agencies should also seek to eliminate unnecessary visits to the office, McNamara urges. That may mean using automation to avoid dropping off paperwork, for instance.

Munson Home Care has begun conducting branch meetings via teleconference instead of in person, when appropriate, Rutman says.

11) Restrict service area. HHAs may have to limit travel to certain geographic areas to keep costs under control, Anderson says.

12) Step up lobbying. When gas prices are highest is the time to remind lawmakers' that home care needs adequate funding to provide a vital service.

That may involve lobbying state legislators for Medicaid increases, says Brian Ellsworth with the Connecticut Association for Home Care. Or it may mean lobbying state and federal legislators for telemedicine funding, adds Dan Hull with the Utah Association for Home Care. With another market basket index freeze looming for 2007, HHAs also need to remind federal legislators of why the inflation update is so vitally needed, industry reps say.

13) Don't overreact. Whatever methods agencies decide to employ to combat high gas prices, they need to avoid knee-jerk reactions to every fluctuation that comes along, McNamara urges. "The energy issue and its associated cost is not a temporary problem treated with a band-aid solution," she says. Agencies must opt for a long-term, well-planned strategy versus a short-term overreaction.