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Changing a Culture by Developing Management Tools and Implementing Pay-per-Visit Patrick Armstrong Intermountain Homecare (801)887-6185

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Page 1: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Changing a Culture by

DevelopingManagement Tools

and

Implementing Pay-per-Visit

Patrick ArmstrongIntermountain Homecare

(801)887-6185

Page 2: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Agenda

vIntermountain Homecare

vProcess of Changing a Culture

vImplementing Pay-per-Visit

vScorecards

vNext Steps

Page 3: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Intermountain Homecare

Ø4 Business LinesvHome Medical Equipment

vHome Health

vHospice

vIV Therapy

Ø13 Service Locations

Ø870 Employees

ØGross Revenue $115 million

ØCharity Care $2.6 million (annual report)

Page 4: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Home Medical Equipment

ØAnnual Revenue $36 Million

ØOxygen

ØWheelchairs

ØVentilators, and Tracheostomy Care

ØApnea Monitors

ØNebulizers

ØCPAP Machines

ØEducation and Support

Page 5: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Home Health

Ø1,200 Average Daily Census

ØAdult and Pediatric Skilled Nursing

ØPhysical, Speech, Occupational & Respiratory Therapies

ØAide Services

ØNutritional Counseling

ØSocial Services

Page 6: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Hospice

Ø300 Average Daily Census

ØPain and Symptom Management

ØFamily Education and Support

ØEmotional Support

ØSpiritual Counseling

ØVolunteer Support

ØGrief and Bereavement Assistance

Page 7: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

IV Therapy

ØAnnual Revenue $44 Million

ØAntibiotics

ØNutritional Therapy

ØChemotherapy

ØGrowth Hormone

ØImmune Therapy to Include Synagis for RSV

ØPain Medications

ØHydration Therapy

Page 8: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Intermountain Homecare Mission

To be the Homecare of choice for patients, employees, and referral sources.

Page 9: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Intermountain Homecare Vision Statements

ØWe promote a culture that is accountable, productive, nurturing and empowered

ØWe focus on customer service excellence to distinguish us in the marketplace

ØWe maintain financial viability

ØWe strive for clinical consistency and integration within the Intermountain continuum

Page 10: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Common Purpose

Intermountain Board Goals

Intermountain Homecare Goals

Service Line Goals

Department Goals - Key Indicators

Page 11: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Changing a Culture

vVisionØGood to Great

ØCrucial Conversations

Ø If Disney Ran Your Hospital

vRight People in the Right Positions

vHiring the Right People

vSetting Clear Expectations

vAccountability/Measurements

vTraining

Page 12: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Right People / Right Positions

Experienced Turnover

ØSelf Selected

ØStructure Changes

ØStaff Reductions

•Management Positions

•Support Staff

Page 13: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Hiring the Right PeopleBehavioral/Situational by Skill

Analyzed cause of deficiency

Engaged others in understanding problem

Corrected problem in a timely manner

Monitored compliance with new process

Sought opportunities to elevate patient care

Describe a situation where your unit did not meet patient care standards. How was the deficiency identified?

What was done to make improvement?

Share an example of when you utilized research to improvepractice.

Where do you see the greatest opportunity for improving care on your current unit? Describe an action you had to take to seize this opportunity.

Enforces high patient carestandards

Standards Bearer

ScoreElements of Desired Response

Sample QuestionsSkill

Page 14: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Setting Clear Expectations

ØEstablished Standards

ØMonitor Results

ØBenchmark w/ other Companies

ØDemonstrated that it could be accomplished

ØEducate

ØCoach when Necessary

Page 15: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Accountability/Measurements

1. What’s gone right/wrong: Monthly staff meetings

2. Standardization of process: Ongoing3. Peer review (visit/chart review):

Annually4. Sharing information: Regularly and

timely5. Share financial report: At least

quarterly6. Management chart review: Monthly

• a minimum of five charts

Page 16: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Accountability/Measurements

7. Share visits: At least annually8. Customer service calls: Monthly

• a minimum of five calls9. Productivity: Monthly 10. Utilization management: Monthly 11. HR Report: Quarterly 12. Infection control: Monthly13. Improvement in Corrective Action Plans

(CAPs): At least quarterly14. Event reports: At least quarterly

Page 17: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Accountability/Measurements

15. Customer service reports: Twice a year

16. Trunk/Bag checks: At least annually

17. Site specific patient care coordination meetings: Quarterly

18. Education: Review reports 2 weeks before due date

19. Referral data: Quarterly

Page 18: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Training

ØNew Employee Orientation

ØManager Training Program

ØStaff Training Program

Page 19: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Implementing Pay-per-Visit

ØDefine Eligible Positions

ØDefine Work Standards

ØCompensation

ØEducation

ØTracking Tools

ØLessons Learned

Page 20: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Eligible Positions

Ø“Thinking for a Living” by Thomas H. Davenport

ØFour Types of Knowledge Workers• Transaction Workers

• Integration Workers

• Expert Workers: “have highly complex jobs that require little interdependence. They perform judgment-oriented work that relies on their individual expertise and experience. This kind of work is typified by a primary-care physician.”

• Collaboration Workers

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Expert Worker: Clinician Productivity

“Expert workers are very autonomous, but some organizations have applied technology to key aspects of the process, such as hospitals managing and measuring doctors as they order medications, tests, and so on. Instead of specifying the details of work flow, the intervention should provide templates, sample outputs, and high-level guidelines.” Thinking for a Living by Thomas H. Davenport

Page 22: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Opportunities

ØDisciplines with Greatest Impact

vRegistered Nurse

vPhysical and Occupational Therapists

vHome Health Aides

ØFull Time Employees

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Defining Work Standards

ØEvaluated other Systems

ØIdentified different visit types based on requirements and time

ØDeveloped visit weights based on historical and expert user information

Page 24: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Implementing New Standard

ØInvolve knowledge workers in the training of the new standards

ØUnderstand existing process

ØUnderstand the “Why’s” behind the process

ØRemember that they are the experts, clarified definitions

Page 25: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

RN Visit CodesVisit

Visit Type Weight

RN VISIT 1.00RN SUPERVISORY VISIT 0.25RN ADMIT 2.00RN RECERT SKILL VISIT 1.50RN ROC/SCIC VISIT 1.50RN ADDON VISIT 1.50RN OASIS DSCG VISIT 1.33PHLEBOTOMY VISIT 0.50REFUSED CARE 0.25NOT TAKEN ON SERVICE 1.00PATIENT NOT HOME\EQUIP DEL 0.00Hourly

RN HOURLY 0.67Extended Travel (Over 30 miles, One Way) Write the # of Occurences 0.33

Page 26: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Compensation

Overall Compensation = PPV Rate + Overtime + Premiums + Mileage

Pay Per Visit Rate = Visit Credits * Visit Incentive($)

Visit Credits: Sum of weekly visit credits

Visit Incentives: Based on Discipline and Years of Experience

Page 27: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

PPV Education Tool

Page 28: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

PPV: Clinician Tracking ToolCOLUMN {A} (1) (2) (3) (4) (5) (6) (7) {B} Weekly

Visit VISIT Visit CreditVisit Type Weight Sun Mon Tue Wed Thu Fri Sat TOTAL {A} X {B}

RN VISIT 1.00 0 0.00RN SUV VISIT 0.25 0 0.00RN ADMIT 2.00 0 0.00RN RECERT SKILL VISIT 1.50 0 0.00RN RECERT VISIT NO SKL NC 1.00 0 0.00RN ROC VISIT 1.50 0 0.00RN SCIC VISIT 1.50 0 0.00RN ADDON VISIT 1.50 0 0.00RN OASIS DSCG VISIT 1.33 0 0.00RN ADMIT AIDE ONLY 2.00 0 0.00EQUIPMENT DELIVERY 0.33 0 0.00NOT TAKEN ON SERVICE 1.00 0 0.00PATIENT NOT HOME\REFUSED CARE 0.25 0 0.00Hourly

RN HOURLY 0.67 0 0.00Extended Travel (Over 30 miles, One Way) Write the # of Occurences 0.33 0 0.00

Total 0 0 0 0 0 0 0 0 0.00{C}

Sun Mon Tue Wed Thu Fri Sat TotalActual Hours Worked 0 {E} From Time Sheet

Productivity Calculations

Weekly Visit Credit 0.00 {C}

Total Hours Earned {D} 0 {C} x 1.6 hours

Actual Hours Worked {E} 0 From Time Sheet (Hours)

Difference from Earned Hours and Actual Hours Worked 0 {D} - {E} Green for Favorable (Total Budgeted Hours Earned - Actual Hours Worked) Red for Unfavorable

Compenstation Your Rate: 0

Page 29: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

PPV Impact 2004HOME HEALTH AND HOSPICE : AVERAGE MINUTES PER VISIT

Mar - Sep 2004

60.00

75.00

90.00

105.00

120.00

135.00

150.00

Min

ute

s

HH SL Avg 129.12 122.70 148.34 102.98 83.75 85.11 90.31

HH UT Avg 139.80 136.40 102.75 72.95 77.44 92.10 90.66

PT SL Avg 96.09 86.51 84.09 73.02 74.81 76.10 85.07

PT UT Avg 113.44 111.03 88.76 75.34 68.32 81.38 93.02

PT Standard 92.3 92.3 92.3 92.3 92.3 92.3 92.3

RN Standard 96 96 96 96 96 96 96

Mar Apr May Jun Jul Aug Sep

Page 30: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

PPV Impact 2005HOME HEALTH : AVERAGE MINUTES PER VISIT

Jun - Dec 2005

60.00

75.00

90.00

105.00

120.00

135.00

150.00

Min

ute

s

HH SL Avg 91.00 100.00 96.67 98.75 108.33 102.50 98.00

HH UT Avg 87.67 87.25 94.67 88.50 94.33 92.25 98.67

PT SL Avg 72.75 82.50 78.75 81.25 79.00 76.75 75.33

PT UT Avg 72.00 71.75 78.25 78.67 71.25 75.75 69.33

PT Standard 92.30 92.30 92.30 92.30 92.30 92.30 92.30

RN Standard 96.00 96.00 96.00 96.00 96.00 96.00 96.00

Jun Jul Aug Sep Oct Nov Dec

Page 31: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Manager Tools

Pivot TableØClinician Detail Report

ØDepartment Summary

Web PageØDepartment Summaries

ØClinical Details

Page 32: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Department Summary TablePivot Table

Productivity : Average Visit Time (Minutes)/Visit CreditsEmployee Name Emp Type WK15 WK16 WK17 WK18 AVG WK

CLINICIAN 1 RN-PPV 50.29 58.43 45.00 - 51.24CLINICIAN 2 RN-PPV 80.23 80.04 91.88 - 84.05CLINICIAN 3 RN-PPV - 76.68 96.19 - 86.44CLINICIAN 4 RN-PPV 81.42 94.53 95.76 - 90.57CLINICIAN 5 RN-PPV 113.00 111.50 - - 112.25CLINICIAN 6 RN 181.07 101.20 102.33 - 128.20

Average 126.23 81.88 84.03 113.29

RN/LPNBudgeted Standard Standard StandardHrs Visits/Wk Hrs/Visit Min/Visit40 Hrs 25 1.6 9632 Hrs 20 1.6 9624 Hrs 15 1.6 96

Page 33: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Clinician Detail ReportPivot Table

Clinician Name 4/3-4/9 4/10-4/16 4/17-4/23 4/24-4/30

CLINICIAN 2 WK15 WK16 WK17 WK18 AVG WK

Visit Credits(VC) 20.33 19.99 11.33 - 17.22Visits (Trips, Visit Types) 17.00 17.00 11.00 - 15.00Hours Worked 27.18 26.67 17.35 - 23.73

Productivity:Avg Total Visit Time (Min)

(Prod Hrs - Ed)/VC 80.23 80.04 91.88 - 84.05In-Home Time (Min)/VC 27.15 27.71 32.57 - 29.14Patient Mgmt Time (Min)/Visit 42.47 42.35 44.09 - 42.97Travel Time (Min)/Visit 21.00 19.06 18.18 - 19.41Education Time (Minutes) - - - - 0.00

Page 34: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Department Summary TablePortal

Page 35: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Staff ProductivityPortal

Page 36: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Clinician Weekly SummaryPortal

Page 37: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Clinician Daily DetailPortal

Page 38: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Weekly Patient InformationPortal

Page 39: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Patient Detail InformationPortal

Page 40: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Lessons Learned

ØKeep it simple

ØReduce Selection Options

ØEducate

ØMonitor Usage

Page 41: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

SCORECARDS

ØExpand to all Service Lines

ØReflect Homecare’s 5-Year Strategic Plan

ØDrill Down to Department Indicators

Page 42: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

IHC Home Care ScorecardJanuary 2006

Service Line Quality

Extraordinary Caring /

Customer Service Affordability of Care

Membership /

Customer

Attractiveness

IS Development /

System Development

DME

Joint Commission Measures

Employee Retention: Decrease 1st Yr Turnover

Utilization: Pulse Oximetry

Volume Growth: 6.4% Computerized Physician Order Entry

Pinnacle: Increase Overall Satisfaction to 4.6

2211 Ded: ($142,112) Benchmarking: AA Home Care's

HHOBQI: Readmission below Utah Avg

Employee Retention Utilization: PPS Visits/Episode = 13

Volume Growth: 8.1%

OBQI: Emergency Visits below Utah Avg

Pinnacle 2211 Ded: (112,057) Benchmarking: Fazzi

OBQI: Overall Productivity: Meeting or Exceeding Visit Stds

Benchmarking: Other Systems

Home Care Referral Survey 2211 Ded: (500,000) Volume Growth: 6.6% Billing SIPIntegration into CDRPhysician Order Entry

Green Yellow RedOn Target Possible Serious

Challenges Challenges

Greater Than (5%) of Goal

Between (5%)&(15%) of Goal

Less Than (15%) of Goal

Project Status Indicators

Page 43: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Home Health UtilizationHOME HEALTH MEDICARE PPS BILLABLE VISITS

Jan - Aug 2005

20.1

19.0

14.1

16.5

10.4

16.6

11.8

20.3

16.6

11.8

-

5.0

10.0

15.0

20.0

25.0

Salt Lake Utah County McKay Central Southern Logan Cassia Heber IHC Avg Bapt Mem

Vis

its

Page 44: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Home Health HeberUtilization 2005

HEBER HOME HEALTH MEDICARE PPS BILLABLE VISITS

Jan - Aug 2005

19.120.1

21.020.1

19.020.1

18.0

20.0 20.3

-

5.0

10.0

15.0

20.0

25.0

Jan Feb Mar Apr May Jun Jul Aug 2005 Avg

Vis

its

Page 45: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Home Health Heber UtilizationAVG YTD 2005

HHRG Guideline Episodes

Avg Total

Visits

% Over

Guideline

6 5.00C0F0S0 1 1 8.00 700%C0F1S0 9 4 12.25 36%C0F2S0 10 2 6.00 C0F2S2 14 4 15.75 13%C0F2S3 14 1 13.00 C0F3S0 12 1 30.00 150%C1F0S2 10 1 7.00 C1F1S0 10 4 12.25 23%C1F1S2 12 2 21.00 75%C1F2S0 10 14 15.00 50%C1F2S1 14 1 26.00 86%C1F2S2 14 8 12.38 C1F2S3 14 3 19.67 40%C1F3S0 12 2 7.50 C1F3S2 13 4 15.25 17%C1F4S3 22 1 22.00 C2F0S0 7 1 44.00 529%C2F0S2 10 1 9.00 C2F1S0 10 5 12.80 28%C2F1S1 10 20 25.00 150%C2F1S2 12 2 30.00 150%C2F2S0 11 10 12.00 9%C2F2S2 14 11 25.00 79%C2F2S3 16 2 20.00 25%C2F3S2 14 5 18.40 31%C3F2S2 18 3 33.67 87%Grand Total 100 20.30

Page 46: Changing a Culture · Sun Mon Tue Wed Thu Fri Sat Total Actual Hours Worked 0 {E} From Time Sheet Productivity Calculations Weekly Visit Credit 0.00 {C} Total Hours Earned {D} 0 {C}

Home Health Heber UtilizationC2F1S1 Details

Primary Clinician Patient Name

Total

Planned

Visits Guideline

Exceeds

Guideline

Mgr

Review SN Visits

AIDE

Visits PT Visits

Clinician A Patient 1 10 14 4 No 10Clinician A Patient 2 10 14 4 No 9 1Clinician A Patient 3 15 14 -1 Yes 7 8Clinician A Patient 4 17 14 -3 Yes 6 11Clinician A Patient 5 27 14 -13 Yes 27Clinician A Patient 6 15 14 -1 Yes 15Clinician A Patient 7 33 14 -19 Yes 8 7Clinician A Patient 8 37 14 -23 Yes 5 14Clinician B Patient 9 50 14 -36 Yes 5 45Clinician B Patient 10 15 14 -1 Yes 6 9Clinician B Patient 11 9 14 5 Yes 9Clinician B Patient 12 19 14 -5 Yes 18Clinician C Patient 13 22 14 -8 Yes 21Clinician C Patient 14 20 14 -6 Yes 20Clinician C Patient 15 11 14 3 No 11Clinician C Patient 16 19 14 -5 Yes 18

RETURN to SCORECARD

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IHC Home Care ScorecardJanuary 2006

Service Line Quality

Extraordinary Caring /

Customer Service Affordability of Care

Membership /

Customer

Attractiveness

IS Development /

System Development

DME

Joint Commission Measures

Employee Retention: Decrease 1st Yr Turnover

Utilization: Pulse Oximetry

Volume Growth: 6.4% Computerized Physician Order Entry

Pinnacle: Increase Overall Satisfaction to 4.6

2211 Ded: ($142,112) Benchmarking: AA Home Care's

HHOBQI: Readmission below Utah Avg

Employee Retention Utilization: PPS Visits/Episode = 13

Volume Growth: 8.1%

OBQI: Emergency Visits below Utah Avg

Pinnacle 2211 Ded: (112,057) Benchmarking: Fazzi

OBQI: Overall Productivity: Meeting or Exceeding Visit Stds

Benchmarking: Other Systems

Home Care Referral Survey 2211 Ded: (500,000) Volume Growth: 6.6% Billing SIPIntegration into CDRPhysician Order Entry

Green Yellow RedOn Target Possible Serious

Challenges Challenges

Greater Than (5%) of Goal

Between (5%)&(15%) of Goal

Less Than (15%) of Goal

Project Status Indicators

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HME Admin Write Off’s2005 HME Admin Write Off

Goals vs Actual Achieved YTD

$-

$50,000

$100,000

$150,000

$200,000

$250,000

Team or Department

2005 Actual YTD 2005 YTD Goal

2005 Actual YTD $87,430 $14,128 $136,133 $82,128 $194,914 $227,688

2005 YTD Goal $61,756 $17,195 $116,823 $71,862 $206,806 $138,822

ABN CMN Intake PAS Auth Other Adj

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HME Admin Write Off’s2005 HME Admin Write Off by Site

Goals vs Actual Achieved YTD

$-

$20,000

$40,000

$60,000

$80,000

$100,000

Site or Department

2005 Actual YTD 2005 YTD Goal

2005 Actual YTD $87,430 $51,865 $18,288 $10,000 $25,764 $75,000

2005 YTD Goal $41,647 $41,647 $13,882 $6,941 $27,764 $69,411

Provo OG Delta Heber St. George SL

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SL HME Admin Write Off’s

$-

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

Ad

min

istr

ati

ve

Wri

te O

ff

2005 Goal 2005 Actual

2005 Goal $9,735 $19,470 $29,206 $38,941 $48,676 $58,411 $68,147 $77,882 $87,617 $97,352 $107,08 $116,82

2005 Actual $21,585 $29,184 $36,633 $49,572 $58,522 $70,638 $84,018 $136,13

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

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Quality Outcomes

Dan Jones Survey June 2003:

Ø234 Home Medical Equipment Patients Surveyed

Ø“Intermountain Homecare ranked highest across the board in all categories”

ØNumber 1 in Overall Customer Service

ØNumber 1 in Service Quality offered

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Quality Outcomes (Cont.)

Intermountain Homecare:

Home Health Quality Indicators

ØOBQI Nationally published, outcomes

based quality indicators

ØIntermountain Homecare scores better

overall than National and State

measurements

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HH OBQI Quality IndicatorsOutcome Measures Time

Period 6/1/04 - 5/31/05 Risk Adjusted

Na

t A

ve

rag

e

Uta

h A

ve

rag

e

Sa

lt L

ak

e

Og

de

n

Lo

ga

n

Sa

np

ete

Improvement in Ambulation/Locomotion (Getting better at walking/moving around using less equipment)

38.0% 40.0% 49.0% 42.0% 42.0% 41.0%

Improvement in Transferring (getting better at getting in and out of bed without help)

52.0% 57.0% 67.0% 54.0% 67.0% 63.0%

Improvement in Pain Interfering with Activity 61.0% 57.0% 55.0% 64.0% 61.0% 62.0%

Improvement in Management of Oral Meds 39.0% 39.0% 47.0% 36.0% 31.0% 44.0%

Improvement Breathing (Short of breath less often) 58.0% 63.0% 73.0% 56.0% 82.0% 64.0%

Acute Care Hospitalization (Had to be admitted to the hopital)

28.0% 23.0% 28.0% 22.0% 24.0% 15.0%

Any Emergent Care Provided (needed emergency medical care)

21.0% 21.0% 23.0% 19.0% 23.0% 16.0%

Key

Score stayed the same or change by 1%Improvementy by >1%Decline by >1%

Higher Percentages Are Better

Lower Percentages Are Better

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Customer Service

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Prioritized Scorecard Prioritized Scorecard Goals by Service LineGoals by Service Line

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DME

Ø2211 Deductions (Administrative Adjustments related to a process breakdown)

ØVolume/Revenue Growth

ØCustomer Satisfaction (Pinnacle)

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Home Health

ØUtilization

ØGrowth

ØProductivity

ØCustomer Satisfaction (Pinnacle)

ØJoint Commission

ØOBQI

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Hospice

ØVolume Growth

ØCustomer Satisfaction (Perforum)

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IV Therapy

Ø2211 Deductions

ØCustomer Satisfaction (Pinnacle)

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Homecare

ØQuality

ØCustomer Service

ØClinical Consistency and System Integration

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Next Steps

ØFinalize ScorecardsØIdentify Access LevelsØFollow Through on Action Plans for

Goals with Serious ChallengesØFormalized Monthly Review of Goals

with Executive Team by Responsible Business OwnersØLead by Example Every Day

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Contact Information

Patrick Armstrong

Manager Decision Support

Intermountain Healthcare(801)887-6185

([email protected])


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