Case Studies

CareSouth Performs Assessment for Southeastern Georgia Health Care System

A Health Care system in the southeast engaged CareSouth Consultants to perform an assessment of their hospital based home care agency and the linkage to the acute care and rehab facilities within the Health System. As part of a comprehensive assessment, CareSouth performed an analysis of the referral opportunity for home care. Recommendations for improvements included:

• Creation of a Central Intake department for all business lines to streamline referrals
• A collaborative redesign of the referral process with representatives from the acute care facilities and home care management
• Education of the case management department on the capabilities of home health
• CEO led summit on patient care access across the continuum
• Tracking and reporting of referrals by facility and conversion rates by home care. The assessment, completed in the second month of the fiscal year, yielded an immediate increase in referrals which has been sustained.

CareSouth met with the acute care task force working to reduce Medicare length of stay (LOS) in the hospitals. The consultants performed a clinical chart review of Medicare discharges from the health system and identified a patient population with high LOS and readmission rates. The collaborative efforts of all departments resulted in an increased referral rate to home health from 7.3% to 14.4%. The rehab referral rate increased from 25.9% to 39.5%.

An assessment of the agency financial status was performed. The agency analysis was compared to industry averages and benchmarks. A focused review was conducted on all significant variances.

LUPA episodes were reviewed for appropriateness and a process for ongoing clinical review was implemented. A significant decrease in avoidable LUPA episodes has been sustained.

CareSouth conducted an in depth study of agency productivity. Consultants accompanied caregivers on their daily visits to identify obstacles to meeting the standard. Recommendations included:

• Organization of work load
• Decreasing frequency of meetings
• Developing geographic teams
• Right sizing the field staff model with a combination of full time and per diem staff
• Published weekly results to all staff

The productivity improvements resulted in a 33.2% decrease in direct cost per visit.

While the agency administrative model total FTE complement was within the industry standards, the positions in the model were not supporting the field staff nor were they adequate for the clinical management of the agency. CareSouth:

• Redesigned the organizational structure
• Provided key functions and job descriptions
• Added a clinical team with a clinical supervisor and scheduler to support the field staff
• Moved clinical management functions from the field to the clinical team managers
• Combined three fragmented education, regulatory and quality functions into one centralized role.

The redesign and implementation was completed in month six. Pay out of severance and remaining paid time off occurred in month seven. The agency achieved a 62.3% decrease in administrative cost.

Four months after the start of the project, the agency had a positive EBITDA. It is able to support the allocations from the central business office and the hospital as well as the consulting project fees and expenses.

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