Blog and Helpful Articles

What We’re Reading – 80% of Americans Fear Converting Health Data into Electronic Form

As our country moves more rapidly into the widespread adoption of electronic medical records (EMRs), fear of improper access of their healthcare data or misuse of the information.  Of the people surveyed, 80% of Americans expressed concern about converting medical information into electronic form. Identity theft topped the list of fears, particularly by co-workers or other employers. It seems their concern is not so out of line.  Twenty percent of American employees admitted they would steal electronic data from their employers.  HIPAA has grown tentacles since its enactment 15 years ago and violations, even accidental ones, can carry stiff penalties.

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What We’re Reading – How important is it to conduct Exit Interviews?

Regardless of the size of your company, it is important to ensure that you have some idea as to why employees leave. It certainly will help you to make decisions across the board as to what and how much to invest to retain your employees. The cost of hiring a new employee and the retraining involved for every turnover, will most likely exceed the cost of analyzing the exit interviews and possibly investing time and some monetary fund’s to make improvements that will make a difference in employee retention.

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Part Five: How do I find patients?

This last installment of our five-part series explores the crucial need for patients and referrals to keep your business afloat and profitable.

Long before you embark on the expensive and lengthy licensing (and accreditation) process, it’s important to solidify the ability to bring patients and revenue into your agency or registry.  Sadly, some clients are clueless about how to find patients; when ill-prepared, they can quickly become stymied and discouraged by the difficulty and competitive nature of long-term care.  As if there wasn’t enough pressure, the State of Florida can terminate licensure if an agency does not serve at least one patient in a 60-day period.  By now, I think we’re all clear on the importance of referral sources, right??

Some suggestions include becoming active in the community and spreading the word early in the process. Put out solid “feelers” with all types of referral sources – physicians, discharge planners, various healthcare personnel – so that you can obtain patients as soon after licensure as possible; this is critical to success and maintaining licensure. Keep in mind the very strict marketing guidelines and Patient Brokering statutes in Florida.  Violations carry stiff penalties and even criminal sanctions.

Another idea is to mine areas where the adult children of your potential patients can be found, especially if your business will offer personal care services.  These members of the “sandwich generation” are excellent sources and you will do them a huge service to lighten the challenge of caring for Mom or Dad.

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Part Four: How much capital do I need to get started?

So far in this five-part series, we’ve reviewed various aspects of a new long-term care-related business venture.  We’ve looked at the types of care that can be provided, the various business models and staffing requirements. Today, we’ll explore the all-important question of required capital.  Unfortunately, it’s a question we really can’t answer with any degree of certainty.

First, we suggest that you explore the marketplace to determine the range for the common expenditures of your preferred business model, and then familiarize yourself with the financial schedules in AHCA’s licensure application (for home health agencies and nurse registries).  Based on your projected expenses (salaries, rent, insurance, taxes, etc.) and expected revenue from all sources, the schedules will provide you with the minimum capital required by the State of Florida.  Remember that a CPA must certify HHA financials, so even if you prepare the preliminary schedules yourself, it’s a good idea to ask your accountant to review your work so you can accurately plan your capital requirements. The licensure application for HHAs and NRs cannot be submitted without this information.

Remember that proving to the State your financial ability to operate is paramount.  The State has specific formulas and targets so it would be a huge mistake to under-estimate this step.  If the projections look unrealistic, your application may be denied or deferred.  The bigger issue, however, is that improper projections can make a start-up agency appear financially sound “on paper” but unable to maintain financing until the agency is operational and generating revenue.  We always counsel clients to maintain a very lean operation, and minimize expenses as much as possible. Although this sounds intuitive, you would be surprised at how many clients go “all out” only to get in a bind when licensure, accreditation and referrals take longer than initially modeled.

Homemaker/Companion Services do not require financial projections; however, a good business venture can be crippled by insufficient capital so we recommend that you work with your CPA to ensure you’re properly funded.

Tomorrow, we’ll examine the last piece of the long-term care business puzzle: finding patients.  See you then!

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Part Three: How much staff do I need to get started?

In Part Three of this five-part series, we’re discussing staffing needs for the various Florida business models.

For a non-skilled home health agency, Florida requires an administrator, alternate administrator and registered nurse that meet specific requirements.  Because one individual can occupy two positions, this requires a minimum of two individuals.  For skilled agencies, the registered nurse assumes the position of Director of Nursing which places the clinical oversight and responsibility squarely on that person’s shoulders.  For a nurse registry a qualified Administrator and an RN who shall be available to patients 24 hours per day, are required. This could be the same individual.

If you’re not clinically oriented and/or don’t meet the state’s criteria for these positions, you will need to retain the appropriate individuals. After securing capital, that’s probably the biggest challenge.  The key personnel will probably not do very much in the initial stages, learn the policies and operational aspects of the agency and be available and ready for survey.  So paying these key people is the issue in a fledgling organization with no revenue but specific requirements.

Several models have been pursued, from a nominal monthly stipend to hourly wages.  Obviously, the preparation time before survey can range from three months to a year, depending on the business model and regulatory body workloads, so this can represent a significant overhead expense to your new business.  We find that this is the one “make or break” issue to a new client’s licensure success so do your homework and inquire with friends and colleagues to find the right mix of clinical and business acumen at a reasonable price.

Securing direct care personnel is slightly easier.  Your accountant should advise you on whether these staff members are better classified as employees or independent contractors.

We’ll see you tomorrow for Part Four of the series regarding capital requirements.

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Part Two: What business model makes sense for me?

This is Part Two of a five-part series on exploring a long-term care-related business.  Yesterday, we discussed the different types of care that can be provided.  Today, we’ll discuss your choices of business model.

Home health agency (HHA):  State licensure is required.  In Florida, this will generally suffice to accept patients covered by third-party insurance plans although Florida adds the requirement of accreditation.  Accreditation is akin to a “Gold Housekeeping Seal of Approval” (are we dating ourselves with that descriptor?? LOL) by an independent organization which, in essence, stakes its reputation on the quality of your organization.  Accreditation requirements surpass state licensing rules by a long-shot, but the oversight and resulting processes can give you a competitive advantage in the marketplace, especially compared to older Florida HHAs that pre-date this requirement. Serving Medicare or Medicaid patients requires accreditation and separate applications for certification.

HHAs can provide skilled or non-skilled care.  Nurse registry (NR):   State licensure is required; NRs can provide skilled or non-skilled care, but they may not be Medicare-certified.  Accreditation exists for NRs and here, too, the requirements exceed Florida licensing guidelines.  You may want to base this decision on your feasibility studies of the NR field and payor requirements.

Homemaker/Companion Service (HCS):  State registration – not licensure, per se – is required in Florida, and there are no financial requirements or stringent regulations.   In every case we’ve seen, an HCS can be up and running in 30-60 days after application to the State.  One key distinction is that HCS cannot provide any personal care.  (Check Part One for a definition of personal care.)  Depending on your business model, an HCS may be just the ticket to tap into the long-term market.

Join us tomorrow for Part Three of the series concerning staffing.

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Part One: What type of care do I want to provide?

Home health agencies can provide skilled or non-skilled care.  Skilled care requires the skills of a licensed professional, such as a nurse or therapist.  Non-skilled care is custodial or personal in nature, encompassing assistance with Activities of Daily Living (ADLs) such as bathing, grooming, eating and toileting, and/or Instrumental Activities of Daily Living (IADLs) like using the telephone, cooking, housekeeping and marketing.  This last category represents activities that individuals need to perform in order to maintain independent living. As expected, third party payors such as Medicare and health insurance generally cover skilled care when the individual meets eligibility criteria established by the insurer; these services are usually needed on a short-term or sporadic basis. However, aging and societal trends point to a great need in Personal Care.

Thanks to modern medicine, individuals are living longer and families are less able to provide the required care for elderly or incapacitated family members.  Paid caregivers are becoming the norm and we believe our society has relaxed the social stigma formerly associated with hiring someone to care for Mom or Grandma.

As you consider a potential long-term care business, start by considering your interests.  Do you feel called to provide medical or therapeutic care?  Or does the aspect of lending personal care appeal to you?  What is your background?  Skilled agencies require clinical leadership; is this something you can provide yourself or at a reasonable cost?

During this five-part series, we will explore some key aspects of your venture so that you can make a more informed decision.  CCG can help with all aspects of your new business venture, from planning and start-up to accreditation and operations.  Call us today to discuss your business needs.

Tomorrow, we’ll explore the various business models in the State of Florida.

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Launching a Long-term Care Business: Where Do I Start?

Today’s entrepreneurial culture and trends in the long-term care industry have converged into a perfect storm.  We regularly receive inquiries from individuals interested in establishing healthcare-oriented businesses that cater to the elderly and Baby Boomers.  The home health field is rife with opportunity for building a profitable business that provides needed, quality and compassionate care.  In response to the questions we receive about how to build a successful agency, we’ve developed this five-part series of articles covering issues to consider before investing the time and capital in a new venture.

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What We’re Reading – Seven Legal Errors Practices Make When Handing Medical Records

Misconceptions abound concerning a medical practice’s responsibilities concerning medical records and a patient’s access to records.  This article busted several myths, such as physicians can refuse to provide a patient with copies of her medical records, or whether fees can be charged for copies.  The best reminder in the article is for practices to review their internal policies and ensure they are accurate and being followed.

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What We’re Reading – You Must Trust Yourself in Order to Make a Real Difference

In this article, the author explains that while the traditional workplace was created to exert control, the new workplace gives up control for influence and membership in a larger community.  When you trust yourself, you won’t hesitate to share your knowledge, wisdom and secrets.  He calls this an “immigrant perspective” and it’s all about allowing those around you to experience the real you and not the title.  The author presents a three-phase, five-step plan to help executives learn to trust themselves, and in turn, become more influential in the workplace.

Phase I: Discovery

1.  Explore: Strengths and Passions
2.  Identify: Purpose and Cause

Phase II: Relevancy

3.  Believe: Market Demand

Phase III: Delivery

4.  Build: Market, Invest, Practice, Live
5.  Trust: Share, Teach, Lead

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