Shaping Home Care and Hospice Practices at the National Level

Episode Summary

What does a top 50 accounting firm have to do with home care? Find out when you listen to our latest guest, Lindsay Doak, MBA, Director of Research at BerryDunn. Lindsay is a seasoned healthcare leader, with over 15 years experience in healthcare education, business intelligence, and patient satisfaction initiatives. In her role at BerryDunn, Doak helped drive the advancement of healthcare as part of the firm's services and dedicated home health and hospice team, who work with agencies to strengthen their care delivery methods and patient outcomes. Doak has also had the unique opportunity to spearhead the 2021 National Healthcare at Home Best Practices and Future Insights Study. Learn more about these important initiatives here on the MEDITECH Podcast.

Episode Transcription

Title: Create Transcription Shaping Home Care and Hospice Practices at the National Level

Guests: Lindsay Doak, MBA, Director of Research at BerryDunn

Host: Christine Parent, Associate Vice President, MEDITECH

Lindsay: What we're finding is that when we had asked organizations whether or not their EHR communicates with other Health Care settings, so the physician, the hospital that there's tremendous value to that. 

Christine: Welcome to another episode of MEDITECH Podcast, the leader in healthcare technology empowering you to be a more informed Healthcare consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about. 

My guest today is Lindsay Doak, MBA, Director of Research at BerryDunn. Lindsay is a seasoned Healthcare leader with over 15 years experience in healthcare education and patient satisfaction initiatives. In her role at BerryDunn, she had the unique opportunity to spearhead the 2021 National Health Care At Home Best Practices and future Insight study. She also currently serves on the education committee for the National Association for Home Care and Hospice. Welcome, Lindsay. Can you start by telling our listeners about BerryDunn and the work you do there?

Lindsay: Yeah, absolutely. A lot of people out there know that BerryDunn is one of the top 50 accounting firms. I think a lot of people might be wondering, why is a top 50 accounting firm researching and providing a national study? 

Actually, over the past 10 or so years much of that has shifted. We're doing more consulting work than we are a lot of our accounting and tax services. That includes a lot of growth in the Home Health and Hospice. With our Home Health and Hospice team, we're really seeing an expansion with this study being a critical component to that. We've always kind of done work to support Home Health and Hospice organizations financially but we now have outsourced OASIS and coding and the research and education because we really want to help that industry. We believe Home Health is the future of health care and we want to help it grow. Then, my past experience I worked at a company called Fazzi Associates. I know there's a lot of people out there that know Fazzi Associates, so much of my 15 years experience came there, but I'm excited to be transferring that over to BerryDunn to help that Home Health and Hospice team, really help these Home Health and Hospice organizations grow and thrive and survive as we continue on this challenge of healthcare at home. 

Christine: BerryDunn was one of several industry-leading Home Care organizations sponsoring a national study of trends and challenges. Tell us about your leadership in this study. 

Lindsay: Yeah, the study was started surprisingly almost two and a half years ago. If you think about where we were two and a half years ago, we were in the midst of COVID. We had just started in Home Health with the patient during the grouping model, so a new payment system, and so our conversation has evolved around how do we support this industry? How do we support them with everything that's happening at massive staffing issues, especially with COVID but we're still seeing those staffing issues. BerryDunn took the lead in initiating research that could help Home Health and Hospice organizations with Best Practices to help them navigate all of these changes happening in the industry. 

This was the first time. I had this wonderful co-chair Keith Crownover. He's a tech guru. You probably know who Keith Crownover is. He helped me co-lead this effort. This was the first time in the history of any national study— we’ve been a part of these National studies before where we had the National Association for Home Care, National Hospice and Palliative Care Organization, Leading Age, Home Care Association of America, The State Council of State Associations all come together and support this critical effort. You can see how expansive it was. Then, the phenomenal steering committee members we had. The goal of the study was really to find these Best Practices for Home Health and Hospice in five major categories. That was the operations in Clinical Best Practices for Home Health and then for Hospice. And then, we had Palliative Care. Really, figuring out what is Palliative Care with Medicare Advantage risk share agreements going on. There's a lot of interest now in Palliative Care, and then, technology and staffing and then we'll have some future insights as well. We had this fantastic group put together a lot of questions based on those categories and then initiated this national effort to help these organizations in those five areas. 

Christine: Well, that's amazing. Where do you see technology fitting into some of this?

Lindsay: The technology was a significant component. When we were initiating the study, I think, when we had thought about technology, it was Telehealth that was at the forefront of everybody's mind. Because during COVID, we saw this massive expansion of Telehealth and so now how are people using Telehealth how has it shifted with COVID? What is the increase in usage with Telehealth? We did ask those questions and of course, as people expected, we saw a massive uptick. I think it went from about 30 percent of agencies who had used some sort of Telehealth prior to the study in the midst of COVID, that increased to almost 90 percent of Home Health organizations that had used some form of Telehealth. The interesting part of that though is that we didn't really see any correlation between Telehealth usage and improved outcomes. That tells us, as an industry, we're still trying to figure it out. We're not saying that Telehealth doesn't work, but we are still trying to figure it out. 

Then for the other area, which I know you're very familiar with, we did take a look at EHRs and implementation. I think when people think about technology, they instantly jump. What are the leading age technologies that people should be using but what they skipped past is what are the technology essentials that we have to get right now before we can jump to those future technologies? What was exciting was that we saw a growth, and you'd be surprised. I think that people who've used EHRs for a long time now were shocked to hear that five years ago there were a lot more organizations on paper.

Now, we're happy to say that 99 percent of organizations who filled out this study were on some sort of EHR. Then, in addition to that, taking a look at interoperability. If you have an EHR and you're using it very well. What we're finding is that well we had asked organizations whether or not their EHR communicates with other healthcare settings, so the physician, the hospital. That there's tremendous value to that. Organizations whose EHRs communicated with hospitals, although hospitalization rates. Those who had EHRs that communicated with physicians offices had higher patient satisfaction. As we all know, value-based purchasing is underway. Both of those are very very important. We looked at the interoperability of the EHR and that ability to have that continuum of care for the patient. 

Then, of course you know we should be looking at AI Machine Learning which again are the future technologies. We are seeing a high amount of, especially the centers of excellence, use those technologies. With staffing shortages we are seeing a lot of organizations are really looking at automating processes as they are dealing with these staffing shortages to help maintain that efficiency so they can continue to provide excellent patient care. 

Christine: Now, that's interesting. For Telehealth, did you guys look at the study and look at the particular areas that they were using Telehealth and break it down a little bit that way to what they find value in or maybe some additional outcomes. I know a lot that we saw was around accessibility which was a positive in particular areas that maybe there is a shortage of certain specialties. 

Lindsay: Yeah, or managing chronic conditions. You know, the one thing that was pretty interesting was seeing the amount of Home Health organizations that even after discharge are keeping their patients on telehealth to be able to manage those chronic conditions. We are seeing some very interesting usages and as you said it's kind of filling those gaps to make sure that that patient doesn't fall through the gaps or has a discontinuity in care. Yeah, that obviously had some interesting impact as they are filling specific gaps versus just trying to provide a single Telehealth solution because that doesn't work. You really have to fine-tune your Telehealth solution for your specific organizational needs. 

Christine: Let's talk a little bit about common leadership challenges. You know you obviously did this study, you observed some of these challenges firsthand. What advice would you give to leaders? 

Lindsay: That you put your staff as your number one priority. Do you look at Maslow's hierarchy of needs? We start with those basic necessities that Maslow comes up with. For our Home Health agency, I would say, I know there's a lot going on. We have to think about value-based initiatives, technologies, Medicare Advantage, new payment models, but that staffing should be your number one priority. I think that sometimes when we talk to organizations, some of these things are pushed aside. You talk about staff retention, these soft skills, they're not as critical as OASIS training or these hard skills that you can teach. When we look at where the future is going with Home Health, I think we've seen that the industry needs 25,000 new nurses every year to maintain the patient population and we need some millions of workers over the next five years to be able to meet the needs of this growing in your population as a person from a research perspective who looks at that. We see that there's a major crisis about to occur with staffing. 

My thought with leadership is that everything should be going into nurturing your staff, retention strategies, and leading. We saw a direct correlation between leadership turnover and staff turnover. Trying to reduce that leadership turnover, building a culture of empathy, because the number one thing that an organization could do that has the most significant impact would be to lose an employee that was valuable to that organization. There's no room for that. Really focusing on that retention and your leadership and making sure your leaders are trained and making that your number one. 

Christine: That's perfect, especially, the pandemic, there's a lot of discussion now about different models on even some hybrid workers and how do you manage that and manage productivity. I do think that to your point the biggest asset in healthcare in general is the people. I think that that's fantastic advice about retention and interesting correlation between leadership and staffing. Let's shift a little bit of our focus and can you tell us about your committee work for the National Association for Home Care and Hospice? 

Lindsay: Yeah, I am on the NAHC education and also recently joined the HHFMA Innovation committee so it's really exciting to be a part of this National Association for Home Care or NAHC committee. I would say to anyone out there, if you're thinking about joining  a committee but are a little skeptical or scared, I know sometimes the Imposter syndrome comes into play. Just join, it's such a valuable experience. We need as many people to help with a lot of these initiatives as we can get. With recently my addition to the HHFMA committee which is the Home Health Financial Matters Association, my first thought was I'm not a financial person like I don't qualify for HHFMA but guess what everybody does because every portion every aspect of what we do in this business ends up resulting and leading to the bottom line. 

With the NAHC Education Committee, we help guide the education and sessions specifically for their annual meeting, making sure that the members get the education they need to survive and thrive in this environment. Then, with the HHFMA Innovation Committee, we also provide education through webinars but are also coming up with Innovative models. Recently we did a presentation on Medicare Advantage and talked about where that's going and leading and helping agencies understand the impact of Medicare Advantage on their businesses and what they need to do to start preparing for some of that. It's a really valuable experience for anyone who participates and I do recommend anyone that wants to and encourage them to join some of these committees as well. 

Christine: Anyone that is part of an organization will always say a committee will take you so and you learn a lot and you get to meet interesting people along the way. Going forward, what future trends in the industry are you anticipating? 

Lindsay: Well, going back to that Medicare Advantage. I think again from a data perspective you take a look at this was the first year that we almost reached 50 percent of Medicare eligible patients on Medicare Advantage. I speak to a lot of organizations who say to me Medicare Advantage doesn't pay so I'm just going to deny Medicare Advantage patients so I'm going to turn them away. In five years, that number is going to be 65 percent. That's not an option. In terms of future trends, I know it's not exotic to talk about Medicare Advantage. I know some people want to talk about robotic nurses entering the home. For a realistic perspective, agencies have to start thinking about how to prepare for those Medicare Advantage Partnerships. 

We talked to a Medicare Advantage provider, a significant Medicare Advantage provider. They had said they do not even talk to organizations that do not have a three star quality star rating or higher.  If you're out there and you're an agency and you don't have the three star quality rating or higher, I would be working aggressively at getting to three stars because you're going to be squeezed out of the market and there's not going to be a possibility of success for you. Figuring out ways to reduce costs, improve your incomes, trying to figure out how to negotiate rates which I think is very foreign to a lot of Home Health and Hospice providers. We've always worked with traditional Medicare and you kind of got your rates handed to you. You got to sharpen those negotiation skills. You've got to get a seat at the table because that is going to be the key to your future. The organizations that aren't thinking about that right now aren't going to be around in the next 10 years. Really thinking about that and trying to figure out how you can make that happen. 

Christine: And, why you would go to an organization such as yours to partner with them. Your insights have been incredible and you can kind of see the breadth of your experience in the Home Care Arena. Do you have any mentors or strong mentors that worked with you along your professional journey?

Lindsay: Yeah I was lucky to have worked with the GOAT of Home Health and Hospice. By goat, I'm not talking about the animal, You know, the “Greatest Of All Time”, Dr. Robert Fazzie. I think most people who have worked in Home Care for the past five or ten years know who Rob Fazzie is. He was the person who introduced me to Home Health and Hospice. Phenomenal leader and I think the number one thing that he taught me was how to lead with empathy and passion. He was passionate about what he did. He was empathetic. He truly made time for every person he spoke to and knew so much about the industry. 

Before I started at Fazzie Associates, I didn't even know that Home Health and Hospice existed. It was like foreign to me. I didn't even know that care could be provided in the home. Then, he really guided me, taught me the ways of Home Health and Hospice. He was an integral part. He was the one who started a lot of the research projects in this industry because he saw a need. It's just pretty exciting to carry on his torch and legacy. I couldn't have asked for a better mentor than a man who lived, breathed everything Home Health and Hospice for much of almost 60 years. I learned a lot from him and am very excited to be carrying that on. 

Christine: Well his passion certainly rubbed off on you. You can hear it through our conversation. I want to thank you for speaking with me today about the important work that you are doing. I usually end with something on a lighter side. If you are not working, what would you be doing? What energizes you outside of the Home Care environment? 

Lindsay: I'm an athlete. I ran in college and I took on Marathon running about 30 years ago. I've been running marathons for quite a while and because I've really gotten into that I don't have as much time to run marathons these days since I have work and kids, so that's a little more difficult as my body ages. It's just not as easy on the body. Then, I transitioned over to triathlons because that kind of balances out for me. You're not overdoing it with your body by running. It's a piece of what I do. It helps balance out, but also I think I get some of my best ideas while I'm at exercising, while I'm running or swimming. Swimming is very therapeutic. You'd be shocked at how many times you're running or you're swimming or you're biking and it's just you have that aha moment and you just figure something out and you go and move from there and it ends up being some fantastic revolutionary thing. I'm glad I have that component to my life. It's just exciting to have that feeling of accomplishment both in work but also on a personal side, as well. 

Christine: Well, that was wonderful, Lindsay. Thank you again for joining us today on the MEDTECH Podcast. Thanks for listening. Stay informed and subscribe to MEDITECH Podcasts and be sure to check out our Resource page for links from this episode. We'll talk to you next time.