Quantity:

The home health industry's obsession with quantity, numbers, statistics, has always been in the forefront of reports for years. After all, most home health agencies are formed for profit. Agencies invest in getting more referrals in order to survive the ever-decreasing reimbursement rates. The higher the census the more success their agency achieves. Numbers do translate to growth.

"We are concerned about our patient count every day," says a small Michigan HHA administrator. "On top of that, our agency tries to have 5 admissions, 4 RAP and 4 EOE claims submitted, 10 signed physician orders returned, and at least only 1 recoup per day". "Our OASIS needs to be submitted by the assessing nurse within 72 hours, coded within 2 hours, and billed within 7 days."

The pressure to keep up with the quantitative aspects is always on agency administrators' backs and a little too often, quantity takes over quality.

Quality over quantity: 

In the age of social awareness also comes the age of quality. The focus shift to quality of service and quality of documentation is becoming more prominent. Yes, it still involves statistical data, but the attention to quality is now just as important. 

More than ever, patients are getting involved in making sure the care they are provided is accurately documented. Surveyors are increasingly getting engaged in reading chart documentation until 2am in their hotel rooms. Physician and patient access to his own chart has become easier. Seniors have even adapted to the social media frenzy and publicizing complaints has never been convenient.

The impact of quality in growing and retaining a business brings change in how we operate. Apple (AAPL), even on its hiring interviews, asks what's more important between fixing the customer's problem and creating a good customer experience. In home health, achieving quality care through quality documentation is a key factor.

Balancing act:

This is an area only a few HHAs have tapped into. How can you get quality and quantity on either side of the scale without compromising the other? You increase your quantity but the volume of documents to review becomes overwhelming; you take time with QA and your pending final claims pile up. You catch up on quality assurance by expanding your QA staff but you hand out pink slips once your backlog's gone; your QA overhead increases but you have the confidence that your charts are survey-ready. It is a tough act to follow.

No matter what solution an agency implements, it all boils down to staying in business and maintaining profitability without sacrificing quality patient care, without taking shortcuts in documentation. Every HHA needs help in this department and there is help out there.