When the twin pressures from government and private payers to shrink reimbursement rates and increase claims denials make it too difficult for some home health and home care providers to survive, Peter Miska’s Chicago agency will still be standing, and thriving. At last month’s “Healthcare in Transition” seminar, he spoke with our Tamela Buhrke about the difficult operational and cultural changes that have strengthened his agency in an extremely competitive market.
The repeated message driven home by experts at HCTR publisher Tim Rowan’s “Healthcare in Transition” seminar last month made it clear that faster patient recovery times must become the norm. What used to take twelve visits must be done in six. Home health care agencies will adapt if they are to survive. This means restructuring business models and retraining employees. The question on everyone’s mind was how to make these changes without a crippling loss of clinicians and disruption of their business?
There was one seminar participant who did not have to ask that question. Peter Miska of Phoenix Home Care, LLC saw the writing on the wall back in 2009. His transition to a new care model took several years but he is now happily reaping the benefits. We asked him what steps he took to transform his agency and how the changes have benefited him. —Editor
by Tamela Burhke
Be the change you want to see
Miska quickly realized that major change has to start at the top – he had to lead if he wanted his staff to follow – so he hired some of the best consultants in the industry. The first thing he learned was that he had to stop thinking about census and start focusing on outcomes, getting the patient better, faster. His mantra became “this is a low-cost, patient-centered practice.”
His implementation plan included five key points:
That was the plan.
Change is rarely easy but Miska learned that complete change of culture never is. He initially lost much of his clinical staff, those unable or unwilling to adapt. Even new hires initially resisted the unfamiliar methodology he described during orientation. Eventually, turnover slowed as consistent training helped new clinicians accept a system of common language, measurable outcomes and team mentality.
What turned the tide was clinicians seeing the difference in their patients. Ultimately, they discovered that focusing on outcomes was easier and more meaningful. The team approach also made work easier because they were all speaking the same language. “Now, instead of one clinician looking at the glass as half empty and another as half full, the whole team was saying that there were 500cc’s in the glass,” Miska said with a note of pride.
Effects on the business
These days, morale is high within Phoenix Home Care teams. Clinicians have embraced the changes because they can see care is more organized, standardized and predictable. Patients are happier because they are healing faster, which is reflected in higher satisfaction scores. Readmission rates are lower and the agency has had multiple perfect Joint Commission and state surveys.
As of now, Phoenix Home Care has been picked for a model three bundled payment initiative for hip and knee replacements and is seeking other ACO partnerships. Miska is happy with the changes that have made his business more organized and efficient. Everyone is on the same page, there are fewer problems, and Miska feels more in control of the business.
Regarding improvement in revenue and margins, Miska says it is still hard to assess the financial impact of a modernized clinical culture. There was some initial financial pain during the transition, partly because he implemented the changes just as a huge increase of competition flooded the Chicago market.
What was more important to Miska, however, was that the changes meant he would be ready for what is coming. When many of his new competitors get bogged down in healthcare reform, he will be sailing smoother, already familiar waters. “I think that only those companies with a mindset of low-cost, high-quality, evidence-based, patient-centered healthcare are going to be the ones left standing — regardless of how hard that change is,” Miska said.
When asked what advice he might give to others, he reiterated that the hardest part is dealing with cultural change. Clinicians are no longer just “doing a visit.” They have to develop a case management mindset. That transition was the hardest, though he does find more clinicians today who understand evidence-based practice than there were a few years ago.
Back to the top
As for changes within management, the hardest part was to get away from census thinking, to shift away from numbers toward quality-centered care. He acknowledged that these changes were tough but that they increased the quality of his organization. His employees are happier now that they are achieving better patient outcomes. Patients are happier because they are getting well faster. Insurance companies and Medicare are happier because they save money as their home care and hospital costs decrease.
In Peter Miska’s view, when the patient wins so does his business.
©2015 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org