The Fazzi/BlackBerry Report: Preliminary Findings of Major Study Say Handhelds Thrusting, Monitors Rusting

Home care agencies that pay their nurses per visit report higher profit margins than those using salary systems or hourly pay rates. This one but one of many findings of a comprehensive study previewed on Wednesday during the closing session of the 2009 NAHC Annual Meeting.

Researcher Dr. Robert Fazzi, Ph.D. stole the limelight from luminaries Colin Powell and Hollywood film producer Peter Samuelson when he led off the final morning by revealing preliminary results of his study, "The BlackBerry® Report: The National State of the Home Care Industry" sponsored by the Hospital Home Care Association of America and the National Association for Home Care and Hospice, along with Fazzi Associates and BlackBerry.

"There will be a much more detailed report as soon as we have had sufficient time to analyze the data," Fazzi told the HCTR reporter in attendance after his presentation. The sneak preview he offered to the standing room only Wednesday crowd was enough of an attention-getter to build serious anticipation about the final report.

• 72% of agencies use back-office software systems
• 12.4% are either very or somewhat unsatisfied with their system.
• More than one in five (21.3%) plan to replace their software system within the next year; of those, 40.5% will switch vendors when they do.
• More than 65% have Electronic Medical Record (EMR) systems. 83% of those say the systems has lead to improved care coordination.
• Nearly 40% use some form of point-of-care software. As past studies have found, large agencies drive that average up, smaller ones bring it down. POC is used by:
  • 61.5% of agencies with $10 million or more in revenue
  • 39.8% of agencies with between one and five million in revenue
  • 28.9% of agencies with less than one million in revenue

That last finding above supports the long-held belief that roughly half of all home care nurses use point-of-care software. 61.5% of agencies at the $10 million and above level represent many more individual nurses than 28.9% of the smallest agencies.

Is device-type selection changing?
Even taking into account that this study was funded by BlackBerry -- which may not even be worth mentioning since the study was conducted by the profoundly impartial Fazzi research team -- it is striking to note the shift in hardware platform choices indicated by the preliminary results. Although 91% of the 900 senior executives interviewed said their clinicians currently use Windows OS systems (laptops, tablets, notebooks), more than a third (36.8%) who are looking for new POC systems are most interested in PDAs (handhelds, smart phones) running Windows Mobile OS. Apple's iPhone is not yet a factor but that may be changing in home care's near future as well.

In a related finding, Fazzi explained, handheld devices may be the wave of the future for Home Health Aides as well. More than one-fourth of agencies report they will change their Aides from paper (currently 78.3%) to electronic (currently 10.1% telephone and 11.5% handhelds). Of those, 74.6% say they are looking seriously at handheld devices.

Agency owners in the lead
There may be a reason small hardware looms large. Fazzi interviewers asked the 900 executives what they use personally and found that more than a third already use smart phones. Again, owners of large agencies lead the way. When revenue is less than $5 million, 33% have smart phones for their personal use. Over $5 million, the rate is well over 50%. Among users, the BlackBerry owns 50% of the market, followed by the iPhone and some type of Windows Mobile device, tied at 14.8%, with the Palm Treo showing up at 5.5%.

Home Telehealth: waste and dust still accumulate
The industry continues to struggle with the issue of home telehealth devices gathering dust on agency shelves, the BlackBerry/Fazzi study discovered.

• 23% report using telehealth systems, up from 17.1% in 2006
• 22%, however, say that, on any given day, fewer than 25% of units are in use
• Note small vs. large again: revenue under $1 million = a whopping 48% say fewer than 25% of their units are in use on any given day; revenues over $10 million = only 4.9% say less than 25% of their units are in use.

Other significant findings were less related to technology but still worth a mention. 72.6% of agency executives interviewed said they plan to cut costs over the next 12 months. If you isolate hospital affiliated agencies, the percentage soars to 92.2%.

The 900 executives also report that they provide between 1% and 5% of revenues in free care to people who cannot pay. More than one-fourth say their percentage of free care increased in the past year.

Lastly, there is the clinician pay model question. As mentioned, pay-per-visit seems to appear in agencies that report positive profit margins and patient outcomes. Over 36% of agencies use pay-per-visit now but the report is uneven by agency type. More than half of for-profit organizations use it but fewer than one in five not-for-profit agencies do. Urban agencies use it more than rural agencies -- 41.8% to 17%. Freestanding agencies use it more often than hospital-based agencies (44% to 9.6%).

As Dr. Fazzi explained during his presentation and in our conversation afterward, the data is in but the myriad ways in which is can be sorted and understood will continue to evolve until reaching its full potential. Research details and further information is already available at www.fazzi.com but more will be coming as Fazzi Associates' work continues analyzing the data. HCTR will continue to follow the story as Fazzi releases more analysis.