Serving the home health, home care and hospice industry since 1999.

The Southwestern Illinois Visiting Nurses Association, under the direction of clinical manager Amanda Shoemaker, RN, realized their legacy processes were not going to take them into the value-based payment system era. Completing and correcting every OASIS assessment was a long, inefficient, inconsistent process. Field staff were overwhelmed with charting and QA was struggling to bill RAPs within 30 days. They decided to implement a combined software and business process system from OperaCare.

OperaCare's Total Quality Management combines data analytics with change management and streamlined process integration, which prepares home health agencies to succeed in a value-based payment model. Michael McGowan, President of OperaCare, puts it this way, "Great clinicians and data analytics are both necessary to provide care in our new Value-Based industry. The challenge is to effectively combine the two in order to provide the best care at the lowest cost. There are many solutions providing data analytics on some level and there are consulting companies that provide paper-based solutions to re-engineer processes. OperaCare is the only solution providing streamlined processes along with robust data analytics in an automated tool, allowing SIVNA to effectively use their data to proactively manage their agency."

After implementing OperaCare SIVNA has seen a

  • 50% increase in productivity of OASIS SOC for all clinicians
  • 100% decrease in after-hours and weekend charting by clinicians
  • Average OASIS-to-RAP in 24 hours or less
  • referral acceptance increase

Multiple Challenges

When Amanda Shoemaker took over as clinical manager of the hundred-year-old SIVNA, she discovered several challenges. OASIS productivity and clinician morale were low. Clinicians were able to do no more than two start-of-care visits in a full work day. Charting lagged days behind. Clinicians would often need an unproductive "paper day" in the office to catch up. Still, clinicians felt like they never would catch up, with charting perpetually hanging over their heads.

The QA team had struggles of its own. OASIS, plan of care, and coding corrections often had to be submitted multiple times to finally achieve MAC acceptance. Amanda realized there was no accountability for OASIS data collection and therefore no OASIS consistency. All of these issues combined to make billing RAPs in under 30 days almost impossible. She further explained, "There was not much that was accurate or consistent in our OASIS data. Every clinician was doing the SOC OASIS in her own way, despite all our OASIS training. Consequently, we were taking great care of our patients, but our documentation was were not reflecting it."

Taking the challenge head on, she started looking for answers. First, they outsourced coding and QA. This helped initially, but the agency fell behind again and again. Clinical documents continued to require lengthy corrections and billing was still delayed. The SOC OASIS productivity requirement was decreased from three per day to two to help nurses keep up, which only provided temporary relief while decreasing the agency's capacity for care. They were forced to turn referrals away due to what they perceived as a staffing shortage, not an efficiency problem. An additional QA person was added, but documentation continued slow, corrections repetitive and subjective, and billing way behind.

How OperaCare Helped

It was during this frustrating time that Amanda attended the Illinois Home Care & Hospice Council's annual conference and met the team from OperaCare. She realized immediately that OperaCare had a solution that addressed every aspect of her agency's struggle. First, OperaCare conducted a 12-month Lookback / Forensic Analysis of SIVNA's OASIS data to identify trends and deficiencies, length of stay and service utilization patterns.

Next, OperaCare installed its "Automated Quality Assurance" tool, giving the QA team the ability to completely QA an OASIS in about 3 seconds with 100% consistency among every QA nurse. OperaCare's automation also provided acuity-based length of stay and service utilization guidelines. Automated QA, unlike benchmarking products, provides a clear path to compliance and revenue integrity never seen before in-home health.

Next, OperaCare instructed the SIVNA how to move the entire QA process live into the OASIS visit, while the nurse is in the home with the patient. This was accomplished through the use of medical scribing, long used by emergency departments and now adapted for use in home health. It is this proactive marrying of automated quality assurance with live, medical scribing that creates the perfect combination of data management and clinical judgment.

Results and future plans

The SIVNA has seen dramatic results. Their latest report to OperaCare included:

  • 1 hour for all QA, coding, and care planning per SOC OASIS
  • 24-hour average OASIS visit to RAP
  • Each clinician completes three SOC OASIS daily – with no after hours or weekend charting
  • Morale is up and other local clinicians want to work for SIVNA
  • 485 Plan of Care is signed by physicians and returned an average of 5 days after SOC
  • Patient outcomes have dramatically improved due to more accurate SOC acuity
  • RAPs are normally submitted the same day the OASIS is performed.

The SIVNA has recently added another case manager to handle the increased capacity for admissions. "We are able to admit more patients with OperaCare's process, so it is allowing our census to grow," Amanda reports. When asked about goals for the future, she responded, "Continue to grow our census with OperaCare while increasing OASIS productivity to 4 SOC daily."

When asked what her staff members had to say Amanda related the following statements;

  • "I feel relieved with no paperwork hanging over my head."
  • "Our team was the first to start scribing and, although other teams were skeptical at first, they became jealous when they realized we were going home with no charting to do. They started wishing their team had been first."

And from the QA staff:

  • "QA nurses get more of a feel for patient care without actually doing it."
  • "I am not behind. I go home with my work done every evening."
  • "Overall morale is way up! OperaCare is awesome.


About OperaCare
Led by an experienced State OASIS Coordinator, the company's mission is to protect HHA provider revenues, enhance business growth, and increase financial stability. OperaCare's "Total Quality Management" was built to lead HHAs into value-based payment success.

Southwestern Illinois VNA is a not-for-profit home health agency serving seven counties along the Mississippi River east of St. Louis. In 2018, the agency is celebrating 100 years of service to seniors in their homes.


©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.