Four Stars: The New Minimum Standard

As the cover feature suggests – your stars might be aligning and bringing huge opportunities or they might not be aligning and you could be left in another world void of critical Medicare referrals from hospitals.  Whether your agency is located or operates in an MSA where the CJR Model is now being piloted, your quality statistics and ratings are important.

Over the past year, Home Health Today has focused a lot on Home Health Compare’s introduction of star ratings to their database.  In the past year, the healthcare community, as a whole, has also caught on and is now forcing agencies to justify their effectiveness in providing care to patients.

As our experience indicates with agencies across the country, quality is now front and center.  The advent and implementation of the CJR Model (page 1), only solidifies the importance of education, awareness and ability to adapt to a rapidly changing healthcare system.  Agencies who continue to strive not only do so because of their ability to adapt, but because they know how to play the game.

Every rule that you followed in the past has virtually changed in the past 5 years.  It’s tough to swallow, but necessary to save your agency, and to be clear – you must be with the times, and getting ahead of the curve to survive.  Agencies who continue to rely on old practices, are slow to adapt to changing compliance trends or even embrace technology are going to be left behind and eventually forced to close.

Compliance isn’t going to ease up in the near future.  We can expect, as this is an election year that the focus will shift to healthcare at some point over the summer and in the fall.  The plans will likely differ very greatly.  While one side wants to convert the country to a free healthcare system which dictates to providers how much they can earn and the level of services they can provide, the other side wants to open up the system, placing fraud and compliance at the forefront.

Which side is correct? That’s for you to decide, but it’s clear that, as a for-profit agency, you are more likely to lean to the side that would like a system in which your agency can do well and grow based on your abilities, not on what the government dictates.  But you are still a government contractor and therefore must follow government rules. Either way, you are going to need to be aware of what is going on.

The star ratings are just the beginning of the focus. As we get more involved with new programs, pilots, and test runs, you can expect your agency will be pulled in many directions.  But what can you do right now – this month and next month?  Develop a QA program – review your QA program – focus on education. Focus on playing ball, not sitting inside while the other kids play outside during recess.  If you are the agency that is sitting back waiting to see what happens rather than being proactive and taking charge of where you want your agency to be in 6 months, you will be struggling.

To succeed, be the agency that is out there, learning, educating staff, and focusing on becoming that collaborator or preferred provider.   Do not be the agency owner who finds it difficult to login to your agency’s software and run reports, check on staff or be active in the operations.  For this is not the time to delegate all duties and sit back and relax.  This is the time to take charge, develop the plan, implement the plan, manage the plan, track results, and then analyze, assess, and improve.  Then do it again, adapting to the changes that have occurred.  We said it six months ago – agencies that do nothing and keep the status quo will be barely hanging on. Don’t wait another six months if you are one of these agencies, because in six months, there might be nothing left to hang on to.