New to home health- HELP

caliotter3 · Jun 23, 2011

Per visit is better from your standpoint because you set a certain wage per type of visit and the nurse is not paid for anything extra. The nurse doesn't like it, but that is the way it is. Wages depend upon your area and what your competition is paying. Try to find a nurse who works for Maxim Healthcare to tell you their wage and you will have the bottom of the pay scale for your area. A starting point to look at: $10-$12/hr for HHA; $18-$22 for LPN; $25-$30 for RN for extended care work. Almost all agencies fax to doctor's offices for orders, 485 signing. You won't have the time or resources to be driving all over to do this in person. Make up a cover sheet for your faxes that contains the "privacy of medical info" clause at the bottom; you can find examples online. Time frame for signing the POC depends on when you get it to them; give them plenty of time. Lots of them don't sign it until the certification period is more than half over, probably a time lag on both ends. A communication note would be appropriate for most logging of communications to doctors, etc. Make up a blank form with lots of blank lines, at the top you can put check-off boxes for routing to different individuals: physician, case manager (outside), nurse, HHA/CNA, Other discipline, nursing supervisor, etc. You can find blank forms to use, for a fee, online. You can go either way with supplies. As a minimum, the HHA/CNA should be provided with gloves. These are not always in the home because lots of supply companies are refusing to supply them or they don't supply enough. You can require the worker to have their own steth, bp cuff or you can put one in each extended case home or you can provide these to each worker at the beginning of employment and collect it back when they leave. Do a search on this forum for bag technique, there are a few good posts about this. Your hardest task is getting the referrals, sorry can't give advice on that one.

KateRN1 · Jun 23, 2011

Much of this depends on whether you are accepting Medicare cases, insurance cases, or private pay cases. If you have this many questions on the basics, you might want to consider hiring a consultant to help you navigate these issues. If you are a franchisee and this wasn't covered by your franchisor, please give them a call to make sure that you got all the materials you need.

nurse955 · Jun 24, 2011

Thank you for the quick response.

Can't afford a consultant right now, funds are low. However, If you know of one that is willing to accept payment installments, please let me know. :)

You are definitely correct about the difficulty of getting referrals. I believe our hard work, persistent, free food is paying off. Thus far, I have 5 patients on the roster.:)

caliotter3 · Jun 24, 2011

Everybody had to get their first five customers. Often a nurse owned agency starts off with said nurse doing all her own visits, shifts until there is enough going on to warrant hiring additional nurses. Good luck.

KateRN1 · Jun 24, 2011

Honestly, the consultant will pay for him/herself in saved lawsuits, audits, and billing failures, as well as staff turnover. What state are you in? I can help if you're in FL, otherwise, call your state homecare association and ask for referrals. Also inquire about membership--it's worth it.

nurse955 · Jun 26, 2011

I live in Texas.

Hoping to hear soon from the credit union about loan approval.

nurse955 · Jun 26, 2011

You're correct!

To curb expenses, I've been doing all the visits in addition to working fulltime nights at a local hospital.

Biggirl71 · Jun 26, 2011

OK, I am employed part-time with a Home Health Agency in Texas and I am considered the Alternate Administrator (on paper). The very little I know is as follows:

1. You can design your own forms with your logo at the top. You can use Word to get this done.

At minimum you'll need:

Physician order form

Blank nurse's narrative notes

IV Infusion notes (make sure to include spaces for vital signs pre and post, IV start information, medication lot# and expiration, etc)

Time Sheets for your providers with a place for the patient to sign

Make sure you have a care plan for each patient which includes the nurses recommendation for length of treatment (this information will generally come from the physician order).

You should probably come up with a form that documents the teaching of the patient or spouse/parent in doing a particular treatment. I find that I do a lot of wound care and infusion treatments that I must teach to the family. It is nice to have the family member sign off on what they've learned and agree to do it in writing.

2. As far as pay rates, they vary and I agree with the comment above that Maxim would be bottom of the pay scale. Generally, if you have a high acuity patient (for example, a wound vac pt or infusion pt.), you will pay the RN more for the higher skills. If the nurse is going in weekly to set up meds for a patient and do an assessment, $30 sounds right. If it's a CNA providing 24/7 care, $10-12. LVN's are probably at $20. Make sure you pay per visit for the nursing skills. If you agree to hourly, it can get costly. BTW, as your business grows, you can make deals with your nurses to pay hourly for difficult-to- staff patients.

If you are billing Medicare for services, they have a whole slew of requirements that you can obtain by calling Medicare. Your record keeping must be meticulous.

I know there are agencies that specialize in billing for you. They will do both commercial and Medicare/Medicaid. You will have to do your research.

You can also market your business as cash only. When you write up your contracts, make sure to include things like nurse phone calls. People forget that their time is worth money and I personally have spent many hours (depending on the complexity of the case) on the phone with physicians, pharmacies, and patients. So if you tell your nurse she gets $30 per visit, work something out for her hourly time spent doing other things.

If you intend on becoming JAHCO accredited, do a Google search of what is required by JAHCO for Home Health Agencies

3. Marketing

It is my recommendation that you spend time deciding what exactly you are willing to provide.

If you are interested in pediatric infusions, you must come up with a brochure that targets your pediatric audience. Again, Google some ideas. Then make sure you drop them, your business cards, an some sort of food off at every pediatric office in your area.

If you are interested in post-op care, make your brochure and be sure to include plastic surgery! Remember, plastics is generally CASH. Put detailed info about the services that target that audience. Be sure to hit every office in your area and take treats!

As many items as you can afford with your company info on them, will pay off!

Make up folders for physician offices that include copies of your physician orders, brochures outlining your services, etc.

If you have a friend willing to do some marketing for you, jump on it. I hate to say it but the cuter she is, the better your chance. Unfortunately, the male dominated physician world likes to visit with the cute ones.

The whole idea is to saturate the area with your name and the wonderful services you can provide.

4. Make sure you keep a binder for each patient in the office. If you are running the agency from your home, dedicate a room to your business so you can have everything you need in one place. The binder should include all orders, care plans, contract, all original nurses notes, medication lists, a face sheet of sorts with contact info, address, etc.

Time sheets should be kept electronically in your computer and stored in the employees binder.

Be sure to get diagnosis codes from the physician for billing purposes.

Fax the orders to the physician office with a cover sheet as mentioned above that includes a time frame for returning the signed order.

I hope this info helps. I know it's a lot of info and it's kinda scattered but hopefully it's useful to you.

If you have any other questions, please let me know.

Can I ask which area in Texas you are located?

Good luck to you!

nurse955 · Jun 26, 2011

Biggirl 71,

Thank you for taking the time to respond to my question.

We purchased a manual from a reputable company which contained lots of policies dealing with HR, infection control, patient care, etc. It also included several forms and I took caliotter3 advice and created a blank narrative nursing note which wasn't included in the purchased manual.

My husband is very talented and proficient with microsoft, he created the brochures, business cards on word.

As for marketing, we have allocated 2-3days a week to visiting physician offices, clinics, nursing homes, free standing ER, hospitals. Surprisingly, a lot of the plastic surgeon offices were not very receptive and often, we were told " we don't send out referrals to home care agency".

We are located in the outskirts of Houston.

Biggirl71 · Jun 26, 2011

I work for a home health agency in The Woodlands and a LOT of the referrals we get are for one-time assessments for insurance companies. The assessments are MMSE's for claims on long-term insurance policies. The other large part of our work is for round-the-clock care of patients (these are our cash cases). The RN oversees the CNA's so they can be checked off for med pass and other tasks that the RN delegates.

Keep up the hard work. It will pay off. I have 4 patients that I see weekly or more. 2 of them are pedi infusion cases that pay me $60. The other 2 are elderly 24/7 cases that I pack the meds for.

Some plastic surgeons actually have nurses in their office that will go home with their patients and provide the initial care at discharge. Just keep going out and getting your name into the market. The other places you may want to focus on are LTAC's, Rehabs, Acute Care hospitals (of course), Pedi offices, Internal Med offices, etc.

Good luck and if you have any other questions, you can contact me at [email protected].

Thanks. . .

caliotter3 · Jun 27, 2011

I found a blank "Case Communication" form and this is what is on it: At top: identifying, name, client number and box for certified, non-certified. 1) Then: Communication with: boxes and lines for name- Nurse Manager, Nurse, Physician, HHA/PCW/NPCW, Therapist/Asst., Pharmacist, MSW/SWA, Patient/Respons. Party, Referral Source, Discharge Planner, Community Svc Agent, External Case Mgr, Other, and another Other 2) Summary of Communication-(lots of blank lines) 3) New Authorization # , New Auth Period: From To 4) This is boxed in: Changes to Patient's Plan of Care/Physician's Plan of Tx Box for No, Yes specify (List services added, deleted, and/or changed. Update frequency and duration as applicable. Use physician's interim orders for all medication changes. Describe all other changes in detail): [in very, very small print] Then a few blank lines--Bottom of boxed in area, Plan of Care updated? Yes, No boxes

5) Another boxed in area at bottom of form: Date (m/d/y) Name/Title (print)

Time: am,pm Signature

Guess this was a generic form because it did not have identifying info for the agency printed on it. Actually the best form I've seen for this purpose.