Episode Transcript
Alan Helgeson (announcer):
“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations.
Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.
In this episode, Courtney Collen with Sanford Health News talks with Lindsay Doak, director of health care research and education at BerryDunn, on the topics of leadership and culture, quality, and rural health access.
Courtney Collen (host):
Lindsay Doak, happy to have you here. Thanks so much for your time.
Lindsay Doak:
Thank you for inviting me.
Courtney Collen:
I’d love to start by having you share a little bit about your background and your work with BerryDunn.
Lindsay Doak:
Yeah, absolutely. So I have been working in home health and hospice for, I want to say 20 years. It’s hard to believe, but 20 years. Prior to this, I worked for an organization that also did home health and hospice consulting called Faci Associates.
And then I started at BerryDunn because I really, really thought that the industry needed the research that we were doing and the data and the insights and the education. And I was fortunate enough to have BerryDunn want to participate in that. And ever since then, we’ve done so many different things to help the home health and hospice industry grow.
Courtney Collen:
Amazing. I look forward to learning more here. You use data and research to improve quality outcomes and experience in home health. What does the data tell you are the biggest indicators of quality?
Lindsay Doak:
Yeah, it’s a loaded question because there’s a lot. I could probably talk about that. And I know we don’t have four hours, but we did a national health care home best practices study, and that was completely full of data of indicators that would impact quality outcomes, like quality of care or the patient experience or the caregiver experience, or your financial metrics.
So there’s a lot of different things that agencies can do to improve their quality outcomes. We can take a look at caseloads. So there’s different caseload metrics. For home health, it’s about 20. And then for hospice we’re kind of ranging between the 18 and 20. Productivity of course impacts your quality, but I think the thing that always, you know, when I looked at the data and analyzed everything, one of the things that always came up was your employee engagement, your turnover rate, and the percent of positions on the field.
So organizations can’t achieve success, I can definitively say that because every single data point, and this was from 781 home health organizations and 249 hospice organizations, they cannot achieve success if they don’t have an engaged workforce, people filled in the positions and reduction of that turnover. So you’re looking at less than 10% unfilled position and a less than 15% turnover rate, then you can start seeing that impact on your organization outcomes.
Courtney Collen:
Sure. Thank you. Tell us about your role in the education committee of the National Association for Home Care and Hospice and what you’ve learned through your involvement.
Lindsay Doak:
Yeah, so I always recommend if you can, and you work in the home health and hospice industry, get involved. So get involved in the Alliance. There’s Leading Age, there’s all kinds of committees that you can participate in if you’re a finance person or you’re a clinical person.
As a part of my role for these organizations, what we’ve done is we’ve taken a look at what is happening in the future of the industry. So what’s happening in the future of home health is drastically different than what’s happening in hospice. And what are the resources and education and tools, organizations, people working in the field need as they attend these conferences, as they participate to help them prepare for all these things that are changing. So I’ve just learned so much being a part of this from others on the panel, and really it’s a great place to just come together and talk about how we can help the industry.
Courtney Collen:
Yeah, absolutely. Lindsay, how do you define success in home health and hospice?
Lindsay Doak:
Yeah. Well, again, a loaded question, right? Because success can mean so many different things. You know, if you’re looking at any health care organization, success is going to be defined by meeting the quadruple aim. So you’re looking at engaged employees, engaged patients and caregivers, improved outcomes and reduced cost of care. So that’s the quadruple aim.
What we need to focus on though, is the priority of how you approach the quadruple care. Because you know, right now we are heavily focused on reducing the cost of care. Why is that? Because it’s predicted in 12 years, we won’t even have enough taxpayer dollars to cover the Medicare benefit. But we got to start with the patient experience and the outcomes because I strongly believe that if we start and start there and focus on the experience, the finances will come. And so making sure that you’re really taking a look at that quadruple aim.
Courtney Collen:
Thanks for the insight. What is one action home health and hospice providers can take to reach their full potential?
Lindsay Doak:
We’ve got to start aligning ourselves with different areas of health care. So what we’re seeing now is that organizations need to really start aligning with hospital systems, making sure that when hospitals are discharging patients to the home, particularly for home health, but also for hospice, that that is a seamless process. So with team, coming up with hospitals, that’s going to be important, that re-hospitalization rate. And what we’re seeing is that hospitals that are discharging hospice patients home without hospice are seeing significant increases in rehospitalization. So being a part of that continuum and really partnering with those hospital or organizations.
Courtney Collen:
What is the greatest challenge facing home health providers today? And how does this impact services provided in predominantly rural areas?
Lindsay Doak:
Yeah. Well, rural areas, particularly, the biggest challenge, and it’s been this way for five years or longer, is workforce. Finding people. We’ve got to start advocating to our colleges, to our universities. And when people, you know, get graduation degrees or nursing degrees, they’re not electing home health and hospice. And we need more advocacy around those graduates coming into home health and hospice. So really focusing on our workforce, improving that, and then training them to their best abilities.
Courtney Collen:
Are you optimistic about the future of home care? And if not, what would you say needs to be done?
Lindsay Doak:
You know, some days, I’m mostly optimistic. I will say that. I’m mostly optimistic. You know, there’s a lot of things that happen. We just got announced, in home health, we’re going to get another pay rate cut. Say, you know, MedPAC has proposed a 7%, normally what we see is we end up getting about half of that, and we’re already struggling with margins and covering our costs. The average nursing visit is 30% higher than it was two years ago.
And so, if we’re not getting the revenue to support what we do, we can’t do what we do. So, I stay optimistic in that I truly do believe health care at home is the best possible setting for our patients and their caregivers. But we need CMS to understand the value of what we provide so we can get reimbursed.
Courtney Collen:
We are so grateful for the work that you do and that your teams do. And we thank you for being here and for your time.
Lindsay Doak:
Absolutely. Thank you so much.
Alan Helgeson:
You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series wherever you get your podcasts and at news.sanfordhealth.org.
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Posted In Hospice, Leadership in Health Care, News, Rural Health, Senior Services
