Playing Nicely in the Sandbox

For as long as I have worked in the home health care arena, there has been friction between the nursing and business office departments within home care agencies. I suspect this occurs in any business setting where two departments working towards different goals are dependent upon each other for success. As a nurse, I can be quite flippant to a biller who wants me to review an OASIS assessment when I have three additional patients getting out of the hospital in the same 24 hour period. And I suspect billers who are billing next to nothing because of incomplete assessments do not feel very kindly towards nurses.

In a good agency, a low level of friction is actually good. People are challenged by others, reminded that their work impacts the entire agency and things tend to get dropped less frequently. When the friction escalates to a level nearing hostility, agencies can be crippled.

And this situation is not unique to agencies. Almost every agency at one time or another has a period where the level of hostility between clinical and business operations is unhealthy. Here are some of the things that I have found to help.

1. Email. How simple is that? Emails requesting information create records. It is one thing to ask a nurse to please come to the office to complete an assessment. It is a request that is easily forgotten. An email on the other hand, stays in the inbox until the nurse has time to read email and it creates evidence that the office staff did in fact contact the nurse.
2. Weekly meetings. At least once a week, department heads should get together and discuss outstanding issues. This may include late paperwork submissions, end of episode billing issues, incorrect and incomplete paperwork. Weekly minutes with action items should be created and reviewed at subsequent meetings. Marketers can often assist if they are involved.
3. Develop indicators for each department. Not every agency can adhere to the same indicators but in general, management needs to know:
   1. How long between admit/recert and dropping raps
   2. Average length of time before a 485 is sent to the MD
   3. Number of times an admit or recert packet is returned for corrections
   4. How long it is taking for paperwork to be brought to the office from the field
   5. How many claims require corrections

When the friction gets to the breaking point, agencies are often forced to make very painful decisions. A time consuming but often effective way to get the two warring factions to understand each other and work together is to have them shadow each other. All business office people should ride along with nurses for a day or two and all nurses should sit in with the office staff. When the two sides are able to actually experience how inefficiencies affect the agency, support from both sides may be exponentially increased.

When all else fails, call a consultant. I know a good one if you need a name. But ultimately, it all comes down to playing nicely in the sandbox.

Your suggestions are most welcome. Please post below or email us.