There comes a point when you are in this business long enough that you think you have seen everything. Today I saw something that I never even thought existed. A long term client received their ZPIC results from AdvanceMed. In my life, I never thought I would see anything like this.
Make no mistake. This is a good client who acquired an agency several years ago and then called me to look at it. I explained that most people performed due diligence before buying an agency. As luck would have it, it was a great agency but once sold, there was nobody there who knew the business side of homecare and they were a little less than profitable.
So after a few months, a new administrator was hired. She has an MBA but she sold drugs prior to accepting this position. (She will read this and get mad if I do not clarify that she sold pharmaceuticals.) The only home health experience she had was well, frankly, none.
One of the first things I did was encourage her to pay her staff per visit instead of hourly because their overall productivity was about 2 visits per day. That was a mistake. I should have told her exactly how much to pay per visit. But, I left that open and so she pays her nurses a ridiculously high per visit rate. Her field nurses make more than I do and they only work three days a week.
And because they are down the bayou, their length of stay is about the twice the national average and they have a lot of therapy. It is difficult to educate people who have never been to school and South Louisiana is known for its large Catholic families so lots of repeat teaching is needed as family members rotate in and out. Two of their largest referral sources are orthopedic surgeons and as such an enormous amount of their patients require therapy.
So what do these overpaid nurses with time on their hands do all day? They talk on the phone and write stories. They love the copy machine so they make copies of pretty much every piece of paper they can find and give it to people. Then they call the people they gave them to just to be sure they got them. They play with scissors and tape and send all these lengthy faxes to the MD with the med profiles taped on them so the doc can see everything they are taking. I keep trying to show them how to cut and paste the meds on the faxes and remind them that even if the computer explodes, they will still be able to get to their documents. I cannot begin to imagine what they spend on paper.
Once or twice a week, they all sit down and have lunch together and talk about their patients in case conference. This of course is documented. It is rare that at least one or two nurses don’t come to the office to chart in the afternoons. The geography is such that it makes more sense to chart in the office since they turn their notes in timely. (What else do they have to do?) In fact, some of the most entertaining reading I have done in the past year has been in their charts. I am still on the fence about how much is appropriate to chart about the infected penile prosthesis but I know more than I wanted.
Probably the owners would take exception to their over paid, underworked employees but since they were making money they never really noticed. And because they were paid per visit, it didn’t really cost them too much.
They are my only client who as had a deficiency free survey in the past several years.
And their ZPIC result? AdvanceMed determined they were overpaid by a little less than 2 percent*.
I am in awe.
There are lessons here to be learned unless you are my client in which case, there is a well deserved good night’s sleep waiting for you. Pleasant dreams.
*For those of you unfamiliar with the ZPIC process, most results are well over 50 percent and I have yet to see an overpayment assessed at less than a million. This agency’s overpayment was measured in tens of thousands.
What I got from this is that it may not matter if you work you tush off all day or lolly-gag about, you could just get lucky. We work hard to try to do it right. It upsets me no end to know that it might not be enough.