Simione™ Healthcare Consultants

Operations


Assessment & Financial Analysis Clinical Operations OASIS Review & Validation
Process Engineering Strategic Planning Value-Based Purchasing Start-up Services

Our Operations consulting team provides the complement of services that enable organizations to improve quality, reduce cost, improve outcomes, and streamline operations. Key areas of focus include the following.

Assessment & Financial Analysis

We provide an in-depth review of your organizational structure, service delivery models and management of information, both operationally and financially, to identify opportunities for improvement in your organization.

Customized services may include:

  • Re-engineering of operational and organizational design

  • Mock state, federal and accreditation surveys

  • Competency assessment programs

  • Interim Executive Management Services

  • Assessment of performance in key indicators

  • Needs assessments for additional services

  • New service integration

  • Assistance with start-up activities for new product lines

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Clinical Operations

We assess all aspects of clinical operations from policy and procedures and quality programs to scheduling and staffing competencies. Our clinical team is highly experienced in agency management, quality improvement, process engineering, direct care provision and staff development.

Customized services may include:

  • OASIS review/audit and training

  • Clinical documentation studies

  • Tools and resources for value-based purchasing

  • Assistance with pre-claim review

  • Productivity and staffing analysis

  • Assistance with policy and procedure development

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OASIS Review & Validation

Successful home care organizations constantly strive to achieve maximum efficiencies and effectiveness in their service delivery through outcome-based quality management activities.

The keys to managing maximum effectiveness include:

  • Use of reliable, concrete measures of service outcomes

  • Consistent, accurate measurement of outcomes

  • Identification and use of best practices to reach desired outcomes

The home health care industry has a growing number of mechanisms to compare agencies on outcomes measures using standardized data from the OASIS data set. Organizations must utilize a systematic approach to maximize opportunities and minimize risks associated with outcomes measurement, thereby:

  • Assuring a consistent approach to patient assessment that results in accurate OASIS data

  • Providing ongoing OASIS education for clinical staff to assure uniform OASIS documentation

  • Identifying methods of improving practices associated with the outcomes

Simione has developed an OASIS Validation Program to assess the accuracy and consistency of OASIS documentation and implementation of corrective action. Our strategies for developing best practices will help you improve outcomes for each of the indicators used by CMS.

This program includes:

  • Best practice protocols designed to improve patient outcomes

  • Action plans for effective implementation

  • Tools to evaluate best practice program effectiveness

  • Monitoring for compliance with the protocols

This practical yet successful approach is designed to enhance results in patient clinical outcomes. It can also be modified for the management of outcomes for services outside the Medicare Home Health program.

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Process Engineering

Fundamental review of processes from referral management to claims generation with recommendations for achieving best practices to maximize resources and gain a competitive edge.

Strategic Planning

We facilitate the development of a strategic direction for many organizations every year, helping leadership teams and boards of directors identify priorities and potential opportunities for both short- and long-term business plans.

Our goals at Simione center on helping to position strategic-thinking organizations to thrive in changing environments and identify the resources needed for maintaining high quality and cost control, while working to achieve organizational growth.

Simione’s strategists provide insightful support to busy home care and hospice executives through these and other strategic services offerings:

Organizational Strategic Plan

  • Board development and strategy sessions

  • Research and interpretation of industry trends

  • Identification and analysis of existing opportunities

  • Strategies to capitalize on opportunities

New Business Development Plan

  • Market analyses

  • Feasibility studies

  • Business plans

Mergers and Acquisitions Services

  • Due diligence (clinical and financial)

  • Business valuations

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Value-Based Purchasing

Where do you stand with value-based purchasing? Have you performed a readiness assessment for your agency? Do you have the tools to succeed in an environment that rewards for value, not volume?

Simione Healthcare Consultants understands that home health agencies (HHAs) want and need more information about the requirements for Value-Based Purchasing (VBP). We will provide real-time strategies to operate within this developing CMS purchasing model designed to develop greater transparency regarding quality and align the market to deliver care based on value over volume. To be ready for these changes, HHAs will need to evaluate operations, ensure OASIS accuracy, and provide education to determine the most efficient structure and processes for demonstrating high-quality care and compliance in an integrated, streamlined and cost-effective manner.

As the largest consulting firm in the U.S. dedicated to post-acute providers, Simione has developed a Value-Based Purchasing Toolkit to prepare HHAs for success with the VBP model. The Toolkit includes resources and support to improve performance with quality measures and public reporting, including:

  • Snapshot Assessment: Simione will assess your HHA's currently reported measures and status to identify specific opportunities for improvement, and compare your performance to providers in your state.

  • Readiness Checklist & Analysis: Simione will help your team understand what VBP means, its potential impact on your agency, and what clinical and operational strategies will be necessary to improve outcomes.

  • Newly Reported Measures & QAPI Assessment: Simione will prepare your HHA for the measures not currently reported, and assess your QAPI program to help you incorporate these measures in an efficient manner.

  • Training & Support: Simione will provide training for OASIS and the Home Health CAHPS Survey to help your team understand these measures, and facilitate improvements for public reporting, survey readiness and VBP.

Let Us Help You Succeed with Value-Based Purchasing – Call 844.215.8823

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Start-up Services - Home Health and Hospice

Simione Healthcare Consultants provides comprehensive consulting support for the start-up of home health and hospice organizations, helping numerous agencies open and/or launch additional lines of business to support growth.

Essential first steps for home health or hospice start-up include the completion of a market assessment, business plan and budget proforma to ensure effective implementation and successful completion of licensure and certification to meet state and federal requirements. New owners/operators should expect the process to open a new home health or hospice organization to require:

  • a capital investment in the range of $200,000-$300,000 for start-up costs

  • approximately 12-18 months to obtain state licensure and Medicare certification

SCOPE OF START-UP SERVICES: HOW SIMIONE CAN HELP

Simione experts provide both on-site and off-site consulting, depending upon each client’s needs with respect to scope of work, budget and timetables. Services and support may include the following based on a specific work proposal and project estimate prepared for each client:

  • Market Assessment

  • Business Plan

  • Budget Preparation and Financial Proforma Review

  • Operations/Organizational Structure

    • Table of organization, staffing/service delivery models, staffing ratios, personnel functions, job descriptions

  • State, Federal and Accreditation Survey Preparation (application, documentation, CMS 855A, mock survey)

  • Policy & Procedure Manuals and Forms Development

  • Quality Assessment/Performance Improvement Planning

    • Measuring and improving quality outcomes

    • Staff Training/Competency Testing/Clinical Skills Validation

    • Reporting requirements, patient/family satisfaction, adverse events, safety, infection control

  • Implementation of Best Practices

    • Referral/Intake

    • Scheduling

    • Admission

    • Clinical Record Documentation/Documentation Review - EMR implementation

    • Back office implementation (billing, reimbursement, financial services responsibilities)

  • Hospice Specific (volunteer/bereavement programs, hospice vendor contract review, IDT meetings)

  • Benchmarking for operations and finance to assess and improve daily operations

STATE LICENSURE REQUIREMENTS

Licensure requirements, timetables, fees and survey frequency vary significantly from state to state for home health providers. Simione recommends that you visit the websites of your state health department and your state’s trade association for home care and hospice providers to determine state requirements and guidelines for home health, hospice and private duty agencies.

MEDICARE REQUIREMENTS

Medicare certification enables home health and hospice providers to serve the growing population of older Americans who require services at home. It remains a critical source of revenue for the majority of providers. Visit cms.gov to learn about the Medicare requirements for home care and hospice, including the Conditions of Participation, reporting of quality data, claims processing, and more.

ABOUT SIMIONE HEALTHCARE CONSULTANTS

Founded in 1966, Simione Healthcare Consultants embodies a diverse group of business talent across the U.S. to provide accessible, cost-effective business solutions for the home health and hospice industry. Key areas of expertise include operations, compliance and risk, finance, sales and marketing, cost reporting, and mergers and acquisitions. Simione supports performance improvement across the healthcare continuum, engaging agencies, hospitals and health networks for more effective delivery of home health and hospice care. More than 1,500 organizations use Simione’s experts and tools to improve quality, reduce costs, and minimize risk to drive business performance.

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