With a proud 118 year heritage of service, the VNA of the Midlands is a vital and diverse organization providing home health, home infusion, hospice, palliative, and private duty companion care in addition to public health nursing services to clients in Nebraska and Iowa. The agency’s home health staff conducts 72,000 visits annually, private duty bills $1 million annually, and the hospice program has a daily census of 70-80 patients in addition to a public health nursing staff and providing EMR support for children attending a local Easter Seals summer camp.
Making the Decision to Change
Changing EMR providers was not a quick or easy decision, but Chief Executive Officer James C. Summerfelt summed up their frustration with the agency’s legacy vendor: “…we were promised so many things and there were so many delays and failures…if you had an employee perform like that there would be no question that you’d fire them.”
The agency embarked on a thoughtful search for a new EMR partner and went live on HealthWyse in March of 2013. A year post-implementation the team is pleased and excited about the results that they have seen: both in terms of financial and clinical performance.
A year in, the agency is “…in the best position that we’ve been in for a while.” The agency achieved this, he noted, in spite of rebasing, the continued sequestration holdback and a spate of regulatory changes.
Quarterly operating income in the first quarter of 2013 was a negative $425,000; a year later first quarter shows operating income of $188,000 – a swing of $613,000 in just twelve months.
During this same period DSO dropped 30%. In 2014 Days to RAP is averaging just 10 days--a 60% drop from 2013 rates. In addition, LUPA management improved 33%: dropping from a rate of 15-17% to approximately 10%, meeting the agency’s target.
HealthWyse has provided the data and reporting needed to drive the process improvement which has underpinned recent gains. The agency’s management team realized that, ultimately, success was tied not only to changing EMRs, but to seizing the opportunity to improve processes. Said Summerfelt: “…with our old system we didn’t have a line of sight to managing processes and people…Who is doing what, and who isn’t doing what.”
The agency’s strong performance since adopting HealthWyse gave the team the confidence to expand their business: they incorporated the Fremont Medical Center and the Hospice of Southwest Iowa under the VNA’s umbrella. Billing is centralized for all agencies, and after only a month on HealthWyse, the Fremont and Iowa teams are “starting to see results”.
Gains on the Clinical Front
Clinician productivity is up along with financial performance. For example: the average time to do an initial assessment was slashed 50%. Vice President of Home Care Bridget Caniglia notes that: “field staff no longer have to rely on air cards, they don’t struggle with dropped calls and they don’t have to restart documentation because of data loss.” These, and other improvements at point of care, facilitated by MobileWyse have helped to decrease the staff turnover rate and have helped the agency to attract and retain quality clinicians.
Caniglia also noted that because the MobileWyse point of care solution provides a more immediate view of patient needs they have the information needed to modify care plans and be more responsive to changes in status than they were previously.
Her staff appreciates the MobileWyse user interface: “it is well organized and outcome goals are tied to interventions, simplifying compliance with the plan of care.”
One proof point that HealthWyse is helping drive clinical productivity and improved outcomes: compensation is up. The VNA’s clinician “focused compensation” is based on a variety of metrics, including: visits, meetings, and outcomes. Summerfelt noted that staff compensation has “gotten so good that we’re revisiting it to see if we’re exceeding the market too much.”
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