Fluent Essays

I need you to spin this paper and prepare proper answers with no grammatical errors or plagiarism (Will pay you 1500bob) Review the Hillsboro County Home Health Agency, Inc. (HCHHA) case study in this week’s Learning Resources. Note: Your Final Project should show effective application of triangulation of content and resources in your conclusion and recommendations. The Assignment HCHHA’s board of directors and executive leadership team have asked for your assistance with addressing some of the major issues that have adversely impacted the organization’s financial and operational performances. They have requested that you advise them on the following: Strategies to help the organization address the absence of a Medicare-certified hospice, which has inconvenienced patients and their family members and has led to negative publicity for the organization Strategies that might improve HCHHA’s overall financial performance Strategies that might improve HCHHA’s operational performance Strategies that might assist HCHHA with effectively addressing the various external factors that may potentially threaten its market share In a 20-page strategic plan, include the following components: Mission statement (provided in the case study) Vision statement Core values SWOT analysis Grand strategies or long-term strategic priorities Operational and tactical plan Key performance and evaluation indicators Change management plan, including the following: The size of the change and its impact on the community and the organization The organization’s readiness for change Change management strategy Team structure and responsibilities Sponsor roles and responsibilities Planning and implementation Communications plan Change management resistance plan Training plan Incentives and celebration of successes Timeline/schedule of activities Budget for change management The 20-page narrative plan should be written as if it were to be presented to the board of directors. The plan should also include the following pages that will not count toward the 20-page limit: One-page Executive Summary Tables, graphs, and/or charts The plan should include at least 15 current (no older than 4 years) quality resources, with 10 of those resources being from peer-reviewed sources. The American College of Healthcare Executives Competencies Assessment tool is used to assess health care managers and executives in critical areas of health care management. This valuable assessment is designed to help you identify areas of strength and areas you may wish to include in your personal and academic development plan after you graduate from Walden’s MHA program. Also, you can use the assessment score to identify gaps in skills necessary for optimizing performance. For the Final Project in this course, your Instructor will assign you an overall competency level score based on the work submitted in the Final Project. This competency level assessment score is for your information only and is offered in addition to the grade rubrics, grade points, and grade feedback provided by your Instructor. The competency level designations are as follows: Novice = 1 Competent = 2 Expert = 3 Attachments area T he Hillsboro County Home Health Agency (HCHHA), originally named the Middleboro Home Health Agency, was founded in 1946 as a nonprofit home health agency to provide healthcare services to the area's population. Three years ago, in conjunction with establishing an office in Jasper, the organization changed its name to reflect better its countywide orientation. Today, it is the only Medicare-certified home health agency in Hillsboro County. The Joint Com­ mission also accredits it. MISSION "The mission of HCHHA is co serve individuals in their usual environments and is concerned with well people as well as people with illness or disabilities. We strive co prevent disease or co retard its progress and to reduce the ill effects of unavoidable disease. We provide quality nursing and therapeu­ tic care co the noninstitutionalized sick and disabled. We also provide information and encourage­ menc to individuals and families, special groups, and the community as a whole for the promotion of health." (Approved by the board of directors, December 31, 2010.) Case 2: Hillsboro County Home Health Agency, Inc. GOVERNANCE Overall responsibility for HCHHA rests with the board of directors. The 21-person board meets monthly to review the status of the corporation. Except as noted the board acts as a committee of the whole. All directors serve for a three-year term and may be reelected by the board. The executive committee nominates individuals for membership on the board. The new board then elects its officers. The election of directors is done by the full board at the June meeting. New directors and officers take their positions beginning July 1. Last year a consu ltant recommended that the board cease being self-perpetuating and establish mandatory term limits. The board is still considering this concept. The executive committee (president, vice president, secretary, and treasurer) meets, as needed, with the executive director to resolve special issues and plan board meetings. In April of each year, the executive committee prepares a slate of nominees for new board members. The finance committee meets monthly with the executive director to review the financial status of the corporation. It also reviews and recommends the new annual bud­ get to the full board for approval. The professional advisory committee meets monthly to review issues related to clinical care and quality standards. Membership on the current board includes Janet Myer, senior vice president at the Middleboro Trust Company. She is currently president of the board of directors and has one year remaining on her third three-year term. She lives in Middleboro. This is her fourth consecutive year as board president. It should be noted that Myer was instrumental in the reorganization of the agency three years ago. David Ruseski, owner of Ruseski Auto Sales in Middleboro and Jasper, is in his second year as vice president of the board. His first three-year term on the board will expire next June, but he has agreed co serve for another three-year term if he is nominated. During 2012 he chaired the firntnce committee. Ruseski lives in Miffienville. Mary Steel, JD, is the elected sec­ retary. She maintains her solo law practice in Miffienville and lives in Middleboro. Steel has been on the board for nine years. Steve Meadows is the elected treasurer. He is the senior partner in the accounting firm of Meadows and Associates in Middleboro. He has served on the b.oard for 14 years. As treasurer, he is a member of the finance committee. He lives in Statesville. William Bond, vice president of finance at Master Tractor, was elected to his first term on the board two years ago. He chairs the finance committee and has indicated that he will be unable to serve beyond this coming June. He lives in Miffienville. Martha Logic, JD, is an attorney in the law offices of the Jasper Legal Assistance Clinic and has served on the board for five years. She lives in Jasper. Carl Fisher was elected co the board for his first term three years ago. He is a retired major general from the us· Army and is active in the local chapter of the MRP. He maintains farming ·interests at his family's farm in Boalsburg. Nancy Blau w� elected to the board for her first term two years ago. She is 47 48 The Middleboro Casebook a former county commissioner, a member of the regional school board, and a trustee at Webster Hospital. She lives in Middleboro. She serves on the finance committee. Helen Vosper, RN, was reelected ro the board four years ago. She was the director of nursing at Middleboro Community Hospital until 2010 and recently retired as director of nursing at Webster Hospital. She lives in Middleboro. Lois Metz, MSW, was elected to the board lase July and is serving her first term. She maintains her independent practice as a social worker in Middleboro, where she specializes in marriage and family counseling. She lives in Middleboro. Janee Doe was reelected to the board two years ago. She is a retired regis­ tered nurse and the former director of school nursing for public schools in Middleboro. She resides in Middleboro and has been a member of the board for 16 years. Melissa Giles, a recent law school graduate and alumna of the Middleboro school system, was elected to the board lase year. She is currently a legislative aide to US Representative James Giles, and she specializes in elder issues. She resides in Jasper. Mary Care, RN, was reelec�d to che board three years ago. She is the executive director of Valley Hospice and has served nine years on the board. Cindy Donnelly has been a member of the board for 19 years. She is a former reporter with the Midd/eboro Sentinel and lives in Miffienville. Walter Graham was recently elected co fill a board vacancy created by a resignation. His first term has cwo years remaining. He is the senior administrator at Medical Associates, a multispecialry group practice located in Jasper and Middleboro. Matty O'Brien, OT, has been a member of the board for seven years. She is professor emeritus of occupational therapy at State University and has lived in Middleboro for the past cen years. Board Committees, 2014 Chair Members Executive Myer Ruseski, Steel, Meadows Finance Bond Blau, Logic, Giles, Martin Professional Advisory Vosper Metz, Doe, Care, O'Brien, Ellis Publicity and Public Relations Fisher Donnelly, Black Building and Grounds Shields Graham, George Mark Shields has been a member of the board for 17 years and is the chair of the building and grounds committee. He resides in Statesville, where he operates a large feed and grain business and serves as an elected town official. Conner George has been a mem­ ber of the board for 13 years, lives in MifHenville, and has a professional background in Case 2: Hillsboro County Home Health Agency, Inc. landscaping. Dennis Martin lives in Jasper and is a retired superintendent of schools in Jasper. He has been on the board for four years. Frances Black lives in Middleboro, where she is active in civic affairs. She has been on the board for seven years. Jennifer Ellis lives in Jasper, where she maintains a private practice in speech pathology. She has been on the board for rwo years. In 2001, the board created a community advisory council to provide advisory ser­ vices to each of the programs provided by the agency and to increase commw1ity participa­ tion without expanding the formal board of directors. Because of the increased possibility of conflict of interest in a competitive healthcare market, as well as declining attendance at quarterly meetings, the board abandoned this council in 2011. It should be noted that in 2010, the board passed a resolution that stated, "Board members represent themselves, not their employers." Physician interest in serving on che board has been nonexistent since Maynard Cushing, MD, completed his service in 2010. Dr. Rita Hottle ofMiddleboro serves as the agency's medical director. For the past three years, the agency has experienced a decline in operating margin. In 2013 and 2014, the agency experienced its first losses from opera­ tions. The losses were funded out of net assets. The finance committee is concerned by the downward trend in financial perfor­ mance from operations as well as the impending significant change in reimbursement for the agency, mandated by the changes in Medicare and Medicaid. MANAGEMENT TEAM Hired at the time of corporate expansion in 2010, Martha Washington, RN, MHA, is HCHHA's executive director. Prior to serving in chis position, Washington was the regional' director for a large for-profit chain of home health agencies, and she managed the affairs of 13 separate agencies. Before that, she was director of marketing for a large medical products firm headquartered in Capital City. She also has approximately ten years of experience as a visiting nurse with a large visiting nurses association located in a major midwestern city. Today, she is vice president of the Seate Home Health Association and maintains an active presence in the state legislature, lobbying for home care issues. After formal review, the board recently extended her four-year contract for another four years with an increase in salary. Since her arrival, Washington has reorganized the agency into three divisions: Home Care, Private Duty, and Community Health. As approved by the .board prior to her appointment, she opened an additional office located in Jasper to support all pro­ grams. Under her leadership, existing services were expanded and new services were added. Above all else, she has worked co ensure that the agency continues to fulfill its mission. 49 50 The Middleboro Casebook Her management style emphasizes the delegation of clearly expressed responsibilities. She has delegated responsibility for operations to each full-time division manager, added a special assistant co the executive director co assist with projects related to human resources adminisrratio; and marketing, and upgraded the bookkeeper position to a professional position as controller. In her first year at the agency, Washington-with the able assistance of select board members and consultants-selected and installed an electronic medical record and patient care planning system specifically designed for home health ca.re. The system has been operational for 18 months in the Home Care Division and 12 months in .the Private Duty division. The system required a significant financial commitment. Ruch Marcin, RN, is che manager of the Community Health Division. Four years ago she asked the board co relieve her as executive director, a position she had held for three years. She asked to be retained by the agency as the program manager for the Co\Ilmunity Healrh Program, which upon reorganization became the Community Health Division . The board, after much discussion, agreed and then recruited Washington as executive director with the understanding chat Martin would be retained for at least three years. Prior to being appointed executive director, Marcin had been the assistant director for 12 years. During chis tenure she was responsible for beginning che high blood pressure and maternal and child health program initiatives. Prior co relocating to Middleboro, she was employed by the Capital City Home Healch Agency as a home care coordinator. She is a graduate of a southern university and has completed her graduate education in community health nursing. Catherine Newfields, RN, is the manager of the Home Care Division. Washington hired her in 2011. She is a former assistant professor of community health nursing at Stace University. Prior to her faculty appointment, Ms. Newfields completed her graduate studies in community health nursing at a major southern university and has 17 years of experience in all aspects of home care, including a brief tenure as the executive director of a small visiting nurses association in another part of the state. Michael Carlstcad, LPN, manages the Private Duty Division. He has more than 30 years of experience as a home health aide (HHA) and licensed practical nurse (LPN). He completed his nursing training 18 years ago and recently earned his bachelor's degree in business administration from a small college chat offers distance education opportunities for working professionals. Carlstead has been affiliated with the agency for 24 years and plans to retire in six months. Steve Callahan is the controller. Washington promoted him upon completion of his bachelor's degree in accounting two years ago. He has worked for the agency for ren years. He was originally hired as assistant bookkeeper and then promoted to bookkeeper. He is currently matriculating part-time for his graduate degree in business administration Case 2: Hillsboro County Home Health Agency, Inc. at Seate University. Since his promotion, he has become very active in the State Home Care Association. Judy Herman, RN, is the quality improvement and utilization review manager. Herman devotes most of her time to the Home Care Program and regulatory compliance with Medicare and Medicaid. She is also responsible for the electronic medical record sys­ tem. She is a graduate of State University and holds an MS in nursing quality improvement from a private university. She has approximately 15 years' experience in quality improve­ ment in home care and worked with Ms. Washington prior to coming to this agency. Washington has indicated thac she is not yet satisfied with the agency's ability to qualify for Medicare reimbursement under the Home Health Prospective Payment Sys­ tem. "1he coordination between our clinical personnel and our business office needs to be improved. For example, last ye--a.r we had more than 20 cases where we failed to adhere to the 60-day physician review requirements. Also, too often we need to begin providing home care services before we actually have the signed physician's certificate, thereby jeop­ ardizing and delaying our qualification under Medicare. These remain some of the issues chat Steve Callahan and Catherine Newfields need to address. I am, however, delighted chat Steve has taken on an active role with our state association. We need someone who is on top of Medicare's Outcome and Assessment Information Set and in a position to represent our interests." When interviewed, Steve Callahan indicated chat the agency is attempting to address some major problems including "our operating margin and days in accounts receivable. We have some specific challenges that are taking a great deal of attention." Mary Bird is responsible to Martha Washington for special projects involving human resources administration and marketing, and she staffs the Jasper office when needed. She completed her baccalaureate-level studies in health services administration at State Uri.iversity two years ago, then returned to Middleboro, where she was born. Dur­ ing her academic career, she had interned under Washington when Washington was the regional director for the for-profit chain of home care agencies. She has told Washington chat unless her position is made full time in 2015, she will be forced to look elsewhere for employment. Every two weeks the management team meets formally to review operations and to solve problems. The entire management team attends all monthly board meetings. Wash­ ington used the opportunity created by her recent performance review to share certain confidences with the board. She indicated chat the Jasper plan needed a complete reevalu­ ation and that she was unsure exactly what an office location in Jasper was. really gaining for the agency. She also noted that she had learned that Unicare Home�o, a national for-profit home care corporation, had recently completed a feasibility study to enter the Jasper market. 51 The Middleboro Casebook She indicated that more rime was needed to meet personally with major referral sources and chat additional funds were needed for advertising. She also said chac she was not pleased with the overall decline in financial performance of the agency, par­ ticularly in the Community Health Division, and thac she foresaw a steadily declining revenue picture in char area. She mentioned co the board chat her relationship with Marrin, while professional, seemed co highlight the difference in their perspectives and the old versus the new approaches she was attempting to implement. She also stated that to continue expanding services, she would need more help and chat she felt chat the long-term care program offered by the Home Care Division faced an expanding market. Washington also said that she faced some "productivity problems" with some of the older employees and alerted the board that some changes may need to be made. Repeat­ edly, rhe board emphasized to her that it wanes the HCHHA to remain the sole provider of Medicare-certified home care services in the county and chat it expected the public to so value the agency that they would continue co support the agency with their contributions. William Bond, chair of the finance comminee also indicated to her that he and the rest of the board felt comfortable with her at the helm. The board felt that she understood the finances as well as che dynamics of the home care market. Bond was cautiously optimistic about the financial future as long as the long-term care program matured counrywide and as long as the agency could operate effectively under the prospective fixed-price reim­ bursement environment imposed by Medicare. Myer assured her of board support if the Community Health Division had to be resized and refocused to correspond better with its financial support. Washington expressed her concern over the increased competition in the home care field as well as the changing reimbursement system. In addition co the interest expressed in the Jasper market by a national home care company, she noted char insurance companies and managed care organizations were expressing increasing interest in using home care ser­ vices. She pointed out the agency's relatively high dependency on government programs, particularly Medicare, in spice of reasonably successful efforts to establish contracts with managed care organizations. A recenr article published in the State Home Care Association Newsletter reported that the number of agencies consolidating or going out of business alrogerher had been increasing dramatically within the past six months, primarily as a result of rhe impact of reimbursement changes. HOME CARE DIVISION This program provides nursing (RN and LPN) and other services (e.g., occupational rher­ apy, physical therapy, speech therapy) to patients in their homes. Medicare, Medicaid, and self-pay and private insurance carriers provide funding for this program. Within the past Case 2: Hillsboro County Home Health Agency, Inc. five years, the agency has pursued contracts with local managed care organizations. As a result of these efforts, contracts are in place with Central Scates Good Health Network and one other commercial HMO. Medicare finances four categories of service: intermit­ tent nursing care; physical, occupational, or speech therapy; medical social services; and intermittent care provided by a home health aide. RNs assess and monitor all patients. They are responsible for treatment planning, administering medications, and other nursing services. LPNs work as team members in implementing treatment plans and providing assistance with self-care activities within rhe context of Medicare and Medicaid regulations. Therapists and other contract professionals (e.g., physical therapists, occupational therapists, speech therapists, social workers, nutri­ tionists) are available as consultants and to implement treatment plans. The division manager is responsible for the development of the treatment plan when a patient enters the active caseload. Case management is then delegated i:o the appropriate staff member(s). The responsibility for timely patient discharge and case find­ ing rests with the division manager. The division manager is also responsible for the design and implementation of an appropriate quality assurance system. For the past three years, the staff has reported chat patients served by this program immediately following a hospital discharge required more intensive services than they had in the past. This division also provides pediatric services to children who are born prematurely, who are recovering from surgery, or who are experiencing a chronic disease. Special therapy services are also available. Typically, these types of services are covered by medical insurance plans, Medicare, and Medicaid. When interviewed, Catherine Newfields, division manager, said "staff turnover was a real and-sometimes-a critical issue." Specifically, she indicated that a primary diffi­ culty with this program was her staff's reluctance to provide N therapy to cancer patients who routinely require 24-hour, seven-day-a-week coverage. She also scared that she was somewhat concerned that hospitals in Capital City were referring their patients living in Jasper to rhe Capital City Visiting Nurse Association (VNA), not HCHHA, which had been the practice until 2012. She mentioned being annoyed that almost every time she drove into Jasper, she heard a radio commercial extolling the services of the Capital City VNA. She felt an office location in Jasper was needed more for the Community Health Division than for this division since most of "her staff" lived in the Middleboro area and traveled from the Middleboro office of the agency. She also indicated that getting the required physician recertification every 60 days for Medicare patients was a frequent chal­ lenge. Medicare�s changing definitions and rules (e.g., definition of homebound) were also mentioned as a source of stress and fruscrarion. Newfields has recently obtained the following national data and is considering whether it might be appropriate in special benchmarking studies. 53 54 The Middleboro Casebook National Utilization Statistics- Home Health Patients currently being served by home health agency Patients under 65 years of age Patients 65 years or older Home health care patients discharged past 12 months Under 65 years of age 65 years or older At time of discharge, patient. .. Remained in community Transferred to another setting Is deceased Unknown NOTE: Discharge means when a case is closed by the home health agency. Rate per 10,000 population 16.4 91.0 1,439.3 Percent 71.5 20.5 2.3 5.7 Newfields indicated char her division's experience closely parallels the national Medicare percentages by International Classification of Disease Codes (ICDA) and chat­ similar to the national data-few cases extend over a long time, making the division's mean service time significantly higher than the median values. Current efforcs are under way to compare this division's service rimes with these national statistics. A recent study done by a student ac the scace university indicated that on aver­ age every Medicare home visit involved an average (round trip) of 11.2 miles. Over the past five years the study showed that one of the hidden costs of services was the price of gasoline. When asked about her assessment of the agency, Newfields indicated chat she had questions about the impact of the three-division model. She indicated chat "her Medicare patients" needed stronger nutritional counseling, flu and pneumonia prevention programs, and chat formal programs in pain management, fall prevention, and diabetes education needed to be considered but chat "these type of programs typically end up in the Com­ munity Health Division." As she said, sometimes "our silos get in our way." She seated that her division needed the opportunity co expand its emergency preparedness. She also Case 2: Hillsboro County Home Health Agency, Inc. indicated that Medicare's rule that client eligibility requires a patient to be "homebound" continues to prevent meeting the needs of a number of individuals. "Too often we have to explain co senior citizens that they do not qualify for Medicare Home Care because they are nor homebound as defined by Medicare," she said. PRIVATE DUTY DIVISION This program began in 2012. Its primary intent is to assist patients with activities of daily living and to provide other services as needed. Medicare does not provide payment for these services. All funds come from Medicaid, self-pay, and private insurance. The division and its programs began for both service and financial reasons. A formal marketing study completed in 2011 indicated a strong demand for these types of services. To date, demand has surpassed expectations. All services are purchased based on an hourly, daily, or weekly charge. Medicaid sets its own hourly rates by service. PRIVATE DUTY SERVICES Under chis program professional LPNs can be hired to provide assistance with nursing care including medication assistance and blood pressure screenings. RNs provide skilled nursing care under a physician's order, administer medications, and provide other specialized services. As needed physical, occupational, and speech therapy, and social work services are also available. COMPANION AND HOMEMAKING SERVICES This service provides trained staff for light housekeeping, grocery shopping, meal prep­ aration, laundry, and similar duties. Homemaker/housekeeper aides provide in-home services. PERSONAL CARE SERVICES Clients are provided assistance with bathing and other activities of daily living as well as respite care. Services are provided by personal care attendants. Overall this program provides a menu of services (and prices) clients can select to meet their rreeds. No medical authorization is needed. When interviewed, Carlstead stated, "We never seem to have enough staff to meet our clients' needs:' He.attributes this to the low pay and benefits and says that "not everyone is. really suited to provide these types of services." He also stared that the paperwork really "gets me down. Over the past 20 years the paperwork has just increased and increased-it never seems to end." He did 5 5 56 The Middleboro Casebook say that his loyal staff is great and that he really enjoys working with them and will miss them when he retires. Clients contract for a specific number of hours per week and are billed at the end of the week. Most clients pay by credit card, although some pay with cash or check. Any client with an outstanding balance for more than two weeks is reviewed and potentially dropped from the programs. For Medicaid to pay, the client muse be Medicaid-eligible and the service plan muse be approved by Medicaid before services are provided. Carlstead stated concerns about the human resources dimension of the agency: "le is essential that we have current information of the professional status of all of our employ­ ees, but sometimes we don't. Credentialing and background checks are an issue that could gee us into trouble." He also indicated that "work rules" need to be the same within each of the divisions and char the current employee handbook was old and out of date, having been published in 2006. "Ocher issues we face include the poor and potentially unhealthy condition of the client's home sometimes created by a client's inability to car� for (coo many) family pets," he said. COMMUNITY HEALTH DIVISION Unlike in che other divisions of HCHHA, the manager of this division must apply for grants for private, scare, and local funds and attend town meetings co secure funding for services. TELEHEALTH PROGRAM This program provides home monitoring for individuals with a chronic iJlness who pres­ ent a high risk of rehospitalization. It is a cooperative program between the home health agency and both hospitals. Hospitals and attending physicians identify potential patients who are then offered this service free of charge. An HCHHA nurse works with each patient to help him develop self-care skills. MATERNAL AND CHILD HEALTH PROGRAM The Maternal and Child Health Program provides educational, direct services, and health screening programs to expectant mothers and their children who are less than one year of age as well as child home care visits for qualifying children up co one year after birch. As-needed bilirubin photo light therapy services are also available. Funding is provided by the state through an annual grant and from Medicaid. All recipients of state public assis­ tance are eligible (without charge) for this service. Ochers may receive service for a modest contribution. Classes and clinics are also held in Middleboro and Jasper based on funding Case 2: Hillsboro County Home Health Agency, Inc. 57 received from scace, county, and cown grants. The agency's prenatal program includes a home visit from a maternity nurse co evaluate the health of both the mother and the child, and to provide counseling on breast-feeding, diec, …