This article is sponsored by Simione Healthcare Consultants. In this VOICES interview, Home Health Care News sits down with Simione Healthcare Consultants Managing Director Julia Maroney to learn the road that clinicians take to become business managers, starting with education, training and mentoring — and how Simione can help them get there.
Home Health Care News: Julia, you’ve been with Simione for 13 years. What career experiences do you most draw from in your current position?
Julia Maroney: In my current position as the managing director for Simione, I came into the position with well over 25 years in the industry in home health and hospice clinical operations, which means looking over the whole operation for service delivery. Certainly now, looking forward and dealing with clients in my current role, it’s clear that things are going to change. We’ve dealt with a lot of changes in the industry over the years, and the biggest challenge that we’ve had in my career has been with the COVID-19 pandemic.
Along with that is the challenge that we had with the first year of PDGM (Patient-Driven Groupings Model). I think the industry and its leaders are certainly the most versatile group, caring group, and take change as a constant. That’s what I draw from the many years that I’ve been in the industry, is that change is inevitable, change is coming, and change is our norm. Being able to spin on a dime and do what we do to care for our patients is what home health and hospice does.
Beyond COVID-19, what are the top three challenges facing home health providers in 2021?
Maroney: I think the biggest thing for providers in 2021 is staffing. We got hit with the pandemic and people got scared and got out of the industry, retired, what have you. From a clinical standpoint, we have to bring in skilled providers and caregivers to deliver the care and services that we need. These are going to be more intensive, because we now have people who are skipping long-term care facilities and coming directly from hospitalizations to home health. This is something that we’re completely capable of doing, but the challenge is making sure we have the staff, not only for that intensity, but also for the growth that we’re going to experience and have been experiencing over the past year.
Another challenge is certainly the impact of the No-Pay RAP and the issue of cash flow. Our processes are going to impact how we get paid. Cash flow has been an issue for organizations. I know there were a lot of predictions in the beginning of 2020 that many organizations would be going through the M&A processes because they were unable to meet their regulatory challenges. We’re going to see that more and more this year. That’s a challenge for everybody — from the big national organizations to the mom-and-pops. Cash flow is huge.
The third challenge is the dynamic between quality and growth. The value-based purchasing, five-star rating is not going away. In fact, we’ve been told that it’s going to be expanded. What does that mean to provider organizations? Making sure that agencies are paying attention to how they are doing within clinical outcomes while experiencing growth and staffing challenges. It’s a three-tiered problem to have for an organization, but those are the biggest challenges I see.
Tell us about this idea of clinicians becoming business managers. Why in your view do they have that potential to do that job in an excellent fashion?
Maroney: In this industry and certainly in any health care industry, when we have a good clinician, we often promote them into being a manager without the necessary business training that goes with that. They obviously know how to provide care for the patients. They understand that extensively. They understand the quality issues with the delivery of care, ensuring that patients are not being re-hospitalized, making sure that we have good outcomes.
But they often don’t have a background in finance or understanding the business aspects of the overall operation. They need to understand the impact of their decisions – including the financial impact — to the organization.
What are the top management responsibilities that clinicians are typically not ready for?
Maroney: By and large, clinical managers are lacking in that financial and business operations understanding. That’s definitely one of the areas that they need. What is my financial report? What are the key indicators that I can impact? What’s the impact to the organization if the productivity is low or utilization is high?
Understanding those dynamics is the biggest thing that they’re not always ready for and, to a lesser extent, understanding their impact on the overall leadership within the organization. That they are leaders in the organization, that they have an impact on the overall behavior and success of the culture of the organization. They need training and support there as well.
What are the best practices for filling those skills gaps and providing that training?
Maroney: The simple answer is always education. Provide people with the training that they need. But mentoring is also very important. The mentoring of a higher level leader is vital, and the external, industry-based mentoring can help guide the clinical managers. That is vitally important.
Mentoring can also occur with an internal financial colleague, such as the director of finance or the CFO, in coaching clinical managers and leaders and talking with them on a routine basis about their indicators and performance. That helps them learn, and helps them guide clinical teams.
How does Simione help agencies execute those best practices?
Maroney: One of the things that we do a lot is certainly our operational assessments and looking at the overall operation, and part of that is always talking with the clinical managers and leadership to understand their challenges, their knowledge, their data and what they look at every day. We want to see how they manage, and then assess what they need to do differently, if anything.
What we have found in the past several years is that the advent of PDGM has helped us to work with organizations across clinical and financial operations. It really has come to the forefront that clinical managers had a deficit, so being able to train them mattered. We offer our clinical manager training series, and we also do it privately with organizations through classes, mentoring and interim management. We also do mentorship with clinical managers and clinical leaders, meeting with them monthly to review data and progress.
We can meet with their clinical people and their financial people and tag team with our clinical and financial folks to go over their key performance indicators, talk about what we would look at from our standpoint. It helps them to develop a rhythm, a cadence in reviewing that data and how they should relate to one another.
Some types of language are a little different. Things are not as black and white in the clinical world as they are in the financial world. Sometimes there’s a gap that we can help organizations bridge so that clinical and financial people are routinely talking to one another, reviewing their data and moving forward as a team, with everyone having the same goals for the same outcome.
Simione Healthcare Consultants is a renewable resource. We’re not there 24/7, 365, but sometimes executive teams may be small and need new perspective. Giving them guidance on a growth plan and then helping them take it to market can be a real lifeline if an organization is starting to struggle.
We say once a client, always a client. We have a lot of long-term relationships with clients. Sometimes they’ll reach out to us for a tune up — just a pep talk kind of a thing. There’s no bad time to do that, but I think when you’re looking to embark on a new year, or you’re looking at your end-of-quarter or mid-year results, or it’s budget time, the reality is that new information can make your process a lot smoother.
Why does strong clinical leadership matter in the home in 2021 and beyond?
Maroney: Strong clinical leadership matters because it’s the key position in an organization. Right now, a clinical manager is managing the overall care of the patient by coaching, teaching, training and supervising the staff members who are providing the services. These managers are ensuring that care is being delivered effectively and efficiently. They’re monitoring the staff productivity, the use of overtime, everything, making the overall organization cost and quality outcome dependent on that clinical position.
When they’re doing what they need to do, things run smoothly. If they don’t know what to do or can’t manage effectively, then the operation will have issues. They truly are the linchpin and the overall key to success for the organization.
I’ve been asking everyone, 2020 was a rough year but there is reason for hope. What makes you hopeful about the home health industry in 2021?
Maroney: The industry has risen to the technology challenge, as people are moving in that direction. We rose to the challenge of being able to care for patients in their homes. We had more use of telehealth, which is certainly a vital service now, as some people want to avoid skilled nursing facilities or long-term care. They want to come home. The hope is that now we’re more able to prove our value to the overall health industry, to the overall health care continuum.
We want home health to be that missing link in the connection for patients and their families. I think that’s the hope. I think that was said almost every year since I’ve been in this industry that, “Our time has come. Our time has come.” Well, I really believe it. I really believe that the time has come for home health. There’s huge growth in our industry now that we didn’t have in previous years, so I think it’s a good thing.
Editor’s note: This interview has been edited for length and clarity.
Simione Healthcare Consultants is a consulting firm dedicated to providers of home health, hospice, palliative care, home care, pediatrics, home infusion, applied behavioral health (ABA) and DME. Learn more at Simione.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact email@example.com.