This article is sponsored by nVoq. This article is based on a Home Health Care News discussion with Jason Banks, Vice President of Post-Acute Development at nVoq. The discussion took place on September 15, 2022 during the Home Health Care News FUTURE Conference in New York City. The article below has been edited for length and clarity.
Home Health Care News: Can you give a brief background of nVoq to the audience?
Jason Banks: nVoq is a speech recognition provider, and we have been around for over 20 years, primarily in the acute and ambulatory space, serving physicians as more of a utility under the covers for companies like Dolbey and Suki and Konica Minolta. I was around operating in that mode for the better part of 15, 16 years. A few years ago, I got involved in post-acute care, home care and hospice.
We thought there was a huge market there to really make an impact with home health clinicians, home health hospice, nurses, social workers, chaplains, PTs, and OTs. We got involved in that industry just a couple of years ago and just took off. I had no idea if it would take off, I was hopeful, because I thought it really could make a difference in the average lives of the clinicians.
What we found over the past couple of years, it’s doing what we hoped it would do, which was giving some space back to these amazing superheroes that are out in the homes, serving patients and families. Ultimately, that has a lot of really awesome downstream impacts to the business as well.
HHCN: What have you learned in the last year about how this can affect the home health and hospice space?
Banks: We learned a couple of things and some of it was just by reporting. There’s a study in the Journal of Nursing Education and the study was done right before COVID. The net of the study is that you have home health which used to be a much more satisfied workforce than acute and ambulatory care in the year 2000. That started to flip in about 2004, and has gotten progressively worse since. We try to really figure out and understand why.
The theory is that the regulatory and documentation burden has gotten so high, that it is driving these clinicians out of the industry. One of the things that we were looking to solve is to create that work-life balance for those clinicians. Then, like I said, it ultimately will result in a lot of good downstream things too. Not just retention, which is probably the most important thing, but it also results in decreased QA costs, because the quality of their documentation actually goes up, decreased write-offs for the organization, decreased ADRs for the organization.
Our mission is to serve the frontline clinicians and make their documentation process as easy as it possibly can be. Then over the last year, what we’ve actually been able to do is work with some of the folks in the room, as well as other providers across the country to realize that data and codify it in study. We have a number of clients that we’ve either had case studies, formal studies, or just anecdotal sort of research that we’ve done with them to prove out that dictation is really saving them material time up to 90 minutes, sometimes two hours a day per clinician.
I had the good fortune of running a hospice in Chicago for a couple of years. I had clinicians that we paid very competitively. We had a really fun culture supporting each other, but they were still leaving the profession and we were bound and determined to figure out why. Through a number of efforts, ride-alongs, meetings, one-on-one meetings, exit surveys, looking at all the data we found the same thing. It was after-hours charting.
It was two to three hours of after-hours charting after they went to see a full day of caseload that was making a significant impact on their satisfaction and ultimately driving them out of this profession. I’m speaking to the choir, you all know this, but the reason that most clinicians get into home health or hospice in the first place is because they love relationships with people in their home. They love that relationship factor. That’s one of the drivers that drew them to the marketplace.
Yet what they’re finding when they get into the profession is that they’re constantly worried and thinking about all their after-hours workload and getting from patient to patient. There’s a lot of solutions to this speech. We think it is an important one, but we also think smart scheduling is absolutely a factor in this. It’s been talked about a lot today, making sure that you’re paying proper benefits and making sure that your employees have certainty and schedules and things like that. That’s all part of it.
Our main focus is I believe what is the main driver of turnover in the certified home health and hospice industry, which is that after-hours charting.
HHCN: The recruiting and retention piece is huge. How have you seen these helping providers with retention over the last year?
Banks: Again, we look at leading indicators of retention, that work-life balance, that satisfaction, the leading drivers of people that are leaving either the organization or the profession as a whole, and we’ve seen dramatic time savings. Again, we did a recent study, a very formal sort of rigorous process with the VNA health group, which is out of New Jersey and Cleveland. We took a hundred of their clinicians and put them in with our dictation tool, they had over an 85% adoption rate. Their time savings was on average an hour.
Some of their clinicians, the clinicians that struggled most with the documentation, were saving upwards of two hours. They had over 10% of their clinicians saving two hours of time. What we found is that even those clinicians that weren’t materializing that time savings, we saw two other things. One of them is that they still love the product, quite frankly. [laughs] It was so easy to adopt and use that they absolutely loved it. Even if we couldn’t necessarily quantify the savings.
The second was that the quality of the data went up. They saw that the volume of documentation actually increased as their time documenting decreased. That’s an unusual thing to have happen. Usually, there’s a trade-off between quality and efficiency. If quality goes up, usually efficiency goes down. If efficiency goes up, usually quality goes down. We actually had a positive impact in both.
HHCN: When it comes to new lines of business some of those we’ve talked about today, also we’ve talked about getting a value-based care arrangement. What are some of the opportunities you’ve seen there?
Banks: With value-based care and when I was on the provider side, we were just starting to get involved in it. Obviously, things like reporting and analytics are really important when you’re going to payers. When you talk about HEDIS scores or you talk about Star Ratings, it’s absolutely important and imperative that you speak the same language as them.
I see organizations like Aspirus or Prospero or some of these organizations that Home Health Care News has absolutely reported on in the past and talked about the impact that they’re making in the community. What’s the difference with those organizations?
When you dig under the covers really truly there’s a couple of differences. One of them is that they’re adopting technology at a rate that most certified home health and hospice providers are not adopting it. Other than you’re a medicist or some of the larger organizations in our space are adopting it. The second is that quite frankly, the documentation requirements are different. They’re not completing OASIS. They’re not having to do after an admission, 130 questions that I would argue are subjective in nature and have really no objective measure of quality.
Everybody’s afraid to say it but that’s the truth. There’s two objective measures to quality caps and rehospitalization in emerging care, the rest is a documentation exercise. That’s the reality. I think this MA Plans understand that and they’re looking for organizations that can truly bend the cost curve without having to deplete 48 pages of documentation and so you have these organizations that are taking care of the chronic care management.
I have friends, nurses, social workers, PTs, OTs, that have moved into these organizations working with MA Plans and I said, “What’s the difference? Why are you so much happier at the organization?” They said, “We adopted technology at a rate that we couldn’t before and so we’re using things like dictation tools as just a standard, we don’t even think about it.”
Then the second thing is the documentation requirements aren’t nearly what they are in certified home health, or hospice episodic care, it’s not even close. What we got into the profession to originally do again, driving back to the relationship with the patient and family is exactly what we spend all day doing, which is taking care of the patient and family. We don’t necessarily even think about the charting at three hours after the workday is done.
HHCN: What have been some of the barriers to technology adoption in the post-acute space that you’ve seen?
Banks: I come from the EMR side. They have an impossible job, they do an amazing job. I know everybody likes to bash their EMR, but they do an incredible job and you should thank your EMR provider for keeping you in regulatory compliance and what they do around that.
Other than the EMRs, I don’t see much innovation, Andrew, in the clinician efficiency space. Most of the innovation that I see outside the EMR vendors has to do with coding, and billing, and hosting, and all of the other tech services, but it really doesn’t drive home on exactly what the core issue is. There was a recent study by a company called BerryDunn, which is an accounting firm, and I’ve recently posted about it on LinkedIn.
The study talked about the fact that all of these signup bonuses and retention bonuses, all of these short-term things have a real shelf life. What truly matters is making a change in the lives of the individual clinicians, and that will have significant downstream impacts.
The point of the study was that all this focus is being put on recruitment, and that is a part of it but retention is the most important thing that providers can do today to make their organization poised to take on new lines of businesses or expand into value-based purchasing or any other areas.
HHCN: Why has there been such little advancement in clinical workflow?
Banks: It’s hard. I think I had a chart somewhere that talked about the post-acute regulatory environment as compared to an acute care setting. We have four times as many regulatory hurdles to jump over as a hospital. The regulatory burden is really difficult. I just think it’s hard. It’s really hard work but it’s worthy work, and I’m happy to be part of finding the solution to it.
HHCN: How can you change course there?
Banks: I think ultimately painting a vision for the future. Today, we help with narrative documentation, and not just the speed of that documentation but the quality, but I see a truly voice-enabled note. I’m sure you all see this, particularly on the provider side where you’re employing more millennials, Gen Zs than ever.
I see this as ultimately what we provide is table stakes. It’s going to be commonplace in the industry. Then we look at how we can automate the dictation on top of what we’ve done and we’ve built some features in there to really automate and supercharge some of that, we’re happy to show any of you. I think we can take it to the next level, but I think voice dictation will someday be commonplace just like it is in a hospital or ambulatory setting.
nVoq Incorporated provides a HIPAA compliant, cloud-based speech recognition platform supporting a wide variety of healthcare delivery scenarios including post-acute care with an emphasis on home healthcare and hospice. To learn more, visit: https://sayit.nvoq.com/.