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The home health industry is never going to “figure out” staffing. Most providers understand that.
They can’t snap their fingers and increase the amount of nurses there are in the country, nor can they make the Centers for Medicare & Medicaid Services (CMS) pay them the rates they feel like they deserve.
But there’s so much more they can do. And they’re starting to figure that out.
“We don’t have a staffing issue at Amedisys,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton told me this week during HHCN’s Staffing Summit. “We have a nursing staffing issue at Amedisys, and we don’t have a nursing staffing issue. We have a nursing turnover issue, and we don’t have a nursing turnover issue. We have a nursing first-year turnover issue.”
With so much noise in the home health industry these days – around staffing, Medicare Advantage (MA) penetration and CMS’ payment rate proposals – leaders are finding that the best approach may be to strip everything down.
In other words, figuring out the causes behind first-year nursing turnover at Amedisys, or finding a way to get just a few, solid MA contracts on the books. Even focusing advocacy efforts on something more secondary than the actual payment rate proposal, such as rectifying forecast errors CMS may have made in the market basket updates over the last couple of years.
If providers try to figure out everything, they’ll end up solving nothing. That’s especially true with staffing. Future-facing strategies that are detailed and focused will end up paying dividends.
Those strategies are the topic of this week’s exclusive, members-only HHCN+ Update.
Steady improvement
Bayada Home Health Care is not in the business of handing just anybody a job.
But its chief people officer, Jeff Knapp, wants every candidate that is worth hiring to have a seamless experience.
“The truth is, it’s much easier to get a job with DoorDash than it is to get a job at Bayada,” Knapp said. “We’re trying to think about how other organizations do that in a seamless way.”
The Moorestown, New Jersey-based Bayada is a provider of home health, hospice and home- and community-based services. It has over 360 locations across 23 states and six other countries.
Amedisys, meanwhile, is a Baton Rouge, Louisiana-based provider of home health, hospice, palliative and high-acuity care. Its network includes 16,500 employees and 522 care centers across 37 states and the District of Columbia.
Holton and Knapp are both chief people officers, an increasingly popular position across organizations in general, but especially in home-based care.
Holton took that position with Amedisys about seven months ago. While he and Knapp acknowledge there is no silver bullet to the “staffing problem,” organizational improvements are certainly feasible.
For instance, Amedisys’ nursing applications are up 50% year over year. Its accepted offers are up 20%, and its turnover is down 10%. Turnover is down in every category across the company outside of the clinical manager role, Holton said.
Early turnover, as referenced earlier, is still high. Holton asserted that’s likely due to the contingent of nurses still taking advantage of sign-on bonuses and jumping from one company to another.
Amedisys is able to pull these numbers – and more specific data – from its new applicant tracking system (ATS).
“This year, we put in a new applicant tracking system,” Holton said. “And I think for the first time in my career, I’ve seen the difference between an average applicant tracking system and a world-class one. And – legitimately, with nothing else being different – what that actually can do for you. In an increasingly digital world, you can get to many more candidates.”
Amedisys is also changing how it thinks about what an ideal candidate is. Given its scale and reputation, the organization tended to be more picky in the past. Now, the goal is to have a more open mind during the recruitment process.
“You always want to be picky in who you’re bringing into the door and making sure that they’re the right fit for the set of values you have as an organization,” Holton said. “But I think we were maybe overly picky around the set of experiences that they needed – like they needed to come from home health care, for instance. And I think all of us are beyond those days where you can get away with that.”
Amedisys isn’t the only company that has seen improvements in staffing of late, either.
Enhabit Inc. (NYSE: EHAB) hired over 100 net new full-time nurses in the first quarter, a number its leaders were very happy with.
Addus Homecare Corporation (Nasdaq: ADUS) saw significant improvement in the first quarter as well, with its personal care segment averaging 84 hires per business day, a 9.1% year-over-year increase. Its clinical hiring improved, too. Addus has also been crediting an internal tool for those improvements
“A part of our improved hiring results have been due to the recent investment we made in a candidate tracking system, which allows us to better engage with potential employees, as well as shorten the time between application and hire,” Addus CEO Dirk Allison said in February. “We are continuing to roll out this system to all of our sites, a process that should be completed in 2023.”
First-year nursing turnover is a specific focus for Amedisys. Even within that, though, there are areas to hone in on.
For instance, at Bayada, Knapp said speed is everything.
“One of the really key things that we’re finding is that speed is absolutely essential,” Knapp said. “Whereas in years past, you might have had a week to get back to a candidate, we’re now seeing that, if we don’t get back to candidates within 24 hours, the leakage starts there, if not faster than that.”
Of course, you can’t make sure speed is a priority until you know speed is an issue.
That’s where investment comes in.
“When you look at the numbers, it’s hard early on to see anything other than maybe the increase in price tag of what [these tools might cost],” Holton said. “Then there’s also real work that comes with the implementation that may cause some pause. But, for us, we’ve seen a huge advantage in doing that in the end.”
With the ATS up and running, Amedisys is paying far less for recruiting this year than last year. Meanwhile, its applicants are up 50%.
Holding onto what you have
The data are clear. There will not be enough caregivers and nurses to satisfy all home health demand in the U.S. over the next decade.
Rather than focusing on what they don’t have, providers have taken the approach of focusing on what they do have – and making sure they hang on.
“What appears to be a staffing problem on the surface, it’s much more a retention problem than it is a sourcing problem,” Knapp said. “We’re trying to pay a lot of attention to that candidate. To the early onboarding experience, or the overall experience of an employee who is with the organization. Those are the [points of emphasis] where we can make an impact.”
Bayada and Amedisys are both employing proactive intervention.
Before a worker even thinks of leaving the organization, they want them to know that there’s a good leader in place, a career path for them in place and an organization that cares about them sending the checks.
“They don’t leave because of a little bit more money or something like that,” Knapp said. “We’re spending a lot of our time on trying to enhance the employee experience so that they’re not as likely to leave. Because if we could just fix our retention problem, it would go a long way toward helping to address what we call the staffing problem.”
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