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Staffing is a universal pain point for home health providers.
Specifically, that pain point is about recruiting and retaining talent, and most provider leaders argue that retention is the area their organizations need to focus on. Break retention down even further, though, and you find a main culprit for turnover: scheduling.
“[Scheduling] is one of the things that’s most inefficient in our business today,” Chris Gerard – then the CEO of Amedisys Inc. (Nasdaq: AMED), and now the CEO of TheKey – told me last year.
A study conducted by University of Pennsylvania’s Population Aging Research Center in 2021 found that scheduling volatility was a reliable predictor for turnover in home health care.
Volatility was measured by the the variability in daily home health visits over a month period, crossed with the likelihood of a nurse quitting. Nurses with low schedule volatility were 40% less likely to quit than the average home health nurse, while nurses with the most volatile schedules were 50% more likely to quit than the average.
Yet providers are still grappling with the issue of schedule volatility, and find it to be a massive logistical hurdle.
It also exists on top of other and larger concerns, such as shrinking margins due to fee-for-service rate cuts and taking on more Medicare Advantage (MA) patients. Scheduling can get lost in the shuffle.
But an argument can be made that scheduling should be placed at the forefront, as its ties to retention are so strong that providers can no longer ignore it amid those rate cuts.
That’s the topic of this week’s exclusive, members-only HHCN+ Update.
The scheduling problem
Most home health provider leaders recognize scheduling as an internal problem. But they don’t always have the time, or the solution, to do anything about it.
Last year, HHCN and the home-based care technology company AlayaCare conducted a survey that examined the home health industry’s biggest pain points. Close to 20% of respondents said inconsistent schedules were their agency’s top reason for turnover.
More providers are starting to believe that scheduling should top that list. AlayaCare is also one of the technology companies that’s trying to improve its clients’ scheduling processes.
“Schedule volatility – that’s a big thing that we’ve really been working on. When a nurse or therapist has one visit one day and seven visits the next day, you can’t build your life around that,” The LTM Group CEO David Kerns told me last week. “You’re missing your kids’ soccer games, patients are getting frustrated because you’re showing up late and then here you are another day and you’re only doing one visit.”
Based in Dayton, Ohio, The LTM Group is a network of home health, hospice and home care agencies across the Midwest. Kerns called retention one of the provider’s “biggest costs, and biggest areas to improve” in the near-term future.
Behind that problem is – at least in part – scheduling. That’s why Tina Hardwick, the president and co-founder of LTM Group, has begun to dig further into it on behalf of her company.
“It’s something we’re looking at across the organization,” Kerns continued. “How much is that individual clinician’s schedule varying? Then we’re looking at it between clinicians. If you have one clinician who has 10 visits scheduled and another one who has 30 visits scheduled, that’s going to create that person — who probably is your most productive employee — to be upset and leave. Fixing that within their own schedules and within the team schedule, that’s a huge focus right now.”
Traditionally, scheduling has been conducted manually across home health care. Last year, Amedisys had over 700 manual schedulers employed across its over 500 locations.
That isn’t always a sound process. Gerard even said, within Amedisys, those 700 schedulers were all conducting business “a bit differently.”
Shelley Ackerman, a home health veteran and physical therapist by trade, witnessed this problem firsthand when she was on the provider side of the industry. She’s since left to try to solve it as co-founder and COO of CareStitch, a home health scheduling software company.
I asked her earlier this year what was wrong with providers’ current scheduling processes.
“Well, it’s not always clear what their processes are,” she said. “A lot of times, especially the larger agencies, when they have multiple schedulers, they’re kind of working in silos. You have to define their processes and make them more efficient, removing that manual redundancy that the schedulers are having to do today.”
Gerard himself proposed technology-enabled solutions, ones that would centralize that process. It’s likely that Amedisys has taken steps to do that since last year, but they’re also in the midst of being acquired by UnitedHealth Group’s (NYSE: UNH) Optum.
If a provider as large and advanced as Amedisys has had recent troubles with scheduling, it’s a near-guarantee that most of the 10,000-plus other home health agencies across the country are having trouble, too.
It can also trickle down to patient care. The referral rejection rate is higher than ever, for one, which is reducing patients’ access to care. That’s mostly due to staffing inadequacy, which can be improved by less turnover.
On a micro level, a clinician with 10 visits coordinated in a sloppy way may have a difficult time getting to that 9th or 10th patient of the day.
“You can order a pizza right now and you know exactly when that pizza is going to be here and who’s delivering it,” Kerns said. “Yet in home care, where it’s dependent on your health and going back to the hospital, you don’t know when they’re going to be here, you’re waiting on a phone call, you don’t know who’s showing up. There’s really a disconnect in our industry and really an opportunity to improve.”
In a vacuum, scheduling in home health care is already a problem – it’s tends to be unorganized and inefficient.
It also has a downstream impact. It affects retention greatly, which can lead to increased costs and suppressed growth. It affects clinicians, and, in the end, patients.