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Webinar: Creating a Home Care Readmission Program to Win Referrals

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Derek Jones: Thank you for hopping on the webinar. We have an incredible agenda packed with tools to help your agency grow. Today's webinar is titled "Generating a $250,000 Referral With a Readmission Program." And, that seems like a big topic, but we're going walk into that topic and show you how it's very realistic and then give you tools that you can actually, you can use today, you don't even have to wait until tomorrow ... tools you can use today to start marketing to hospitals, hospice, rehabs, and assisted living facilities. Again, thank you for hopping on with us today.

The program will run about an hour. We will, have at least 15 minutes for question and answers. And this webinar, right now, is being recorded. We will make the broadcast available to everyone who attended within 24 hours, and we'll also make the slides and all the tools that you see on the webinar available as well. All of your lines are muted, and you're in listen-only mode; however, throughout the webinar, you can type in any questions into the "go to webinar panel." There should be an orange or red button in the upper right-hand corner. If you click that, the "go to webinar panel" will expand and you can type in a question, and we will try to do our best to even answer those questions real time; however, we will address all the questions at the end of the webinar. So with those housekeeping items, let's move right into our agenda.

We're going to first start out by introduction of our panelists. We're going to just, set a baseline; why are readmissions a big deal? Now this webinars about how can you generate a quarter-million dollar referral program by creating a readmission program, and ... but why are readmissions a big deal? So y-, you may be a better end of the home care industry, but we want to, get everyone on the same page about why readmission ... why we're even talking about that today.

We then want to set a baseline, too, for the lifetime value, of a client. You know, there's ... We receive a question all the time from agencies that say, "Should I wrap my car? Should I hire a full-time marketer?" And the good news is we have some updated data to help you make that decision and that will paint a great backdrop in how you're marketing to hospitals and, frankly, to answer the question for you, "Is it worth it to execute the tactic that we'll cover on today's webinar?"

We will then have Steve Weiss, from Hurricane Marketing, give us some incredible tips to specifically target referral sources at hospitals, hospice, rehabs, assisted living, and home health agencies. Those are, five or six of the highest vole referral sources today, and, we'll have tips and tricks, for each one of those sources, and tools that you can begin using today. And then, of course, we'll have, fifteen, ten, fifteen minutes of Q and A.

So I'd first like to introduce, our first panelist, Steve Weiss, is the President and CEO of Hurricane Marketing Enterprises. Steve, in addition to Hurricane Marketing Enterprises, which is a consulting firm, a sales and marketing and training consulting firm for non-medical home care agencies ... but prior to that, Steve also has, walked the walk. He knows the joy and the challenges of owning a home care agency, and, he had owned for just over five years, an agency in New Jersey called Care Choice. he was responsible for all the operations and the marketing and sales activity. And when, Steve left Care Choice, to start Enterprise Marketing, he had grew, revenues well into six figures and five X over where they were at, when he first joined. So, Steve, thank you so much for being on the webinar today.

Steve Weiss: Derek, thank you so much, and I really appreciate it. And welcome everybody. I'm, this is me, Steve the Hurricane. So (laughs) I've been looking forward to this webinar for a while. Derek put together some incredible things for you. Being able to leverage your readmission rates, to grow your census, increase your profits, and increase referral sources, really, and getting places to send you referrals, it's one of those essential items that's a must-have in today's marketing and in the future if you want to get business from hospitals and other entities, as Derek mentioned, and we're going to go through some of those today and how you can position yourself as the agency of choice in your respective market. But it all starts from keeping accurate data.

Derek Jones: Thanks, Steve. Steve, yes, you could tell is highly enthusiastic for today n.

Steve Weiss: (laughs)

Derek Jones: Yes, and it's, Steve ... It's Steve's MO. You know, I've known Steve for, six or seven years now. Prior to joining Clear Care, I was working at one of the national home care brands in Philadelphia, and, would, you know, Steve was on my speed dial. We would text message. He was always helping, our agency grow with tips and tricks, and, of course, now, today's webinar, we're bringing this webinar free to all of, all of ClearCare's customers.

So today's learning ... We'll have an hour of learning, but we did want to make you aware, too, that, you can continue if you like, ... and I'm sure that you will, ... the style, the energy and the passion that Steve brings. ClearCare, is, the primary sponsor for Steve Hurricane Marketing boot camp. This is taking place, August 13th and 14th, frank-, you know, we were at this event. He held, holds two of these during the year ... one of the best events that we've attended. It's specifically for private-duty agencies. It's almost, if not already, sold out, Steve, or close to sold out, I believe.

Steve Weiss: It, it, it's, it's getting there, and, and I, and it's still four months away. I mean, we, we just w-, did a, a, a online campaign for people to register today. We sold a couple tickets yesterday, and it, it's just, these are fantastic events. They all sell out. And these are, these are national events that, when people come and you see the testimonies in the video and ... It's on, it's on our new website. It's, homecaremarketing.net, and it talks all about the boot camp right there. Homecaremarketing.net, all the details there ... and we're going to give you a code. You see right here, CARE50, is for $50 off of registration if you can get one of those remaining tickets. So we'd love to see you there. It's fantastic and, and it's, really is ... We're going to teach you everything that you can take from today's webinar and execute it in your field to get the referrals you're after and grow your organizations, and it is a private-duty event.

Derek Jones: Excellent. Sounds great. I think the, the best quote that I saw after the conference was, $30,000 of consulting for 500 bucks.

Steve Weiss: Yes.

Derek Jones: That's the, the, one the favorite quotes. I know we've, brought our pen and paper and we get a lot outta, out of it today. We also see a lot of ClearCare customers there so, it's an opportunity ... We'll have a whole team there, so if you're a current customer or thinking about this offer, we'll be there as well. So let's dive right into the agenda. We formed the agenda based on your feedback. So when you registered for the webinar, we asked this question: What is your biggest challenge when partnering with hospitals? And w-, when Steve and I were forming the agenda a couple weeks ago, we said, you know, we think we know what we want to talk about, but let's make sure that it's on point by asking that question.

And some of the verbatims that we received were "Can't get a meeting," and that sounds very common. We have hospitals, just, many times, won't let you in. Another verbatim is, "How to speak their language." , these referral sources have certain pain points, whether it's home health or hospice, and so that resonated with us as well. "So many other companies competing for their time," so I think this was referring to the discharge planner and the social worker. Even if they let you in the door ... they're so busy ... you have such little time to make an impact or an impression, and so we want to make sure we address that.

And then "blending in." I think this, this was referring to probably this, that there's so many competitors that everyone's saying the same thing, and how can we separate yourself ... as Steve mentioned ... How can you get your brand, your agency, viewed as the agency of choice at least somewhere on their referring list. So with those verbatims, we, finely tuned the agenda, and we thought that we'd set a baseline by discussing the lifetime value of a referral source.

Whether you're selling Philly Pretzels, home care services, or automobiles, one principle in marketing is understanding how much your average customer earns in revenue for you. That way, you can make informed decisions about how much to spend to actually get new business. The fantastic news is we have this data, you know. The 2014 ... It's actually the, the 2015 benchmarking study, but it's the data from, just over 800 private-pay agencies from 2014 ... is collected by a company called Home Care Pulse. They do an annual benchmarking study, and the study was just released this week. ClearCare, ... We had over 100 agencies participate in that study, and we're a huge advocate. But this is, you know ... I print this out. It stays on my desktop, and whenever I travel to a conference, it's in my, it's in my bag. The best 150 bucks you're going to spend, but we wanted to bring an updated because they actually ask agencies and track, "What is your lifetime value of a referral source?"

So one of the first questions that they ask, is, "What is the average lifetime value of a single, private-pay client?" And just for terminology, you know, average lifetime value just, you know, it sounds like a buzzword, it's just kind of a mouthful. The, simply put, this just, you know, we know some clients are only with you for one day, but we know some clients are with you for two years. Some clients have a lot of care and a little bit of care, some are hourly, and some are live-in.

But if you take thousands of private pay clients, and that's what this study does, to try to understand, on the average, what's the average home care client worth today? That, you know ... Think about what you may think it is for your agency, but the that are just recently released show that the leaders in home care, or the average private-pay client generates $19,000 of revenue, now that includes, caregiver earnings, right, as well.

But what we're, what we're also seeing is, the report is reporting a ... The updated is that your gross profit margins are 38 percent, which are still fantastic, you know. If you're, if you're a franchise or an independent home care company today, and you were in, let's say, the fast food business, your, you know, margins are, you know, maybe two percent, three percent. So agencies are seeing nine-...

Steve Weiss: Derek, we lost your voice there for a second.

Derek Jones: And what we, how we translate that is, you know ... The question is, "What's the lifetime value of a referral source?" So in the tips and tricks that we're going to share today ... If you can break into one referral source, and that referral source, let's say a hospital, sends you one client every month, using this, what's the average lifetime value of one referral source? Well, we just do the simple math. We did 19,000 times 12, and that equals, you know, right at, just over a quarter million dollar account, and that's why these tactics today, ... Even using these tools, it's still not easy, right? I mean, it, it's going to take time to develop these referral source. You're going to need to refine your pitch, learn how to use the tools and to become comfortable, but it's worth the, the effort, you know. They're, you're always ...

Steve Weiss: And you ...

Derek Jones:... asking yourself the question ... I think the other way to look at these, too, is when you get questions about should you wrap your car? Should you move out of the basement office space and move into the place, you know, that's $3 or $400 extra that has, curbside visibility from traffic? Should you advertise online? Should you redo your website? Should you hire a marketer? Every time that phone rings, that's $19,000 calling, if it's a client, so it's a great just to memorize no matter what ... if you take that away ... to help you make smart investments in your business.

Steve Weiss: And, you know, Derek, I'm going to actually jp in here and it, it ... I'm actually so glad that we saw, saw this because the, the 2015 report shows $19,000. That's up from the 2014 report, which you, we had said was $11,000 per client. The $19,000 I absolutely love because it does make sense. That could be a client who's using you twelve hours a week, three days a week for four hours a visit for two, three years. That's $19,000 they spend with you. Or it could be a hospice client who's with you 24/7, around the clock, for 4 or 5 weeks before they eventually pass away, so it's a nice benchmark there.

And if you look at the, the l-, the value of one referral source in a hospital giving you a client once a month, that's extremely conservative. I actually know companies, my clients, people I work with, who get one hospital to refer them and easily that hospital is sending them anywhere from two to five patients a month. So you go on the, on the high side of this, a pat-, five patients a month, you're talking about fifty patients a year. I mean, that's almost a million dollars right there in itself ... that's more than a million dollars ... and from one referral source, so the, the information that we're going to talk about, how to leverage or to get into it, it just makes sense.

We want to get business. W-, the, the value of a client is fantastic. We need to be more statistical than we currently are, and if we can show and prove our stats, we're going to get the referrals that we're after and, like you say, one hospital ... extremely conservative ... one client a month is worth a quarter of a million dollars, and really I know for a fact we're talking, you know, three, four times that for the average hospital.

Derek Jones: Fantastic. And what we'll do when we send the slides out ... We've actually, written a blog post here at ClearCare, it's titled, "A Secret, One-Two Punch When You're Investing In Your Home Care Agency," which walks through this. This lifetime value of a customer and your gross profit margin, it walks you through how to make these decisions, like should you hire a marketer? Should you, you know, should you invest in the car wrap? Should you invest in whatever marketing vehicle? So you'll be able to find that, or you can find that on our blog today.

Okay. And then we'll set a baseline here. Just, why are readmissions a big deal? You know, Steve and I are talking about the, you know, the ... okay ... got it, you know, well ... I can generate a quarter million dollar referral from a hospital, and we're ... keep saying this readmission talk [inaudible 00:15:28]. Why are readmissions a big deal? Well, we, when we ... To address that, we have to look at the Affordable Care Act. As everyone knows, it's been in the news. It was passed in 2010, and it, it includes a of things, right? And a few of those things are specific and address, the home care industry. I mean, there's certainly the individual mandate, which we're all dealing with today about, providing health insurance to full-time equivalents.

We were fortunate that, some of that re-, legislation has been, you know, stymied at least for the moment. The other portion is the insurance marketplaces that were set up, ... the employer mandate, as well ... but relates mostly to home care agencies is, there is a specific mandate for preventing readmissions that are avoidable. And when the CMS, the Center for Medicare/Medicaid Studies, came out with their initial findings, the reason they wanted to have preventing readmissions in the Affordable Care Act is they saw that with 30, I think it's 38 billion dollars each year are attributed to, are spent for Medicare patients who come back to the hospital within one month after being discharged.

And based on the CMS data, they forecasted that 17 billion of that 38 is preventable and ... which is over half ... and so there, there's an aggressive mentality, first, at, a-, at the CMS office said, "We, we need to get that number down," that's why you hear about accountable care organizations. There are all kinds of, initiatives going on. And in 2014 ... Actually, the penalty, we should talk about that. The hospital, if, if they have a higher than the average, national readmission rate, there's a formula, ... it's kind of complicated, but , it can be looked up now ... But they have a formula that says, "If you are poor-performing at preventing certain conditions from co-, staying out of the hospital once they leave, we're going to take back three percent of the reimbursement that Medicare is supposed to pay that hospital." Now, you know, the first year that this started, the penalty was, like, o-, around one or two percent, now it's gone up to the maxim penalty, in 2015, to three percent ...

Steve Weiss: Mm-hmm (affirmative).

Derek Jones: ... it's about the penalty, and it's certainly, it's these big hospital networks, especially, since they're m-, a lot of times, network hospitals, if, they're missing the revenue and forecast targets by three percent, someone's upset, but it's not, you know, ten percent. It's not 20 percent. The big hit to these hospitals is their reputation, and what we'll share here in a few minutes is that not only are they taking a financial hit if they're, can't keep these individuals out of the hospital, their hospital networks are being ... The data is being published, and in one of the, first couple rounds of the data, hospitals ... we won't name any here ... but hospitals that are nationally and r-, regionally recognized, even teaching hospitals for geriatric, had some of the lowest poor-performing readmission rates.

Steve Weiss: (tsks) And ...

Derek Jones: ... and so it's really, it's providing transparency for these hospitals to say, "You know what? We're going to publish these rates," and, you know, it, it's going to attest to the Hawthorne principle, which is, you know, "Let's publish the data and, and folks will find a way, to make those numbers improve."

Steve Weiss: And, Derek, you know, you're a hundred percent right here too. They're a-... And this is, this is a growing problem, this is a growing, situation that, that there really is no, no, no one can really put their finger on how to do this and how to reduce it. What we know is private-duty is where it's at. But I saw ... There's a report that came out from Kinnser or Kaiser Health, Kaiser Health, which is one of the largest hospital systems in the country, 721 hospitals, folks ... all right ... 721 hospitals all across the country, all 50 states, were penalized up to 3 percent last year.

That, that's a, that's a huge percentage of all the hospitals in the country that we're talking about that got these penalties for having excessive amounts of readmission. So, trust me, you're readmission data is important, and I guarantee, I guarantee if you look at the list and ... it's Kaiser Health put this out ... you look at the list and it's 721 hospitals ... and we're not saying any names here ... but I guarantee at least one of those t-, hospitals, if not more, are in every single person's market on this webinar right now.

Derek Jones: Yes, you got it. The only exception there is Maryland, which has some exceptions in the way that they except, they c-, they calculate and receive reimbursements, but they even have the focus rates there.

Steve Weiss: Mm-hmm (affirmative).

Derek Jones:And, and Steve's absolutely right, every state was affected, nearly every hospital was affected and every regional, metro area was affected. And, for 2014, these numbers did just come out and were published by Kaiser. You could just, Google "Kaiser, readmission rates," and the, the, a bunch of great articles pop up. But, in 2015, two additional, actually three additional conditions to the list. So, in 2014, CHF, or heart failure, heart attack and pneumonia were a part of the conditions, where if someone came into the hospital for those and came back to the hospital for certain types of readmissions, they would be penalized.

In 2015, emphysema and additional lung conditions and elective hip and knee surgery were also added, to that list. So not only were hospitals affected, but now they're having to look out for additional conditions that they would be exposed for, excessive readmission. W-, what does that mean? I-, if you look into all the details of the reports i- ... there's a lot of data, a lot of study. What it means for home care agencies is, these hospitals are having issues keeping people out of the hospital when they're readmitted. And when we look at the, the role that private-pay home care can play ... being the lowest cost institutional provider of care serving that highest cost patient population ... that in non-medical home care, serving that last mile of care in the home, it's a, a extremely viable way. But we need to give you the tools and the language to help approach these hospitals who are having to pay in with the readmissions.

So how are they doing? , I'm going to go off the slides here for just a moment because this is the first tool of the webinar. we want to go to medicare.gov, there's, "compare readmission rates for your local referral sources." I'm going to take our browser right here, and, I'm going to enter a ZIP Code. So I'm going to enter a ZIP Code here in San Francisco area where the ClearCare offices are, and let's find the hospitals in our local area. And this is a free resource that you can use today. I'm going to pick, St. Francis, I'm going to pick the Kaiser, and San Francisco General, and say, you know, "I would like to see, to compare their readmission rates."

So now I'm going to click on this middle tab, "readmissions, complications and deaths." I'm going to click the "30-day outcome," and then "show graphs." Okay. When I go down, what's fantastic is you can see ... Let's take, this one; for example, we see St. Francis and Kaiser all in one graph, and we can see the number of patients that were affected, the national average and what their average is. So, in this example, you can see that San Francisco General Hospital, for this particular condition for, clients who were ... in this particular example ... pardon me ... For this particular example, is for heart failure patients; we can see that the national average is, 22.7. Their average is 24.7. So this is an example where their readmission rate is about two percent higher for those, for the, than the national rate for clients who are being readmitted for heart failure.

You can look at all the conditions here for pneumonia, and you can compare all the hospitals, and you see it's a fantastic tool; one, just to know how are they doing. It'll give you a whole new level of a conversation to have with that referral source. And, in a second, you can begin comparing your rates, with theirs that show them how a non-medical home care can really, help improve, to get their number at the national average or beat that average. Okay. And before we turn it over to Steve here ... I think this is probably well understood, but how do you even know what your readmission rate is? The, to do this, you could do it manually, you just take the number of, patients or clients that you have that were referred from a hospital that had one of those conditions, one of the five conditions, and you tag which ones have been referred back to a hospital within the 30 days and just [crosstalk 00:24:38] ...

Steve Weiss: And, Derek, I'll ...

Derek Jones: ... for example ...

Steve Weiss: And, Derek, I'll add that, too, hospitals or a skilled-nursing facility rehab. So if somebody went from a hospital to a rehab, it's whenever they're discharged home, so you take all of those referral sources collectively. If they started with your services upon discharge from one of those places, then you go back 30 days, that's, that's, there it is because that h-, that also counts in the readmission if it's on a SNIP discharge ... and we'll talk more about that later ... but that should be included in this group for sure.

Derek Jones: Excellent. Thanks for that, Steve. That's where Steve's expertise really comes in handy for ... We know we have a lot of ClearCare customers on the line today too. You can accomplish this by using the tag management feature for clients and running reports. It's a very simple way. we have, knowledge articles in our knowledge base as well, and our support team is well-versed in how to handle this. You could shoot me an email, I'm glad to forward you those knowledge articles. But it's very simple, you can tag these clients who are coming out, you know that they came from a hospital, and using the ClearCare platform, when you terminate a client, there's a reason, and one of those reasons is going back into the hospital.

So using the tag feature, we can tag which condition they had, and then pull a report so that can show you those readmission rates, so a very simple way to do it. if you're not using the ClearCare platform, you can obviously do this by hand today. But the better, more accurate, more consistent way that you can have that data is going to really equip you because you can see in that Medicare data they don't even start, calculating that data unless they have, several hundred patients at the hospital level because, otherwise, they don't consider the data statistically significant.

Now, home care agencies have much smaller client-base, so, even if you have 10, 15, 20 clients over a 6- or 12-month span who come out of a hospital, that's enough to start telling a story of how your home care prevents those readmissions and comparing that rate. So if you know the national rate for pneumonia readmissions is seventeen percent, but only one out of ten of your customers went back into the hospital, you're beating the hospital national average by seven percent. There's a compelling story there the hospitals will start to listen to. With that, I'm going to turn it over to Steve to start, running through how to apply all this framework, lifetime value of a customer, readmission rates, the Affordable Care Act, and Steve's going to walk through how to approach, generally, any referral source but specifically hospitals, home health, rehab, and assisted living, and nursing facilities.

Steve Weiss: Fantastic. And thank you so much again, Derek. I really appreciate it, and I love these three universal questions to ask because the, the first one there, "Are you aware of what non-medical home care is?" That, that's probably the biggest miscon-, misconception. So many times ... And they may say, "Oh, yes. I know, I know private duty. I understand it. It's fee-for-service and so on." But it's, more often than not, the case managers, discharge planners, the social workers, the physicians, the nurses, the people who are in a position to make a referral to us think that we compete with the Medicare home health skilled agencies that exit out there, and that couldn't be further from the truth.

We actually wrap around the Medicare benefit. We supplement and provide additional coverage and support as to what they're given from the Medicare and from the home health. And so we come in and they think, "Oh, yes. Another home care, another home care, another home care." But the truth is, 99.9 percent of all of these people that we're talking to, asking for referrals, they never worked in private, non-medical home care before, so they really don't know it. So even though they may say, "Yes, I do know it," you may not come out and say, "Do you, are you aware what non-medical home care is?" You may not see it in that exact way, but make sure that they understand the difference between home health and the private duty. And make sure that they understand how limited the home health is.

Home health, in all essence, covers about six, maybe eight hours a week of services. That's it. They get a therapist a couple of days for a few hours, and they get a nurse a couple of days for a few hours that's, that's pretty much all that Medicare is going to cover. Now, there is, sometimes there's a benefit for the, CNA, the nurse's aide to go out there, but even still it's limited. So when somebody's been in their hospital who has pneonia, congestive heart failure ... Congestive heart failure is like, is like a, an epidemic. They'd don't know how to keep these people home. It, it's, it's clear-cut that when the hospital has the readmission rate of 26 percent for the CHF patient, well, why is it 26 percent? It's 26 percent because they're sending people home on home health, so that number is also related to what the home health is providing.

So, clearly, there is a need for this hospital to bring in additional support ... that's you. All right. How many clients do you discharge per week? This is a huge question to ask because this is how we can determine the, the, the, the referral potential. All right. Now I just said that congestive heart failure, you know, 26 percent ... So let's just go 25 percent, okay? And I know that that's about the national average, but if the hospital's a 25 percent congestive heart failure rate, and you're talking to the social worker who deals with all the CHF patients or you're talking to the director of case management, or the director of social services who's in charge of all of her social workers and all of her people making the referrals, when you're having that conversation, if, if she discharges ten patients a week with CHF ... very realistic from some of these hospitals that discharge 200 and 300 patients a month ... so ten a week is very realistic ... y-, you're talking about two to three of those patients will be back within 30 days.

That's two to three referrals that she should be sending to you. This comes out to helping to set expectations and how much they should send you and how often they should send to you and so on, so that's a very important number to know. And then what makes a great referral partner, and that's kind of, you know, what are their expectations? What are they looking for? What are they, ... What's their protocol for referrals? How can you fit their mold? The y-, the reason why my client's are so successful, the reason why I was successful at doing this and getting referrals from all of my social workers and case mangers is because I set up specific referral procedures with each of my accounts.

So what worked in one place didn't work in another, and what worked with this social worker ... Even sometimes in the same account, I'd have two or three social workers, but they referred me in a different manner: some wanted to shoot me a text message; some would set the appointment up for me; some wanted to call me; some wanted to fax, email, you know. Whatever it is, you set up the, whatever makes it easiest for them, and then follow through with it, and then obviously your turnaround time and how quickly can you get out there and so on. You're, that, that's where you're going to prove that ... your, your worth and your value to them by being available at, you know, within an hour's notice to show up at their hospital.

So, you know, now, Derek here, you see he's got all the information here. I'm loving this. You can just put the whole slide up there. so if you, if you look right here, before you go into a hospital, one of the most important things ... And this I where so many people go wrong with this, folks, you know. I'm, I'm a national sales trainer. I, I work with thousands of people every year through the, the boot camps and the speaking events, and so I'm training people on this, and one of the most common mistakes is people don't do their research.

We, we have to do the research. You know, that tool that Derek just showed you before with the, the medicare.gov/hospital compare, that is fantastic. Know their weaknesses before you try to get in there, and, and, and don't, don't tell me this doesn't work. Just, just last week, I was speaking at my chamber event about something that had absolutely nothing to do with healthcare, but a, a professional from the hospital happened to be there. He came to my office yesterday. He was talking to me about what I can do to help the hospital. And I said, "Well, I know your hospital has problems with congestive heart failure. I can help you through my network and through what I do for a living ... blah, blah, blah ... reduce your readmissions for congestive heart failure." And he was like, "This is fantastic." He's getting me a meeting with the CEO.

This was yesterday. I don't even own a home care company anymore. Trust me, this still works, but how did I know it? I looked at that public data beforehand. Now when it comes to going into hospitals, who are those key contacts? And obviously it's the people who are sending patients home, the people who are managing the care, it's the discharge planner. Now the, a lot of people know about case managers and social workers, but what's the difference? Who, who does what? Usually, in most hospitals, the case manager is the person who's coordinating the care, communicating with the doctors, the nurses, and everybody while the patient is in the hospital. And then the social worker is usually the one handling the discharge. So it's usually a team effort. Every patient gets a, a case manager and a social worker, and that's usually how it goes.

Now the case manager's are great because they can refer us people who are fall risks, who have dementia, Alzheimer's. And while they're in the hospital they run the risk of injuring themselves, that's sitter service, that's a great service that we can offer somebody while they're in the hospital to keep that person safe. And then obviously the social worker can make that referral to us upon discharge, or really we want the referral before the person leaves because if we can meet with them before we, they leave, we can actually be the person to bring them home, and that's, that's a, you know, a good talking point to have with the social worker.

Now, you know, you see right here, ask this, "What initiatives are you taking place to prevent readmissions?" And this is where you come in knowing the pain points going in ahead of time, you know. You want to get that meeting with the director or case manager. You want to get that meeting with the director of social services, but when you have that meeting, what are you presenting to her? And th-, this is where n-, so many agencies go wrong, and, again, you know, I, I'm d-, I'm speaking to this firsthand, you know, I, I'm ... I'll actually mention the name of a hospital, Robert Wood Johnson Medical Center, New Brunswick, New Jersey.

I walked into that hospital many years ago and sat down with the director of case management, but I was prepared. I knew the readmission initiative. I had my readmission rates. So instead of walking in and saying, "Hey, we have really good caregivers. We're available 24/7. We have competitive rates. We're bonded and insured. We're the employers," you know, the things that every other agency says, which just goes back to the very second slide that Derek posted about differentiating ourselves and blending in. Everybody says those things. All right.

I came in and said, "Well, here's our congestive heart failure program [inaudible 00:35:32]. All right. This is specifically what you're having a big trouble with, and this is our statistics on congestive heart failure patients," and she was super impressed with that. And, you know what happened? A 15-minute meeting that I had scheduled with her turned out to be an hour and a half long, and she gave me a patient right there on the spot to take care of and bring home later that day. And then, every time I showed up there, week after week, sometimes twice a week, I walked out with a client, or I was called there with a referral, all because I went in prepared with the statistical data that hit their biggest pain point. And that's just one hospital. All right.

So we have to know all this stuff. But now you still have the bottom two, you know, who does the discharge? Who are they partnering up with home health? Those are power part-, they're called c-, power partners, and many of the things that ... not today, but that's something I talk about all the time ... We could work with the home health. If I know that they're working with the VNA; if I know that they're working, with, you know, A-, Alliance, Amedysis, or whichever home health; I can work with them and it, their readmission rates are what they are at a hospital level because of the home health that they're referring.

So a good way to get into the hospital is to work with the home health and help reduce the home health's readmission rates, and then go into the hospital together as the collaborated or the, the combined solution for this CHF patient or pneumonia patient or COPD or whichever paneling diagnosis that they're feeling the most pain for. your, your department, are they part of an ACO? It all comes the same way, but y-, know their data, come in, and then speak to the appropriate person and, and really have your statistics. E-, statistical evidence speaks voles, especially at the hospital level.

Derek Jones: Steve, we have a, a question I think is i-, i-, would be great to answer real time. I have a thought on it, and then you could follow-up.

Steve Weiss: Sure.

Derek Jones: The question, let's see, the question that comes from, Mike Hagman. Thanks for the question, Mike, yes." What if your hospital has good readmission rates?" And, I know we've heard of, a few agencies who ... And that's why we put the, up here, "Getting your name on the list." Well, let's find out how they're doing that, you know. A lot of these hospital networks have formed ACOs. There are now, just a few months back, there are, advanced ACOs, these Accountable Care Organizations ... Kaiser also has a bunch of information. You can actually go to, just Google "where are the ACOs?" And ClearCare has a po-, a blog post on this. You can actually type in your ZIP Code and find the contact name, email address and phone number for the leader. There are over 300 of these AC-, of the pioneer ACOs, and now there are these NextGen ACOs that are forming. The, that could be one possible way.

Now they're doing something right. They probably are organized. Maybe they're using a non-medical home care company, so they kind of get it. But if not, then you can understand a lot of these, hospitals have already started partnering up with ACOs or with, with forming an ACO, one; two, including home health into that. However a lot of those ACOs are still not using home care. Now home care can't start an ACO, but they can participate. There are waivers in the reg that said, "Will pay for private-duty home care." So it's just, one suggestion on a, if you w- ... It's a great question, Mike, because, hey, how do you arm yourself if their rates are better? I think it's just a, a small change of the conversation, in that, "Hey, what are you doing? You're, you're beating these other hospitals in the local market. What are you doing?"

Steve Weiss: Yes, I'd agree with that. And then also, too, just look at all the paneling diagnoses. I mean, it's, it's v-, it's highly unlikely that a hospital is excellent at all of them. Derek named six, you know, so there, there's, there's ... emphysema's a new one, hip replacements, knee replacements, joint replacements, orthopedic procedures ... that's a new one that's in there, so there shouldn't be too much statistics on that, and if there is, you can still ... It's fine. And then also, too, just take a look at everything in your market.

Now one of the things I will say too is, just that every home care agency on this webinar right now has more than one hospital in their territory, and hospitals are so difficult to get into. It's going to take you six months to a year to get into, so be prepared for a long ... This is a battle. This is a war. This isn't a battle or a, you know, one day, you know, you're going to walk in and get referrals tomorrow. It's going to take time to get to this point. But when you go in and you're targeting, start off targeting the hospitals that have the, the, the highest rates. Start off with the ones that are the worst. There's n-, not every hospital is great, but look, look through all of their diagnoses, start with the, their biggest pain points, and then go from there.

So now, moving onto the skilled nursing facilities, and skilled nursing facilities, I, I have a special place in my heart for skilled nursing facilities. I actually feel skilled nursing facilities are the best referral source out there because, if you think about it, who are the people that are the ones that are the weakest of weak and the sickest of sick? Those are the ones that are too sick when they're finished with the hospitals to go home. If you look at national averages and its readmission rates, s-, skilled nursing facilities have higher rates of readmission than hospitals do. Why? Because they're dealing with a sicker, weaker population.

So you can get great clients from skilled nursing facilities. If you understand Medicare and how Medicare works ... and this is why you see the questions under, "What's your monthly Medicare census" ... you know, the, we want to know what their Medicare census is because people who are on Medicare usually have access to some type of funds. If they're on Medicaid, they don't, so unless you accept Medicaid, you're not really interested in the Medicaid, discharge, but you are interested in the Medicare discharges.

But when you find out what their Medicare ce-, census is ... Medicare's only going to cover so much time in a nursing home. It's typically 20 days that they cover at a hundred percent, and then day 21 through day 100, they cover, with a copay of about $150 a day. I think it's a little bit more than that now, like, 153 or something like that, but it's about $150 a day is there copay. Now, if they have a secondary insurance, they're going to get, part of that, but, even still, they usually have to pay something like $30, $50 as their copay. So they're going to walk out of that rehab center with a bill.

Okay. Now, the stroke patient who comes in and takes three months to get back on their feet. When their 100 days are up, this is patient who's now faced with a choice. Either they remain in the nursing home, and because they have funds, they pay to be there, or they go home, but they have to get help. This is the exact client you're looking for. All right. This is, this is the patient who, who is faced with either I stay here and ... By the way, you look up how much the nursing home costs, you're talking about $10,000, $11,000-plus a month, $100,000 a year to be in a nursing home, out-of-pocket.

So when faced with $100,000 versus $19,000, and you're in home versus a nursing home, I don't know about you, I would much rather pay the money to be, remain home and i-, safely. So, you know, that's what I love about skilled nursing facilities that you can use your tool up here, skillednursingfacilities.org. I don't even know where you're located across the country, folks, but I guarantee if you look up your ZIP Code, there is at least 25 places in your ZIP Code within ... Oh, 50, look at that, within 11 miles of where Derek is in San Francisco, there's 50 facilities.

All right. Now those facilities are not created equal, folks. Out of those 50, there are probably about 4, maybe 5, that discharge the kind of vole that we're looking for, so we're not looking for every skilled nursing facility. We're looking for the ones that have the, the rehab patients that come though their doors, and they're discharged on a monthly basis. So I'll give you an example. I like skilled nursing facilities that are discharging 50 or more patients a month. You know why? Because if they're discharging 50 patients a month, it's safe to assess that 10 percent of those people could benefit from extra help. Ten percent of fifty is five. That's five referrals a month.

We're not going to close all five of them. We can get two though. Two patients a month is twenty-four patients a year. Twenty-four patients a year, going back to home care policies study with $19,000 in lifetime revenue, that's half a million dollars in revenue from one well-qualified skilled nursing facility. That's why I love skilled nursing facilities so much, and it's a lot easier to get into those than it is to hospitals.

Now you're looking for the admissions and the social worker. Why are you looking for these two positions? The admission person is the one who knows the Medicare census. It's their job to fill the building, so all of the qualifying and finding out what their discharge numbers are, what their monthly Medicare census is, and, and, and doing things with them, that's the person who's going to be able to tell you that information. And the social worker's the one who's working with the patient going home. So those are two key contacts. And there's other key contact in there, but for the sake of time, these are the two that you want to focus on working with.

When you come in with admissions person, instead of coming in, "Hey, we can help reduce your readmissions and your hospitalizations," come in and talk about what you're willing to do with her to help her grow her census because that's what she's really interested in. "Let's collaborate on some events. Let's do, an activity together. Let, let, let's go co-market together. Let's go to the hospitals together. All right. What, what can we do to get ... How can I help you grow your census?" "Well, what's in it for m-, for, you Steve?" "Well, it's simple, I want to work with you because I want to take care of your patients going home. So if you have more patients coming though your doors, you have more people to send home to me, so I have the best interests in making sure you're successful. I'm going to spend my time helping you grow your building."

All right. And then typical discharge with social workers. Every social worker in the skilled nursing facility usually discharges anywhere from 25 to 30 patients a month, a piece. So one of these skilled nursing facilities who is discharging 50 or more usually has 2 to 3 social workers working there. And when they get difficult discharges, i.e., the ones that have been there several times, the ones that have nobody to help them out at home, and if you can coordinate the care for that patient ... and this goes back to power partners, this goes back to knowing your home health ... if a social worker ... And when I was doing this and my social worker's referred me, I coordinated the medical equipment. I coordinated the home health that was going to come in there. If they needed hospice, I coordinated the ho-, I coordinated everything. So a social worker knew if she's have to do 25 discharges this month and ne-, and she gives me these three that are difficult discharges, and I can sign them up, I'm going to coordinate all of that, I made her job easier. She loves me forever, and she'll give me every patient she has who I've helped her identify as somebody that I could help with, and that, that, that really is what it's all about.

At the last boot camp, Derek, you were there. You saw that video that I have where I film the social workers who talked about why they refer who they do. They both said they refer the people who make the discharge easy. They refer the people who take the referral and, and run with it and, and then coordinate everything because they know they're going to do the job right, and they're going to keep that person home safe and sound because ultimately it's about a safe discharge.

All right. Be the resource th-, you know, know your providers, again, GM, it was ... This goes right back to what I just said, home health, DME, geriatric care, mangers of the GCM. It's, so you are the resource, you're coordinating everything, you know. When you bring your brochures, bring a limited number. Don't come in and give them 200 brochures, give them 20, so that this way, after a month or so, they start to deplete, you can replace it. And then, again, skilled nursing facility's readmission rates are important to them. They don't get penalized, but you know what happens? The hospitals that send their patients to the SNFs, they do get penalized, and they know where they're sending their patient and how many of them are getting readmitted. They will stop feeding the SNFs that have too many readmissions, so they have a vested interest in knowing readmission rates. There's your in.

All right. So assisted living, independent living, I'm not going to spend a lot of time on, on these. But these are good referral sources for the obvious reason of, you know, they're providing care for people in the home and ... the, the home being their assisted living or their independent living ... they're keeping them there as a place for them to live. Why is the readmission rate important to them? If you know the inner workings of an assisted living, they usually charge for levels of care, right? They have levels of care. It's usually a la carte services. So if I come and I need a shower, or I need, toileting assistance, I need medications, I need, you know, a whole bunch of things, I'm getting billed, in addition to my room and board, I'm getting billed for all of the a la carte service.

If I'm in the hospital, I'm still paying the rent for my room, but they're not billing me for the a la carte services because I'm not using them. So they're losing money, so they want to keep their patients in the facility. They don't want their patients moving out. That's where home care comes in. So, you know, this is, this really how we work there. Now in the assisted living, we want to target the, marketing admissions person or the person who's, like, the move-in specialist, the, director of community relations, the DCR, somebody that's community relations coordinator, CRC, that's the marketing person.

And then you have the person who's director of nursing ... and it's because there's usually a little bit of a love/hate between these two positions; director of nursing who makes sure that every person who lives there is supposed to be there and safe to be there, and then the marketing person, they're trying to fill the building and make sure they maintain a hundred percent occupancy. Sometimes there's a conflict because the director of nursing will be discharging people to move into nursing homes, who are no longer appropriate to be there, and it may be happening as fast as the marketing person is bringing new bodies in there.

So this is where you come in. Your great readmission rates, your great hospitalization rates keeps patients there. You're keeping people there. You're helping the director of nursing from discharging patients out, which helps the marketing person slow the exit door while she's still filling people in. That's how you're helping them get to a hundred percent occupancy. So residents needing supplemental care, that's exactly what I'm talking about. How often do you discharge a client that's no longer AL appropriate? On average, I'm going to say it's about two, three times a month, in a full, 80-apartment assisted living community, two to three times a month. So that's two to three referrals a month. Not everybody's going to go with you, but you can get one patient a month.

One patient a month. Twelve patients a year. Derek just said $19,000 per patient. One patient a month who are in assisted living, that's a ha-, quarter of a million dollars in revenue a year for one referral source. This is ... We're not talking about hundreds of patients here, folks. We're talking about one a month from each of these accounts. Let's get cracking. Let's get out there.

All right. Let's move onto the next one, Derek. Home health and hospice, these are my power partners. All right. I ha-, talk about power partners all the time. Home health and hospice ... all right. W-, we're looking for ... a-, and, and when it comes to the s-, to the social workers and finding them, that's going to be a challenge. Reason why it's a challenge is [inaudible 00:51:09] find the social workers who work with the families is because they're in the home, just like we are, so w-, we're not going to find them easily. However, it's usually very easy for us to find that marketing representative from the hospice, from the home health.

This is why I'm such a big, advocate for going network marketing, going to community events and so on, because when you go to these events, who attends these events? The very marketing representatives from these companies. Make a connection with them, talk to them, "What is, what is your, what is your census?" All right. Census is a very important question. Many of the hospices, any of the home health agencies across the country maintain about a hundred clients on their census. Now notice the word I said there, "maintain." All right. Some a little bit less, some much, much more.

All right. I, I've seen hospices that have 700, 800, 1500 patients on their census. All right. Well, we'll just say the average one maintains a census of about a hundred. All right. Maintaining means how many people are currently getting service. Every month, they're discharging 3, 40, 50, 60 patients, but they're also adding 30, 40, 5 60 patients to maintain that number, so in a year's time, many of these agencies will provide care for, like, 5 or 600 people; 5 or 600 lives we're talking about here, folks.

All right. Five percent, just five percent is tw-, is thirty out of six hundred, is twenty-five out of five hundred ... very, very realistic. And if you get in with these marketing people, they can help introduce you to their social workers or the marketing people, usually the ones who are admitting patients on with the services especially with hospice. They can have the conversation, "You're in the situation where you need additional support, let me bring in Johnny and his company and have you speak to him." That's a referral. I got hospice referrals all the time like that, folks, and so do my clients.

All right. Co-marketing, you know, this is power partners ... all right, power partners ... co-marketing, why? Because hospice and home health are going to the same places that we are. Where did they get business? From hospitals, rehabs, skilled nursing facilities, LTACHs, assisted living, independent living. They go, and they also go to physicians. The-, these are the same places we're calling upon. We're the combined solution. What are their readmission rates? Their readmission rates should be about the hospital readmission rates.

If you know your referral source facility that you're trying to go to and you find out what their readmission rates are, and then you find who their hospice, who their home health partners are, who they're referring regularly, the rates of those facilities should be the same as those agencies because they're taking care of them in the home, and they're ending up back in the rehab. So your readmission rates should be much lower.

You sit down with that home health and you're like, "Hey, home health, your readmission rate is 17 percent, mine is 10. How can we be a combined solution and get your readmission rate down to 15 percent or 13 percent? If your readmission rate is that low, would that help you get more admissions? Would that help you grow your census? And, of course, the answer is, "Yes. We're the combined solution. Let's co-market, put our heads together and go from there." So home health, hospice, power partners ... I could talk for, for, for six hours on this. This is, this is the boot camp, folks, all right? So, you know, putting it together. You gotta know your readmission rate. If you took nothing from today, you gotta know your readmission rate.

When you look up all of your local referral sources, find their readmission rates. Derek gave you all the tools here. So when you compare the two, just, just mathematically, because you ... What does home he-, what private home care do? We provide care, custodial care, the things that people need help with: bathing, toileting, transferring, making sure they're doing their physical therapy exercises, making sure they're taking their medications when they're supposed to. All of these things, that's what we do. So those, lack of doing those things is what causes the hospitalization in the first place. Your rates should be lower. You go in as the solution to help with those things which are the causes for readmission ... they all are ... not getting to their primary care physician, that PCP, within a certain time period. Your rates are lower. I, I leverage it. I get in, and then, boom, you start getting your referrals.

Derek Jones: Awesome. Steve, we've got a ton of questions already pouring in. If we look at what we covered, we covered overview of the Affordable Care Act, the lifetime value of a customer, then drove into looking up readmission rates. And while Steve was talking, we dug into the individual tools for hospitals, home health, assisted living, rehabs and, a bunch of great tools. Let's give credit into the Q and A because we've got a bunch of them here.

Steve Weiss: Now, Derek, I ra-, unfortunately, I got two minutes because I'm double booked. I thought, I actually thought we were going to be at 3:00, not, not, 1:00, so I got two minutes here, folks, but I'm going to, I'm going to [crosstalk 00:56:17] ...

Derek Jones: He's a bus- ...

Steve Weiss: ... through.

Derek Jones: He's a busy guy, and I think that'll, that'll stick to our time as well. He's probably got a consulting call with someone who wants to talk about this stuff ...

Steve Weiss: (laughs)

Derek Jones:... so we'll, keep you to your commitment there, Steve.

Steve Weiss: Thank you.

Derek Jones: Someone asked, Jeff Hill, at the beginning, "Where can you get these numbers for your local hospitals?" And then we covered it. We'll send out the link, as well, Jeff. Sarah Shepherd asked, "This is great. How do you get into a hospital to get in front of a discharge planner?"

Steve Weiss: (laughs)

Derek Jones: Steve, you covered a couple of those items, but do you want to recap?

Steve Weiss: Yes. Just real quick, Sarah, I'd say get in with your power partners, find the home health, find the hospice, find the medical equipment, find the pharmacy rep, find the people who are already in the hospital and go co-market with them. Come to the boot camp. I'm going to talk all about that at the boot camp in August. All right. That, that's two days talking about how to get into these accounts and what do you say to the people when you're there.

Derek Jones: All right. We also answered Mike's question on, "What if your hospital has a good readmission rate." We had a question from Mark. Mark Hoskin asked, "What and how does an ACO work? Are they in all markets?" Mark, for time, I'm going to forward, I'm going to forward you the blog post that Clear Care wrote on the pioneer and the next gen ACOs as well as a link to find your local ACO representative. If you're anywhere in the United States, there is an ACO that's formed in your major me-, metro market, except in your extremely rural areas. So I'll send you that link, Mark. i-, we'll take one more question here. and now we do have all the questions. If you typed a question, and we were unable to get to it, we'll compile those and Steve and I will personally reply and, send responses back.

Steve Weiss: Absolutely. That's perfect.

Derek Jones: Let's see. Ano-, a question from Mike, "I wonder, how do you find rates for things you were discussing like the surgeries. I've used the hospital compare already and did not see the stat. Mike, d-, you, you can, the trick to expand that detail is to click the "show graphs." You click the "show graphs." It starts to expand more detail on the specific conditions. and while we were going through, I think the second clicking on that "hospital compare," we were able to do that, but feel free to contact me directly if, you need any help with that. We have a couple other questions, but w-, we want to be respec-... We know you're very busy.

Hopefully, these tools have been, helpful. You can begin putting these into practice. Steve and I can be contacted at any time. Our contact information, we'll send that out. And just remember, we do have the boot camp coming up in the fall. Clear Care will be there. Steve will be covering a similar topic. This is just, just the beginning. So thanks to all the agencies for your participation today. Thank you for the fantastic work you're doing, with client care within your communities. And, Steve, thank you again so much for your expertise and, guidance on the call today.

Steve Weiss: Thank you so much, Derek. I appreciate it, and thank everybody. Have a wonderful day.

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