Bill Dombi: I think the best advice I could offer would be to recognize that health care at home is a different business, in almost every element of it. It’s a different business with maybe the biggest potential exception being patient population, because we are shifting those patients home, but it’s different from a staffing perspective, from the nature of the financials, the scheduling of care, of the reimbursement models, and even how you get your business. If you’re a brick and mortar entity, you’re going to try to get capture referrals from your own operation, but it probably is necessary that you get referrals beyond that. And then even in terms of issues of oversight and risk, since their staffing tends to be a combination of full-time staff and part-time staff. On a visit basis, financials need to look at the cost of time that involves going between one patient’s home and another patient’s home.
It’s just one illustration. Scheduling often is a big financial factor, as well as the staff availability factor. You really don’t want to set up a scheduling so that Mary Smith has to drive 25 miles to her next visit when you could organize it so she takes a shorter path to a patient who is closer. But the reimbursement models, episodic versus per diem, compared to the nursing homes, and then that partnering with many others in the community, relative to referrals are considerations.
I think the first thing any brick and mortar healthcare provider has to understand is this is not just something you plug and play. You don’t just say to your staff you’re now going to start caring for people at home. One of the things that stands out on the staffing side, and this is very, very, important is that you’re sending someone out on their own into the field.
And, yes, you can have virtual connections on a real-time basis, but still that nurse in someone’s home is an independent practitioner at that point. You need to have a competency level that recognizes the judgments are going to need to be made sometimes too quick to call a supervisor and say, what do I need to do? It’s certainly distinct from going down the hall to the nurses station in the hospital or in the nursing facility and saying to an RN, come quick with me to see this patient.