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Guest Corner

How CRM Differs for Home Health and Hospice
From , President and CEO, HomecareCRM

Customer Relationship Management, or CRM, is a business strategy that emphasizes the importance of the customer from acquisition, service, and satisfaction to customer loyalty and retention. Like all businesses, home health and hospice businesses serve customers, in this case patients. However, standard CRM processes don’t address the unique needs of home health and hospice providers.

For example, while you may think of the patient as the customer and your mission is to provide the best possible care and comfort to this customer, your customer base extends far beyond your patients. Who refers patients to you? Case managers, doctors, nurses, rehab directors, insurance agents, trust officers, lawyers, family members of previous patients, and so on. These referral sources are also your customers and should be managed through CRM just as you manage your patients.

Next, imagine a single terminally ill patient who has been referred to you by a doctor. As you care for this patient, there may be several stakeholders who need to be informed as the case progresses including the referring doctor as well as insurance companies and family members. A generic CRM strategy doesn’t take into account the complexities of managing the patient as well as the patient’s stakeholders. In addition to needing a system for notifying referral sources and stakeholders of admissions, terminations, status changes, plan of care changes, and deaths, home health and hospice businesses need a system for acquiring new patients which is a crucial part of CRM strategies.

For most businesses, retaining customers makes sense because it is less expensive to retain a customer than it is to acquire a new one, but for businesses serving terminally ill patients, patient retention is practically impossible. Acquiring new clients requires a stronger focus on managing referral sources. Hospice and home care marketing professionals value their referral sources and need a tool for maximizing referrals and admissions, with the highest possible margin.

CRM software is such a tool. Off-the-shelf CRM software works well for many traditional businesses looking to manage the sales process from origination to conclusion. However, the unique needs of home health and hospice providers require extensive customization and even then the final product may fall short or require extensive training. A better approach is to use a Customer Relationship Management system designed specifically for the home health and hospice industry.

Like all businesses, return on investment, expense management, productivity, conversion rates, access to information, and ease of use are important CRM system considerations. An ideal CRM tool for the home health and hospice provider should incorporate the following features:

~ Automated notification system—Secure, automatic email notifications to referral sources of admissions, terminations, deaths, status changes, changes in plan of care, and so on.

~ Alert system—Automated email/alert notification for key data points such as alerting employees involved with a specific referral source when someone else, such as a clinician, in the organization has met with the referral source.

~ Automated expense management system—Tracks typical business expenses such as mileage as well as tracks expenses to specific referral sources such as physicians. Tracking of expenses at the individual level as well as at higher levels such as the practice, hospital, and clinic level. This type of tracking allows providers to calculate the return on investment per referral source. For example, a calculation could tell you for every $XX spent, X referrals result.

~ Time management system—Tracks how individual sales people spend their time and calculates how many hours it takes to result in a referral.

~ Activity and Productivity tracking system—Tracks the day-to-day activities of sales and marketing personnel and details the progression of relationships with referral sources.

~ Referral source hierarchy—Details admissions and referral counts from referral sources at the physician as well as practice, hospital, county, and organizational level.

~ Referral source conversion statistics—Statistics showing conversion rates at all levels from the individual physician to the larger referring organization.

~ Referral source ranking—Ranks referral sources based on factors such as past performance, potential for referrals, and quality of referrals. This allows the sales team to focus on high value referral sources.

~ Access to information—Includes patient chart lookups for all active and inactive patients as well as patient histories and lists per referral source.

~ Robust reporting—Includes ROI and productivity reports, charts, and graphs detailing business development data, expenses, productivity, return on investment, and the entire referral source layout. Exception reports detailing referrals not admitted along with reasons why.

~ Document management system—An electronic system for storing expense receipts, medical paperwork, contracts, images, correspondence, and other documents.

~ Availability via client/server, laptop, PDA, and Web—A client/server version with offline capabilities, full PDA version for Blackberries and other portable devices, and 100% Web-based access for remote information retrieval and data entry, 24/7.

~ Security—User access control and security ensure that only those with access to confidential information can access it.

The home health and hospice industry serves patients while also managing a complex business. Managing customer relationships is crucial to ensuring that the organization has the resources to provide the level of care and compassion patients require. Adopting a CRM strategy and selecting a CRM tool that facilitates that strategy allows businesses to spend their sales and marketing resources on quality referral sources. While your patients may not be repeat customers, your referral sources can repeatedly refer patients to you if you effectively manage your relationship with them. When it comes to referral sources, remember the foundation of CRM: acquisition, service, satisfaction, loyalty, and retention. A Homecare CRM strategy will help you build on this foundation and grow your referral base.

Karl Dumas can be reached at . Information about HomecareCRM is available at http://www.homecareCRM.com and 888-843-8276.

Previous Guest Articles

10 Principles of Legal Marketing
From

The question of what is and is not legal in marketing your home care and hospice services is one we hear often. Denise Bonn, Deputy Director for the Center for Health Care Law for NAHC (National Association for Home Care and Hospice) did an excellent job of presenting the principles of legal marketing in her session at the NAHC Annual Meeting last week. 

The theme throughout Denise’s presentation was very clear; you cannot pay for referrals. Anyone who receives or pays anything of value to influence the referral of federal health care business, including Medicare and Medicaid, can be held accountable for a felony. This is the basis of the Federal Anti-Kickback Law. 

Denise discussed Stark law as well. Stark law addresses physician relationships. Under Stark Law for example, physicians with a financial relationship with a Home Care Agency may not refer to that agency unless they satisfy one or more Stark Exceptions. There is overlap between Stark Laws and the Anti-Kickback Statute. In addition, your state likely enforces additional laws or statues related to referral source and beneficiary relationships. 

It is important that your agency have policies and procedures in place that address sales and marketing practices. And because there is so much gray area surrounding the Anti-Kickback Statue, Safe Harbors, Stark Law, and Stark exceptions, it is also a good idea to involve legal counsel when establishing your policies and procedures. 

Denise offered Ten Principles to guide you through the Federal Anti-Kickback and Stark Laws. 

The Ten Principles of Legal Marketing, as presented by Denise are:

1) You cannot pay for referrals.
You cannot compensate a referral source in exchange for referrals. Compensation in this situation is not limited to cash payment. You cannot offer a referral source anything of value in exchange for referrals. This is considered inducement. Similarly, a referral source cannot request payment or remuneration of any sort in exchange for referring you patients. Remuneration is a term you will hear used frequently when discussing legal marketing. Remuneration in this context is compensation or a gift delivered in exchange for a service.

2) You cannot offer or furnish free services to referral sources.
According to this principle, you cannot offer your referral sources anything they would otherwise have to pay for in exchange for referrals. For example, offering to clean a physician’s office for free in exchange for referrals would be considered a violation of the Anti-Kickback statute. 

3) You can educate referral sources about Medicare coverage and your services.
Finally, something you can do! Providing education about your services is an acceptable practice, and does not violate the Anti-Kickback Statute or Stark Law. And in situations where you are required to provide education over a breakfast, lunch or other meal setting, it is acceptable to provide a modest meal to those attending the educational session. Consider Stark Law when providing meals to physicians. Stark Law indicates that gifts to physicians cannot exceed an aggregate of $300 plus the CPI-U ($355 for 2009). Food counts towards these limits.

4) If payment to a referral source is not for something reasonable and necessary, payment is likely illegal.
You cannot pay a referral source for something that would not be considered reasonable and necessary. An example of inappropriate payment in this case would be paying an Assisted Living Facility to rent unnecessary space.

5) More than one Home Health Agency Medical Director must be justified.
There has been a significant increase in the number of Medical Directors employed by Home Health Agencies post-PPS. This may be considered a disguise for payment for referrals. In addition, under Stark, Medical Directors cannot be paid for services not defined in their contract. And no payment should be made to a physician prior to their signing of a Medical Director contract. 

Denise also made a point here about sharing Medical Director contracts. Be careful when borrowing contract templates from other agencies, as they may or may not include the services you intend to pay your Medical Director for providing.

6) Free services to influence a beneficiary to choose your agency is likely illegal.
The OIG has determined that gifts with a maximum retail value of $10, or an aggregate of $50 are acceptable practices, and will not induce beneficiaries to use your services. However, no cash or cash equivalent may be offered to beneficiaries. Denise spoke specifically about Blood Pressure Clinics and Pre-Op visits. Provided the BP screening was not tied to the use of any other goods or services you provide, blood pressure clinics are acceptable practices. However, when conducting a BP Clinic, you cannot promote your products that address high BP, and in the case of abnormal readings the beneficiary should be referred to their Primary Care physician. 

Pre-Op visits on the other hand, when conducted by a clinician have been determined by the OIG to influence the provider a beneficiary selects. Some agencies have developed pre-op DVDs or provide pre-op information over the internet. An OIG Advisory Opinion determined this practice acceptable. Be aware that services that may seem modest may still be considered inducement by the OIG. 

7) Free gifts to physicians must be modest, comply with stark, and not violate Anti-Kickback Law.
There are Safe Harbors to the Anti-Kickback Statute, and Exceptions to Stark Law that help to define what you can and can’t do in terms of gifts and payment to Physicians. Familiarize yourself with these, and remember that gifts cannot be in the form of cash or cash equivalents (gift cards), and are limited to an aggregate of no more than $300 + CPI-U ($355 for 2009).

8) You must always check state law.
All 50 states have provisions related to the Anti-Kickback Statute, and Stark Laws. Be sure you understand the provisions in your state, and seek advice from legal counsel as needed.

9) You must oversee your marketer.
It is critical that you establish policies and procedures defining acceptable marketing practices. Also, commission-based compensation is generally considered okay, provided the appropriate oversight is in place, and those being paid commission are employees. In the case of contracted marketers, there is concern for referral influence, and kickback risk, making commission-based compensation more dangerous. Additionally, oversight is harder to accomplish, also a concern. 

10) Technical compliance with fraud and abuse provisions is necessary.
Denise concluded her session by emphasizing the importance of compliance with Fraud and Abuse provisions. The penalty for fraud and abuse is severe, including significant fines, felony charges, and potential exclusion from Federal and State Health care programs. Ignorance of the law does not release you from liability. 

Denise’s session provided a great overview of the principles of legal marketing. She offers these guidelines as a place to start in establishing your marketing policies and procedures. It is critical that you understand and comply with both federal and state laws, and seek professional legal advice when needed.

Thank you, Denise, for your session, and your valuable contribution to our industry.


Separating Your Agency From the Rest With Top of Mind Branding
From

As your competition continues to increase, the branding of your agency becomes paramount.  To be effective, your brand should do three things: differentiate you from your competition, highlight your services, and meet the needs of your client.  Does your current brand strategy accomplish all three? 

In this day and age, there are a number of ways to brand your agency: uniforms, billboards, company cars, brochures, etc. These are all the typical pieces of a brand strategy, used by almost every agency.  This makes it much more difficult to differentiate yourself, so how can you make it easy?

Well, what about your phone number?  This is the last untapped frontier, as not many people have stopped to consider adding an unforgettable toll-free vanity number as part of their branding strategy. Your phone number is the front door to your company and you want the consumer to knock on your door first. 

What if you could offer your referral partners one EASY TO REMEMBER number to call?

Adding a vanity number like 1-800-HOMECARE or 1-800-HOSPICE to your agency’s marketing and advertising efforts will enable you to sell more effectively and immediately enhance the message that you are sending to the community.  What is a vanity number?

A vanity number is an alpha-numeric telephone number that contains a word or phrase that is memorable and communicates a message to the audience.  A great vanity number, like 1-800-HOMECARE or 1-800-HOSPICE, communicates instantly what you do and provides toll-free calling, making it easy for your clients to do business with you without having to look you up in the yellow pages.  Clients will effortlessly commit your number to memory and call again and again. You do not want consumers to search for you on line, where they will also find your competitors.  You want them to call you first.

On top of making it easy on your usual referral sources, as you care for patients and their families they will easily be able to refer you to others because they will always remember your contact number. With Consumer Calls being the fastest growing referral segment in our industry, word of mouth is becoming increasingly important.  Are they calling you first?

Toll-free vanity numbers are vital in corporate identity brand building.

A good vanity number leaves an indelible impression on consumers. And what good is a corporate brand if it can’t be remembered?  A vanity number stands for professionalism, longevity, credibility, and might even make your company a household name to consumers. Become “the Kleenex” of tissues. “The Google” of internet searches.

Today’s business environment requires an impeccable image, and the more you do to create that image, the stronger your brand becomes. A vanity number provides an instant brand identity.

Increased call volume leads to increased sales and increased profits.

The most visible benefit of using an unforgettable toll-free vanity number is the increased consumer response to advertisements/promotions. Studies show that if presented with two promotions, consumers will respond to a great vanity number 14 times more than to a regular toll-free number. 

Primary Wave Media

Primary Wave Media is one of the nation’s leading providers of vanity number marketing services. We have helped companies from all over the country improve response rates and increase the effectiveness of marketing and advertising through our shared use of easy-to-remember phone numbers. 

From Our Clients:

“We are committed to making an inquiry about hospice easy and effortless, and 1-800-HOSPICE is a great tool to access hospice care as quickly as possible”
~ Betty Brennan, CEO of Beacon Hospice, Inc. Licensee for MA, CT, NH, ME, RI and VT

“Southwestern Illinois Visiting Nurse Association is the oldest freestanding not-for-profit in the Metro St. Louis Area.  For the past 3 years, we have relied on 1-800-HOMECARE to help us spread our message. In all this time, 1-800-HOMECARE(TM) has been the most reliable marketing toll we have used. Thank you 1-800-HOMECARE for helping us to be successful year after year.”
~ Michael Bader, Executive Director, Southwestern Illinois Visiting Nurse Association

“One of CIMA Hospice’s strategic goals for 2009 is branding and name recognition. The acquisition of 1-800-HOSPICE for our El Paso, San Antonio, and Rio Grande Valley markets in Texas is a strategic step in achieving this goal.”
~ Rochele E. Esper, CIMA Hospice, LP

Gregg Hamerschlag is the CEO for Primary Wave Media.  Gregg can be reached at (914) 747-2562 ext. 225, or via email at .