The Home Health & Hospice Profitability Podcast

What happens when your hospice is already over the Medicare aggregate cap?

In Episode 03 of the Home Health and Hospice Profitability Podcast, host Doug Walters welcomes Lisa Rivard back for a follow-up conversation about one of the biggest financial concerns facing hospice agencies: hospice cap exposure.

After receiving questions from their previous discussion on the Medicare hospice cap, Doug and Lisa take the conversation a step further and focus on what happens when an agency is already approaching or exceeding its allowable cap.

Lisa discusses seeing more hospice agencies facing cap exposure, with demand amounts ranging from thousands of dollars to potentially millions depending on the individual agency and circumstances.

In this episode, Doug and Lisa discuss:

• Why hospice cap exposure continues to be a significant concern
• The percentage of hospice agencies Lisa says are currently exceeding the allowable cap
• The potential financial impact of exceeding the hospice cap
• Why a large repayment demand can create serious cash-flow challenges
• What hospice operators can do when they know a potential cap liability is developing
• Why monitoring hospice cap exposure throughout the year matters
• How monthly cap monitoring can help agencies understand changing exposure
• Why monitoring shouldn't necessarily stop when the cap year ends
• How patients who remain on hospice service can continue to affect prior cap periods
• Why patients who transfer to another hospice may still affect an agency's cap calculations
• The importance of continuing to monitor active prior cap periods
• How cap monitoring can give hospice operators greater visibility into potential repayment exposure

One of the key points in this conversation is that the end of a cap period doesn't necessarily mean an agency's exposure is completely settled.

Lisa explains why her team continues monitoring not only the current cap period but also prior active cap periods when there are patients whose circumstances may continue to affect the calculation.

For hospice owners and operators, understanding potential cap exposure before receiving a demand letter can be an important part of financial planning and cash-flow management.

Rather than waiting until a potentially significant repayment becomes due, ongoing monitoring can help leadership understand where the organization currently stands and how that position may be changing.

If you own, operate, manage, or advise a hospice agency, this episode provides an important follow-up to our previous discussion about the Medicare hospice aggregate cap.

Subscribe to the Home Health and Hospice Profitability Podcast for more conversations about hospice operations, reimbursement, compliance, financial management, billing, profitability, and the business side of home health and hospice.

#Hospice #HospiceCap #Medicare #HospiceBusiness #HospiceCare #HomeHealth #Healthcare #HospiceManagement #HospiceBilling #HealthcareFinance

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Is your agency's clinician productivity target actually achievable—or is it simply a number that's been passed down for years?

In Episode 02 of The Home Health and Hospice Profitability Podcast, host Doug Walters breaks down the math behind clinician productivity and explains how home health and hospice agencies can build productivity expectations based on the actual workload of their clinical teams.

Many agencies use targets such as 30 points per week, five visits per day, or a hospice caseload of 15 patients. But the more important question is: Where did that number come from?

Doug walks through a practical framework for calculating productivity from the ground up.

In this episode, you'll learn:

• Why simply counting visits can give you an incomplete picture of clinician workload
• Why a start of care and a routine visit shouldn't necessarily carry the same productivity value
• How a point system can help measure workload rather than simply counting visits
• How PTO, holidays, meetings, training, administrative work, orders, calls, and other responsibilities reduce available clinical capacity
• Why a 40-hour employee may have significantly fewer than 40 hours available for visits
• How to calculate realistic visits per day based on actual available hours
• Why a 30-point weekly target could potentially represent more work than a clinician can reasonably complete
• How unrealistic productivity expectations can push documentation and other work outside normal hours
• How clinician productivity affects labor cost per visit
• Why increasing visits per day can reduce direct labor cost per visit—but only to a point
• The difference between productivity and sustainable productivity
• How turnover, overtime, documentation quality, recruiting, training, and patient experience can affect the true cost of productivity decisions
• How to translate hospice caseloads into estimated visits per day
• Why two hospice nurses with different caseloads may have very different workloads
• How admissions, call responsibilities, drive time, patient complexity, and support teams can affect capacity
• The three major productivity mistakes Doug sees agencies make
• How to begin calculating a productivity standard based on your own agency's operations

Doug walks through an example beginning with 2,080 paid hours per year and subtracting time that realistically isn't available for patient visits.

After accounting for PTO and holidays, meetings and training, administrative responsibilities, and patient-related work outside the visit itself, the example leaves approximately 1,555 hours per year—or 33.8 hours per week—available for visits.

If a routine visit requires approximately 1.5 hours from start to finish, including travel, time in the home, documentation, and related responsibilities, agencies can begin calculating what a sustainable productivity target might actually look like.

Doug also examines the financial side of productivity.

Using an example of a fully loaded RN costing an agency $120,000 annually, he demonstrates how changes in visits per day can affect direct labor cost per visit. But simply demanding more visits isn't necessarily the answer.

Once productivity expectations move beyond a sustainable level, potential savings may appear elsewhere as additional costs through turnover, overtime, rushed documentation, recruiting, training, or patient experience.

For hospice agencies, Doug also explains why caseload should be translated into what the clinician's actual day looks like. A caseload number by itself doesn't account for admissions, call responsibilities, geography, drive time, patient complexity, or the support available to the nurse.

The goal isn't to find a universal industry productivity number.

The goal is to find your agency's number.

Start with the hours you're actually paying for. Subtract the time that realistically cannot be used for visits. Determine how long your visits take from beginning to end. Then use those numbers to determine what your clinical team can reasonably accomplish.

And one practical exercise Doug recommends: take your agency's total visits and divide them by your clinical FTEs. Compare what productivity actually looks like today with the target you're currently using.

Knowing what you want productivity to be is one thing. Knowing what it actually is—and what your clinicians can sustainably achieve—is something completely different.

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Your hospice cap report says you're under the limit. Then, months—or even years—later, a Medicare demand letter arrives.

How does that happen?

In Episode 01 of The Home Health and Hospice Profitability Podcast, host Doug Walters sits down with Lisa Rivard to break down the Medicare hospice aggregate cap and explain why hospice owners need to monitor their exposure throughout the year—not simply wait for an annual calculation.

Doug and Lisa discuss:

• How the Medicare hospice cap actually works
• How beneficiary counts determine your allowable cap
• Why longer patient stays can gradually erode your cap cushion
• How patients crossing cap periods create fractional beneficiary counts
• Why wage indexes can make cap exposure dramatically different from state to state
• The relationship between short-term and long-term hospice patients
• What the PS&R tells you about Medicare reimbursement
• Why hospice owners should have access to their own PS&R data
• Why monthly cap monitoring can be so important
• How an agency can initially be under cap and receive a demand letter later
• Medicare's lookback period and how previous cap periods can remain exposed
• Why hospice cap liability is a major consideration when buying an agency

The episode also examines one of the most dangerous misconceptions in a hospice acquisition: assuming that because a seller already paid a previous cap demand, the problem is over.

Historical cap exposure may continue affecting the agency after the sale, making proper due diligence critical for buyers. Doug and Lisa discuss why buyers need to understand potential cap liability and consider protections such as holdbacks or escrow when structuring an acquisition.

For existing hospice owners, the takeaway is equally important: don't wait until year-end to find out where you stand.

Regularly monitoring your beneficiary count, PS&R, length of stay, reimbursement, and available cap cushion can give you a much clearer picture of your agency's financial exposure before a surprise demand letter arrives.

Subscribe to The Home Health and Hospice Profitability Podcast for practical conversations about reimbursement, compliance, financial management, acquisitions, and building a stronger home health or hospice business.

VISIT OUR WEBSITES:

https://waltersaccounting.com
https://waltersadvisors.com
https://waltersbilling.com

VISIT OUR WEBSITES:

https://waltersaccounting.com
https://waltersadvisors.com
https://waltersbilling.com