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12 Ways GPS Reduces Home Health Agency Costs and Improves Operations Nurse visits to patients’ homes have been the foundation of home care since the days when horseback sometimes was the only way to get there. Today, visits still are the key to patient care, but they’re also a major cost for every home health agency. Ensuring the quality of care delivered in the home is of prime importance, of course. But successfully managing travel time and costs gives HHAs the opportunity to increase the number of visits and time with patients while trimming the high costs of travel. Fortunately, several newer technologies offer better methods for managing the travel and visit schedules of agency field staff providing skilled nursing care, social work services, physical, occupational and speech-language therapy, and aide services. These technologies include global positioning satellites (GPS), the Web and handheld devices such as cell phones. This white paper explores those alternatives and their pros and cons.

Traditional tools: Labor intensive First, let’s benchmark the way most home health agencies have managed their mobile workforce. Technologies at play are the telephone, voice mail and pen and paper. Upwards of 70% of HHAs may fall into this category, indicates an informal November 2007 survey of 379 HHAs by Home Health Line, the leading independent newsletter in the industry. Visit scheduling and schedule changes rely on time-consuming and labor-intensive phone calls (and leaving voice mail messages) between the agency and field staff. More phone calls follow to report the conclusion of a visit so office staff have some idea how the visit schedule is progressing. When there’s a change during the day, the scheduler checks the board or screen to find a nurse whose location and visit load can accommodate the added visit. During much of the day, the agency won’t have an idea where its staff are at any given moment. Generally speaking, agencies assign field staff to a geographic area; staff decide the order in which they make their visits. Agencies may provide driving directions based on Internet mapping services (such as

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Written by DecisionHealth White Paper Services

Contents • Traditional tools: Labor

intensive .............................. 1 • Technologies emerge that fit

with HHA business structure .... 2 • GPS/cell phone/software offer

benefits in field and HQ ........... 3 • Advantages for home health

field staff ............................... 3 • Advantages for home health

agency executives .................. 4 • ROI table ............................... 6 • Case Study: Swedish Medical

Center Home Care Division ...... 7 • Final thoughts ........................ 8 • About the Sponsor .................. 8

Executive Summary Home health agency use of cell phones equipped with GPS navi-gation and linked to a powerful Web-based application helps HHAs better manage their field staff of nurses, therapists and aides. Turn-by-turn GPS directions on cell phones provide the shortest/quickest route for visits to patients’ homes, saving fuel costs and driving time. A GPS-based application that tracks cell phone travel shows where all staff are at any moment, generates data for automated timecard and mileage reimbursement calculations, provides additional documentation of patient visits, and sends safety alerts to the home health agency when a nurse may have encountered a problematic situation.

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MapQuest, Yahoo Maps and Google Maps), which takes time to do. Or the nurses or other field staff can do the mapping program look-ups and printing at home themselves. For four to five visits in a day (see on left), it’s time consuming no matter whether the agency scheduler or the field staff member does it. For tracking mileage driven, field staff use pen and paper to record their vehicle’s odometer settings from home to visit to visit, etc. Staff who are paid on an hourly or per-visit basis also manually track their work performed using time or visit sheets. That’s a lot of administrative work (and cost).

Technologies emerge that fit with HHA business structure There are better uses of the time of agency managers and field staff. There are more effective ways to manage home health clinicians and aides in the age of wireless communications and GPS-aided devices. Alternatives include: Equip clinicians’ laptops or tablet PCs with an aircard for wireless communication.

• Pros: Aircards provide wireless communication for field staff who carry laptops. Laptops have bigger screens and keyboards, can work with a point-of-care system and handle collection of answers to the lengthy OASIS form.

• Cons: Laptops must be powered up for GPS navigation and wireless communications to work. Laptops are more expensive and bulkier than cell phones and provide more functionality than is necessary in many situations. Laptops also fail to provide a truly effective solution for GPS navigation – they are similar to reading printed directions and maps.

Give field staff a portable GPS device such as TomTom, Garmin or Magellan consumer brands.

• Pros: They supply driving directions, are portable and sold widely.

• Cons: Mapping features and directions become out of date unless you pay an extra charge for updates. These devices don’t communicate back to the home health agency to provide location, route and time and duration of stops.

Another tool has emerged that combines the Web, wireless

As miles add up, so do costs Home health nurses make an average of four to five visits a day, according to a June 2008 Home Health Line productivity survey receiving 160 agency responses. What was the average number of miles driven between visits? The mean was 13 miles a day and the median 11 miles, 138 of the agencies reported. For an agency with 30 field clinicians, you get something like $1,900 week or nearly $60,000 a year in mileage costs at the IRS rate of 58.5 cents/mile (July-Dec. 2008). Industries outside of home health have been able to lower such costs through use of “location-based solutions” such as GPS-enabled cell phones. An average 13.2% savings in fuel costs and a 19.2% reduction in miles driven were reported in a 2007 survey of 330 enterprises in service industries with field staff such as telecom and utilities. Source: “The Impact of Location on Field Service,” December 2007, Aberdeen Group, Boston.

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communication and GPS technology to enable home health agencies to locate and manage their field staff in near real time. Almost 91% of home health nurses and other clinicians already carry a cell phone during the work day for various professional purposes (see on left) so it’s already a familiar work tool. The key to turning a GPS-equipped cell phone into a true management tool lies in special mobile workforce management software added to the phone and tied to a Web-based platform accessed by the agency to enable work flow, communications, and collection and analysis of data from field staff.

GPS/cell phone/software offer benefits for both field staff and managers Here’s how the marriage of cell phone wireless, GPS and Web tech-nologies can help field staff and their managers at the agency office:

Advantages for home health field staff 1. Turn-by-turn driving directions: This function is built into the

phone. GPS specifies the phone’s location and software provides voice and onscreen directions for the best (shortest/quickest) available route to the patient’s home or other destination. If there’s a traffic jam along the way, the software calculates an alternate route. It gives new directions when the driver misses a turn. Extra benefits: Safety – not driving distracted with map reading and direction finding; but instead eyes on the road and hands on the wheel. The clinician or aide arrives at the patient’s home less stressed and ready to focus on patient care. Also, the field staff member receives the perk of using the GPS directions outside of work hours at no extra cost to the agency.

2. Improve safety: A “stop alert” goes to an HHA dispatcher or

manager if the phone of a nurse or aide remains at a visit location longer than a predetermined length of time. The agency office receives the alert and someone can call, text or e-mail the field staff member to determine whether he or she has encountered an unsafe situation. Many industries and organizations use this feature to monitor the safety of mobile workers. Example: During a winter storm, a worker’s phone was stationary more than 10 minutes. Alerted dispatchers sent help; the worker had suffered a heart attack and was saved. In addition, a “hot key” alert can be configured on the phone so

GPS satellites encircle the Earth

Cell phones get wide use in home health Answering questions posed by HHA office staff and mangers constitutes the top use of cell phones by the 91% of clinicians who carry cell phones during the work day. That’s what 224 home health agencies reported when they responded to an August 2008 Home Health Line survey. Job-related cell uses:

• 95% − answer questions • 89% − contact physicians • 88% − contact patients • 74% − arrange patient visits.

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field staff can alert management quickly when they need assistance. Also, the phone can be programmed to send an alert when it moves outside of a designated geographic area (called a “geofence”). Imagine this feature’s benefit in the case of a possible carjacking or kidnapping.

3. Cut fuel costs: Finding the cheapest gasoline when nurses need to

fill up can reduce their out-of-pocket expenses. Special software makes that possible by listing gas stations near the cell phone’s GPS location in descending order of price (updated daily). Select a gas station and its address and driving directions from the GPS location appear on the cell phone screen.

In a similar manner, field staff can cut miles driven to find health care-related providers such as pharmacies, assisted living facilities, nursing homes and hospitals. Agencies can add information on these local facilities to their GPS information, allowing field staff to quickly find them and generate driving directions, saving time and money.

4. Ease mileage reporting paperwork: GPS tracking software is

ideal for mileage reporting. Equipped phones, after they’re turned on at the beginning of the day, accurately record the distance to patient home A, then to patient home B, and so on until the end of the staff member’s work day. That means the field staff member no longer has to write down vehicle odometer settings and manually fill out mileage sheets.

5. Automate timecard paperwork: For nurses or aides paid by the hour – which many agencies do (see on left) – the right software can turn the cell phone into a time clock. When the phone comes on, the nurse “clocks in” – the phone sends the start time and GPS location to the agency; the same process occurs when the staff member clocks out. (There’s also a way to turn off the clock when on personal time.) As with mileage reporting above, the field staff no longer faces the chore of filling out time sheets. Nurses also can indicate specific codes for services performed and any products used during the visit.

Advantages for home health agency executives 6. Expedite visit scheduling: The agency can push out the next

day’s schedule to field staff members’ cell phones. (In other words, no more labor and time intensive manual telephone scheduling!) When they turn on their phones in the morning, field staff will

Cell phones mesh with timecard needs Many home health agencies pay home health nurses on an hourly basis, making use of a cell phone as a timecard a cost-saving benefit for the agency and the nurse (who doesn’t have to maintain a manual time sheet). About 160 respondents to a June 2008 Home Health Line productivity survey reported paying:

• 33% of field nurses on an hourly basis

• 40% by salary • 23% per visit • 4% on a contract basis.

An analysis of 120 agencies by consulting firm Fazzi & Associates, North Hampton, Mass., found that 51% of home health nurses were paid on an hourly basis, 34% by salary and 15% per visit, the firm reported in March 2008.

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have their schedules for that day, with the order of visits and driving routes optimized (thanks to GPS and special software) to save time on the road. In some cases, that could make more time to spend with patients or time for an additional visit that day.

7. Cut fuel costs: Nearly all home health and private duty agencies

cover mileage costs of field staff (see on left). With gasoline costs remaining high, “route optimization” through GPS and built-in cell phone driving-direction software can achieve significant reduction in agency fuel costs. It’s simple: Give field staff the shortest (or quickest) routes between patient visits – which themselves are placed in the order that requires the least amount of driving – and they burn less gasoline. Example: Such technology allowed one home health agency to capture enough savings over a year to add two staff members and two vehicles to its field staff of 50.

8. Cut agency paperwork: By integrating cell phone/GPS data into

their accounting and payroll systems, home health agencies can slash paperwork and costs substantially. The mileage data for visits referred to in Point 4 can be transmitted to the agency’s back-office accounting systems to calculate the field staff member’s reimbursement and cut a check. Similarly, the time card data (see Item 5) go to the agency where payroll systems (such as ADP, Kronos or SAP) can figure compensation for field staff paid on an hourly or per visit basis. Benefits: Accurate mileage and timecards from GPS data, elimination of the work and data entry errors associated with manual rekeying of mileage sheet and timecard data, and elimination of the need to cut manual checks.

9. Improve documentation of visits: The health care axiom “Not

documented, not done” isn’t cause for worry. That’s because HHA officials can generate what’s called a “breadcrumb report” showing the routes and precise location, times and duration of stops of home health clinician and/or aide visits for any time period. Think what it would be like to show this report to a Medicaid auditor seeking proof that visits were made and your reimbursement is justified. You have an audit trail ready to go at any time.

10. Manage field staff more effectively: Visualize a computer map

of your HHA service area displaying pushpin icons showing where all of your field nurses, therapists and aides are at any given time. (The system also allows you to group field staff in many ways, for example by branch, or by supervisor so a manager sees only those staff for whom he or she is responsible.)

Gasoline prices hit home health The vast majority of Medicare home health agencies reimburse their clinicians for mileage, an April 2008 Home Health Line survey indicated. The results:

• 95% of 73 respondents said they reimburse for mileage

• 42% have increased mileage reimbursement

• 18% lost clinicians who couldn’t afford the higher gas prices

• 15% refused to accept patients who clinicians wouldn’t drive to

• 12% raised clinicians’ rates. Private duty home care agencies also feel the crunch.

• 83% of 69 respondents in an August 2008 poll said they reimburse caregivers for gas mileage

• 47% reported hiking mileage reimbursement

• 42% had to decline taking on clients because of driving distance

• 39% raised client rates • 27% raised caregivers’ hourly

rates.

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Think how much more effective it would be to manage your field staff if you could see where they are whenever necessary, including in relation to a landmark such as a hospital? Example: Say you unexpectedly need to send a nurse to a patient’s home within hours. This technology now allows you to type the patient’s address into a Web site that receives data from your field staff cell phones. Immediately, you see the 10 nearest nurses to the address. Such data will ease your decision-making about who is in the best position to perform the unexpected visit.

11. Communicate to field staff more effectively: Reach all field

staff without making dozens and dozens of calls – and know who received the message and who didn’t. You can expect such efficiency from these systems whether it’s for a notice of a routine meeting or an urgent situation affecting everyone. Example: A big storm approaches. You not only can send a text message to all staff in your geographical area telling them what to do, but the system can tell you (1) who received the message, (2) who read it, and (3) whether the recipient responded. If the message was read, there’s no need to waste time with a follow-up call. If it wasn’t received or read, you know who needs a call.

12. Decrease turnover: The more you can relieve clinical staff

frustration over paperwork and other administrative burdens, the greater their job satisfaction. For example, GPS directions make their life less stressful: Getting directions and schedules via the phone eliminates wasted trips back to the office. With national turnover estimated at as much as 20%, use of the above technologies could pay off by reducing the thousands of dollars in costs of replacing field staff.

A survey of more than 120 organizations providing home health care and services found an ROI for use of all types of wireless devices in home health care of up to $15,000 per full-time-equivalent per year. Wireless handhelds and cell phones showed particularly positive ROIs. Wireless Handheld/BlackBerry Smartphone Phone ROI Field Staff

Admin Staff Savings

Productivity Enhancement

Smartphone/BlackBerry Total Cost of Ownership

Smartphone/BlackBerry Return on Investment

Payback Period

RN $1,150 $13,505 $1,557 964% 38 days

LPN $1,150 $9,990 $1,557 739% 40 days Home Care Aide $1,150 $2,840 $1,557 345% 106 days

Source: Venture Development Corp., Natick, Mass., 8/2007 report “Wireless Home Care Solutions: Addressing the Quality of Service and Performance Gap”

HHAs report existing investment in cell phones Home health agencies already spend significantly on cell phones, according to a Home Health Line August 2008 survey:

• 44% of HHA officials reported their agencies provide cell phones for clinicians

• 36% help cover costs of personal cell phone use

• Only 11% said they provide no financial support.

66% said their agencies spend $20 to $50 a month per clinician for cell phone coverage or reimbursement.

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Case Study: Swedish Medical Center Home Care Division Fiddling with maps while driving was just one of the concerns that the Swedish Medical Center Home Care Division had about the way its 200-strong field staff traveled to homes and facilities where patients lived in the Seattle metropolitan area. Reading maps or calling the office for directions while driving was a safety concern as well as an efficiency issue. Further inefficiencies occurred when the home care office called staff on wireless phones, paged them or even sent text messages to provide schedules and destinations. Such communications interrupted clinical staff and aides during their patient visits, and sometimes compromised patient confidentiality when the home office had to give details of the next case to someone visiting with another patient. It was not the best use of Swedish’s non-profit resources to have mobile field health care workers rely heavily on the office for directions. Facing shrinking Medicare and Medicaid dollars, escalating costs and a nationwide nursing shortage, the Home Care Division turned to TeleNav Track for a cell phone-based solution using GPS navigation enhanced by a Web-based software application. “Providing directions to get around Seattle and the surrounding counties was problematic,” reports Debby Ramundo, Senior Project Manager, Home Care. “Our people were too tied to the office for getting directions. Because patient appointments change often and on-the-fly, it was a significant waste of time for employees just to come into the office to get directions, only to go right back out again. Also, the safety of our mobile healthcare employees is an important issue, not just for us, but also for them.” Using TeleNav Track’s GPS turn-by-turn directions for the shortest or quickest route knocked down travel time considerably and greatly reduced the number of trips into the home office, thus allowing mobile healthcare workers more time for patient calls and to do what they do best—take care of patients. “With TeleNav Track, we can respond to patient needs faster and with more flexibility,” Ms. Ramundo adds.

Field staff for this Washington state home health agency no longer rely on the agency office for directions to patients homes. Instead they use their TeleNav-equipped cell phones for GPS directions and navigation, eliminating wasted trips back to the office.

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Final thoughts Adding the power of GPS tracking to the convenience of wireless cell phone technology gives home health agencies a combination perfectly suited for their needs. Cell phones are supremely portable and already familiar to field staff. Smart cell phones can transmit GPS data – a rich source of information which the right software turns into productivity-enhancing and cost-saving tools for the agency. Not just a manage-ment benefit, the technology combination also makes life easier – and safer – for home health clinical service providers and aides in the field. While the initial home health patient visit may require use of a laptop for recording answers from the more than 90-question OASIS form, most visits don’t require such heavy equipment. Other times, the cell phone/GPS/software advantage has a proven record of:

1. Cutting fuel costs by giving field staff more efficient driving routes

2. Giving staff less time on the road and more time to spend with patients

3. Sending accurate time card and time sheet data to the agency for automated calculation of mileage reimbursement and hourly-based pay

4. Automated generation of paychecks when tied to the agency’s payroll system

5. Displaying a map so agency mangers can see where their field staff are at any moment

6. Issuing a safety alert to the agency when a nurse or aide may be in danger in the field

7. Providing a means to send text messages to all staff and know whether they received and read them.

8. Documenting performance of field staff members’ patient visit schedule, creating an audit trail showing compliance with Medicare, Medicaid and private payer requirements.

The technology that delivers these benefits isn’t something that’s promised to be just around the corner. It is here for you to use now.

About the White Paper sponsor TeleNav, based in Sunnyvale, Calif., is the global leader in location-based applications delivered via a cell phone. The first to launch a GPS navigation and mobile workforce management service on a cell phone in North America, TeleNav is partnered with every significant wireless carrier and device manufacturer. TeleNav provides two solutions for

In Summary Top home health agency benefits of a GPS-aided cell phone enhanced with a Web-based application:

• Cut field staff fuel costs • Cut driving time. • Obtain accurate mileage,

timecard data. • Track location of field staff to

facilitate visit schedule changes.

• Enhance safety of field staff. • And much more.

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home health agency clinical and nonclinical field staff: TeleNav GPS Navigator provides voice and onscreen driving directions on mobile phones and cell phones. Its ability surpasses in-car and stand-alone GPS systems with features that include easy portability, local business listings, voice-activated directions, and free updates to maps and points of interest – all at a fraction of the price of stand-alone systems. TeleNav Track is a Web-based application (no hardware or software to install at your agency), using GPS data from field staff cell phones so managers can see the locations of their staff at any time. TeleNav Track helps cut fuel and time costs by optimizing driving routes and reduce operation costs by collecting mileage and time card data from the field. Tracking enhances the safety of field staff, automatically alerting managers when a potential security problem exists. TeleNav Track is complementary to and integrates with information systems of home health vendors including Homecare Homebase, McKesson and Misys. For more information, go to www.telenavtrack.com/homehealth or call 1-88-TeleNav-2 (1-888-353-6282).