Organization Improvement and Development

Generally, hospices invite Summit to conduct “organizational assessments” to assist them in identifying better ways to conduct the business of hospice care; whether that means helping the hospice operate more efficiently or competing more effectively. Typically, a Summit organizational assessment includes the following:

Quantitative Analysis

• Evaluate the administrative systems to determine if they effectively oversee the current functions of the corporation’s lines of business and are capable of positioning the hospice for excellence and growth. We will also determine if they operate in the most efficient and effective manner possible.
• Review available financial and program information. Included among the items we will review and analyze:
  
  
  1. The level of resources expended on direct patient care. As part of this review we will attempt to quantify:
     1. Level of service—consistent with payer requirements.
     2. Personnel costs and productivity
     3. Durable medical equipment costs
     4. Pharmacy costs
     5. Inpatient care costs
     6. Other ancillary costs
     
     
  2. Analyze the hospice’s program data including:
     1. Admissions
     2. Mean and Median lengths of stay
     3. Medicare claims data to analyze marketplace positioning
     
     
  3. Patient mix and referral sources to determine what might be done to serve additional patients, and to serve all patients for longer periods of time. To that end, we will review:
     1. Physician and community attitudes towards the hospice
     2. Referral patterns
     3. Admission policies and practices

Qualitative Analysis

• Evaluation of f the corporate structure (i.e. governance and management) and corporate culture to determine if they are consistent with the mission, strategic direction, operations and resources of the organization.
• Evaluation of the completeness and effectiveness of internal communications particularly between sites of operation and lines of business.
• Analysis of the hospice’s staffing level to determine if efficiency, effectiveness, quality and skill are in balance and reflect industry standards.
• Evaluation of the various external and internal educational programs to:
  
  
  1. Determine what commitment is being made by the hospice to improve the skills of its own employees.
  2. What, if any, barriers exist that limit the ability of employees to put forward their best efforts in furthering the mission of the hospice.
  
  
• Evaluate the Hospice’s commitment to the continuous improvement of its performance as it relates to:
  
  
  1. Cost and waste reduction
  2. Problem solving and correction of administrative issues
  3. Medical error identification and correction
  4. Organizational creativity and receptiveness to new ideas
  5. The speed of improvement
  
  
• Assess the hospice’s general compliance with the rules and regulations of Medicare. Generally, as part of an organizational assessment Summit does not conduct an in-depth compliance audit (see Compliance Assessment); however, compliance with Medicare’s rules and regulations is critical to the management of hospice programs and therefore we generally propose that:
  
  
  1. We review a random (non scientific) selection of patient charts. Failure to closely monitor the eligibility of hospice patients can lead to serious ramifications.
  2. Review the program for general compliance with the federal requirements under the Medicare Hospice Benefit, the HIPAA Privacy Rule as well the HIPAA Security Rule.
  3. Review board knowledge and oversight function given the OIG’s and Congress’ current interest in the role of governance and compliance.