Private Duty Expansion Business Planning
Portsmouth area expansion business plan
CORNERSTONE VNA
Mission: To promote the optimum level of well-being, independence and dignity of those living in the community by providing trusted, compassionate and expert healthcare.
Portsmouth area expansion
Executive Summary
Cornerstone VNA has had a presence in five counties, in two states, for over 100 years. The services are very well known and respected by other healthcare providers and the community members. Part of our history included the service area of Portsmouth. In 1967, when Medicare was enacted, Portsmouth Rehab formulated Rural Health Council to serve homebound patients in the towns not covered by other organizations. This organization moved their office Farmington, merged with Farmington VNA, Milton VNA and became Rural District Health Council, then Rural District VNA & Hospice and then Rochester District VNA, now Cornerstone VNA.
Our referral sources for Portsmouth would include our current referral sources. The two top referrers for the Portsmouth area would be Portsmouth Regional Hospital (PRH) and Northeast Rehab (NE Rehab). PRH& NE Rehab case managers currently verbalize satisfaction in the services we provide.
Meeting with case managers at Northeast Rehab, Jennifer Gullison Clinical Director and Lauren Jacobs Transition Care Nurse was done in March 2013 and the response from the case managers was positive.Director of Nursing, case management, clinical staff and Marie Sullivan (administrator) was present. Our services, geographic area and expansion plans (with no specific dates) were discussed. NE Rehab had only good things to say about our services and Intake department. They didn't have any constructive feedback, but only positive words about our services. They were very thankful for the meeting.
Meeting with Carol Early PRH Director of Case Management and Julie Reynolds CEO was done on 5/3/13 to discuss our potential for receiving referrals from PRH in the Portsmouth area. Carol shared that there were 1240 referrals sent to homecare agencies in 2012. She feels we have an opportunity to receive referrals in the Portsmouth area and verbalized she never has had any negative feedback about Cornerstone VNA. She has a list of questions she will be sharing with her staff of case managers and will get the information back to me. She verbalized that Rockingham VNA gets most of the referrals as they take all patients no matter their ability to pay and have a very positive relationship with their liaison. Currently, we do not take Medicaid or uninsured outside of our town funded towns; this could be a barrier to us receiving referrals if we continue this practice.
See Appendix A for current referral stats for discharges from PRH & NE Rehab.-will have available at meeting
Planning service area would be done in two phases to ensure that there are adequate resources to meet the needs of the population. Phase one is projected to include the geographical area including;Portsmouth, Newington, New Castle and Greenland. Phase two service area would include Eliot, Kittery & York, Maine. See Appendix Bfor population data by age group and by town/city. (will have available at meeting)
Senior services in the Portsmouth area are currently limited. It appears the non-skilled organizations such as Living Innovations and Home Instead have more visibility than the skilled organizations. There is an opportunity to develop relationships with seniors through visibility and community outreach.
Our services from birth through end of life with all of the specialties and diversity of programs including; Homecare, Hospice, Life Care & Community Care will benefit the communities to be served and we will be recognized as the referred provider.
Expansion Description
Continued branding efforts of our services at Cornerstone VNA will benefit our ability to receive referrals in all of our programs. Our programs will provide this expanded service area to specific communities with trusted, compassionate, expert care just as we have in our current service area for years. The growing trends of increased elderly population, the need for specialty services and the “want” to stay home with assistance will be achieved through this expansion.
Cornerstone VNA has the competitive advantage because of our current highly respected service programs and the value that we bring to community.
Having adequate staffing is the most important, yet the most difficult.
The recruiting should start July/August for September hiring, and January implementation for Homecare and Hospice. Life Care should start training PCSP program October/November with recruiting in December for January hires.
Homecare planning:Portsmouth team
- Add On-call back-up
- Team manager
- Scheduler
- PT FT
- PTA-part-time/perdium
- OT FT
- ST Perdium
- LNA-1 part-time/perdium
- RN-2, 1 LPN -part-time/perdium
Space need- re-arrange some current space
Phones-3 additional
Computer needs- 2 desk tops, 8 laptops & one spare
LifeCare Planning -hire as needed/takes 2-4 weeks to advertise, hire & train
Provide PCSP training program in a facility in Portsmouth (to be determined)-to be completed by December
Hire 2 LNA’s prior to expansion to be ready for patients.
Hospice Planning
Liaison/admission nursefulltime
Administrative assistant/scheduler fulltime
MSW-part-time/fulltime
RN-1
LNA-1
On-call back up
No additional space needs
Laptops-3 with an additional spare
Computer-one desktop
Phone-1 additional
Community Care
Begin outreach visibility in September through senior groups- wellness group, clinics, foot clinic, 10-15 hours per month
Position Cornerstone VAN in the SeniorCenter with regular hours so they know we are there, also a designated space as the VNA drop off/supply office-people seeing our nurses come and go.
See Appendix C:Gantt chart for preliminary timeline
Market Analysis
The senior population is predicted to growthe next few decades and this will generatean increased need for health care, hospice care private pay services at home. Nursing home beds are diminishing and the baby boomergeneration is much more educated about their health care needs and the resources available to them.
With the increased need for home care, home health care agencies continue to grow and expand their service areas. For- profit agencies have targeted the private pay/insurance claim market leaving the under insured patientswith fewer options in home health care, Despite the economic climate in Strafford County, growth of the for- profit companies have grown in our area. Rochester, being one of the most economically challenged cities in the state,may not grow has quickly as the surrounding cities and towns but the incoming threat from the for-profit home health care agencies has the potential to dilute the market share. In order for this organization to grow and sustain itself in the face of this competitive threat, Cornerstone VNA needs to continually expand its services and expand its service area as well. With our recent expansion of services in York County Maine now successfully under way, it is our goal to continue our expansion plan and provide our extraordinary services in the Greater Seacoast area with a focus on Portsmouth, New Hampshire.
Cornerstone VNA has several advantages over many of the for-profit organizations- including ourlong standing presence in the communities we serve; our extraordinary reputation with patients, their families and our health care partners, and our commitment to quality care and continued education for all of our professional staff. All of these advantages give Cornerstone VNA a solid foundation for growth and allow the organization to be innovative in our approach to providing new services as the demand in home care warrants. It is our reputation and the ability to provide trusted, compassionate and expert care consistently that gives our referral sources confidence in referring Cornerstone VNA to their patients.
The following agencies are available for skilled services in the Portsmouth area in order of market share:
- Rockingham VNA & Hospice
- Home Health VNA (Homecare & Hospice)
- Portsmouth Amedysis homecare/Beacon Amedysis hospice
- Interim Health services-homecare and private duty
- Angels at home (Out of Newburyport, Ma)
- Sol Amor and Life Choice
The following agencies are currently available for private pay services (agency size may vary):
- Interim Health Services- provides private pay LNA and nursing services. Over the past few years added skilled services to their programs
- Home Instead-A national company located in Portsmouth providing non-skilled service
- Angels-skilled and non-skilled services
- Abundant Blessings-small non-skilled agency-fairly new
- Atlantic Homelife-new non-skilled agency
- Living Innovations
According to Debra Grabowski, Executive Director from Foundation for Seacoast Health, there is a significant lack of programs and assistance for the senior population in the Portsmouth area. Currently there are no home health care organizationsinvesting in the senior population by providing skilled care in the community setting. Anne Jamison, CEO of Portsmouth Regional Hospital, stated that home health organizations need to do more than just focus on getting referrals. Our plan recognizes the need to be integral part of the communities we serve along with our mission to provide trusted, compassionate and expert home care.
Cornerstone VNA will be the only home health care organization in the Portsmouth market area that will offer a comprehensive range of services in all of the following areas:
Home Care
Hospice Care
Life Care
Community Care
The PortsmouthRegionalHospital positions itself as the regional expert in the following areas of care:
Primary Stroke Center-advanced certification in the treatment and outcomes of stroke patients
NeuroscienceCenter- for brain, spinal cord and nerves injury and treatment
Cancer Care-diagnosis and treatment of broad range of cancers (oncology) and blood diseases (hematology).
Cardiovascular Care-cardiac surgery and rehabilitation along with prevention, early diagnosis, treatment and education
Maternity & Pregnancy Care-level II Care Nursery-specializing in care of the newborn requiring extra support such as IV therapies, oxygen support, heart and respiratory monitoring. Newly renovated maternityfloor balancing high tech with a nurturing family environment.
Bone & Joint Care/Orthopedics-continued reputation as a center of excellence offering a leading edge of surgical and non-surgical treatment for a full range of musculoskeletal injuries for adult and children.
As part of our strategy we will emphasize our strength in our ability to provide expert care. Our certified team of professionals can provide the multi-specialty approach to insure that patients that are referred to Cornerstone VNA from PortsmouthRegionalHospitalwill receive the care they need.
Cornerstone VNA has a comprehensive team of professionals who specialize in the following areas of care:
Rehabilitative therapies-Physical, Occupational and Speech
Fall/Balance Prevention Therapies
Maternal Wellness-Pre/Post Newborn Care/Lactation Specialist
Certified Intravenous Therapies
Certified Chronic Care Management (CHF)
Certified Wound/Ostomy Nurse
Telehealth
In addition, the Life Care, Community Care and Hospice Care Programs position Cornerstone VNA as the home care agency that can provide a continuum of expert care
for the patient and their families.
Organizational and Management
Currently we have two multidisciplinary teams to manage our homecare services. Our plan is to build another team similar to the current team structure with an added on-call back up. The back up on-call would be necessary to manage the increase volume of calls and the larger geographical area served, in order to see our patients timely after hours. To begin there would be no need or any other increases in staffing, but we would need to evaluate the volume month to month and add administrative staff as volume increases. Hospice would add staff to meet the needs of the volume anticipated; team structure would stay the same. Life Care structure would stay the same with added staff. Community care would play an important role in senior wellness visibility and grow as the area expands.
We recently increased Information Technology (IT) hours to meet expanding programs and current project plans. According to the IT Manager this increase should be sufficient with projected volumes. We are in the process of re-evaluating current administrative positions and re-assigning job responsibilities to be more efficient. These changes should be sufficient in meeting the increased demands of added staff and patient referral projections that also includes any referrals from non-local specialty hospitals such as Boston hospitals, Maine Medical and Dartmouth, CMC act. See appendix D.The out-of-market referral sources have consistentlyreferred patients to Cornerstone VNA within our service area and our marketing efforts will also target these health care partners.
Financial Projections
Assuming we receive 10 referrals per month from PRH & 10 referrals from SNF/Rehabs for homecare
Hospice 5 referrals per month
Life Care -160 hours per month
See attached budget addendum-not available yet
Market Strategy
Communication to potential customers will include education to current referral sources aboutour service area, along with new business connections. Director of LifeCare, Homecare and Hospice will be engaged in the referral process and the expected outcomes; working closely with Transition Care Nurses and Director of Advancement. Reaching the public will include advertising through radio, paper, business newsletters and personal face to face encounters with referral sources. Along with connecting with senior service coordinators, senior housing authorities, Assisted Living Facilities and others as identified by the Ad Hoc Business committee and health care partners in the greater seacoast area.
In Summary
The history and reputation of Cornerstone VNA is like none other of our competitors. We have a current window of opportunity to grow our skilled services if staffed appropriately, marketed effectively and managed efficiently,our expansion will be successful. Cornerstone VNA will be able to care for more people for a longer period of time, each program feeds to one another.
Cornerstone VNA has been growing services, programs and service areas and as we continue to grow we need to consider that during growth a new need arise within each department, those needs are often met by existing employees who take initiative, or they may be assigned to particular employees by supervisors or added to the supervisors. Either way, new responsibilities are tacked into existing job roles on an as-needed basis. Expanded workloads cannot be sustained, process efficiency is lost, silos of process and communication can damage morale, decreasing quality, and growth can eventually stall. Time of growth can be chaotic and difficult to control. Our key is to manage efficiently and take time to recognize this growth and adjust within.
Healthcare as we know it is changing; reform will bring more challenges and changes in our payer source. There is no certainty in how reimbursement will effect our organization, but being prepared with a varied payer mix will position us to endure these changes. Expansion with increased volume will make us less dependent on government subsidies and position us to increase our revenue to better manage through reform and to continue to be able to provide the trusted, compassionate, expert care to all of our community members.