Your Mileage May Vary

With a nod to Robert Pirsig, author of Zen and the Art of Motorcycle Maintenance, we can learn a lot about how to run your compliance program at peak effectiveness by viewing your home care company as a beloved motorcycle. Maybe it’s your old dependable warhorse. Maybe it’s a state-of-the-art machine, magnificent in its high-tech glory. Perhaps your goal is to ride it hard and fast, or long and steady. The analogy works well.

What does it take to get the most from your home care company, or from your motorcycle? The ROPE system shows us that the answers are similar.

Rung 1 of our ROPE Ladder focuses on identifying and assessing the way you actually run your home care company and fine-tuning these operations conform both to best practices and to various laws, regulations and other “rules.”

With our motorcycle analogy, this represents your bike’s initial factory inspection, perhaps combined with 20,000/40,000 mile major inspections. Are the parts working well? Do the internal operations at acceptable efficiency? Are the engine idle speed, oil level, tire pressure, etc. at optimum levels? Does everything conform to government and manufacturer requirements (the “rules”)?

For you to get maximum effectiveness from your motorcycle, it must be objectively evaluated and fine-tuned in order to deliver it to you at factory standards. Similarly, within your home care company, Rung 1 of the ROPE Ladder tells us that your compliance program’s effectiveness requires you first to understand how your company actually runs, and to fine-tune it as necessary for maximum efficiency and effectiveness, compliant with the rules.

Rung 2 of our ROPE Ladder focuses on education and training. This correlates to your driving lessons. You now have a carefully inspected motorcycle, but how do you ride it?

It is a shame merely to fumble with the ignition and then putter down the street, ignorant of your bike’s extra features, options, weaknesses and capabilities. For maximum effectiveness as a biker, you should know how to get the most from your machine.

Perhaps it’s not necessary to understand the bike’s schematics, just as the ROPE system teaches us that it’s more important to know what to do than all the details of why you should do it that way. Regardless, even if you don’t fully know why, you must know how to run your bike at optimum performance.

It is also important to know the rules of the road. Speed limits, stop signs, rights of way and the like have their compliance counterpart with reimbursement rules, HIPAA requirements and the like. A basic understanding of “the rules” is necessary for any biker. The type of knowledge you need will vary according to whether you will be staying on fast roads or puttering around the city.

Rung 3 of the ROPE Ladder focuses on finding and fixing problems. This correlates to minor and major repairs for your motorcycle.

What do you do when your bike won’t start? Take it to the shop, of course. What if the problem is more subtle? Knowledge about how your bike is supposed to run will help you determine whether a slow idle is due to bad weather or is symptomatic of a big problem. Similarly, knowledge of how your home care company runs will help you to identify whether an increase in claims denials is due to poor coding or to a change in reimbursement policy.

Next month we’ll ride our motorcycle up the rest of the ROPE Ladder.

Meanwhile, with apologies to Pirsig, here’s a pertinent Zen story:

“The home care supplier eagerly awaited the lessons to come from the teacher’s Zen parable. Anticipation was great; surely the parable would tie the day’s lessons together, offering a pathway to insight and wisdom.

“Finally, the teacher began, ‘The home care supplier eagerly awaited the lessons from the teacher’s Zen parable …’”

See you next time, Grasshopper.

Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. He also is a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting and the author of the Home Care Compliance Answer Book. He can be reached by e-mail at [email protected] or by telephone at 864/676-9075.

The ROPE Ladder

Rung 1: Articulate the way you want things to run, and note how they run now. Then, tweak your systems as necessary to comply with “The Rules.”

Rung 2: Teach your operating systems to your employees.

Rung 3: Implement a clear and simple method for dealing with problems — identify them, report them, investigate them and fix them.

Rung 4: Give your compliance staff resources to help them keep up-to-date with internal and external changes that may sometimes require you to refine your operating systems.

Rung 5: Monitor your operating systems to make sure they continue to run as you intended.