This chapter defines errors, waste, abuse and fraud and gives examples of each. Through better understanding of these definitions, employees will be positioned to recognize opportunities for improvement in their organization.

This chapter reviews the four primary regulations that affect the home care and hospice industry. The False Claims Act will be reviewed including its history and rationale. Anti-Kickback, Stark, and exclusions will also be reviewed to provide clarification so providers and clinicians are better informed and can make good decisions on their day-to-day activities.

This chapter reviews the 7 Elements of an Effective Compliance Program as defined by the Office of the Inspector General (OIG). Understanding these elements will help the clinician look for those resources within their own organizations that can assist them in compliance efforts. Each element is reviewed so the clinician will understand why home health and hospice providers carry out specific activities, such as auditing and monitoring.

This chapter reviews the highest risk areas for a home health and hospice provider. Major risk areas for each provider type are listed and discussed. With this information, the clinician is better able to recognize and proactively report any compliance concerns.

Compliance is not the job of one person or one committee. It is the responsibility of every individual within the organization. This chapter reviews individual responsibilities in reporting a concern and cooperating in an investigation. We will also discuss non-retaliation and what you should expect from your employer.

A nation, an organization, and an individual can each learn from prior experiences. What went well, and what didn’t? How do we do better in the future? This chapter reviews some of the rationale for the development of a National Incident Management System and for the requirements placed on individual health care providers.

A collaborative response during an emergency is essential to positive outcomes. Each health care organization has responsibilities to ensure a coordinated effort. This chapter reviews the role of home care and hospice providers during a disaster. We will also interview the executive director of a health care coalition to understand their purpose and how to get a “seat at the table” during community preparedness planning.

The Emergency Preparedness Rule requires that each health care provider’s emergency plan include, at a minimum, four core elements. This chapter reviews each of these elements and discusses the significance behind each requirement. We will also look at the Incident Command Structure and how home care and hospice can work with and incorporate this structure in their emergency plan.

This chapter takes a deeper look at each of the core requirements mentioned in the previous chapter / It also discusses the after-action review and reviews when to implement your emergency plan.

This chapter looks at the definition of QAPI and the requirements according to the Medicare Conditions of Participation including the various systems and practices that should be included. Leadership responsibilities will also be discussed as they relate to the support of this requirement. A case example will be introduced.

This chapter reviews the process of collecting information that will be monitored during the performance improvement project. Various sources for information will be discussed as well as how to process that information. The case example will be further developed.

During this chapter, the process of developing and implementing a performance improvement project will be reviewed. The components of a meaningful project will be discussed and the case example will be developed into a performance improvement project.

This chapter discusses the analysis of the performance improvement process. We will also review the use of root cause analysis in performance improvement. The case example will be concluded.

An overview of the history and current administrative practices of the Home Health – Consumer Assessment of Healthcare Provider and System (HH-CAHPS) is provided. The home health clinician will gain an understanding of the goals, how the survey is administered and analyzed, and how to respond to a patient inquiry. This is important for clinical practice professionals to understand HH-CAHP impact on agency operations and patient care.

A full review of the structure and scoring of the survey is detailed. The home health clinician will be able to distinguish between the survey, the domains, and top box scoring. Accessing the survey is also covered.

The clinician will identify how HH-CAHPS data feed into the Home Health Compare website and how to complete a review of an agency’s ratings. Star ratings will further be explored as well as how to find these ratings. It is important for a clinician to know how to access and interpret these results in order to educate patients and to make referral decisions. Discussion about HH-CAHPS and value-based purchasing is introduced.

Providing research surrounding HH-CAHPS will be followed by a discussion on the importance of following the research and integrating it into practice. Applying health system research is also addressed in terms of positive patient outcomes.

A detail of each HH-CAHPS question, scoring, and domain is presented. In addition, practical suggestions for integration are included. Home health clinicians needs to be knowledgeable of each question and give consideration to how to improve practice. In addition, considerations for communicating with patients is covered. The clinician, with a fuller understanding of HH-CAHPS, will explore how clinical practice and operations may change in coming years. In addition, through critical thinking and self-reflection, the clinician may determine areas for further performance improvement.

An overview of the Conditions of Participation (CoPs) will be provided along with the genesis, recent revisions and importance of this document to all levels of the home health agency. An overview of the five (5) key areas that comprise the Home Health Conditions of Participation will be introduced.

Newly expanded, this key component of the Conditions of Participation (CoPs) outlines the essential elements required by participating home health agencies (HHAs) to ensure patient rights and define agency responsibilities. Part one will explore the specifics related to meeting the standards for Notification of Rights, exercising patient rights, and what is included in patient rights. Instructors will provide insight on how to ensure clinicians can demonstrate compliance in these areas through documentation.

Newly expanded, this key component of the Conditions of Participation (CoPs) outlines the essential elements required by participating home health agencies (HHAs) to ensure patient rights and define agency responsibilities. Part two will explore the specifics related to agency expectations surrounding transitioning patient care during transfer and discharge, investigation of patient complaints and accessibility to care. Instructors will provide insight on how to incorporate and prepare for agency survey events.

This revised component of the Conditions of Participation (CoPs) outlines the essential elements required by participating home health agencies (HHAs) related to care planning and care coordination. These areas include content of the comprehensive assessment and continue with the planning, coordination, delivery of care, and transfer and/or discharge from patient care. Instructors will provide insight on how to ensure clinicians can demonstrate compliance in these areas through documentation as well as provide insight on how to incorporate and prepare for agency survey events.

This new component of the current Conditions of Participation (CoPs) focuses the individual home health agency’s (HHA's) QAPI activities based on their individualized performance and resultant data analysis. Part 1 of this two-part QAPI section will overview the key required areas of a home health agency’s QAPI program. Instructors will provide insight through case example of how each required element of a HH QAPI program can be satisfied in documentation and meet survey expectations.

This new component of the current Conditions of Participation (CoPs) focuses the individual home health agency’s QAPI activities based on their individualized performance and resultant data analysis. Part 2 of the two-part QAPI section will detail building your QAPI team simulation of a QAPI project, from data analysis and performance tracking through documenting outcomes and generating reports. Instructors will use common home health case(s) to outline key functions of the QAPI team.

This new component of the current Conditions of Participation (CoPs) focuses on agency requirements related to infection prevention, control, and education. Per CoPs, infection control is a required component of any home health agency’s QAPI program. Instructors will outline data collection and analysis methods related to infection control activities and discuss required documentation to address survey expectations.

This new component of the current Conditions of Participation (CoPs) will delve into realignment of the roles of the skilled professionals, their responsibilities, and supervision of assistants within the home health agency operations and patient care services. Instructors will provide insight on how to ensure clinicians can demonstrate compliance in these areas through job description review and revision, case management activities, and home health aide supervision.

It is important to know the type of survey being conducted. In this chapter, terms relating to the various types of surveys will be defined. This way, staff can respond appropriately to dispel the fear, mystery, and frequent myths associated with surveys.

Learn the inside secrets to make the surveyor smile (even if it is only on the inside). In so doing, you will learn how to expedite any survey, audit, or inspection. Plan ahead to avoid an unpleasant survey. Learn how to start out on the right foot and stay on the right foot. Survey processes will be discussed along with lessons learned.

Do you have your survey binder ready? Do you know what QIES are and who CASPER is? Learn the inside secrets to demonstrate smooth operations and further facilitate the survey. Learn interpersonal skills to demonstrate the care and respect needed for the surveyor and the processes of the survey.

This course provides practical guidance to expedite any survey or government inspection. The first two survey tasks (Presurvey Preparation and Entrance Interview) will be presented, along with tips for starting the survey appropriately.

Observation, documentation review, and interviews comprise Information Gathering, the third task of the survey process. Home visits and patient records are a large part of this information gathering. Learn how to stay one step ahead of the surveyor with knowledge, and know how to apply information to avoid the common mistakes that lead to standard and condition-level deficiencies.

Chapter Three describes survey tasks Four and Five (Information Analysis and Exit Conference) and what to expect after the survey. Learn how to avoid deficiencies when possible, even near the end of the survey.

Apply the knowledge shared in this course to avoid survey disconnects and develop systems to always be survey ready! Utilize survey processes to deliver quality and continuously improve patient care. Use the survey processes in your Quality Assurance Performance Improvement program to address any findings in Task Six, the Statement of Deficiencies.

Coaching and counseling is a fundamental component of the achievement of work and management goals. There are a number of definitions of coaching and counseling, and chances are your organization has a policy that defines them.For purposes of this course, the authors offer practical definitions that may be used that incorporate multiple aspects of these important terms.

Unfortunately, there are sometimes negative connotations related to the terms coaching and counseling. This course and chapter seek to help reframe these terms. All team members want to know how they are doing and if they are on the right path from the perspectives of their managers and of the organization. This chapter reviews some of the data, literature, and other information available to assist managers in achieving success related to coaching and counseling.

This chapter integrates what we learned about coaching and counseling with practical applications, real-world examples, and strategies with feedback. Coaching and counseling will be demonstrated using different scenarios. No two organizations or team members are alike, and these interactive episodes seek to show this variation in action. Included in this chapter are sample positive as well as negative case scenarios. Practicing before coaching and counseling, maintaining balance and calm, deep breathing, and other strategies are presented to help new managers address feelings that many leaders and team members experience.

The role-playing that occurred in the prior chapter will be reviewed and documented to provide a sample of what documentation might look like for practical application. Some organizations use a number of methods for documentation of such encounters, and this chapter will explain why the use of a SOAP format might also lend itself well to coaching and counseling sessions. A checklist for completion of related documentation will be offered. Information, concepts, and the other materials presented in this course can be applied immediately to practice and operations.

This foundational chapter sets the stage for why the clinical supervisor role is so important. Clinical supervisors need to be competent clinicians, in addition to performing a number of administrative and other activities that comprise the role. As home care and hospice models of care flex to meet the increasing needs of the aging and other patient populations, this role remains the anchor for a number of organizational metrics. Though there may be different words for this role, many of the activities remain the same. Some of the roles for success will be addressed, as well as the skill set needed for orientation, success, and retention.

In this chapter, a practical, holistic definition of home care is presented for clarity and application. Because of the complexity of home care, a listing of trusted sources is provided for course participants. Other education and competencies addressed in this chapter include orientation components, care planning, critical thinking, physician considerations, and case management models for organization and workload. In addition, information about making effective home visits with team members, the clinical supervisor’s role in the documentation, understanding of Medicare complexities, and an overview of health care in flux are all presented for practical application. The more focused and holistic the visit, the more quality and safety are brought to the home visit. This chapter helps new and experienced supervisors see these visits with new eyes and value.

This chapter seeks to help bring order and structure into the busy days of home care and hospice operations and management. The chapter reviews priorities on a scale of "have to" to "want to." How are decisions best made with dueling and competing workloads? This chapter also addresses making the transition from clinician to manager, highlighting the responsibilities of the manager regarding quality improvement and clinical oversight, and providing tools to aid decision-making in these areas.

This summary chapter pulls together information from Chapter One and from the previous course, Making a Successful Transition from Clinician to Manager. These two courses together provide a road map for success for the new manager, who is responsible for clinical oversight and related duties at the organization with respect to people, workload, and shifting priorities and schedules. Tools, dashboards, and reports are provided that can help the new manager get a realistic snapshot of the organization on a daily, weekly, monthly, and annual basis. This chapter also addresses what to consider when the new role is not working as expected, as well as information on networking, supporting your further professional development, and maintaining your sanity during your transition, helping you to identify your next steps and goals for your personal path to leadership.

There are several definitions of the term “digital age” as well as differing understandings of the terms "ethics" and "ethical principles," depending on the field to which they are applied. After a general overview of the terms digital age, ethics, and ethical principles, this chapter will focus on the definitions used for the purposes of this course, the ethical principles of greatest concern in home care, and ethical leadership.

Confidentiality is an often discussed issue in health care. Communication technology continues to advance, which can put respect for patient privacy at risk, e.g., where and how patient information can be shared. How does one know they are keeping patient information confidential? This chapter identifies potential scenarios when confidentiality could be compromised in the delivery of home care services.

Individual rights have long been considered important in American society. Yet, there is an inherent struggle between exercising those individual rights and when those rights negatively impact the lives of others. Additionally, the rise of social media has blurred the lines about which personal information is appropriate to share and with whom the information is shared. This chapter takes a look at individual expressions of thoughts and feelings by home care personnel and their potential impact on the person and on the rights and privacy of those under their care.

Trust is needed for an effective relationship between a patient and care provider. One might argue that patients need to trust the information given to them in order to follow the plan of care. This chapter will explore actions and behaviors that can be taken by home care personnel to establish and nurture trusting relationships.

We’ve gone from the industrial age to the digital age, so what is coming next? The future holds many changes as new technologies develop. What might these changes be and how might they impact home care? What will the challenges be in trying to determine what the right thing is to do in a given situation? This chapter will discuss selected emerging technological advances, their potential use in home care, and ethical challenges that might accompany their use.