This article is brought to you by nVoq. This interview took place during a live Q&A session with nVoq’s Senior Director of Post-Acute Sales, Jason Banks, at the HHCN FUTURE event in Chicago held on September 30, 2021. The interview has been edited for clarity.
Home Health Care News: Jason, earlier today we talked about the operational side of running a large post-acute provider. For the better part of two decades, this has been your experience. What do you see as some of the top trends affecting home health and your customers in the next couple of years?
Jason Banks: Particularly now with COVID, there are three main themes in a lot of the shows that we go to, and in our conversations with prospective providers or clients. I think the workforce shortage is first and foremost on a lot of the providers’ minds.
The second thing is regulatory, and the regulatory burden that comes along with running a post-acute care organization, and we’ll talk more about that, but it’s significant. Then, the third is the shift towards value-based care. We’ll hear a lot about this all throughout the day — the hospital, the home, ER diversion, SNF-at-home and all the other models and flavors coming out.
It seems like overnight, I was just entering into post-acute care, and now I’ve been in the industry for over 20 years. We’ve been talking about, “Hey, we can probably do more with these incredible men and women that go to people’s homes and take care of them.” It’s incredible that post-acute care has become the flavor of the day when it comes to providing care for chronic care management, end-of-life care and those sorts of things in the home.
Over the past seven years, I’ve been thinking about, “What are some of the root causes of these opportunities or challenges that providers are facing?” One of the root causes or common threads throughout are the documentation requirements or the challenges associated with documentation. Clinicians are spending between 30% to 50% of their time documenting.
If you’ve seen other environments or explored home care and hospice outside of the U.S., you’ve probably found that the number greatly decreases for multiple reasons, whether regulatory compliance or other factors. You’ll also notice that the care really is fantastic in those environments, the patients are happy and the clinicians are satisfied.
A common theme that’s been running through my head for well over a decade now is, “How do we get to hands-free documentation?” chiseling away at some of the things clinicians are doing that don’t add value to the patient experience — that’s what nVoq does. nVoq is speech-to-text at a 30,000-foot level, but deep under the covers, we’re addressing opportunities these providers are experiencing on a daily basis with revenue optimization and making sure that they’re recruiting and retaining the right talent.
I got the phone call from Chris Moran, who’s in the audience, and Debbi Gillotti, our COO, about six months ago, and they said, “Hey, we’re getting interest from these post-acute care providers around bringing speech-to-text to not just the physicians, but also to the frontline clinicians providing care. The interest is across the board from large providers, medium, small providers, nonprofit, for-profit, hospital-based, non-hospital based. We think there’s something here, would you be interested in exploring this?” I said, “Absolutely. This is exactly what I think the industry needs.”
HHCN: That’s great. One of the themes a lot of our clients are talking to us about as well is that shift to value-based care; I call it everything at-home. Talk to us about how you guys are positioning what you do in terms of value-based care from a risk standpoint, and how you are laying the groundwork for value-based care in the long term.
Banks: I was told not to say what I’m about to say, but I’m going to say it anyway in my true nature. Some of the folks who have worked with me in the past will think this is funny because I’ve said this for a while. Post-acute, over the past 20 years that I’ve been involved, is similar to AA, Alcoholics Anonymous. Meaning, I’ve never met anybody going to post-acute care that said, “I had a fantastic day. I need post-acute care.” It’s, “I had a really bad day.” Sometimes the worst day of their lives.
If physicians come in and tell them there’s nothing more they can do and they need to seek out hospice care, it’s sometimes the worst day of their lives. I’ve equated it to AA for the past five or six years in that you need something bad to happen to go to post-acute care. Why does it have to be that way? Plenty of people are living with chronic care conditions who can be serviced to prevent those acute events from happening. In order to do that, those providers need to operate at the highest level of their licensure.
You need to have cross-discipline functions within the home to make sure you’re addressing everything from the physical needs to the spiritual and emotional needs, to the social determinants of health. I often talk about patient tax. Patient tax, in my mind, is anything that doesn’t add value to the patient experience. In value-based care and the at-home models, the hospital-at-home, the ER diversion, the SNF-at-home models — you’re seeing a lot of those patient taxes being eliminated.
Patient tax, in my mind, would be doubled documentation. I had the pleasure of serving in a hospice and palliative care organization here in Chicago. I ran the organization for about two and a half years. We would have our nurses documenting two or three times in a single visit. Did it add value to the patient or family? Absolutely not. Was it regulatory-compliant? Absolutely. There are a thousand of those things across any provider organization that you can strip out of the process. And by new innovative programs, you’ll see more organizations strip those out of the process and add value to the patient experience.
HHCN: Let’s spend a minute talking about that regulatory environment because it’s changing. With COVID and the pandemic, new things have come about and we’ve had some freedom and flexibility in certain areas. What does that look like for you going forward, and how does that impact providers today?
Banks: I read an AMA article that said hospitals have about 96 continuous learning points (CLPs) while post-acute has 288, and they have to comply with all the other technical requirements associated with data security, HIPAA compliance and everything else. When you’re providing either at-home care or care in a facility setting, there are so many regulatory requirements to consider.
One of the things we’re looking to do is alleviate some of that burden of the regulatory requirements by allowing the clinicians to be with the patient to take care of them. Then, we’re actually taking some of those components of regulatory compliance off their hands and saying, “Hey here’s something you may want to add to the note that is either regulatory compliant or going to add to the patient experience.” That’s one of the things that we do with nVoq as well.
HHCN: Let’s talk about workforce shortages. I think that’s permeating into everything we cover nationwide. How can your voice tech help clinicians and frontline staff combat the shortage issue?
Banks: This is probably one of the strongest value propositions, albeit not the only for nVoq, but it’s one we’re laser-focused on. At the beginning, we talked about three core challenges that providers are facing with workforce shortage, regulatory compliance and the shift towards value-based care. The workforce shortage is number one, two and three. You have excellent leaders in this room that have varying degrees of participation in, “How do we solve for that workforce shortage?”
Things like hiring. I know there are a number of organizations in the room that can help you find and stand out amongst potential recruits. There are also sign-on bonuses, hiring bonuses, referral bonuses, retention bonuses, increased pay and cultural things you can do as a provider. Those all play a part, but I think there’s an underlying problem with the workforce shortage.
That is, why do clinicians leave organizations? Why do they select organizations? What’s different about home health and hospice from other settings they might practice in? One of the things I think a lot about is, “Why do clinicians select home health and hospice as a profession?” One thing jumps right out to me, and it’s that they prefer relationships. They prefer relationships with the patient and family over transactional care.
Again, the common thread that’s a barrier to relationships are the documentation requirements. If they’re spending 30% to 50% of their time documenting, either because of regulatory requirements or other reasons, and the whole reason they got into post-acute care in the first place was because of that relationship component, that is what’s driving them out.
I’ve seen that in exit interviews over and over and over again. “We’re leaving because of the documentation requirements. We’re leaving because of the regulatory burden. We’re not leaving because of the organization, and we’re not leaving because we don’t care for patients or families.” These are incredible men and women serving our primarily elderly population. We’re laser-focused on alleviating that documentation burden for them.
HHCN: I have one last question for you. One of the things I like to read about is technology. Amazon just came out with some new Alexa devices and Siri is permeating everything that we do. How do you see the proliferation of consumer voice tech affect those who are working with your software today?
Banks: I think it’s great because I use voice tech in my own home. We have Alexa in the home today. I use an iPhone, so I use Siri particularly when I’m in a mobile environment where I want to shoot a quick text or something like that. When I’m riding in the passenger seat and I want to shoot a quick text, I’ll use voice-to-text. We’re seeing that capability more and more, and I think it’s going to become second nature for those clinicians.
This article is sponsored by nVoq. nVoq Incorporated provides a HIPAA and PCI-DSS compliant, cloud-based speech recognition platform supporting a wide variety of healthcare delivery scenarios including post-acute care with an emphasis on home healthcare and hospice. nVoq’s speech recognition solutions convert speech to text in seconds and are highly accurate for most medical specialties. To learn more, visit sayit.nVoq.com
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