Optimizing home health nurse capacity to maximize productivity and meet market demand
By Anand Rampuria and Zoe Colman
The home health nursing workforce continues to fall short of the growing demand
In an annual survey of home health leaders, the majority of respondents continue to cite clinical staffing as their greatest growth challenge. While the demand for home health services saw an exponential rise in COVID and continues to grow at record-breaking demand, the industry sits at a turnover rate above 30%, leaving a significant gap between the healthcare needs of an aging population who are the primary users of home health and the supply of providers to fulfill these services.
Reasons behind the home health nursing shortage
The industry sits at a stubborn turnover rate over 30% and the high costs of replacing a nurse adds to the growth challenge for home health providers. There are a several factors that are contributing to the shortage:
- Nurse burnout; exacerbated by COVID: As hospital-based nurses felt the strain of COVID, many shifted to the home health space looking for lower-intensity settings but found the work no less challenging, therefore left the industry.
- Competitive hospital pay: Providers offered significant incentives for nurses to return to the hospital space and sign-on bonuses of $20,000 to $30,000 became standard, falling well outside of market practices for home health leaders.
- Compensation that is mis-aligned with key responsibilities: While many home health nurses are eligible for incentives, their total compensation often doesn’t account for the full scope of their work including long hours, travel time, time spent on charting and administration without compensation and flexing role responsibilities to meet demand
- Aging nursing population: One third of the nursing workforce is approaching retirement age, leading to a shortage of nurses and a newer, less highly trained workforce.
Consequences of the home health nursing shortage
Home health organizations cannot maximize capacity if they don’t have enough nurses to meet demand. This has negative implications for an organization’s bottom line. Home health organizations are under pressure to maximize volumes as reimbursement decreases and leave revenue on the table if they cannot staff to volume needs.
Further, organizations rely on a skilled workforce to maximize reimbursement on each visit under new policy changes such as PDGM; it’s much more challenging to meet these expectations with high turnover and overburdened staff. Many home health organizations turn to contract labor to solve these challenges which cuts into their overall profitability and may also impact performance on quality measures and patient experience.
How leaders can optimize their nursing workforce
Home health leaders must combat the challenges of the nursing workforce on multiple fronts by retaining current staff, increasing the productivity of the staffing model and optimizing recruitment to meet gaps in future demand. Consider five tactics for a comprehensive approach to improving nurse capacity to maximize home health patient volumes and revenue:
- Predict future demand for nurse capacity: Home health organizations can use historical performance and predictive analytics to understand which markets will have the greatest demand for nursing staff. Leaders can take action on these insights by right-sizing nurse deployment across geographies and directing recruitment efforts to fill anticipated staffing gaps.
- Evaluate and optimize recruitment channels: Leaders can leverage recruitment data to analyze lead channels by market and identify the most impactful recruitment tactics for each nurse type and geography. Understanding the unique competitive dynamics of each region is key to combat recruiting headwinds such as new market entrants, hospital competitors and geographic challenges. Leaders can also take into account the demographics of the nursing workforce and consider new digital strategies to engage younger nurses.
- Leverage intelligent routing: Re-vamp current staffing models by assigning patients to the most appropriate nurse based on their skill set, location and availability. This strategy reduces travel time, optimizes revenue per nurse and may even improve nurse satisfaction. Consider ways to flex nurse roles such as deploying nurse managers to the field or leveraging intake of nurses for follow-up visits, where clinically and geographically appropriate.
- Invest in technologies that support productivity: Consider technology support to streamline workflow, automate administrative tasks and provide more efficient patient care that all leads to increased productivity. For example, home health leaders are leveraging telehealth capabilities such as remote patient monitoring to increase nurse capacity while maintaining patient outcomes.
· Understand the voice of the nursing workforce: To build a tenured, skilled workforce, home health leaders must engage with their nursing staff directly to understand what drives motivation and retention. Leaders can consider what supports they can offer beyond financial incentives; some nurses may prefer job enablements such as a fleet vehicle, on-the-job clinical support or upward career opportunities. Understanding what nurses need will help leaders tailor investments that prevent further attrition.
Industry leaders can evaluate their current staffing model and consider where to begin meeting critical recruitment, productivity and retention needs. Leveraging the strategies above will lead to a more productive and satisfied workforce that can maximize home health growth that is critical to meeting the needs of patients today and for the future.
Anand Rampuria is a leader in ZS’s Health plan and provider practice with 15+ years of experience working with Healthcare clients helping them succeed in their growth and value focused initiatives.
Zoe Colman is a consultant in ZS’s health plan and provider practice with nearly 10 years of experience. She focuses on value-based care, total rewards strategy, and strategic growth across all types of Healthcare stakeholders.
