Conducting Home Health Care Like a Business

Resource Allocation in a Home Health Care Agency

As the U.S. population continues to show growth in the senior and elderly generations, a corresponding increase in health care agencies and facilities will reflect the increased demand for health and nursing services. Growth is particularly anticipated in the home health care industry as the "boomer" generation is geared toward independent living far into their lifetimes at unprecedented rates (Cubanski, 2014). Competition between these home health care agencies is expected to heat up, as economists say, since demand for quality care will be bolstered by the rise of the upper socio-economic strata in the U.S. (Varkevisser, et al., 2009). What this means for home health care administration and management is an elevated need to ensure that resource allocation exhibits the stewardship demanded by the marketplace (Cubanski, 2014).

How does your health care facility manage resource allocation?

In order to create a forward looking auditable resource allocation system, senior management at the Home Health Agency in La Mesa, California, prepares an annual budget, budget justification, and operating plan. This process ensures that sufficient and appropriate amounts of money are available for program implementation and to provide the service articulation that will meet the needs of the home health population and their families. The governing body of the home health agency conducts quarterly reviews of the approved resource allocation plan.

What systems and processes are in place?

The development of the annual budget and the resource allocation plan rolls up information from a comprehensive review of data about operations. The annual budget is designed to dovetail with the short-term and long-term strategic plans for the agency (Sussman, 2003). This means that resource allocation is determined on a basis that extends well beyond the current and next fiscal years. An important part of developing the annual budget is consideration of the assumptions upon which the operating budget is built, and these considerations are reflected in the budget justification. Projections for market demand are based on data collected and analyzed for patient care needs forecasts and associated staffing plans and challenges across the organization. These projections are likely to include an annual or bi-annual survey of the marketplace serving key patient populations.

Once this basis has been established, data from risk management studies and the utilization review are considered so that identified performance improvement activities receive appropriate levels of funding. As with any budgetary review, the sources associated with revenue, capital expenditures, and operating expenses are factored in to provide a dependable assessment of the adequacy of fiscal resources and allocations. Information that indicates a need to refine the fiscal allocation for the provision of care, such as new legislation, compliance reviews, staffing wages and salary adjustments, and such are all factored into the budget allocation and budget justification. These figures would also reflect the findings of processes that measure the performance and describe the improvement of performance for each department, office, and service that are or should be represented by line items in the approved final budget.

How are resource allocation and distribution determined?

The process that leads up to the establishment of an approved budget is highly collaborative and engages senior management and representatives from all programs and departments. Through a series of meetings and multiple rounds of communication, the budget justification is completed and the budge is prepared. These activities are followed by implementation and ongoing monitoring once the annual operating budget has been approved. The annual budget process outline and time frame is the responsibility of the Chief Financial Officer, who also prepares a long-term capital expenditure plan that is paired with the annual budget and presented to the Finance Committee for review. The Finance Committee relies on historical statistical data and current data on spending in order to prepare a draft schedule of revenues and expenses for the upcoming fiscal year and for the proposed capital expenditures. Senior management and other designated personnel, such as department heads and program directors, review the draft budget and the capital expenditure plan. A set of criteria is used when considering these planning documents in near final draft stage. The criteria include the following indicators: 1) The appropriateness of the plan for meeting patient care needs; 2) the fit with strategic plans that can influence, involve, or otherwise affect the provision of care and services provided; 3) fiscal variables that can directly or indirectly impact the capacity of agency personnel to provide care and service according to their strategic plan, such as the articulation of revenue, capital, and expense budgets; 4) any operational plans that have the potential to directly or indirectly impact the capacity of agency personnel to provide appropriate, caring, continuous, effective, efficient, ethical, respectful, safe, and timely patient care and service; and 5) any new or updated policies or regulations that directly or indirectly affect agency personnel and the care provided by agency personnel to patients (Bottrell, 2013; Sussman, 2003).

Any changes to the draft budget or the capital expenditure plan that are considered necessary or advisable following a review by senior management and other designated personnel are proposed to the Chief Financial Officer. The final draft of the budget and the final draft of the capital expenditure plan are presented by the Executive Director or Administrator to the Professional Advisory Committee for review. Following their formal review at the time of the presentation during the board meeting, the governing body authorizes final approval of the draft budget and the draft capital expenditure plan. Any requested alterations must be made by the Executive Director or Administrator or their designees, and then resubmitted to the governing body at a formal meeting for final approval.