by Tim Rowan, Editor

When Joseph Furtado, RN, COS-C, moved from one Phoenix-area Home Health agency to another earlier this year, he faced a seemingly insurmountable problem. The new place had dropped to a 600 census during the pandemic and got stuck there. Marketers had nurtured strong relationships with referring physicians, but the agency was turning away most of them for lack of nursing staff.

Over a span of 70 days, Furtado hired 60 nurses. As of our conversation this week, none of them have left.

Furtado, the Administrator at MD Home Health told us about his hiring philosophy that helped grow the company’s census to 1,000 and boost it to second largest in the area. “People want to work here because of the way we treat them,” he said. His plan includes several strategies:

  1. Pay clinicians what they are worth:
    • Free up funds for salaries by eliminating marketing positions
    • Free up funds for salaries by reducing most training costs
    • Reduce training costs by hiring only experienced nurses from other agencies who need little or no training
  2. Treat clinicians like professionals:
    • Center orientation days around presentations about company culture, not nuts and bolts of the job
    • Include presentations by top employees
    • Include presentations by actual patients, who talk about what the company has done for them
    • Eliminate obligatory mass training sessions. Replace them with as-needed meetings with nurse supervisors, sometimes in a patient home, sometimes in a nearby coffee shop.
    • The invitation is never “you need to stop doing this wrong” but “may I take you to lunch?”
    • Adapt schedule and pay policy to accommodate the needs of the professional
    • Replace minimum productivity requirement with mission-driven expectation and rewards
  3. Replace marketers with a single visit from the administrator:
    • We are the best, we will keep your patients out of the hospital, we will not turn away your referral
  4. Constantly monitor Indeed and other online job sites:
    • respond to new job seekers within seconds
    • schedule same-day interviews when possible

Favorite Hiring Story

Furtado enjoys telling the story of his favorite hiring win. “I was a few minutes late to call a top-notch, experienced Home Health nurse who showed up on Indeed,” he began. “When I called her, she had just parked her car and was on her way into an interview appointment with another agency. Thinking fast, I said, ‘What do I have to say to stop you from walking in that door?’ She couldn’t believe I was asking her to do that; actually, I couldn’t believe I had said it either. I told her our agency was the best place to work in Arizona and she should get back in her car. I kept her on the phone and said, ‘Let me hear you start your car.’ Then ‘Let me hear you drive away.’ She drove straight to my office and I hired her.

Today, she is our Director of Nursing.

Productivity Without Mandate

He told us that he has heard criticism from peers at various conferences and other meetings for his lack of a visit-per-week requirement. “I use a point system,” he explained to us. “A one-hour visit is one point, an OASIS visit is two, and there are other points for driving distance and other factors. We ask for an average of five points per day, and we pay bonuses when they exceed that. We tell clinicians during an interview that we offer a generous base salary, but that he or she can earn 20 or 30 thousand more than that. By doing that, we achieve two things. We hire an enthusiastic clinician, and we have the luxury of not having to hang onto underperforming nurses out of desperation.

Next Up

Now that MD Home Health has a full clinical staff, Furtado plans to implement a medical scribe system, based on the concept taught to him by his Medicare reimbursement consultant, Michael McGowan, a former CMS OASIS instructor and founding owner of OperaCare. During an OASIS visit, the field nurse consults live on a speaker phone with a QA nurse in the office. There is no computer between the nurse and the patient, and the OASIS is complete, quality checked, and ready to be submitted that day.

“We will make it optional,” Furtado said. “If it works as well as it has for Michael’s other clients, our hope is that more and more OASIS nurses will opt in once they see their co-workers going home at the end of the day with all their documentation already complete.”

©2023 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. One copy may be printed for personal use; further reproduction by permission only.