Full Transcript

Valerie V:                           Hey, everybody. Welcome to the Valerie V Show. We are live on Facebook with Cheryl Peltekis. Did I say that right?

Cheryl Peltekis:                 Yes, you did. Thank you. Thank you for having me.

Valerie V:                           Great. I’m so glad you could be here, because today we get to talk to you and you get to answer questions that I get asked all the time, and I am not the expert that you are, nor do I want to be.

Cheryl Peltekis:                 I appreciate that, but I know that there’s areas that I absolutely need to refer back to you. And I just actually wanted to take one moment just to thank you personally, Valerie, for being that person that, that nurse that’s a leader in the industry that helps so many companies get patients ultimately served, which I know is what we both believe in is so important.

Valerie V:                           Yeah, absolutely. The folks that are out here running these home care agencies are probably doing some of the toughest jobs on the planet. Being a nurse is tough work when you’re in a hospital or whatever, but … We were just talking earlier, managing all the employees, trying to make sure the patients are serviced correctly, boy, that takes a lot out of you every day.

Cheryl Peltekis:                 You’re not kidding, sister. I feel ya.

Valerie V:                           Cheryl, why don’t you give us a little bit of background about yourself and how you came to home care sales with Melanie and just give us a little because people may not know your whole history of owning a home care agency and all that.

Cheryl Peltekis:                 Sure, I’ll try to be really brief. I grew up in a little bit of a strange situation. My mom and dad were full time caregivers to my grandparents, my great grandparents, and a great aunt. So I lived at home for about 22 years and at least 16 of those 22 years, there were seniors being cared for in my home.

So I kind of joke and say I was born into becoming a nurse. It was normal to change diapers at a young age, to help feed somebody, blenderize meals, and I don’t know. It just felt really good and I think that I saw my mom was such a phenomenal caregiver … I also saw the other side of how the services that we actually both work in today are being delivered in a home. And I would see what would happen and a caregiver didn’t show up and my mom was left to change another diaper. And I don’t think that we appreciate how hard it is to be a full time caregiver. And that stress and that burnout that they experience.

Valerie V:                           It’s amazing.

Cheryl Peltekis:                 It’s a lot of selfless giving. It really is. And I think that seeing my mom do is so tremendously with such grace and dignity, it really made me feel like that’s what I want to do. And so I became a home health nurse. I was blessed to have gotten a scholarship from Pennsylvania Hospital, the nation’s first hospital. And that’s what launched me to be able to go to nursing school. And with that scholarship, I knew then I didn’t want to waste that opportunity. And I knew that eventually after I served three years at that hospital, I had to give them a three year prison sentence, I say, in order to pay off the tuition that they paid for me to go to school. I immediately, right when it got close to the end of the three years was going to HR and saying, “Do you have any spots in home health? I want to go to home health.”

So then, I immediately went into home health and I fell in love with it so much. And I started to see that there were contracts that came into place by insurance companies that would dictate how many visits a patient would be allowed to be seen. And it made me so angry that a diabetic, blind patient they could say one visit only. And I just got really frustrated that my company that I was working for allowed contracts like that to be taken into place and that the services were so poor that I said, you know what? I can do this better. And I got his crazy idea to call the Department of Health and say hey, can you send me everything so I can open up my own home health?

So my husband thought I was insane but I opened my first one in 1995. I actually got my joint commission accreditation in 1996. And then, I opened up my private duty in 1997. And then, I saw my mom goes through hospice and that was a really bad experience and she actually helped me write some hospice policies before she passed. And in 2008, I opened up hospice.

Valerie V:                           Wow, wow. That is a long history. So you have done it all.

Cheryl Peltekis:                 I have. I have. And I’ve been so blessed to have had phenomenal success because I’ve been really lucky that God has sent me incredible people into my life. And without them, I don’t think I could have ever gotten to where I am. So I’m very thankful to everyone in my life.

Valerie V:                           That is awesome. And you know what? It’s folks like you that have those businesses that are so, I guess, just really intense and want the best for their patients. Those are the kinds of clients that we work with all the time. In fact, my dad’s been on hospice for a while now and he probably will … He doesn’t have cancer or anything. It’s kind of a long term thing. But I can tell you that with the right hospice, as soon as that was implemented, it was a huge relief to our family.

Cheryl Peltekis:                 So first let me say, I hope he has the smoothest transition. And I hope that it’s a beautiful experience for you because it truly can be. When my mom was on hospice, I have to tell you, we did some amazing legacy preparing. And even at my niece … My mother had passed away and my nieces weren’t even married. But my nieces recently had their first babies and we had a gift to give them from my mom.

Valerie V:                           Oh, that’s so cool. That is really neat.

Cheryl Peltekis:                 So Val, if you ever want to talk offline about some ideas I have for legacy planning, please reach out to me because I can share with you some really impactful things that we were able to do for our children.

Valerie V:                           Oh, that’s really neat. Well, good. Absolutely. And never knew … I’m a nurse too, been around the block a lot with different kinds of agencies and in hospital and I did my sentence as well here in St. Louis, two years for that scholarship. But having done all of that, I never realized the benefit or the relief that hospice could provide. I mean, instantly there’s stuff in the house. There’s somebody to come and give baths. And it’s not 24/7, in the house, but it certainly is such a relief for that caregiver who really can’t get away at all.

Cheryl Peltekis:                 They say there’s two times in life that we never forget and it’s the birth of somebody and the death of somebody.

Valerie V:                           Yeah, absolutely. There’s …

Cheryl Peltekis:                 I will keep you in my prayers and my thoughts and I just hope you have a beautiful transition.

Valerie V:                           Well, so far so good. Like I said, we’ve got a while. But this has been a long time coming so we’re good.

I do have some questions. I’m going to go through them. Let me put them on our little screen here.

Cheryl Peltekis:                 I’m going to tell you I’m a little nervous. I know how much … You are such an expert at everything so it makes me a little nervous to have you interviewing me. So I’m just going to be honest.

Valerie V:                           It’s okay. You know the answers to these questions much more than I do. And you probably can’t see the whole question.

Cheryl Peltekis:                 I see, I am eight years into owning a home care business and we’re doing pretty well. So what tips can you give …

Valerie V:                           Me to solidify those or even establish new direct referral relationship or renew and refresh the ones we already have?

Cheryl Peltekis:                 Okay, great. So thank you for reading that to me. I appreciate it.

First of all, I want to say thank you to the person that would be in the business already for eight years, right? That’s a lot of lives touched. Whether you’ve been able to employ individuals in your community and support the community by funding jobs as well as the care, the direct care that you’re providing. So congratulations.

And hopefully, you’ve done such a great job that you’ve already got some of those referrals coming from word of mouth, right? Because typically that’s one of the best feeders is that we deliver such excellent care at one of our locations that we’re providing services for or directly in the consumer’s home, that they tell everybody. So that’s phenomenal.

But there are definitely some things that you can do to help yourself grow even if you’ve been around for eight years. And sometimes I notice that businesses that get around 8-10 years old, start to get flat even. I think that they end up working so much in the business that they don’t have enough time to work on it and actually growing it.

Have you noticed that?

Valerie V:                           Oh yeah, absolutely. And if you have relied on the same referral sources and the same type of billing and same things and you pretty much know everybody in town or you feel like you do. Then, it is easy to just coast right along. And then, all of a sudden maybe there’s a little dip and we need to refresh ourselves a little bit.

Cheryl Peltekis:                 Yeah, so some of the ways that typically if I go on site and I do an operations assessment for somebody or if I’m managing or coaching sales reps, one of the things that will get involved with is the owners is to start to look at the other pipelines that potentially could be opened up to feed into that referral funnel. Because it’s hard, and typically they don’t have a salesperson. Obviously, I’d love to help with that. Hiring them, help coach them up, and get them up following a sales process. But I also think they could so some things internally in best practices like making sure they’ve got the best use of SEO optimization, right? Making sure that their website is working to help attract leads and clients that are coming to them. Maybe doing newsletter pushes and all the great things that you do to help your clients. I think that’s very important.

I also think, and I challenge a lot of the private duty companies, is that every time you get a referral, even if it’s from a patient’s daughter that finds you via the internet, if you get invited to come into the home and do that sit down, make sure that you’re looking for three additional points of contact using that patient’s, potential patient’s name as leverage, to have a conversation to build another referral source.

When you go into the home, ask the daughter, ask the son, who is the PCP? Now that you have the primary caregiver’s name, you have a place that you could go and say hey, I just met with Mrs. Jones’s daughter, we were talking about do you by any chance have somebody that looks just like her? And that visualization sometimes gets that physician’s practices to identify another patient that looks just like that?

Yeah, that new car smell, right?

Valerie V:                           Right. Right.

Cheryl Peltekis:                 Don’t you love it? And while you’ve got that referral and it’s easy for them then to visualize off of that, that’s like gold in your hand. So if that’s not something that you’re currently doing, that’s a real quick easy flip of the switch.

Some other things is like even identifying does she go to an adult daycare? That would be another great place to grab it. Does she belong to a senior center? What about a discerning specialist? And I always hear reps say hey, I went on site to meet the client but I couldn’t identify three referral sources that I could potentially call on as a result of this one phone call that got triggered from the internet. And I would say well, did you by any chance look at any of the pill bottles in the home?

Valerie V:                           Yes, there they are listed right there.

Cheryl Peltekis:                 Yeah. So you would have the endocrine. You would have the cardiologist. Quick little tiny things that are really easy and even if a patient’s cognitively impaired, they may not remember the names of their doc, that’s where it lies. You know, it doesn’t take a brain surgeon to figure it out. Optimize your time in the home. Make sure that you just do three quick tiny little thing that develop these patterns and these good habits, and the rest becomes really easy. Because it’s so much easier to go into a doctor’s office with that visualization of Mrs. Jones than it is to start off fresh.

Valerie V:                           Absolutely.

Cheryl Peltekis:                 And so many times, I think sales reps or I think owners miss the opportunity that that patients actually, that that referral has. They don’t see the holistic value of all the other touchpoints that they could potentially utilize as a strategy.

Valerie V:                           Right. Because that person didn’t get sick last night. They have progressively probably coming to this. And you know that there’s three or four doctors probably involved. Or at least one.

Cheryl Peltekis:                 Yeah, I couldn’t have said it any better. Absolutely.

Valerie V:                           All right. Well, let’s switch gears a little bit and let’s talk about the home care agency owner’s same question but I’ve only been in business for six months and I need clients. Help me figure out how to get clients. And what do I do? That’s a big question.

Cheryl Peltekis:                 So Valerie, yesterday I was actually in this situation that you just typed. I actually flew out to Chicago yesterday and I had to go out to an owner’s agency because they, for six months, have been working and have not gotten referrals. And so, I’m like well, what are you doing wrong? I don’t know. I have a full time salesperson. I don’t know what’s going on here. I said okay, would you like me to come out and do a day in the field with your reps and figure it out for you.

So I said to the first rep that I get in the car with, I said, “Take me to one of the accounts where you think you’re going to get your next referral from.” And she gets a big smile on her face and she’s like yeah all right. Perfect. And she takes me to this big, large family practice office. And as soon as we walk in, the doctor happened to be behind the counter. He immediately came over to her and gave her a hug and said how are you? Blah, blah, blah. Very friendly. Easy access to get in front of him. I was like thumbs up. This looks good.

And he says, “Did you go to the nursing home I sent you to?” She said, “Yes, I went and made sure I’m on their list. I made sure they knew who I was.” “Did you go to the two hospitals where I put patients?” “Yes,” she says, “I did all that.” And then, he finishes up and he says, “Okay.” So I say to him, “So Dr. Jones,” Let’s just use the pretend name, “Dr. Jones, can you share with me how many referrals do you make every week for private duty?” And he says, “Oh, I don’t refer at all.” I said, “You don’t?” He said, “No. I let the hospital do it. I let the social workers do it at the nursing homes. I don’t refer at all.”

As soon as I walked outside of that account with that rep, I immediately said to her, “You identified this as your high probability account. I identified this in five minutes as a zero probability account. You’ve wasted, for six months, went there weekly for 45 minutes that you could have invested if you had qualified the account as a place that you’re calling on that has the ability and willingness to refer patients.” I’m not saying that every referral is going to turn out. It doesn’t, right?

Valerie V:                           Right.

Cheryl Peltekis:                 We’ve got to do a good job too at the bedside and at the meet and greet, on explaining our services, building that instant bond and connection. And probably we’ve got to be a good listener. That’s why God gave us two ears and one mouth.

Valerie V:                           Right.

Cheryl Peltekis:                 During that home visit, that’s probably the most critical thing, right? It just makes me a little frustrated when I think that reps especially with new startups, they think that everywhere is the place to go or they invest all their eggs in one basket. Like in this case, this rep was really investing only in skilled nursing facilities. Which yes, they have the best referrals, right? Everybody coming home needs services. I get that. Same thing with hospitals. But ultimately, they’re also the most called on.

Valerie V:                           Right.

Cheryl Peltekis:                 They’re flooded with salespeople who are trying to see them. Maybe 10 a day, even. And access is getting harder and harder unless we’ve got leverage as a patient’s name that might be in their facility, to access the right people to make these connections. So I honestly feel that if your sales reps, if you’re brand new, you’ve got to first of all get out of your offices and go make sales calls, right? You’ve got to comb the top accounts. The nursing homes, the skilled nursing facilities, the assisted living facilities, the elder attorneys, the senior centers, large physician’s practices, bank trust officers, elder planning attorneys. I mean, there’s a million of them, right?

You’ve got to have a variety. If you’re just expecting that you could have a sales rep just call on own facilities, you probably are not going to get the results that you anticipated in the first six months. So look at their list. Make sure that they’re calling on 20 doctor’s offices. Make sure that they’re calling on five or six dialysis centers and large senior centers. And look to see are they not just going there to drop off a be a professional brochure dropper offer.

Valerie V:                           That’s right.

Cheryl Peltekis:                 But are they actually coming in to explain about a patient that we can serve. That they follow a structured service sales process that’s going to help them to get success.

Valerie V:                           Right, got it. And being professional brochure dropper offers is what a lot of us tend to do.

Cheryl Peltekis:                 And all that does is we should just get them a branded trash bag with our name and logo on it. Right? They might see that longer as they’re carrying it out to the curb. Right?

Valerie V:                           Yeah.

Cheryl Peltekis:                 Because it’s just not fair that fortunately, everybody can drop off a brochure. The worst agency in town can drop off a brochure. The worst agency in town can buy cookies or ice cream, right? But it’s really what makes you different and I think that that’s the other reason why people are so non successful in the first six months is that they really haven’t owned a differentiation statement.

Valerie V:                           That’s a good one.

Cheryl Peltekis:                 I had somebody today on one, I did the High Performance Sales Academy. We have a monthly call for all of our tribe members. And so, I had that call earlier today. And one of the tribe members was sharing with me … She’s specifically does private duty, that they do a letter out to the doctors that says even if the family member generated the referral from the internet that she was the person that went to the bedside to do the meet and greet. She was able to get them sign onto her contract with her company. So she sends a letter to the physician to introduce the company and say hey, we’re here. We’re the ones that are the providers. And she sends them a monthly scorecard. I thought that was brilliant.

Valerie V:                           Very nice. So when you’re in the door with one, make sure that doctor knows everything that’s going on.

Cheryl Peltekis:                 Yes, and now you’ve got a reason to do at least a monthly sales call to him because she can personalize that experience by dropping it off.

Valerie V:                           Yeah, absolutely. That is great. And I like also the recommendation of diversifying.

Cheryl Peltekis:                 Oh God, yes.

Valerie V:                           The elder law attorneys, the trust officers, there’s care managers everywhere. The assisted living facilities and the independent … There should be a huge list of people that you can go see.

Cheryl Peltekis:                 Absolutely. If anybody wants an account list that reaches out to you, please let them know that I can send it to them for free.

Valerie V:                           Okay, absolutely.

Cheryl Peltekis:                 I think that that’s helpful for newbies.

Valerie V:                           Oh, absolutely. And I will just tell you right now, everybody wants that so …

Cheryl Peltekis:                 I could just post it.

Valerie V:                           Or you can post it or you can send it to me. Your contact and all your info is all on there, right, for you?

Cheryl Peltekis:                 I believe so, yeah. I think so. But I will more than happy to share it with you. I’ll email it to you when we’re done. And then, I’ll also post it just to make sure that everybody has it if they want it.

Valerie V:                           All right, okay. So let’s go onto our next question which is this is a little bit about building relationships and getting past the gatekeepers. But if I were to walk into an assisted living facility and I’m kind of new and I don’t really know the receptionist and she’s the gatekeeper, is it okay to do something nice like leave her a little bitty small bag of Hershey Kisses and just tell her to have a great day, if I can’t get past her? What do you do with that kind of stuff. And we’re getting into gifting here and I know that that is not okay at certain levels or maybe ever. But just tell us your opinion on all that and building a relationship with the gatekeeper?

Cheryl Peltekis:                 So in 20 some years, I don’t want to age myself too much Val, okay? But in all my years of doing this, I don’t know of anyone that has gone to prison over Hershey Kisses or even a box of donuts, right? But what I think happens is that sometimes there’s providers that are out there that work and maybe over gift. So under home health, that’s considered a designated health care facility and so we’ve got to be real cautious there, right? But in the private duty realm, we’ve got a little bit more freedom and you’ve really got to refer to your state laws as well as federal laws and really speak to your attorney. And I think ultimately with your owners developing what they feel is comfortable with an attorney’s advice, they should really develop their policies as far as their marketing concerns.

I personally, I like to have a fun week and it doesn’t necessarily … I imbed in all of my 52 week sales plans that I do for clients, I imbed a fun week because as a business owner, I want to be the company that when a sales rep is walking in the door, that the people are happy to see the rep and they’re celebrating. I don’t want to be the one where oh crap, Cheryl’s car just pulled in, run and hide.

Valerie V:                           Right, exactly.

Cheryl Peltekis:                 So I personally, I made myself have a fun week on my 52 week sales plan. Every four weeks was a fun week. It did not mean that I had to be a week where I threw around promo items like crazy. It meant that I had to be somebody that was stopping by to have some fun. So last week, I talked about a patient about medication and reminders in the home. I may this week come in and say, here’s a crossword puzzle about medication safety in the home. And if you guys want to have some fun or during your break, if you guys all submit it at the end, I’ll bring back a Snickers bar for everybody that participates.

Valerie V:                           That’s good.

Cheryl Peltekis:                 It’s just something off the wall. Some of my reps have done pirate day for, what is it called, Krispy Kreme Donuts. They have a pirate day. But I don’t think that you’ve got to get into the place where you’re giving out all of that junk.

Valerie V:                           Right.

Cheryl Peltekis:                 I think that you can position yourself as the healthcare expert by getting invited to stop in one time a month with a monthly observance flyer. Something that educates everybody that could potentially see it in their office. Position yourself as a rep that they would go to for information and guidance. And not just the person like oh, here she comes with her M&Ms.

Valerie V:                           Well, I would be okay with that, but yeah.

Cheryl Peltekis:                 She be you. So would I. Those are one of my favorites.

Valerie V:                           So back in the day, and I won’t date myself either, when I was a case manager in the hospital. And this is before things got all locked down. We’re talking maybe 15 or 20 years ago. There was a sales rep from Home and Stead Senior Care that would come by every week. She would come by almost daily. I don’t know if it was daily. She had clients that she was getting ready to serve. We would see her a lot.

But at least once a week, she would come by and we all had desks. And this was before everybody’s locked down and you can’t get to the case managers. She could come right in the door and usually we were up on the floor so we wouldn’t always see her but she would leave something that was cute. I mean, it was no more than … It was just this big. Something tiny that would say … like it would be a little bee. She did all these crafts. I don’t even know how she does this. And it would have maybe little candy wrapped underneath it and it would say be magnificent today or I don’t know. It was something cute.

Cheryl Peltekis:                 Something cute, yeah.

Valerie V:                           I know. And I was like oh my gosh, how does she have time for all of this? And then I realized she probably bought a lot of it off of Oriental Trading.

Cheryl Peltekis:                 Am I right that you loved it?

Valerie V:                           Oh yeah. It was so cute. Like when it was summer time, she would leave us a little flip flop candle or something just goofy and her little business card or a little tag that was attached to it that said have a happy summer. Let Home and Stead help you or I don’t know.

Cheryl Peltekis:                 I typically program on my calendar every month, usually, one fun week like I said. And typically I do do a promo item. And I buy something less than a dollar.

Valerie V:                           Oh yeah, absolutely.

Cheryl Peltekis:                 Because typically with something less than a dollar, I feel like I’m not … I’m not buying a referral for a dollar. Right? Typically that says on there, like recently we did microwave popcorn. I bought a whole case, cases, I think it was 17 boxes of microwave popcorn because we do have a lot of accounts. And we put little stickers on it that said pop me your next referral.

Valerie V:                           Oh, that’s cute.

Cheryl Peltekis:                 Before I left some of the doctor’s offices, they were already making the popcorn. Right?

Valerie V:                           Oh yeah.

Cheryl Peltekis:                 But it’s like … I know you’ve got to take on a little risk. And I know that there’s other companies that are doing a heck of a lot more than a little dollar item. But I never felt that that was a big enough risk for me to take as a business owner. And I always wanted to position myself as the expert. And even though I wasn’t the expert, I always said hey, I’m not really the expert. All I can tell you is I’ve experienced the other side, and I’ve experienced the caregiver side, so I’m going to try to do my best by you.

Valerie V:                           Yeah, and you know. We just went through … We have a mentorship program and a lot of the folks that will see this are in that mentorship program. And one of the things, we had our monthly call yesterday just like you had your tribe call, we had ours yesterday. And one of the things they asked me for was we … Because we do content all the time, we know what all the celebrations are for each month, fun ones and the healthcare related ones, we know all of them.

So I got my list out which I have shared with them and I did four handouts, four one page write ups. One was I don’t remember, what did I do? It was May is older Americans month.

Cheryl Peltekis:                 So believe it or not, on my computer, I have all of the websites up because I’m working on one for a hospice company right now.

Valerie V:                           Right. And so I did two healthcare related ones, ALS and national whatever, older Americans month. And two that were kind of fun. So one is May is gifts from the garden month. Now I didn’t tell them what kind of little trinkety items or one dollar items, but my instructions were here are four things. So you have one for each week in May to go by. You can do something with this. You need to jazz it up, make it your own, but you can pick two of these and do something fun with them. Maybe a little flower pot or a little something, something cute, that you can leave behind.

I think the dollar items is a good place to stay whether you’re going to the dollar store or you’re ordering something from Oriental Trading in bulk. Easy stuff. And Pinterest probably has a ton of ideas.

Cheryl Peltekis:                 It’s amazing.

Valerie V:                           Pinterest is probably full of ideas. So we’ll leave it at that. So yes, you should always contact your own lawyer, know all your state laws. Are you home health care or are you private duty? There’s a difference. Know what you can and cannot do but if you’re going to do little dollar items, then make them fun. Enlist the help of some ladies in the office or maybe a wife or a sister or somebody who might be crafty. And that’s not me. I’m not crafty.

Cheryl Peltekis:                 Me either.

Valerie V:                           I might provide you the information but I’m always amazed at all these little crafty items.

Cheryl Peltekis:                 Me too, me too. I just have to tell you I have a little bit of envy when it comes to some of the creativity that I’ve seen. But there is not much creativity with coming up with little promo gifts that I have in this brain.

Valerie V:                           Okay. So I have us on, and this question doesn’t show the whole question either. I need to make my questions shorter. Okay, CMS came down with some changes recently.

Cheryl Peltekis:                 Yes, they have.

Valerie V:                           And they have thought about or say they are going to let Medicare Advantage plans include private duty home care services. Tell me what that really means.

Cheryl Peltekis:                 So first I want to say, I can’t even tell you how many phone calls I’ve gotten about this.

Valerie V:                           You’re well versed.

Cheryl Peltekis:                 Oh boy. And I felt like my phone rang a lot and I also felt like I was just seeing a lot of emails asking me oh my God, what strategy, what should I do? Ah! I think first of all, hit the brakes and let’s wait to see what’s going to happen in the next few months. Typically when that letter like that comes out, there comes other guidance. So let’s keep our eyes out and look for the laws. But I also think that you’ve got to start to think about what does it really mean to get in bed with the federal government if you’re strictly private duty, right?

Valerie V:                           Yeah.

Cheryl Peltekis:                 Because in a lot of my clients and your client’s worlds, they’re getting paid directly from a consumer and there is no well, did you get this signed. Did you do this? Did you have an authorization? What did the plan of care say? There is none of that. We have an agreement. We provide the services with a smile and we bill and we get paid. It’s that simple.

With that being said, I work under the home health hospice and private duty model with multiple insurance company and one of them is the Medicare Advantage plans, especially for eligibles in the Philadelphia population that’s high. I also will waver in an options provider for the private duty so we have to deal with service authorizations and approvals and if you want to change hours you’ve got to communicate that back to the providers and ask them. Sometimes it might take a while to get those adjustments in place but hopefully you’ll have somebody who will get out there quick to identify and address the issue so that they can increase the service hours. But it’s ultimately out of our control.

It’s not like a private duty patient where you’re offering one on one concierge level type of services and now the patient says, you know what? Can you stay for two more hours? I think I want to go for a manicure, right? You can’t do that when you’re dealing with the insurance side of the business. So I think the biggest challenge and where I’ve seen organizations fail with trying to take on this model is that it really needs to have a separate person managing this side of the business and maybe even a dedicated staff because the acuity and the differences, we’re not even sure what they will be. They have not clarified what it will mean to be eligible to receive the services from Medicaid.

But what I’m expecting is that there are going to be some type of expectations listed similar to probably those of options and waver programs. That means that we’re going to have to have an authorization person that’s going to track the authorizations that they’re obtaining. We’re going to have to be monitoring our utilization of the hours as the time is consumed. We’re going to have to make sure that we are billing for them timely. They really, really are going to have to have somebody review their contracts.

There’s contracts that say you could only bill for stuff outstanding 35 days. They’ve got to be very, very cautious and know what they’re signing. I’ve seen too many fly by night insurance companies go into town, offer some private duty services. People rush to get on the bandwagon and then they end up losing $80,000-$90,000 in receivables because they didn’t meet a little loophole in a contract.

Valerie V:                           Oh my God.

Cheryl Peltekis:                 So we’ve got to be cautious, right? I think though ultimately, isn’t this a beautiful thing?

Valerie V:                           Oh yeah, absolutely.

Cheryl Peltekis:                 Isn’t it about time?

Valerie V:                           It’s about time. It’s about time. So what I hear you saying is if you are new to this business and you have never taken this on, expect a ton of paperwork, a fair amount of hassle, and be very careful about what you’re signing and you may not get paid like you do from a client. It may be well down the road before you get paid for whatever hours you’re servicing.

Cheryl Peltekis:                 Potentially. But on the flip side, there’s some contracts with Medicaid and with waver and some of us in different states experience a very easy payment system. Right? We bill electronically and we get paid in seven days or 14 days and we’re doing the dance.

So I think that it’s not all negative. I think that you just have to understand. Review your contracts. Make sure that you have key personnel and systems in place like your electronic medical records or something that you can do cost accounting, meaning that you know exactly when you utilized services. And you know exactly what you have remaining. Because what I’ve seen with insurance companies is that you’ve got to stick with their strict authorization process. If they say six hours a week, they don’t mean six hours and 15 minutes. And they don’t mean four hours and 10 minutes, right?

So they can also track your missed visits. Because if you’re not fulfilling what they’ve authorized in their service hours because of an aide that’s a no call, no show, you’re also exposing yourself to data that’s going to be collected that you may not have even any idea that they’re going to collect this data and they are going to make their own report cards of our companies.

Valerie V:                           Oh yeah. You’re going to find yourself on the home healthcare Medicare website.

Cheryl Peltekis:                 I hope not, right? But ultimately, we could.

Valerie V:                           But you could easily be replaced if people are no calling, no showing. They could replace you with someone else they have under contract if things aren’t going the way that they’re supposed to. So you know, yeah.

Cheryl Peltekis:                 The second we put money back into the control of the government on how they spend it is where they’re going to put standards in place that are going to make us more unified. Now, there’s pluses to that. Right now, we don’t even know what to call ourselves, right? I mean, some people say care means all non-skilled. Other people are offended by private duty services. You can never choose the right language.

Valerie V:                           That’s true. We’re all over the place and every state is different.

Cheryl Peltekis:                 Yeah. So maybe now that the federal government will get involved, they’ll slap us around a little bit and make us all speak the same language.

Valerie V:                           Yeah, maybe so. And that would be great. Yes, I can’t tell you how many times we’ve had to quickly run through a website and delete all the words that are related to anything that says the word health or anything that says the word caregiver or it has to be caregiver, it can’t be home care. It’s just insane.

Cheryl Peltekis:                 Yes.

Valerie V:                           And it has to be done right now or I’m going to get a … It’s crazy.

Cheryl Peltekis:                 The one other challenge that really makes me a little nervous about this too is that a lot of us in private duty world are used to staffing for sometimes longer hours. And if these service authorizations come across for 60 minutes, for 90 minutes, we might run into a situation where people will be like who the heck wants to take these cases?

Valerie V:                           Right.

Cheryl Peltekis:                 So it’s going to be a challenge. But that’s how home health has been all this time. We get in there with our aide and we do an hour of care, personal care. Get them bathed, get them washed, get them fed, and run out the door to go see the next seven patients. So it’s going to be an eye opening experience. And the companies that are going to figure out how do they deliver their concierge, high level private duty services and also be able to figure out how to do this non-skilled paid for Medicare Advantage services, are going to be the ones that are going to be victorious.

Valerie V:                           Awesome. That is awesome. So everybody needs to stay on their toes. And we won’t know until closer to 2019, if even then, end of the year, how this is all going to roll out. So they’ve got a little time.

Cheryl Peltekis:                 Wouldn’t it be interesting if Medicare now also starts to pay for non-skilled services?

Valerie V:                           Yes, that would be awesome. It would make a lot of lives, even though the paperwork would get a little more hassley, but definitely a lot easier for some folks. So it would be great.

Cheryl Peltekis:                 Ultimately, with the least costly provider they have higher outcomes when they’re working with us so why not follow that model? If they want to save Medicare and save Medicaid, allow services to be provided in the least costly areas. I mean, we can do so much to keep people in their homes.

Valerie V:                           Oh yeah.

Cheryl Peltekis:                 Just give us the opportunity.

Valerie V:                           Oh yeah, if you want to decrease those hospital readmission rates, it’s often about what you have in the home or can afford to have in the home. And some folks will never be able to afford it without the help of Medicare. So truly, yeah, it would be great for everyone. So yeah.

Cheryl Peltekis:                 It truly would be. I’m so looking forward to seeing how this evolves. I think that this is going to be really exciting. I think there will be some challenges. I mean, I know that I’m a little concerned about those challenges as an owner. But I also think that it’s a great opportunity for me to really dive into another realm.

Valerie V:                           Oh yeah. And for those who are kind of used to it the way you are, this might be a little bit of an easier transition to offer some of those services. I think, you know what, it sounds to me like a big learning conference that you put on at the end of the year would be great. [inaudible 00:38:45]

Cheryl Peltekis:                 Tag team up on that now.

Valerie V:                           Yeah, okay. So that is … Let me just see about anybody … I think we’re good. We answered all of the questions. There were a few questions and people are very excited about your checklist of different referral sources. I can see those comments in here. So that’s all I have for today. And you have been so gracious to be on with us for 40 minutes of your time. Is it snowing behind you?

Cheryl Peltekis:                 So it snowed yesterday here in Pennsylvania but no not today. I know.

Valerie V:                           April 18th.

Cheryl Peltekis:                 And I know that you’re also a hockey girl.

Valerie V:                           Yeah, go Blues.

Cheryl Peltekis:                 Go Flyers. I’ve got a game tonight. Thank you so much for this opportunity. And you are always a privilege and it’s an honor to speak with you. And if I can help you at all with answering any hospice questions, please don’t hesitate to reach out to me.

Valerie V:                           Okay, great. I will. Thank you, Cheryl.

Cheryl Peltekis:                 You’re welcome.

Valerie V:                           We have learned a lot from you today. We always learn a lot from Melanie too and you guys are welcome to …

Cheryl Peltekis:                 I love that girl.

Valerie V:                           … join all of us on our groups and everything. So thank you so much.

Cheryl Peltekis:                 Thanks, Val.

Valerie V:                           We’re ending live. We’ll talk to you later.

Cheryl Peltekis:                 Bye, have a great day. Bye everybody. Thank you.