GPS technology integrated with cell phones and software allows home health agencies to better manage their field staff and operations. GPS-enabled cell phones provide turn-by-turn directions to save driving time and fuel costs. Software tracks staff locations in real time and generates automated timecards, mileage reimbursements, and documentation of patient visits. This reduces paperwork and gives agencies tools to expedite scheduling, monitor staff safety, and cut costs.

1. Sponsored by
12 Ways GPS Reduces
Home Health Agency Costs
Written by and Improves Operations
DecisionHealth White Paper Services
Nurse visits to patients’ homes have been the foundation of home care
Contents since the days when horseback sometimes was the only way to get
there. Today, visits still are the key to patient care, but they’re also a
• Traditional tools: Labor major cost for every home health agency.
intensive .............................. 1
• Technologies emerge that fit
with HHA business structure .... 2 Ensuring the quality of care delivered in the home is of prime
• GPS/cell phone/software offer importance, of course. But successfully managing travel time and costs
benefits in field and HQ ........... 3
• Advantages for home health gives HHAs the opportunity to increase the number of visits and time
field staff ............................... 3 with patients while trimming the high costs of travel.
• Advantages for home health
agency executives .................. 4
• ROI table ............................... 6 Fortunately, several newer technologies offer better methods for
• Case Study: Swedish Medical managing the travel and visit schedules of agency field staff providing
Center Home Care Division ...... 7 skilled nursing care, social work services, physical, occupational and
• Final thoughts ........................ 8
• About the Sponsor .................. 8 speech-language therapy, and aide services. These technologies include
global positioning satellites (GPS), the Web and handheld devices such
as cell phones. This white paper explores those alternatives and their
Executive Summary pros and cons.
Home health agency use of cell
phones equipped with GPS navi-
gation and linked to a powerful Web-
Traditional tools: Labor intensive
based application helps HHAs better
manage their field staff of nurses, First, let’s benchmark the way most home health agencies have
therapists and aides. Turn-by-turn managed their mobile workforce. Technologies at play are the
GPS directions on cell phones
provide the shortest/quickest route telephone, voice mail and pen and paper. Upwards of 70% of HHAs
for visits to patients’ homes, saving may fall into this category, indicates an informal November 2007
fuel costs and driving time. A GPS- survey of 379 HHAs by Home Health Line, the leading independent
based application that tracks cell
phone travel shows where all staff newsletter in the industry.
are at any moment, generates data
for automated timecard and mileage Visit scheduling and schedule changes rely on time-consuming and
reimbursement calculations, provides
additional documentation of patient labor-intensive phone calls (and leaving voice mail messages) between
visits, and sends safety alerts to the the agency and field staff. More phone calls follow to report the
home health agency when a nurse conclusion of a visit so office staff have some idea how the visit
may have encountered a problematic
situation. schedule is progressing. When there’s a change during the day, the
scheduler checks the board or screen to find a nurse whose location
and visit load can accommodate the added visit.
White Paper Program During much of the day, the agency won’t have an idea where its staff
homehealthwhitepapers are at any given moment.
.decisionhealth.com
Posting of this white paper on any Generally speaking, agencies assign field staff to a geographic area;
Web site or intranet without prior staff decide the order in which they make their visits. Agencies may
written permission by DecisionHealth
is prohibited.
provide driving directions based on Internet mapping services (such as
© 2008 DecisionHealth
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2. White Paper: 12 Ways HHAs Can Leverage GPS
MapQuest, Yahoo Maps and Google Maps), which takes time to do.
Or the nurses or other field staff can do the mapping program look-
ups and printing at home themselves. For four to five visits in a day
(see on left), it’s time consuming no matter whether the agency
scheduler or the field staff member does it.
For tracking mileage driven, field staff use pen and paper to record
their vehicle’s odometer settings from home to visit to visit, etc. Staff
who are paid on an hourly or per-visit basis also manually track their
work performed using time or visit sheets.
That’s a lot of administrative work (and cost).
As miles add up,
so do costs
Technologies emerge that fit
Home health nurses make an with HHA business structure
average of four to five visits a day,
according to a June 2008 Home
Health Line productivity survey There are better uses of the time of agency managers and field staff.
receiving 160 agency responses. There are more effective ways to manage home health clinicians and
What was the average number of
aides in the age of wireless communications and GPS-aided devices.
miles driven between visits? The Alternatives include:
mean was 13 miles a day and the
median 11 miles, 138 of the
agencies reported.
Equip clinicians’ laptops or tablet PCs with an aircard for wireless communication.
For an agency with 30 field • Pros: Aircards provide wireless communication for field staff
clinicians, you get something like
$1,900 week or nearly $60,000 a who carry laptops. Laptops have bigger screens and keyboards,
year in mileage costs at the IRS rate can work with a point-of-care system and handle collection of
of 58.5 cents/mile (July-Dec. 2008). answers to the lengthy OASIS form.
Industries outside of home health • Cons: Laptops must be powered up for GPS navigation and
have been able to lower such costs wireless communications to work. Laptops are more expensive
through use of “location-based
solutions” such as GPS-enabled cell
and bulkier than cell phones and provide more functionality
phones. An average 13.2% savings than is necessary in many situations. Laptops also fail to
in fuel costs and a 19.2% reduction provide a truly effective solution for GPS navigation – they are
in miles driven were reported in a
2007 survey of 330 enterprises in
similar to reading printed directions and maps.
service industries with field staff
such as telecom and utilities. Give field staff a portable GPS device such as TomTom, Garmin or Magellan
Source: “The Impact of Location on
Field Service,” December 2007,
consumer brands.
Aberdeen Group, Boston.
• Pros: They supply driving directions, are portable and sold
widely.
• Cons: Mapping features and directions become out of date
unless you pay an extra charge for updates. These devices
don’t communicate back to the home health agency to provide
location, route and time and duration of stops.
Another tool has emerged that combines the Web, wireless
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3. White Paper: 12 Ways HHAs Can Leverage GPS
communication and GPS technology to enable home health agencies
to locate and manage their field staff in near real time. Almost 91% of
home health nurses and other clinicians already carry a cell phone
during the work day for various professional purposes (see on left) so
it’s already a familiar work tool.
The key to turning a GPS-equipped cell phone into a true management
tool lies in special mobile workforce management software added to
the phone and tied to a Web-based platform accessed by the agency to
enable work flow, communications, and collection and analysis of data
from field staff.
GPS satellites GPS/cell phone/software offer benefits
encircle the Earth for both field staff and managers
Here’s how the marriage of cell phone wireless, GPS and Web tech-
nologies can help field staff and their managers at the agency office:
Advantages for home health field staff
1. Turn-by-turn driving directions: This function is built into the
phone. GPS specifies the phone’s location and software provides
voice and onscreen directions for the best (shortest/quickest)
available route to the patient’s home or other destination. If there’s
a traffic jam along the way, the software calculates an alternate
route. It gives new directions when the driver misses a turn. Extra
benefits: Safety – not driving distracted with map reading and
direction finding; but instead eyes on the road and hands on the
wheel. The clinician or aide arrives at the patient’s home less
Cell phones get wide use stressed and ready to focus on patient care. Also, the field staff
in home health member receives the perk of using the GPS directions outside of
Answering questions posed by HHA work hours at no extra cost to the agency.
office staff and mangers constitutes
the top use of cell phones by the 2. Improve safety: A “stop alert” goes to an HHA dispatcher or
91% of clinicians who carry cell
phones during the work day. That’s manager if the phone of a nurse or aide remains at a visit location
what 224 home health agencies longer than a predetermined length of time. The agency office
reported when they responded to an receives the alert and someone can call, text or e-mail the field
August 2008 Home Health Line
survey. Job-related cell uses: staff member to determine whether he or she has encountered an
unsafe situation. Many industries and organizations use this feature
• 95% − answer questions to monitor the safety of mobile workers. Example: During a
• 89% − contact physicians
• 88% − contact patients
winter storm, a worker’s phone was stationary more than 10
• 74% − arrange patient visits. minutes. Alerted dispatchers sent help; the worker had suffered a
heart attack and was saved.
In addition, a “hot key” alert can be configured on the phone so
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4. White Paper: 12 Ways HHAs Can Leverage GPS
field staff can alert management quickly when they need assistance.
Also, the phone can be programmed to send an alert when it
moves outside of a designated geographic area (called a
“geofence”). Imagine this feature’s benefit in the case of a possible
carjacking or kidnapping.
3. Cut fuel costs: Finding the cheapest gasoline when nurses need to
fill up can reduce their out-of-pocket expenses. Special software
makes that possible by listing gas stations near the cell phone’s
GPS location in descending order of price (updated daily). Select a
gas station and its address and driving directions from the GPS
location appear on the cell phone screen.
In a similar manner, field staff can cut miles driven to find health
care-related providers such as pharmacies, assisted living facilities,
nursing homes and hospitals. Agencies can add information on
these local facilities to their GPS information, allowing field staff
to quickly find them and generate driving directions, saving time
and money.
4. Ease mileage reporting paperwork: GPS tracking software is
ideal for mileage reporting. Equipped phones, after they’re turned
Cell phones mesh
on at the beginning of the day, accurately record the distance to
with timecard needs
patient home A, then to patient home B, and so on until the end
Many home health agencies pay
of the staff member’s work day. That means the field staff member
home health nurses on an hourly no longer has to write down vehicle odometer settings and
basis, making use of a cell phone as manually fill out mileage sheets.
a timecard a cost-saving benefit for
the agency and the nurse (who
doesn’t have to maintain a manual 5. Automate timecard paperwork: For nurses or aides paid by the
time sheet). hour – which many agencies do (see on left) – the right software
About 160 respondents to a June
can turn the cell phone into a time clock. When the phone comes
2008 Home Health Line productivity on, the nurse “clocks in” – the phone sends the start time and
survey reported paying: GPS location to the agency; the same process occurs when the
• 33% of field nurses on an
staff member clocks out. (There’s also a way to turn off the clock
hourly basis when on personal time.) As with mileage reporting above, the field
• 40% by salary staff no longer faces the chore of filling out time sheets. Nurses
• 23% per visit
• 4% on a contract basis.
also can indicate specific codes for services performed and any
products used during the visit.
An analysis of 120 agencies by
consulting firm Fazzi & Associates,
North Hampton, Mass., found that Advantages for home health agency executives
51% of home health nurses were
paid on an hourly basis, 34% by
salary and 15% per visit, the firm 6. Expedite visit scheduling: The agency can push out the next
reported in March 2008. day’s schedule to field staff members’ cell phones. (In other words,
no more labor and time intensive manual telephone scheduling!)
When they turn on their phones in the morning, field staff will
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5. White Paper: 12 Ways HHAs Can Leverage GPS
have their schedules for that day, with the order of visits and
driving routes optimized (thanks to GPS and special software) to
save time on the road. In some cases, that could make more time
to spend with patients or time for an additional visit that day.
7. Cut fuel costs: Nearly all home health and private duty agencies
cover mileage costs of field staff (see on left). With gasoline costs
remaining high, “route optimization” through GPS and built-in
cell phone driving-direction software can achieve significant
reduction in agency fuel costs. It’s simple: Give field staff the
shortest (or quickest) routes between patient visits – which
themselves are placed in the order that requires the least amount
of driving – and they burn less gasoline. Example: Such
technology allowed one home health agency to capture enough
Gasoline prices savings over a year to add two staff members and two vehicles to
hit home health its field staff of 50.
The vast majority of Medicare home 8. Cut agency paperwork: By integrating cell phone/GPS data into
health agencies reimburse their their accounting and payroll systems, home health agencies can
clinicians for mileage, an April 2008
Home Health Line survey indicated. slash paperwork and costs substantially. The mileage data for visits
The results: referred to in Point 4 can be transmitted to the agency’s back-
office accounting systems to calculate the field staff member’s
• 95% of 73 respondents said
they reimburse for mileage reimbursement and cut a check. Similarly, the time card data (see
• 42% have increased mileage Item 5) go to the agency where payroll systems (such as ADP,
reimbursement Kronos or SAP) can figure compensation for field staff paid on an
• 18% lost clinicians who
couldn’t afford the higher gas hourly or per visit basis. Benefits: Accurate mileage and timecards
prices from GPS data, elimination of the work and data entry errors
• 15% refused to accept associated with manual rekeying of mileage sheet and timecard
patients who clinicians
wouldn’t drive to data, and elimination of the need to cut manual checks.
• 12% raised clinicians’ rates.
9. Improve documentation of visits: The health care axiom “Not
Private duty home care agencies also
feel the crunch. documented, not done” isn’t cause for worry. That’s because HHA
officials can generate what’s called a “breadcrumb report” showing
• 83% of 69 respondents in an the routes and precise location, times and duration of stops of
August 2008 poll said they
reimburse caregivers for gas home health clinician and/or aide visits for any time period. Think
mileage what it would be like to show this report to a Medicaid auditor
• 47% reported hiking mileage seeking proof that visits were made and your reimbursement is
reimbursement
• 42% had to decline taking on justified. You have an audit trail ready to go at any time.
clients because of driving
distance 10. Manage field staff more effectively: Visualize a computer map
• 39% raised client rates
• 27% raised caregivers’ hourly of your HHA service area displaying pushpin icons showing where
rates. all of your field nurses, therapists and aides are at any given time.
(The system also allows you to group field staff in many ways, for
example by branch, or by supervisor so a manager sees only those
staff for whom he or she is responsible.)
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6. White Paper: 12 Ways HHAs Can Leverage GPS
Think how much more effective it would be to manage your field
staff if you could see where they are whenever necessary, including
in relation to a landmark such as a hospital? Example: Say you
unexpectedly need to send a nurse to a patient’s home within
hours. This technology now allows you to type the patient’s
address into a Web site that receives data from your field staff cell
phones. Immediately, you see the 10 nearest nurses to the address.
Such data will ease your decision-making about who is in the best
position to perform the unexpected visit.
11. Communicate to field staff more effectively: Reach all field
staff without making dozens and dozens of calls – and know who
received the message and who didn’t. You can expect such
efficiency from these systems whether it’s for a notice of a routine
meeting or an urgent situation affecting everyone. Example: A big
storm approaches. You not only can send a text message to all
staff in your geographical area telling them what to do, but the
system can tell you (1) who received the message, (2) who read it,
and (3) whether the recipient responded. If the message was read,
there’s no need to waste time with a follow-up call. If it wasn’t
received or read, you know who needs a call.
12. Decrease turnover: The more you can relieve clinical staff
frustration over paperwork and other administrative burdens, the
greater their job satisfaction. For example, GPS directions make
HHAs report existing
their life less stressful: Getting directions and schedules via the
investment in cell phones
phone eliminates wasted trips back to the office. With national
Home health agencies already spend turnover estimated at as much as 20%, use of the above
significantly on cell phones, technologies could pay off by reducing the thousands of dollars in
according to a Home Health Line costs of replacing field staff.
August 2008 survey:
• 44% of HHA officials reported A survey of more than 120 organizations providing home health care
their agencies provide cell and services found an ROI for use of all types of wireless devices in
phones for clinicians
• 36% help cover costs of
home health care of up to $15,000 per full-time-equivalent per year.
personal cell phone use Wireless handhelds and cell phones showed particularly positive ROIs.
• Only 11% said they provide
no financial support. Wireless Handheld/BlackBerry Smartphone Phone ROI
66% said their agencies spend $20 Field Admin Productivity Smartphone/ Smartphone/ Payback
Staff Staff Enhancement BlackBerry BlackBerry Period
to $50 a month per clinician for cell
Savings Total Cost of Return on
phone coverage or reimbursement. Ownership Investment
RN $1,150 $13,505 $1,557 964% 38 days
LPN $1,150 $9,990 $1,557 739% 40 days
Home
Care Aide $1,150 $2,840 $1,557 345% 106 days
Source: Venture Development Corp., Natick, Mass., 8/2007 report “Wireless Home Care
Solutions: Addressing the Quality of Service and Performance Gap”
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7. White Paper: 12 Ways HHAs Can Leverage GPS
Case Study: Swedish Medical Center Home Care Division
Fiddling with maps while driving was just one of the concerns that the
Swedish Medical Center Home Care Division had about the way its
200-strong field staff traveled to homes and facilities where patients
lived in the Seattle metropolitan area. Reading maps or calling the
office for directions while driving was a safety concern as well as an
efficiency issue.
Further inefficiencies occurred when the home care office called staff
on wireless phones, paged them or even sent text messages to provide
schedules and destinations.
Such communications interrupted clinical staff and aides during their
patient visits, and sometimes compromised patient confidentiality
Field staff for this Washington state when the home office had to give details of the next case to someone
home health agency no longer rely
on the agency office for directions to
visiting with another patient. It was not the best use of Swedish’s non-
patients homes. Instead they use profit resources to have mobile field health care workers rely heavily
their TeleNav-equipped cell phones on the office for directions.
for GPS directions and navigation,
eliminating wasted trips back to the
office. Facing shrinking Medicare and Medicaid dollars, escalating costs and a
nationwide nursing shortage, the Home Care Division turned to
TeleNav Track for a cell phone-based solution using GPS navigation
enhanced by a Web-based software application.
“Providing directions to get around Seattle and the surrounding
counties was problematic,” reports Debby Ramundo, Senior Project
Manager, Home Care.
“Our people were too tied to the office for getting directions. Because
patient appointments change often and on-the-fly, it was a significant
waste of time for employees just to come into the office to get
directions, only to go right back out again. Also, the safety of our
mobile healthcare employees is an important issue, not just for us, but
also for them.”
Using TeleNav Track’s GPS turn-by-turn directions for the shortest or
quickest route knocked down travel time considerably and greatly
reduced the number of trips into the home office, thus allowing
mobile healthcare workers more time for patient calls and to do what
they do best—take care of patients.
“With TeleNav Track, we can respond to patient needs faster and with
more flexibility,” Ms. Ramundo adds.
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8. White Paper: 12 Ways HHAs Can Leverage GPS
Final thoughts
Adding the power of GPS tracking to the convenience of wireless cell
phone technology gives home health agencies a combination perfectly
suited for their needs. Cell phones are supremely portable and already
In Summary familiar to field staff. Smart cell phones can transmit GPS data – a rich
source of information which the right software turns into productivity-
Top home health agency benefits of
a GPS-aided cell phone enhanced enhancing and cost-saving tools for the agency. Not just a manage-
with a Web-based application: ment benefit, the technology combination also makes life easier – and
safer – for home health clinical service providers and aides in the field.
• Cut field staff fuel costs
• Cut driving time.
• Obtain accurate mileage, While the initial home health patient visit may require use of a laptop
timecard data. for recording answers from the more than 90-question OASIS form,
• Track location of field staff to
facilitate visit schedule most visits don’t require such heavy equipment. Other times, the cell
changes. phone/GPS/software advantage has a proven record of:
• Enhance safety of field staff.
• And much more.
1. Cutting fuel costs by giving field staff more efficient driving
routes
2. Giving staff less time on the road and more time to spend with
patients
3. Sending accurate time card and time sheet data to the agency
for automated calculation of mileage reimbursement and
hourly-based pay
4. Automated generation of paychecks when tied to the agency’s
payroll system
5. Displaying a map so agency mangers can see where their field
staff are at any moment
6. Issuing a safety alert to the agency when a nurse or aide may
be in danger in the field
7. Providing a means to send text messages to all staff and know
whether they received and read them.
8. Documenting performance of field staff members’ patient visit
schedule, creating an audit trail showing compliance with
Medicare, Medicaid and private payer requirements.
The technology that delivers these benefits isn’t something that’s
promised to be just around the corner. It is here for you to use now.
About the White Paper sponsor
TeleNav, based in Sunnyvale, Calif., is the global leader in location-
based applications delivered via a cell phone. The first to launch a GPS
navigation and mobile workforce management service on a cell phone
in North America, TeleNav is partnered with every significant wireless
carrier and device manufacturer. TeleNav provides two solutions for
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9. White Paper: 12 Ways HHAs Can Leverage GPS
home health agency clinical and nonclinical field staff:
TeleNav GPS Navigator provides voice and onscreen driving
directions on mobile phones and cell phones. Its ability surpasses in-
car and stand-alone GPS systems with features that include easy
portability, local business listings, voice-activated directions, and free
updates to maps and points of interest – all at a fraction of the price of
stand-alone systems.
TeleNav Track is a Web-based application (no hardware or software
to install at your agency), using GPS data from field staff cell phones
so managers can see the locations of their staff at any time. TeleNav
Track helps cut fuel and time costs by optimizing driving routes and
reduce operation costs by collecting mileage and time card data from
the field. Tracking enhances the safety of field staff, automatically
alerting managers when a potential security problem exists. TeleNav
Track is complementary to and integrates with information systems of
home health vendors including Homecare Homebase, McKesson and
Misys.
For more information, go to www.telenavtrack.com/homehealth or
call 1-88-TeleNav-2 (1-888-353-6282).
© 2008 UCG Page 9