Time Management Aids Cost Containment in Home Modifications

By Corey Staver, OTR, CHAMP, CAPS | October 29, 2014

Part Three: Time Management

During this three part series the objective has been to introduce you to the cost containment formula and demonstrate how it can be used to contain your cost and improve your outcomes with home modifications.

The first article discussed the importance of an accurate design and scope of work as the foundation of a successful process and outcome. The second article provided a standardized method that can help you achieve a reasonable cost that is consistent and dependable. In the final article we will take a look at the final addend in the formula, time management.

Cost Containment = Accurate Scope + Reasonable Price + Time Management

It’s been said that Benjamin Franklin was the first to say “time is money”. When referencing insurance claims, it could also be phrased that “time is expensive”. I heard a property claims manager once say that the best file is a closed file. The longer a file remains open the more costly it becomes.

Managing for closure is ideal however we also know that when it comes to an injured worker, waiting for closure can literally last a lifetime. Although an ideal workers’ compensation claim outcome is functional independence and return to work, in some cases that never happens. The focus then turns to maximum medical improvement, improved functional independence and hopefully returning home.

In both scenarios, the sooner you can achieve the outcome, the better the result and usually the less associated cost. So the industry trains its professionals to watch the financial investment and balance that against the results or outcomes. It’s no different when it comes to home modifications however the home modifications process seldom gets the attention it really needs. Far too often assignments for modifications are a last minute afterthought rather than an early intervention deliberate action. Far too often our company receives assignments for catastrophically injured workers within two weeks of discharge. The carrier puts a “rush order” on the modifications but at that time there is usually little we can do.

Depending on the state and county, permits can take up to a month or longer to be issued, even with a hardship request. Not to mention the need for an assessment, possibly architects drawings, estimates, discussions to achieve agreement and the unforeseen variables that often come up. Unless the work is done by the time of discharge, the carrier is put in the position to provide temporary housing.

An adjuster recently advised that they were paying in excess of $33,000 per month to house a claimant at a skilled nursing facility while waiting for the modifications to be completed. Unforeseen complications can happen and spoil the best of plans, but so many times the significant costs associated with temporary housing could easily have been avoided with a little foresight.

Non-catastrophic claims can be turned around much faster and two weeks might be plenty of time if all that is needed is a ramp and some grab bars. But significant injuries usually present the need for significant modifications. And when it comes to significant modifications, nothing beats early intervention. One carrier that we work with took the initiative to create internal protocols and processes to standardize the way they handle home modifications. One of the wisest things they did was to make it a policy to start the home modification process within the first two weeks of the claimant’s admission to the rehabilitation hospital. Many carriers would argue that this might be too early because it’s often too soon to know what the injured worker’s functional outcomes will be. While you might not have a clear picture of the injured workers outcome, you can most certainly gain a clear picture of their current living environment and potential needs.

While the claimant is usually in a state of fluid recovery, the home is a constant structure. A good home assessment provides the current condition and baseline that the recommendations are built upon. The pinch points in the home can be identified at any point. Get the assessment completed as early as possible and then revise the recommendations when the outcomes become clearer. In most cases, our company likes to provide multiple options based on various outcome scenarios. When the outcomes are identified, the carrier can then choose the correct option or they can be revised based on the specific needs of the individual.

While early intervention is the key to getting off on the right foot, unless systems are in place to keep the job moving, the time can easily extend beyond what was planned. In a perfect world, all projects would go according to plan. However the reality is that every project has issues. Some issues are avoidable and others are not. From experience I know that issues aren’t necessarily problems. They’re simply part of the process of completing construction. How you resolve the issues is what may or may not cause the problems. One of the most common complaints we receive from home owners, is that “no one is working on my house today”. So why isn’t the contractor there every day? Here are a few acceptable and unacceptable answers to that question:

Acceptable: Weather conditions do not allow the continuance of work, i.e.; pouring concrete or exterior painting is influenced by temperature and moisture.
Not Acceptable: Weather conditions caused severe damage in the contractor’s coverage area and they are needed for services elsewhere.

Acceptable: Waiting on inspections from the county in order to proceed.
Not Acceptable: The county inspector is waiting on the contractor because of failed inspections.

Acceptable: Questions on scope addressed with the carrier and waiting on their response.
Not Acceptable: Scope changes performed without carrier permission are in question.

Acceptable: The homeowner has a scheduling conflict and can’t be on site.
Not Acceptable: The contractor has too many open jobs and has to flex staff to make progress elsewhere.

Managing the ongoing project can be challenging and communication or the lack of communication is by far the most common root of production problems. While many contractors and vendors say they find communication important, few actually are good at it.

When I was working in rehab hospitals and skilled nursing facilities, my supervisors always stated that “if it wasn’t documented, it didn’t happen”, and “if didn’t happen, we didn’t get paid”. We learned that in order to get paid we had to be skilled at documenting everything. As therapists we had to complete a treatment plan. Once treatment was started we had to complete weekly progress reports and daily treatment notes. Each point of documentation supported the overall plan and justified the current status.

Workers’ compensation claim handlers, nurses and adjusters are skilled at reading and understanding rehab reports. The information is important to establish the outcome objectives and discharge plans. When completing a home modification project, I strongly suggest that you require the vendor or contractor to complete similar reports. If you think about it, a contractor’s written cost estimate is similar to a therapist’s rehabilitation plan. It tells you what the plan is, what the modalities are and what the expected outcomes are.

The therapist writes weekly progress notes explaining where they are in the process and the progress the claimant is making. In the home modification process, I strongly recommend that you require the vendor or contractor to submit a weekly progress report. In our company, we require a weekly report that the contractor has to submit each Friday. It’s a simple form that has two sections. The first section is supposed to state what the contractor accomplished during the previous week. The second section is supposed to state what the plans are for the next week. The form is filled out and signed by the contractor and homeowner showing they’re in agreement with what was written. The contractor then submits the report with photos demonstrating the progress noted.

Do this on a weekly basis and you will find that the projects are more easily tracked, fewer phone calls are necessary and when issues arise they are recognized before they get out of hand. We take this serious and contractor’s that handle our assignments are even fined if they don’t submit the report when it is due.

While there are many excuses why jobs take too long, there are fewer actual reasons that can be justified. Early intervention, early decisions, communication and documentation can go a long way to manage the process.

When it comes to home modifications, containing cost should be nothing more than a by-product of an otherwise healthy home modification system. The simple formula presented in these three articles is simply one way to put a process in place that, if applied, can provide a significant improvement in your current program.

Each addend can be defined in many ways and strategies in each category can differ. However, the constant is that every project starts with an accurate scope of work. Every estimate is based on the accurate scope and pricing can be regulated. And finally, if early intervention is embraced time issues can be greatly reduced.

Enjoy the process of making houses homes again, and let me know how you’re doing.

By Corey Staver, OTR, CHAMP, CAPS
CEO David Corey Company, a full service home modification company that provides skilled home assessments by occupational therapists.

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