DOME home
Search Dome
A publication for all the members of the Johns Hopkins Medicine family Volume information



At the Helm of Home Care
For Dan Smith, quality—and safety—are job No. 1

Dan Smith, now officially president of the JH Home Care Group, is already receiving high marks.

Handling tough assignments for Hopkins Medicine is nothing novel for Dan Smith, newly appointed president of the Johns Hopkins Home Care Group. When he began his career with Johns Hopkins in 1983, he served on the team that helped transform the financially moribund Baltimore City Hospitals into today’s thriving Hopkins Bayview Medical Center.

Smith became senior director of finance for the Health System in 1995, and in 2001 he was also made chief financial officer for the Home Care Group, then staggering under $5.5 million in losses. He quickly helped turn the business around and actually generate a $1.6 million profit by 2003.

Late in that same year, a well-publicized patient death, caused by what appeared to be human error, led Smith, who became acting president of the Home Care Group in April 2004, to reinvigorate the organization’s wide-ranging safety and quality initiatives. These efforts recently earned it one of the best reports it’s ever had following a state audit. The glowing assessment—and continuing profits of more than $1 million a year—are positive signs of the team’s efforts, Smith acknowledges, “but over the next five years, there are many bumpy roads still coming our way.”

The Johns Hopkins Home Care Group (JHHCG) has three main businesses: Home Health Services, which provides nurses and therapists to care for patients at home; infusion therapy, which operates a pharmacy and has nurses administering the infusion to patients at home; and durable medical equipment, which provides respiratory therapy and products, such as oxygen, and equipment, such as walkers, wheelchairs, canes and beds. JHHCG also manages three pharmacies on the East Baltimore campus and one at Bayview.

JHHCG now faces a few key challenges. Under the federal Balanced Budget Act, Medicare will be reducing payment rates over time. These cuts are bound to have an adverse effect on the group’s bottom line unless new business can be generated. Retaining nurses and therapists is proving difficult, with Medicare instituting a new system that requires cumbersome documentation and limits compensation. Maintaining quality control remains a critical, ongoing requirement.

For each challenge, however, Smith and his team have devised new strategies. JHHCG has instituted sweeping quality enhancements since Smith took its helm. A senior project administrator for the Health System’s office of operations integration, Mary Myers, now leads JHHCG’s quality performance improvement efforts. Myers and vice president Nancy Pasternak have developed a plan for extensive quality improvement and safety initiatives, one that includes having individual quality experts oversee each of the group’s three businesses. Another new hire will run an enhanced employee education and training program.

In addition, precise procedures now are in place to monitor medication and equipment safety. Employees are encouraged to report potential mistakes. In the past, employees might have feared they would be reprimanded if they reported errors, Smith says. “Now we want to congratulate them for reporting variances, help them track the problem’s history, and determine what we can change to make sure it doesn’t happen again.”

The group is raising its nurses’ base salary to make it more competitive with other home care providers and to close the income gap between home-care nursing and hospital nursing. The group’s new electronic clinical and documentation system is particularly attractive to nurses familiar with laptops. Human Resources is developing tools that will identify nursing applicants who are more attuned to home care work.

JHHCG has to persuade Hopkins physicians to use the group more often. “Too many Hopkins physicians choose to use competing home health and infusion services,” says Smith. “Once those relationships with our competitors are established, it’s difficult to break them. I know we can provide quality service one would expect from Hopkins.”

Smith has reached out to new clients. Recently, the Visiting Nurses Association of Maryland quit the pediatrics home care field. “We stepped up and said we will take those nurses and try to provide service to patients in our catchment area.” JHHCG now provides home health, intravenous and durable medical equipment to the University of Maryland’s pediatric patients and even has a home care coordinator working there.

“We need to do the same thing throughout the region and grow beyond just the walls of Hopkins’ three hospitals,” Smith says. “I am optimistic about our ability to grow, overcome the fiscal hurdles and provide the quality of care that is deserving of the Hopkins Medicine name.”

Neil A. Grauer




Johns Hopkins Medicine

About DOME | Archive
© 2005 The Johns Hopkins University
and Johns Hopkins Health System