Almost no agency chose this. An agency starts in personal care, buys software that does personal care well, adds a Medicare-certified home health line and discovers that software cannot do OASIS-E2, buys a second product, adds hospice and buys a third. Every purchase was correct on the day it was made.
The result is one workforce, one client base and three databases, and a cost that appears nowhere in the budget because it is entirely made of people's time. Here is how to put a number on it.
the Costs You Can See
Start with the invoices, because they are the easy part and they are not the answer.
- Licence or per-seat cost for each system
- Implementation and annual support fees
- Any interface, middleware or data-transfer fee between them
- Any module you are paying for twice because two systems both do scheduling
Add them up. Then set the total aside, because in most agencies that run this exercise honestly, it is the smaller half.
the Costs You Pay in Hours
Nine places the time goes. Walk your own building and put a real number on each, even a rough one.
1. The client entered more than once. A client who moves from personal care to home health, or from home health to hospice, is frequently admitted again from scratch. Same person, same address, same emergency contact, same allergies, typed again. Count the minutes and multiply by transitions per month.
2. The same hire onboarded more than once. One hire, two or three system records, two or three logins, and a first week where somebody is emailing credentials to somebody else.
3. Credentials tracked in more than one place. The licence expires in one system's tracker. The other system happily schedules the shift. Nothing catches it until a payer does, and by then it is a `CO-B7` and a rebill.
4. Payroll re-keyed from visit data. Verified visits exist in one system. Payroll runs in another. Somebody exports, reconciles and imports, every cycle, under time pressure, and any error lands in somebody's paycheck.
5. Reporting that requires a spreadsheet. Ask a simple question, such as total hours delivered per client across all lines last month, and see how many exports it takes to answer. That spreadsheet exists because two screens disagree and someone has to arbitrate.
6. Training a new administrator three times. Every hire in the office learns three products, three navigation models and three sets of quirks. That is directly visible as time to competence.
7. Managing three vendors. Three contracts, three renewal dates, three support queues, three security reviews, three roadmaps that do not care about each other. Someone owns this, and it is usually the person who can least afford the interruption.
8. Survey and audit response. A surveyor asks for one client's complete record. If that record lives in three places, the response is an assembly job under time pressure, and gaps between systems become findings.
9. Reconciling the same visit twice. EVV in one place, billing in another, and the mismatch surfacing weeks later as a denial that nobody can reconstruct.
a Worksheet You Can Finish in An Afternoon
For each of the nine, fill in three cells:
| Column | What goes in it | |---|---| | Times per month | How often does this happen | | Minutes each | Time it, honestly, including the phone call | | Who | The role doing it, and their loaded hourly cost |
Multiply across, sum the column, and multiply by twelve. That is your annual cost of running separate systems, and it belongs next to your licence total whenever anyone compares vendors on price per seat.
Two warnings from people who have run this. Do not use the fastest person's time as the average, because the fastest person is not the one doing it at 4pm on a Friday. And do not exclude the interruptions, because the cost of a re-key is not the re-key, it is the fifteen minutes it takes the coordinator to get back to what they were doing.
the Cost That Does Not Fit in The Worksheet
Three things this arrangement takes that will not show up as minutes.
Answers you stop asking for. Nobody asks which care line is actually profitable per client, or what the true cost of a transition is, because producing the answer takes three days. The question quietly disappears from the management meeting.
Referrals you cannot take confidently. A referral source who can send you all three care lines is worth more than three sources who each send one. If accepting that relationship means a client is re-admitted at every transition, the source notices, and referral sources route by how easy you are to work with.
Continuity the family experiences. A family moving a parent from home health to hospice is at the hardest point of the relationship, and being asked for the same information a third time reads as an agency that does not know them.
What to Do Before You Buy Anything
Consolidation is not automatically the answer, and a product that covers all three lines badly is worse than three products that each cover one well. Test whichever direction you are leaning against four questions:
- 1.Is a client one record across all three care lines, or one record per line?
- 2.Is an employee one credential file, checked by every schedule in every line?
- 3.Do verified visits become payroll without an export and an import?
- 4.Can I report across all three lines without leaving the system?
If the answer to the first two is no, you have bought one login page in front of three products, and you have kept every cost in the worksheet while adding a migration.
the Short Version
The licence fees are the visible cost and the smaller one. The real number is the work that exists only because the systems cannot see each other, and it is knowable in an afternoon. Do the worksheet before the next renewal conversation, because it changes what the price on the quote actually means.