Healthcare at Home: The Rowan Report

NASHVILLE, Tenn. – December 18, 2018 – Home health and hospice providers in the South and West have higher average lengths of stay than other regions of the country, yet the country has seen an overall reduction in ALOS, according to new data available today from PlayMaker Health.

“As providers prepare to face some of the most comprehensive reimbursement changes within the history of the industry in the form of PDGM (Patient-Driven Groupings Model), they require visibility into the trends that will affect how they plan for strategic growth in the years ahead,”says Ginger Voss, VP of Strategic Partnerships with PlayMaker Health. “Evolving patient mix and understanding the available opportunities in the market allows business leaders to develop a data-driven approach to sustained success.”[Rates of regional differences in  ALOS in South and West are presented and discussed in this article, with focus on both healthcare at home and hospice entities. it’s noted; ”PlayMaker Health will deliver post-acute industry trends and white papers with each quarterly market data update throughout 2019 and beyond.”]

Big Regional Differences

In home health, there continues to be wide differences among geographical regions in average length of stay with the South having a Q2 ALOS of 80.4 days vs 62.4 in the West, 57.2 in the Midwest, and 49.0 in the Northeast. Similarly, the South had the highest average CMW (1.072), the highest recert percent (44%), and the lowest LUPA percent (7.1%). All regions, however, have seen a decline in ALOS over the past four quarters. It will be imperative for home health agencies to evaluate their individual patient population to understand how these regional differences impact them under PDGM.

Regional differences among hospice ALOS have remained steady with the South and West at 82.2 and 80.6 days for Q2, respectively, versus much lower 71.3 and 64.3 for the Midwest and Northeast. In Q2, three regions had greater than 30% hospice discharge rates in seven or fewer days (Midwest 32.8%, Northeast 34.6%, and South 30.7%). The West has remained under 30% for the past eight quarters. Referral community education remains at the forefront of the hospice benefit.

Home Health

• Q3 2017-Average LOS Midwest: 60.3 Northeast: 50.2 South: 83.8 West: 63.9
• Q4 2017-Average LOS Midwest: 59.1 Northeast: 49.2 South: 83.8 West: 63.2
• Q1 2018-Average LOS Midwest: 58.3 Northeast: 49.8 South: 80.9 West: 62.3
• Q2 2018-Average LOS Midwest: 57.2 Northeast: 49.0 South: 80.4 West: 62.4

Hospice

• Q3 2017-Average LOS Midwest: 73.5 Northeast: 66.9 South: 83.5 West: 82.5
• Q4 2017-Average LOS Midwest: 74.9 Northeast: 68.4 South: 84.4 West: 82.7
• Q1 2018-Average LOS Midwest: 72.3 Northeast: 64.7 South: 82.1 West: 81.2
• Q2 2018-Average LOS Midwest: 71.3 Northeast: 64.3 South: 82.2 West: 80.6

“Our ability to provide insight into metrics, which include EHR referral activity, claims data, and business development activity, directly affects how our home health and hospice clients do business, and gives them a clear advantage over simply having claims information,” says John Griscavage, CEO of PlayMaker Health.

PlayMaker Health will deliver post-acute industry trends and white papers with each quarterly market data update throughout 2019 and beyond.

About PlayMaker Health

PlayMaker Health is the post-acute growth platform for hundreds of organizations nationwide. Founded in 2008, PlayMaker Health offers the industry’s most comprehensive technology to radically improve visibility and market performance for post-acute care providers. The combination of market data, including up-to-date claims data, provider and hospital referral patterns and readmission rates, EMR data and business development activity delivered through PlayMaker’s proprietary platform transforms data into actionable sales intelligence.
https://www.playmakerhealth.com

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

The innovative healthcare companies have partnered to offer care management solutions that enable hospitals to improve the post-acute patient experience.

OMAHA, Neb. – December 6, 2018 – EnsoCare, a leading provider of technology-enabled care management solutions, has announced a new partnership with Wellpepper, an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. A good amount of company detail about EnsoCare’s and Wellpepper’s vision and achievements  in planning to care for the plethora of needy LTC patients in today’s healthcare system is  provided in this article

According to a joint news release presented in this article;, “Under the terms of the agreement, Wellpepper’s highly actionable and engaging mobile treatment plans sourced from leading providers such as Mayo Clinic and others will be offered as a supplement to EnCare Transition application will have the opportunity to customize post-acute treatment plans based on established care protocols enmeshed within the Wellpepper system, creating an unprecedented patient experience.”cMore details are provided about the much-improved longer-term planning for post-acute care patients. Luis Castilli, EnsoCare’s CEO notes how one of today’s company’s biggest challenges is hospitals’ and skilled nursing providers is getting patients to adhere to their care plans after leaving their facilities. As an unfortunate result, these staff and facilities are seeing  costly readmissions and care regression that could have been prevented.

A clear call is made for partnerships among providers such as those involved with the EnsoCare and Wallpepper’s long-term care initiatives.]

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

The innovative healthcare companies have partnered to offer care management solutions that enable hospitals to improve the post-acute patient experience.

OMAHA, Neb. – December 6, 2018 – Ensocare, a leading provider of technology-enabled care management solutions, has announced a new partnership with Wellpepper, an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. [Details about Ensocare’s new partnership with Wellpepper and its expected financial benefits are provided in this article. more information about the two partnering companies and their business achievements are also provided in this article.]

Ensocare.com
Wellpepper.com

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

By Elizabeth E. Hogue, Esq.

Two more courts refused to grant requests to prevent the Centers for Medicare & Medicaid Services (CMS) from recouping overpayments before hearings by Administrative Law Judges (ALJs) [Infinity Healthcare Servs., Inc. v. Azar, No. H-18-1626 (S.D. Tex. Nov 19, 2018), and Nirvana Health Servs. v. Secretary, Dep’t Health and Human Servs., No. 6:18-cv-2044-Orl-40DC1 (M.D. Fla. Nov. 29, 2018)].

In the Infinity case, a provider of home health and hospice services was notified of an approximately $650,000 overpayment and filed suit asking the Court to issue an order preventing CMS from recouping before ALJ hearings were held. The Court rejected the provider’s request. The Court based its decision on the fact that the provider already received review through requests for redeterminations to the Medicare Administrative Contractor (MAC) and requests for reconsideration by a Qualified Independent Contractor (QIC).[Further details are provided about the Court’s refusal to try this case. Hogue also provides thorough information about a seemingly similar case, the Nirvana overpayment case brought before the AlJ and explains why recoupment was prevented Hogue provides the conclusions as follows; Now there are court decisions going both ways on the issue of whether providers are entitled to injunctive relief to prevent recoupment prior to ALJ hearings. Perhaps the most damaging aspect of some of the cases in which the Courts would not grant injunctive relief is the finding that providers do not have property interests in continuing Medicare payments. The cases based on this finding must certainly be appealed!

The Court also decided not to grant the provider’s request because the overpayment was primarily based on missing or incomplete documents. The Court pointed out that the documents consisted of records produced by Infinity and within its control. In addition, according to the Court, Infinity had the chance to submit additional documentation at both the redetermination and reconsideration levels, but did not do so.

Consequently, the Court did not see how an evidentiary hearing before an ALJ was necessary to support CMS’ position that the claims at issue were not supported by adequate documentation. The Court also pointed out that Infinity can escalate its appeal to the Department Appeals Board if ALJ hearings are not held within ninety days of its appeals. The Court said that “a provider who promptly pursues this option will be in federal court in less than a year after recoupment begins.” The Court also pointed out that Infinity’s employees would like have no difficulty finding other employment if Infinity closes because there are more than four hundred and fifty other home health agencies in the area that Infinity serves.

The decision in this case is in definite contrast to other recent decisions in federal courts in Texas that have granted providers’ requests for temporary restraining orders (TROs) to prevent recoupment before ALJ hearings [Family Rehabilitation, Inc. v. Azar, 886 F. 3d 496 (5th Cir. 2018) and Adams EMS, Inc. v. Azar, No. 4:18-cv-01443 (S.D. Tex. Oct. 23, 2018)].

In the Nirvana case, the Court said that a home health agency’s claim that it will go out of business if CMS is allowed to continue recoupment pending ALJ hearings was “too speculative” to establish irreparable injury, one of the requirements that must be met in order to grant a temporary restraining order. Nirvana, a home health agency, received notice of an overpayment in the amount of $3,242,185.77. Some of Nirvana’s requests for redeterminations were granted, so the amount was reduced to $2,919,292.43. Nirvana’s requests for reconsideration to the QIC were also partially favorable. Nirvana then requested hearings before ALJs.

CMS began recoupment and Nirvana sought a TRO and preliminary injunction to stop recoupment pending hearings before ALJs. Nirvana said that it would go out of business in the three to five years before ALJ hearings were held. The Court said that arguing the Agency would close does not show an irreparable injury, a requirement to grant a TRO. The Court also noted that providers do not have property interests in continued Medicare payments to support injunctive relief based on procedural due process violations.

Now there are court decisions going both ways on the issue of whether providers are entitled to injunctive relief to prevent recoupment prior to ALJ hearings. Perhaps the most damaging aspect of some of the cases in which the Courts would not grant injunctive relief is the finding that providers do not have property interests in continuing Medicare payments. The cases based on this finding must certainly be appealed!

©2018 Elizabeth E. Hogue, Esq.  All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author. elizabethhogue@elizabethhogue.net

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com