Healthcare at Home: The Rowan Report

BY Iim Rowan, editor and publisher of Home Care Technology Repot

©2019 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

Savii Inc. has announced in a new release dated Dec. 11, 2019, the signing of Eden Health, a division of the EmpRes Healthcare family of companies, to deploy its SaviiCare Electronic Medical Record software system as its home care business line’s agency management software.
“We are thrilled to partner with Savii and excited about the possibilities this partnership will generate,” said Jamie Brown, Eden’s Vice President of Home Services. “As a company, we are always looking at utilizing technology that will enable us to create a dynamic, client-centered approach to our care staff with the tools they need in order to provide exceptional care to our valued clients.”
Eden relationship with Savii blossomed through an in-depth discovery process where key areas of optimization were uncovered. Ultimately, Eden selected Savii for its revenue cycle management, true hierarchical database that supports a multi-location and multi-state agency, and the flexibility of its home care billing module.
Savii CEO Kristen Duell weighed in, “We are excited to be partnering with Eden Health and look forward to supporting their business growth through streamlined workflows.”
Details about EmpRes Healthcare (a division of EmpRes Healthcare — which is a 100% Employee Owned family of companies providing management and consulting services to rehabilitation and post-acute care centers is provided in this article. as are details about Savii, Inc., where it is noted: “Savii is a Home Care technology provider that believes in designing and developing agency management and point-of-care solutions that transform the way care is delivered in the home. Innovation is at the heart of everything Savii does. Savii is owned by United Kingdom-based H.A.S. Technology Group.
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article is a summary of vendor press releases and may be freely printed and shared electronically. homecaretechreport.com. editor@homecaretechreport.com

by Tim Rowan, Editor and Publisher of Home Care Technology Report

2) by Tim Rowan, Editor & Publisher of

Home Care Technology Report

by Tim Rowan, Editor & Publisher, of Home Care Technology Report

AlayaCare predicted that 2019 would be the year of caregiver engagement and home care agencies committed to this did differentiate themselves in their market. :

Clinical care and personal care began to become one in the same affecting the role of the caregiver as a driver in achieving positive outcomes for their patients. With these shifts we also began to see virtual care and remote monitoring become more important as a value-added service to home health care patients.

Prediction1

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A patient may be headed towards an adverse event or negative outcome. Performance measurement against services and communication back to referral sources supports remaining competitive in a market space. Financial well-being of care workers
Satisfied caregivers are directly tied to satisfied clients. While there are many challenges with caregiver churn, data shows that consistency of hours is the single greatest predictor of retention. Savvy agencies are experimenting with new strategies to attract and retain them.According 7o AlayaCare CEO, Schauer, “We believe caregiver satisfaction is driven by building a good schedule, i.e. consistent hours, respect preference/availability, avoidance of split shifts, minimize drive time, and maximize caregiver patient face time.” Caregiver schedules should ensure hourly work assigned helps to maintain income stability for the workers.
Additionally, mobile applications should help caregivers feel empowered when providing care and allow them to finish paperwork while with the patient. AlayaCare built its AlayaCare Mobile application with the user experience in mind and included in it dependent that minimizes repetition and complicated documentation processes.

Mix of payer sources becoming more important
We are continuing to see a major trend toward diversifying payer sources. Private pay agencies are courting third party payers and health authorities; public pay agencies are investing in private pay business lines.
In the U.S., we increasingly watch private duty providers getting into Medicaid and long-term care insurance. AlayaCare’s integration with Waystar facilitates a seamless claims process between providers and insurance payers. With Waystar, AlayaCare clients can pre-screen for claim errors, check insurance eligibility, and consolidate and manage their electronic claims from a single location.
Added Schauer: Private duty home care agencies traditionally have an easier time than other providers in working with third party payer sources because they already have a culture of client service and client experience in place. The back-office billing changes required of the private duty home care provider are manageable and AlayaCare tools support them in accommodating the changes of third-party payer sources.
Long-term care insurance continues to become more prevalent as a payer source and we are seeing assignment of benefits to the home care provider to manage. AlayaCare has just released a Long-Term Care Billing module which manages the whole insurance package for patients as opposed to delivering services, invoicing the patient, and leaving it to the patient to manage. Long term care insurance often presents with complex billing scenarios that AlayaCare’s Long Term Care Billing module addresses.
….. Multiple technological partners seamlessly working together
Each agency needs an IT infrastructure that sets them up for success in a rapidly changing industry. Agencies must ensure their software is capable of growing with it. AlayaCare is an end-to-end solution for delivering home care – its cloud-based architecture is ready for all companies who have perfected tasks to integrate. The formula for success is to have multiple technological partners seamlessly working for an agency all in one space.
Schauer: There is a pattern for enterprise software architecture that is finally taking hold in larger home care providers. These providers want their enterprise software in the cloud with open API’s and event driven architecture. They also expect to easily plug in various solutions with the enterprise system and have it all work harmoniously together.
At the top end of the market larger providers are looking to differentiate themselves and they are choosing best of breed tools that help them realize their brand promise. They expect the chosen tools will work with their electronic medical record (EMR) systems. AlayaCare works closely with these customers to meet these needs.
For the smaller home care providers AlayaCare has been proactively building out an ecosystem of partners with pre-built integrations. Areas such as applicant tracking and customer experience are only a few examples of what the AlayaCare ecosystem addresses.
About AlayaCare
AlayaCare’s platform supports back office functions, client and family portals, remote patient monitoring, telehealth, and mobile care workers in one integrated, secure, cloud-based system. I

©2019 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 Ann McCaughan
Discusses father Harry’s new living situation, with Alzheimer’s Disease–and her role as a lifelong cardiac nurse and arranging for an assisted living placement for him. She notes that he was well cared for there–physically and emotionally but she found out that training she had put together for theLr staff had been overlooked. Central to her father’s daily care routines was drinking large amounts of fluid to control his b.p.and keep it from rising.
A call that the author received one morning about plans to transfer Harry to a hospital was received by the daughter and steps were taken by the ALF staff to regulate the b.p with regular daily use of the FDA-approved Zoe Fluid Status Monitor. The author uses this case to note that the Zoe Fluid Status Monitor, from Noninvasive Medical Technologies, is now carried from home to home by home healthcare nurses to ensure regular testing of their cardiac patients

by Tim Rowan, editor & publisher of Home Care Technology Report

The compassion and expertise of hospice nurses is the stuff of legend. They seem to know what to say, when to say it, and when to simply be present and say nothing. Their loving treatment of grieving families comes not from a textbook but from a deep place where one spirit is able to touch another. But not every homebound patient dies under hospice care. Often, home health nurses are faced with being present at a death or having been the last clinician in the home before the patient crossed over.
Veteran hospice nurse Barbara Karnes, RN, an internationally respected speaker, educator, author, and thought leader on matters of end of life was a hospice administrator when her parents died within five months of each other. As a former home health and hospice field nurse and, later, administrator, and the founder of BK Books, based in Vancouver, Washington, she recently came to notice how often home health nurses are thrust, without warning or preparation, into a hospice-like role. She wanted to help, so she brought her end-of-life education program to last month’s NAHC meeting. We spoke with her afterward.
Knowledge brings comfort
Products from BK Books include videos and books for nurses, family members, and terminally ill patients themselves. Karnes would like to see home health nurses using them for the benefit of everyone involved, just as hospice nurses have been doing for decades. The starting point is a film titled “How People Die.” Karnes recommends the 3-part film, available on DVD, be shared with staff over three in-service days, with ample time set aside for discussion after each segment.
“Taking care of your front-line staff requires preparing them to cope with a death event,” Karnes told us. “Hospice care makes different demands on a nurse. That is why I have materials that help nurses to not only care for the grieving family but care for themselves as well. After conducting the three in-services around my film, I urge management to hold a fourth in-service, using my booklet ‘You Need Care Too,’ and its accompanying DVD, ‘Self-Care.’ There is a lot to talk about during such a session and there is always someone who has experienced it.” She added that she is preparing an online course on the same subjects.
Hospice has changed
One of the reasons Ms. Karnes has turned her years of hospice experience into educational materials, she told us, is that regulatory and payment structures have changed hospice practice. “The goal of hospice, unfortunately, is no longer to be present at the moment life ends. In fact, we know that 55 percent of families have not had a nursing visit in the two weeks preceding a death. That is why specialists, known as “End-of-Life Dula’s,” are now stepping into the void created by hospice nurses not being there.”
This may also be the reason more home health nurses find themselves thrust into the role. “All too often, they do not know, any more than the family does, what they should be doing during the natural dying process,” Ms. Karnes continued. “I teach both healthcare professionals and lay people in the community about the process, specifically ‘here is what you can do while it’s happening.’ I do it because I have seen family standing around the bed holding each other’s hands, wanting to hold the dying person’s hand but afraid to. It is a natural process but many people do not know how to behave during it.”
“There are two ways to die,” Ms. Karnes explained, “suddenly or gradually. When someone is going through the natural, gradual dying process, people need to know what to do, not just hospice nurses but loved ones and non-hospice clinicians as well. That is why I wrote these books and produced the films.”
Books target each need
To help all parties know what to do during the normal dying process, BK Books offers specific titles, targeted to each group:*
“Gone From My Sight” is designed to be read together by clinicians and family members shortly after a terminal diagnosis. Ms. Karnes’ first book, it has been translated into 11 languages.
“A Time to Live” is for the dying patient him/herself. It offers encouragement and strategies to live while their body declines.
“The 11th Hour,” tells people what they can do and say while a loved one is actively dying.
“How Do I Know You?” helps family members understand dementia, which Ms. Karnes describes as “the disease which does not play by the rules.”
“Pain at End of Life” deals frankly with pain and opioids and the fear that accompanies a terminal, painful chronic illness.
“My Friend, I Care” is a booklet the hospice or home health agency gives to the family after a patient dies. It helps people understand the grieving process. Plus, staff members can sign the inside cover, and the book becomes their sympathy card.
Origins: clinical vs. financial decisions
Barbara Karnes ran a home health agency and a hospice early in her career. Her journey to hospice expertise began shortly after graduating from nursing school when she learned about hospice in Great Britain. Captivated, she abandoned ideas of a social work-oriented nursing career and followed her heart into the fledgling U.S. hospice movement. “I had no pre-conceived ideas,” she told us, “no one did. We learned as we went along.”
She spent five years at the bedsides of the dying, comforting, observing, and learning about end-of-life matters from patients and their families. After her parents died, as mentioned above within five months of each other, she left the workforce for a time, eventually electing to return as a writer and speaker rather than join another hospice organization. She wrote “Gone From My Sight” in the mid-1980’s.
“I ran a home health agency as well as hospice,” she explained, delving into her administrative as well as clinical expertise. “I know how home health patients and their families get attached to their nurses and their aides. I also know that an HHA wants to bill for as long as possible. They are sometimes reluctant to let a patient go into hospice…unless they happen to have their own hospice.”
This finance-driven preference, she continued, is often supported by the family but for other reasons. They may have grown attached to their loved one’s nurse, or the patient may believe hospice means having to admit, “I’m dying.” They may not be emotionally prepared to make the move from curative to palliative care, wanting to deny that death is imminent.
“Therefore, it has become necessary to teach home health nurses — and aides and social workers — how dying happens. Most people do not know, even many healthcare professionals. If home health is involved in dying — even when not the result of a clinically-driven decision — they have to know how to take care of both patient and family. They have to know to shift focus from the disease to the person, as a hospice nurse does.

*Some books are available electronically; some videos are available through Vimeo.

©2019 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.comi

by Tim Rowan, Editor and Publisher of Home Care Technology Report
In mid-November 2019,QliqSOFT, a provider of HIPAA-compliant, clinical communication solutions, unveiled a home health nurse distress notification-enabled mobile care-delivery app. For more first hand details, go to see Visit Path, at the 2019 National Hospice and Palliative Care Organization conference.
Visit Path is a care delivery resource management app designed to provide hospice and post-acute business administration staff with data that improves business and patient outcomes. Now, Visit Path puts safety in the hands of the home health nurse by providing a quick, discreet means of notifying staff should a nurse need urgent assistance during a visit or while en route to a home health visit.
“This app is a good solution for hospice and home healthcare agencies that want more insight into their care delivery data to reduce costs and improve their business outcomes,” says QliqSOFT Founder and CEO Krishna Kurapati. “Additionally, the distress notification provides safety and security for nurses while visiting homes and if they should run into trouble while in transit between visits.”

“We wanted to provide hospice and home healthcare agencies with a product that gives them real-time knowledge of completed patient visits activity to help them better manage their field staff,” Krishna also said. The Visit Path web-based administrator’s dashboard integrates with GPS-enabled smart devices to ensure patient care delivery is optimized, on time and recorded. This, along with the ability to manage unscheduled and after-hours visits, improves patient and home health nurse satisfaction, patient outcomes, billing accuracy and maintains a digital record that ensures government reimbursements are never penalized.

As a real-time, GPS-enabled, care management delivery solution, Visit Path verifies where and when a hospice or home health field nurse is on duty, begins service for a client, when they complete service and when they are off duty. This verification of service is the basis for accurate, compliant billing. The administrator’s dashboard is a window into ROI.

About QliqSOFT, Inc.

With its unique, cloud pass-thru architecture, QliqSOFT’s Secure Texting, On-Call Scheduling, Patient Communication, and Clinical Collaboration solutions are trusted by over 1,000 Hospitals, Home Health, and Hospice Organizations to deliver HIPAA-compliant, reliable, and real-time communication between doctors, nurses, caregivers, and patients.
qliqsoft.com

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article is a summary of vendor press releases. homecaretechreport.com. editor@homecaretechreport.com

by Elizabeth Hogue, Esq,
What Home Care Providers Need to Know About New Stark Rules

On October 9, 2019, the U.S. Department of Health and Human Services (HHS) issued proposed rules that include significant changes in regulations under the so-called Stark Law. These changes are in the form of additional exceptions under the Stark Law. [We will note the half dozen or so change below and add, too, details on an upcoming teleconference on changes to the new Stark Rules presented by Elizabeth Hogue.
Upcoming Teleconference

Eizabeth Hogue will be presenting a teleconference on the new rules on November 13, 2019, 1:00 to 2:30 pm EST.
Here are key changes in the proposed rules that [may affect] many providers. such as home health agency nurses, hospice nurses and durable medical equipment (DME) providers.

by Darcey Trescone, RN, BSN
Technology innovations are forever changing the way we practice nursing, regardless of care setting. As healthcare slowly moves into today’s technical world of predictive analytics and artificial intelligence (AI), nursing practice will benefit from the increased insight. The nurse will remain as a critical validation point, ensuring accuracy of the data presented and what the plan of care should be.
The ability to compile data from multiple sources and utilize algorithms to present content such as potential risks and potential disease trajectory of a patient enhances the role of the nurse and care team. This is an area that has been a challenge because documentation of data within an EMR, and across our healthcare delivery system, has been relatively inconsistent, even unavailable, in the past.
As clinicians, we have had to provide and plan care for our patients with minimal information beyond what we had assessed. Nurses frequently enter both home care and hospice settings with little to no information except what is learned through family conversations and a basic, paper face sheet. Even that information sources may come from another care setting. In spite of the advancement of technology, many providers in our industry are still functioning with limited information and are reliant solely on their clinician’s documented assessment.
How AI changes nursing

What changes with the entrance of predictive analytics and artificial intelligence is the activities of our nurse clinicians providing the care. There is a good percentage of time that clinicians spend reading through patient documentation and putting the data puzzle together to determine the best course of care for a patient and family. If information can be compiled and the puzzle of data presented to the clinician prior to care, the clinician is then more knowledgeable and performing nursing activities at a more advanced level, from the first visit to the patient.
This insight helps with understanding treatment modalities that may benefit the patient earlier on, leading to better care quality and improved patient outcomes. These treatment modalities may include the introduction of more technology to better manage the patient, such as telehealth. Telehealth then provides additional data points that feed predictive analytics and AI tools presently available to the clinician, further advannce the level of care that the clinician can provide.
Additionally, a more comprehensive clinical picture that includes social determinants with valid disease trajectory predictions enhances the approach of the entire care team. Case management and nurse oversight can be provided in a more complete manner because data is readily available to all members of the team looking to improve patient outcomes.
Earlier identification of patient improvements and declines enhance the care outcomes for a patient and the nursing practice overall. Important aspects of any technology though are the nursing profession’s involvement in defining what is valuable and participation in developing education regarding nursing practice changes that need to occur with this advanced knowledge. As a profession, nurses are key to understanding, validating, and utilizing predictive analytics and AI data in the safest manner, both to enhance patient care and to achieve the best outcomes.

Darcey Trescone, RN, BSN is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice.

Latest Healthcare at Home News:
Harry’s Zo Holiday (11/13/2019)
The CEO of Noninvasive Medical Technologies knew the tech company’s “Zoe Fluid Status Monitor” helped patients avoid hospitalizations, but she never thought her father would be one of those patients.

Technology is Changing How We Practice Nursing (10/30/2019)
The ability to compile data from multiple sources and utilize algorithms to present content, such as potential risks and potential disease trajectory, enhances the role of the nurse and care team.

by Michael McGowan
Consider the lowly scribe. One person trained to write down what other people do and say. Johannes Gutenberg’s printing press eliminated the need for scribes in the 15th Century. Ironically, modern health information technology has resuscitated it, specifically, credit goes to the Electronic Medical Record.
[McGowan lays the framework for reverting to the use of medical scribes to realise efficienciesLetin an agecies’ efficiencies and comprehensiveness.
Michael McGowan is a former OASIS coordinator for CMS Region IX and the founder and CEO of OperaCare.

©2019 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