Healthcare at Home: The Rowan Report

By Elizabeth Hogue, Esq.

Simply Home Health Care, a home health agency in Illinois, is suing the U.S. Department of Health and Human Services (HHS) and AdvanceMed, a UPIC, for continued suspension of payments from the Medicare Program in Simply Home Healthcare, LLC . Azar et al, Case No. 1:19cv-02313, in the U.S. District Court for the Northern District of Illinois.[Details are provided about the class action lawsuit filed by Simply Home Health Care in the U.S. District Court are

Simply Home Health Care filed a class action lawsuit in the UU Payments to the Agency were originally suspended because of an overpayment. The Agency was later told by AdvanceMed that payments were suspended because of suspected fraud. The Agency says that AdvanceMed cannot support its claims of fraudulent conduct.

The suspension of payments from the Medicare Program was ultimately reversed many months later. According to AdvanceMed, however, the Agency owed the Medicare Program $5.4 million. The amount due to the Medicare Program was later reduced to $4.8 million. Based on the alleged overpayment, Simply Home Health Care was forced to go out of business in 2017.

The Agency claims that AdvanceMed did not correctly apply federal statutes and regulations. Simply Home Health Care also claims that AdvanceMed had incentives to do so in order to win additional contracts from the Centers for Medicare and Medicaid Services (CMS). The Agency also claims in its suit that many other agencies have experienced the same fate as it did and deserve to be compensated for their losses, too. The Agency, therefore, filed a class action on behalf of both itself and these other agencies.

This case is another “chapter” in the continuing saga of providers v. UPICs and ZPICs. So far, the results of these efforts have been mixed. In some instances, providers have been able to obtain temporary restraining orders from sympathetic judges that prevented recoupments until after hearings by Administrative Law Judges. The courts in Texas, for example, have been especially receptive to providers’ requests for assistance with huge overpayments. In other similar instances, however, Courts have been unwilling to provide any assistance to providers even though providers continue to go out of business because of extrapolated overpayments and their inability to financially withstand massive recoupments.

Faced with the loss of their businesses, providers must, of course, continue to seek assistance from the Courts. The stakes are high! Consequently, providers must continue to “knock at the door” seeking relief from devastating actions by UPICs and ZPICs.

©2019 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. This article originally appeared by permission in Tim Rowan’s Home Care Technology Report. homecaretechreport.com

Update to Public Reporting of the Hospice Visits When Death is Imminent Measure Pair
The “Hospice Visits when Death is Imminent” measure pair assesses whether a hospice patient’s and caregiver’s needs were addressed by hospice staff in the last three and seven days of life. The three-day “Hospice Visits when Death is Imminent” measure will be publicly reported on Hospice Compare in summer 2019, as planned.
[It’s noted that this 7-day hospice visit measure “will not be publicly reported at this time because it did not currently meet readiness standards for public reporting. Additional time will allow further testing to determine if changes to this measure or how it would be displayed on Hospice Compare are needed, and to ensure the measure’s accuracy and reliability as an indicator of provider quality.”
For more information please see the “Public Reporting of the Hospice Visits when Death is Imminent Measure Pair Fact Sheet” in the Downloads section of the Public Reporting: Background and Announcements webpage.

CMS: “Beyond the Policy” [podcast, with highlights from the 2019 CMS Quality conference]
Today [April 3, 2018)], the Centers for Medicare & Medicaid Services (CMS) is releasing the latest episode of our podcast, CMS: Beyond the Policy. This episode brings highlights from the 2019 CMS Quality Conference. An annual event attracting over 3,000 participants this year had a strong focus on reducing clinician burden so that they can focus on patients, promote health care choice and drive value-based care. See CMS Administrator Seema Verma’s keynote speech in which she discussed the vision for Medicare and CMS this year as well as audience reaction. It is hoped that readers will enjoy this condensed version of the conference knowing that it’s not always possible to attend in person. This HCTR audience can listen to the podcast here as well as on Google Play and iTunes.

WellSky [formerly, Mediware Information Systems (Lenexa, KS) a health and community care technology company backed by TPG Capital; and Citus Health (New York, NY), a digital health solutions provider for post-acute care providers have formed an exclusive new partnership. Together, WellSky and Citus Health are launching an integrated, web-based, and mobile patient engagement module that enables WellSky CPR+ and CareTend home infusion clients to improve documentation processes and communication between patients and clinicians.

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. homecaretechreport.com editor@homecaretechreport.com

By Jordan Rau, Kaiser Health News

Eight hundred hospitals will be paid less by Medicare this year because of high rates of infections and patient injuries, federal records show.

The number is the highest since the federal government five years ago launched the Hospital Acquired Conditions (HAC) Reduction Program, created by the Affordable Care Act. Under the program, 1,756 hospitals have been penalized at least once, a Kaiser Health News analysis found.

This year, 110 hospitals are being punished for the fifth straight time. [Types of penalties incurred for preventable incidents in hospitals are identified, such as sepsis, bedsores, hip fractures and other complications. It’s noted:”Under the latest round of sanctions, each hospital will lose 1 percent of its Medicare payments for patients discharged between last October and this September. That comes on top of other penalties created by the health care law, such as annual payment reductions for hospitals with too many patients being readmitted.”]

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

Today [April 10, 2019], the Centers for Medicare & Medicaid Services (CMS) finalized policies that will increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continue the agency’s efforts to modernize Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans. [According to CMS Administrator Seema Verma, “Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries… [and, “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”]
For a fact sheet on the CY 2020 Medicare Advantage and Part D Flexibility Final Rule (CMS-4185-F), please visit: https://www.cms.gov/newsroom/fact-sheets/contract-year-2020-medicare-advantage-and-part-d-flexibility-final-rule-cms-4185-f
The final rule can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-06822.pdf

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article was reprinted in Tim Rowan’s Home Care Technology Report from a CMS news release, at homecaretechreport.com Further reproduction is encouraged. editor@homecaretechreport.com

by Darcey Trescone, RN, BSN
[The Patient-Driven Groupings Model will change the way home health is paid starting next year…and this article shares viewpoints of representatives from 3 leading software vendors–Netsmart, Axxess and OperaCare–and discusses what each of them is doing to support the industry in their own words, and most particularly they focus on how PDGM is impacting the healthcare at home industry. As one example, Billie Whitehurst, MS, RN and also the VP and GM of Home Care Solutions at Netsmart, asserted: “PDGM is not about just one thing… “It is really about changing the way home health works. Ultimately, it is a journey toward value-based care, driven by CMS.” Others focused on the newer drive toward efficiencies and value-based care in healthcare at home.]

Other HHA spokespeople interviewed for this piece also noted a newer role for software development companies to assist in PSGM needs. One suggested that software vendors must find means to assist HHAs by helping them with designing systems to educate and coach their clients and so support PDGM. As Stephen Rhoades, a Netsmart Operations Consultant, added, explaining how Netsmart is doing so: “We have created customizable roadmaps for our client agencies. Some are deploying tools complementary to the EMR such as our revenue cycle management or coding services.”

Tammy Ross with Axxess explained, “In addition to our PDGM Modeling tool, we are looking at home health agency operational processes. One simple example is we have added pop-ups in scheduling that let the end user know the LUPA threshold for each clinical grouping. Clinically, we have built episode management and pathway tools that help agencies manage outcomes with appropriate interventions and goals. At the point of care, we have tools that guide the clinician to assess and monitor for exacerbations of secondary diagnoses, and offer notifications regarding compliance with the care plan.“

Author Trescone notes in conclusion about the inception of PDGM: “As this major regulatory change approaches, we are seeing innovative tools surfacing that support providers’ need to comply with CMS’s push toward value-based care.”

©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

Cloud-based provider AlayaCare is expanding how it supports the home care industry, particularly the home infusion market, through data collection, support of the intake process, and analysis of performance.
AlayaCare’s APIs [defined in Wikipedia as a set of routines, protocols, and tools for building software applications] for interoperability, remote monitoring, schedule and route optimization, machine learning/AI, and portals all increase agency efficiency and streamline administration.
With the home infusion therapy market showing significant growth, estimated to be worth $135 billion in just five years, it is now imperative for providers to modernize and use technology to capture data across all areas of operations.

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

A new report from Harvard Joint Center for Housing Studies, “Improving America’s Housing, 2019,” shows that Americans over 55 years of age spend $152 billion per year on improving their homes. These are just the people who are already remodeling.

It seems a no-brainer to encourage these low hanging fruit homeowners to update their homes for “modern longevity.” There is a precedent: The Hartford Insurance Company Center for Mature Market Excellence partners with the USC Leonard Davis School of Gerontology to provide homeowner education at the time of a claim to impact decision-making about home modification.

In their study, “Top Smart Home Technologies for Mature Home Owners,” Hartford and MIT AgeLab staff conducted an extensive review of 25 smart home technologies. The panel reviewing the technologies consisted of leading experts in housing, aging, and technology from the fields of occupational therapy, interior design, computer science, gerontology, and engineering, plus a survey of homeowners.

The panel identified smart home technologies that may particularly benefit homeowners who have a health condition or are caring for a family member. The focus is to help homeowners and caregivers maintain safety, independence, and well-being at home.

The top 5 technologies that the panel identified [include:] Telemedical management systems; medication management systems, smart fall detection systems; smart beds, and sleep sensors. Susan Kimmel and Louis Tenenbaum used this new data to highlight HomesRenewed at the Intercompany Long Term Care Insurance conference last week in Chicago.

A strength of the HomesRenewed Coalition is the broad interest in updating homes. Through the coalition, Long Term Care Insurers, home care agencies, remodeling, technology, healthcare and more business sectors join consumers in saying:

“It is fundamentally unjust to continue medical miracles that add years to lives without also updating homes to live those lives joyfully with dignity.”
The HomesRenewed Coalition opens the door to change.

Incentives are a national topic: HR 1780, a bipartisan bill in the last Congress, called for a $30,000 tax credit. HomesRenewed is working to bring an improved bill to the new Congress.

And worth noting: The breadth of the HomesRenewed Coalition has unprecedented power to move ideas into action. Congress will listen when so many diverse segments of the economy focus on the same topic.
The HomesRenewed Coalition supports the elderly constituency’s planning home updates on Main Street, Wall Street and Capitol Hill. Tenenbaum issued an invitation for home care providers to help make it happen. Information is available here about joining HomesRenewed.

©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