Healthcare at Home: The Rowan Report

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

On Monday[March 25. 2019], CMS announced that the Administration has granted another one-year extension to an executive order that allows insurance companies to sell policies that do not meet “minimum essential coverage” regulations of the Patient Protection and Affordable Care Act. The announcement, reprinted verbatim elsewhere in this week’s issue, spins the extension as an opportunity for people to buy an affordable health insurance policy when they make too much money to qualify for premium subsidies but not enough to afford a market rate policy.
We looked into it and came away uncertain that CMS should be describing exempting some insurance policies from ACA standards as “an opportunity.” It may also cause payment problems for home care agencies providing services, assuming they will be reimbursed by a health insurance policy. [Rowan pursues this line of questioning– but only reaches conclusions for his readers that beg answers. He provides the history of the health insurance problem in the U.S., that began in 2013, when President Obama’s administration gave citizens going without health insurance when they switched jobs, and received a short-term opportunity to purchase non-ACA-compliant health insurance policies rather than go without insurance for a month or more when they moved from one job and one employer-provided insurance plan to another. Typical characteristics of a non-compliant policy were:
lower monthly premiums than can be found on the exchanges;
not being required to cover claims determined to result from pre-existing conditions; and many more such questionable policy benefits.

In other words, these are the types of policies that the ACA intended to eliminate, and policies that charge premiums but almost never pay for care. As Rowan notes: In July 2017, Congress failed to pass a bill that repealed major parts of the ACA– a bill that the then-President Trump’s Administration believed would lower monthly health insurance premiums. In Oct. 2017, in a Plan B effort to slow the rapid rise of insurance premium sums, Congress issued an executive order to change the wording of CMS’s 2013 exemption from a “3-months a year or less” to “less than a year.”
Specifically, the order declared CMS would not enforce requirements that such policies adhere to the ACA minimum time requirements. But almost immediately, some insurance companies began to sell less costly 364-day policies but only to healthy people with no pre-existing conditions. There were several consequences to these changes surrounding insurance policy changes, Rowan notes, some intentional, some not, perhaps.

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1 https://www.commonwealthfund.org/blog/2017/new-executive-order-expanding-access-short-term-health-plans-bad-consumers-and-individual?redirect_source=/publications/blog/2017/aug/short-term-health-plans#/

©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

Administration Will Not Enforce Regs Against Non-ACA-Compliant Health Policies
CMS announces an extension of the right to buy health insurance policies not subject to
By Randy Pate, Director, Center for Consumer Information and Insurance Oversight
Insurance Standards Bulletin Series – INFORMATION – Extension of Limited Non-Enforcement Policy through 2020
Subject: Extended Non-Enforcement of Affordable Care Act-Compliance With Respect to Certain Policies.1

This article covers CMS’s announcement of an extension of the right to buy health insurance policies not subject to ACA minimum standards. It goes through detailed particulars regarding which insured groups (such as small groups and individuals) are affected or not, and under which specific time periods. Readers are advised to refer to
this specific article for particulars about new insurance changes that are specific to small groups or to individuals.
If you have any questions regarding this guidance, please e-mail CCIIO at marketreform@cms.hhs.gov.

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©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. homecaretechreport.com This article is a reprint of a CMS news release. It may be freely copied. editor@homecaretechreport.com

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

Clairvoyant Networks, LLC, a leading provider of remote monitoring technology for family and professional caregivers announced this month that the company’s Theora® Care technology will be engaged in a first of its kind research project funded by The Texas Alzheimer’s Research and Care Consortium (TARCC). The grant from TARCC was awarded to Texas A&M University, the University of Texas at Austin Dell Medical School, and the University of North Texas Health Science Center for the multi-site study, “Assessing the utility and effectiveness of monitoring technology for reducing caregiver burden for Alzheimer’s Disease.”
This grant signifies the first Texas research study to examine the usability of this innovative remote monitoring technology to reduce the risk associated with wandering. Its goal is to prepare family caregivers to respond effectively in situations where their loved ones are at safety risk due to wandering and other behavioral issues commonly found in persons with dementia. [Rowan provides numerous details about the timely need for a study like this as the population of Baby Boomers living with dementia or Alzheimer’s Disease is rapidly increasing. Simultaneously the caregiving requirements of this population as limited amount of this equally growing caregiver population who are untrained to manage the Boomer population living with dementia. Later in this article the astonishing size of the Boomer population is presented: “Currently, an estimated 5.7 million Americans are living with Alzheimer’s and, by 2050, this number is projected to rise to nearly 14 million. Coinciding with the increase of people with Alzheimer’s is the impending care gap and the need to incorporate consumer-friendly technology into current care services to support the additional demand for caregiving.”

Details are provided about the goals of Stephen Popovich, president and CEO of Clairvoyant Networks, who notes that: “Clairvoyant has been working with Texas A&M and Baylor Scott & White since our company’s inception. TARCC recognized the coming storm and the importance of bringing together experts in Alzheimer’s and connectivity technology to help proactively solve what is quickly becoming an elder care crisis. Now we have the additional honor of expanding this collaboration with the University of Texas at Austin Dell Medical School and the University of North Texas Health Science Center.”]
[Many more details about in-home uses of the Clairvoyant system are provided, especially about uses of wearable and customized tracking of current patients’ needs. Wearable vital sign monitoring systems’ use can alert an assigned medical case manager via smartphone that an in-person might be needing assistance and thus timely interventions can be initiated. As a wider goal of the system: “The sensors that track the patients’ vital signs “learn” a person’s daily routine and build a database around normal times for waking, toileting, meal preparation, and the like. A geo-fence is established around the person’s home, allowing for normal activities such as gathering the mail or sitting outside in the yard. Once patterns are established, deviation from the norm can be transmitted to family members or professional caregivers. The wearable device has a cellular radio built into it. When the geo-fence is crossed, not only is an alert sent to the designated quick-response person, such as a family member or neighbor, but two-way voice communication is automatically initiated through the wearable device. “Where are you going, Mary? Do you need help finding your way back home?” The watch battery lasts for years and each charge is good for about 12 hours. It sends an alert to a family member or caregiver when it needs to be charged.”]
[Further uses of the current system for Alzheimers patients and others with traumatic brain injuries are noted, along with plans to partner with home care providers and coordinate work with family providers. The remote system “allows for better workforce management. Coordinating with family members improves customer confidence. And keeping a patient’s historical data enables a statistical view of trends that can help a case manager determine when it is no longer feasible for the person to live alone. The testing of Clairvoyant Networks system’s ability to help caregivers keep loved ones at home as long as possible without major expense is also a goal of this project.

Details are also provided about other entities involved with the Texas project and their work.: Among these are A&M and its study and its key researcher Marcia G. Ory, who notes about the study: “This is an exemplar research study utilizing innovative technology to learn how we can improve the quality of life for those who have dementia as well as their caregivers. While we all strive for a permanent cure for these debilitating diseases, it’s imperative that we develop additional means to positively impact the vast Alzheimer’s community now and in the coming years, as we as a people live longer and face massive forecasted care shortages.”

The overall aim of the study is to examine the usability and usefulness of a wearable device that has several features connecting the care recipients and caregiver. This device enables the caregiver to set up and track physical activity patterns, identify safe zones and monitor location, and provide two-way communication—-all important aspects of dementia and Alzheimer’s care management. The Clairvoyant technology being used in the research project includes the Theora Connect™ wearable for care recipients, coupled with the Theora Link™ smartphone app for caregivers. The two-way communication in the study utilizes multi-band 4G LTE cellular service.

Also very key to this project is TARCC. It is a collaborative Alzheimer’s disease research effort established by the State of Texas in 1999 through the Council, and has grown to comprise nine medical schools, including Baylor College of Medicine, Texas Tech University Health Sciences Center, University of North Texas Health Science Center, UT Southwestern Medical Center, University of Texas Health Science Center at San Antonio, Texas A&M Health Science Center, University of Texas at Austin Dell Medical School, University of Texas Medical Branch at Galveston, and University of Texas Health Science Center at Houston. TARCC’s mission is to address better diagnosis, treatment, and ultimately prevention of Alzheimer’s disease. Since the first state funding for Alzheimer’s research in Texas history was approved in 2005 by the 79th Texas Legislature, the Council has funded $43,422,496.83 in research grants across the TARCC member institutions in Texas.
Other entities described as integral partners in this project and described in more detail in the article are: Texas A&M University Center for Population Health and Aging;
and of course Clairvoyant Networks, LLC. A product that it has developed is describe as follows: “The Theora Care suite of IoT devices and SaaS applications to provide family and professional caregivers with better condition information, communications, and location services for care recipients. Recognized by Caregiver.com and Austin Inno for its innovative technology, solutions deliver situational awareness not only for the caregiver, but also for the home, medical and care management professionals that are involved in the care team.]
www.theoracare.com, support@theoracare.com,
Twitter: @Theora_Care and @ClairvoyantUWB
Facebook: facebook.com/theoracare
YouTube: youtube.com/theoracare
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1 Alz.org
2 Texas Health and Human Services, dshs.texas.gov

OVERLAND PARK, Kan., March 7, 2019—Netsmart announced today that it has been ranked #1 in multiple areas spanning the human services and post-acute care settings, according to Black Book Research’s annual survey. The Kansas-based healthcare IT provider earned the top 2019 client-rated spots in the Behavioral Health EHR, Skilled Nursing and Senior Living EHR, Home Healthcare IT Solutions, Care Coordination Solutions and Highest Client Satisfaction categories.[Netsmart CEO Mike Valentine comments on the value of receiving positive recognition from “a respected survey group like Black Book,” and he says: “Netsmart has also previously earned top Black Book spots in multiple categories in 2017 and 2018 and was named one of its top 50 disruptive health IT companies. This year’s recognition continues to distinguish and acknowledge the Netsmart commitment to excellence in all efforts to create dynamic and innovative technology needed to unite and connect our client communities to the rest of healthcare.”

About Netsmart
Netsmart designs, builds and delivers electronic health records (EHRs), solutions and services for care team members in behavioral health, care at home, senior living and social services. For 50 years, Netsmart’s 1,700 associates have been committed to providing a common platform to integrate care for 600,000+ users in more than 25,000 organizations across the U.S. with technology that automates and coordinates clinical, financial, and administrative functions.

About Black Book
Black Book Market Research is the parent group for Black Book Rankings, a full-service healthcare-centric market research and public opinion research company. Founded in 2002, the company today serves a wide variety of national and international clients. Black Book Rankings offers complete quantitative and qualitative research services, excelling in the design of customized surveys and research approaches to meet specific client needs in healthcare, pharmaceutics, biomedical devices, managed care, health insurance, and technology.

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article is a reprint of a Netsmart news release. Further reproduction is permitted. homecaretechreport.com. editor@homecaretechreport.com

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

By Tim Rowan, Editor & Publisher of Home Care Technology Report
Hospice provider preview reports and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey ® provider preview reports have been updated and are now available.
These two separate reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder. Hospice providers are encouraged to review their Hospice Item Set (HIS) quality measure results from Quarter 3, 2017 to Quarter 2, 2018 and their facility-level CAHPS® survey results from Quarter 3, 2016 to Quarter 2, 2018.
Providers have 30-days to review their HIS and CAHPS® results (March 1, 2019 through March 31, 2019) prior to the May 2019 Hospice Compare site refresh, during which this data will be publicly displayed.
Should a provider believe the denominator or other HIS quality metric to be inaccurate or if there are errors within the results from the CAHPS® Survey data, a provider may request CMS review. Providers must adhere to the process outlined on the Public Reporting: HIS Preview Reports and Requests for CMS Review of HIS Data webpage and the Public Reporting: CAHPS® Preview Reports and Requests for CMS Review of CAHPS® Data webpage.
For more information on how to access these reports, view the HIS Preview Report Access Instructions and the Hospice CAHPS® Provider Preview Reports Access Instructions.

By Tim Rowan, Editor & Publisher, Home Care Technology Report
Every March, the Medicare Payment Advisory Commission submits recommendations to Congress to set reimbursement rates for all Medicare providers for the following year. This year’s report for 2020 rates is due any day now but commissioners already voted on its essential content in January. NAHC is given an opportunity to read and comment on a first draft before the report is published, though NAHC does not release its official comments until after MedPAC submits its report. We spoke with Bill Dombi to get some background.
The NAHC president told us MedPAC’s anticipated recommendations — 2% increase for hospitals, 5% cut for home health — signify another step toward fulfilling a goal set in the IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014). “The Act set in motion a goal to have one payment system for all post-acute care,” he said. [Extensive details are provided in this article about the upcoming changes in the passage of the MedPAC 2020 Payment Recommendations. It’s noted that “MedPAC’s report to Congress is almost always ignored by lawmakers nervous about upsetting senior citizens, the demographic that votes in the largest numbers.” “Congress has a wider view and often reject MedPAC’s recommendations,” Dombi explained. “Some commissioners who have been there a while ask why Congress keeps ignoring them.” The scenario underscores the importance of Congress hearing from post-acute providers in their districts.]

Commissioners have less data with which to make their hospice payment recommendation but, because their primary concern is beneficiary access to care, they see entrepreneurs moving into hospice and conclude from that that access is not a problem and there is obviously too much money to be made.” And that the presence of in-home care is what makes it possible to drastically reduce hospital lengths of stay and, the long and ongoing problem of lessening hospital costs by using home health services instead is unfortunately hammered out falling on deaf ears, very consistently.
He said MedPAC commissioners are finally starting to figure out that more home health means a direct lowering of far larger hospital expenditures. Yet they continue to recommend rate cuts. Dombi explained, “They now admit there is a cost-reduction benefit to home health but still claim they are paying more than they need to pay to get the benefit.”

©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

Ascension’s Senior Director of Revenue Cycle and Senior Director of Performance Excellence to Co-present at Upcoming National Healthcare CFO Summit
marcus evans is proud to announce Andrew Gwin, Senior Director of Revenue Cycle, Regional Lead and David Maxwell, Senior Director of Performance Excellence at Ascension as co-presenting speakers at the National Healthcare CFO Summit taking place May 19-21, 2019 in Palm Beach, Florida.

The background and focuses of the two key presenters at this conference– Andrew Gwin and David Maxwell–are described, as follows: In his leadership role, Gwin is responsible for Regional Revenue Cycle in Tennessee, Wisconsin, Baltimore and the District of Columbia markets at Ascension.
David Maxwell, RN, FACHE has been with Ascension, the largest non-profit health system in the U.S. and the world’s largest Catholic health system, for over 10 years and currently serves as the Senior Director of Performance Excellence.
At the upcoming National Healthcare CFO Summit, Gwin and his colleague David Maxwell, will be presenting a session entitled “Denials: Improving Your Playbook.” In this presentation, they will discuss how Clinical Denials continue to be a leading opportunity to improve net revenue for most acute hospital organizations, and how Ascension is taking a collaborative approach by developing a comprehensive Playbook that invites each hospital to take an interdisciplinary approach to improving denials.

http://events.marcusevans-events.com/nationalhealthcarecfo204

Dallas, TX — March 1, 2019 — NOTIFYD announced an integration with KanTime last week. It further announced the appointment of Josh Guthrie as CTO. NOTIFYD is a Plano, Texas technology company that takes a unique approach to solving a home care provider’s communication issues.
NOTIFYD’s flagship product is a workflow solution that addresses a dispersed workforce’s engagement needs. CEO Clint Peery explained, “Both NOTIFYD and KanTime help companies achieve and maintain the highest level of success and productivity within their healthcare organization. When this happens, patients receive the highest quality and most consistent care. At the end of the day, the patient experience is what matters most. To that end, we are very excited to partner with KanTime to bring these common goals to our mutual customers.” [Among the many benefits that NOTIFYD will bring to KanTime employees are:

Broadcast, fill, and confirm shifts in minutes
Take control and manage schedules by automating shift reminders
Book trainings and fill classes without having to make a phone call
Reduce overtime and decrease labor cost
Improve client retention
Disseminate vital information such as compliance training, weather alerts, hospitalizations, and more to hundreds or even thousands of employees in minutes.]

©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

The U.S. Department of Health and Human Services (HHS) recently proposed a new rule to support seamless and secure access, exchange, and use of electronic health information (EHI).
The proposed rule is designed to increase innovation and competition by giving patients and their healthcare providers secure access to health information and new tools, allowing for more choice in care and treatment. It calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured EHI using smartphone applications.
The proposed rule places a strong focus on a patient’s ability to access their health information through a provision requiring that patients can electronically access all of their EHI (structured and/or unstructured) at no cost. Finally, to further support access and exchange of EHI, the proposed rule implements the information blocking provisions of the Cures Act. The rule proposes seven exceptions to the definition of information blocking.
The public comment period is now open for the proposed rule. We value all of your feedback – both positive and negative as it helps inform the rulemaking process. Below are the steps to submitting your comments:
Download the Proposed Rule [PDF – 3.2 MB]

Comment on the Proposed Rule

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article is a reprint from HealthIT.gov. homecaretechreport.com editor@homecaretechreport.com