Healthcare at Home: The Rowan Report

ATLANTA — Brightree®, a leading provider of cloud-based software for post-acute care providers, announced this week from the Medtrade conference the release of its new Patient Hub to personalize the patient experience and increase revenue for home medical equipment (HME) providers.[Other features about the new Patient Hub app are presented. and include how this app operates by, for instance sending appointment reminders to patients, and helping patients to reorder supplies and make payments. More details about Brightree’s operations are included at the end of this news release.]

©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 Hogue, Esq.

According to a Report from the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) entitled, “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials,” published on September 27, 2018, Medicare Advantage Plans cover more than 20 million beneficiaries in 2018. The large number of beneficiaries now covered by Medicare Advantage Plans and the capitated payment model used to pay Medicare Advantage Plans caused the OIG to be concerned about whether Medicare Advantage Plans were denying care inappropriately in -order to make more money.

With regard to the capitated model of payment, a significant concern, according to the OIG, is the potential incentive the model creates for Plans to inappropriately deny access to services and payment in order to increase their profits. Plans that deny authorization of services for beneficiaries or payments to health care providers may contribute to physical or financial harm. Such denials also misuse monies that the Centers for Medicare and Medicaid Services (CMS) paid Plans for beneficiaries’ healthcare. Even low rates of inappropriately denied services or payments can create significant problems for many Medicare beneficiaries and providers….

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

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

I became a Medicare beneficiary last year and selected Kaiser Colorado as my supplement. I had my reservations about choosing a Medicare Advantage HMO but had heard so many good things about Kaiser, I decided to give it a chance for a year or two.

I am also a U.S. taxpayer.

As I read the OIG report referenced and quoted by my friend Elizabeth Hogue, Esq., in this week’s issue (“What Providers Should Do About Denials From Medicare Advantage Plans“), I began to have doubts about my insurance choice, and to get a little hot under the collar about how my taxes are being used. Let’s break down the OIG report into its simple math: [Rowan provides many specific examples of Medicare Advantage plan numbers of members’ exceedingly high  rates of denials of requests for care as well as numbers of overturned denials per year. He adds that “the rate of improper denials is actually higher than 75 percent.” And he adds: “According to the OIG, the situation is actually worse than this. “During the same period [2014-2016], independent reviewers at higher levels of the appeals process overturned additional denials in favor of beneficiaries and providers.” So the rate of improper denials is actually higher than 75 percent but the OIG report does not provide exact numbers for subsequent appeal levels.”]

[Rowan provides a number of scenarios to account for the large amount of monies being spent by  Medicare Advantage plans for services and the very large number of claims being denied…and he asks near the end of this article “Should this be legal?”

Should this be legal?

Ienforcement actions against MAOs, including issuing penalties and imposing sanctions. Because CMS continues to see the same types of violations in its audits of different MAOs every year, however, more action is needed to address these critical issues.” (emphasis added)

Look at that last line closely. Despite enforcement actions, penalties, and sanctions, the violations continue, not just with a few dishonest MAOs but with all of them. These Plans are absorbing CMS corrective efforts as a cost of doing business. Clearly, CMS efforts are not severe enough to change behavior. What are CMS and Congress going to do about it? We found this headline in the April 2 edition of Healthcare Finance. I think it was a mistake. They should have dated it one day earlier.

Medicare Advantage plans get a rate increase in Centers for Medicare and Medicaid Services final rule released Monday

“Medicare Advantage plans get a 3.4 percent payment increase in 2019, which is above the 1.84 percent proposed, the Centers for Medicare and Medicaid Services announced late Monday afternoon.”

©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

eClinicalWorks is a software company with a cloud-based EHR for physician practices. On May 31, 2017, the U.S. Department of Justice announced a $115M settlement with the Westborough, Massachusetts company over allegations regarding improper payments to referral sources in violation of the Anti-Kickback Statute.

According to Christine Cohn, a partner with Cohn Health Law, Inc. in Tarzana, California, the government’s complaint had to do with asking current customers to recommend its products to prospective customers. Cohn wrote:

“In Paragraph 4 of the Complaint in Intervention, the government alleges that ‘ECW provided remuneration to certain customers to recommend its products to prospective customers in violation of the Anti-Kickback Statute.’ More details about ECW’s ‘incentive’ programs are provided in Part VI of the Complaint (Paragraphs 79-85).

“The Anti-Kickback Statute prohibits a manufacturer of products paid for in whole or in part by federal healthcare programs, such as Medicare and Medicaid, from offering or paying any remuneration, in cash or in kind, directly or indirectly, to induce physicians, hospitals or others to order or recommend the manufacturer’s products paid for in whole or in part by such federal healthcare programs.

 

©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

[Rowan provides examples of international and long-time telehealth exhibitors absent from the conference showroom floor, and asks: “Are these large international companies signaling that they are throwing in the towel on the home health market? Has the wait for public and private payer reimbursement been too long? The adoption rate too slow? If they are they turning their attention to more lucrative markets, where reimbursement codes have recently been designated, who would blame them? ” He proceeds from there by describing 6 new startup companies offering new ideas to service today’s healthcare at home patients.]

We have been warning for years that if home health and home care do not provide remote monitoring services to patients recently discharged from hospitals and skilled nursing facilities, someone else will. Perhaps that warning is coming true. Physicians and hospitals are sending discharged patients home with telehealth systems and using their own staff to monitor them, bypassing the need for a home health nurse or a home care aide. If that is where the money is, it makes perfect sense that telehealth companies would make the business decision to turn their sales efforts toward it.

Exception: startups with new ideas

In place of the giant exhibit hall telehealth displays of yesteryear were a number of small booths with a new take on remote patient monitoring. We spoke with a company called SNAP40 that was introducing a wearable, wireless vital sign monitor. The patient slips it over the upper arm and goes about normal daily activities. Vital signs are sent to a hub in the home that attaches to the world via cellular networks or Wi-Fi. The device’s rechargeable battery, we were told, last about three days. Typically, a patient would be given two, one to wear and one to charge.

True to the scaled-down remote patient monitoring movement we detected, Synzi came to Dallas to talk with Healthcare at Home providers about a tablet-based video visit system that can, Sales VP says, help providers conduct three video visits for every one in-person visit. Video conferencing and secure messaging keep patients in touch with caregivers but also with family. The system can also be deployed on smartphones and laptop and desktop PCs.
https://synzi.com

The Care Button is a Texas company that is dedicated to “making the panic button easier” for patients to use. CEO Jens Kolind told us they found that many elderly people are reluctant to be a bother, or to risk an ambulance ride, so they often decide not to press their call button on their PERS necklace or wristband, even when they are genuinely in need of help. By connecting their button to a family member, a home health nurse, a neighbor, or a 24/7 call center, depending on the time of day and the profile of their condition, instead of a 911 operator, they are finding that help is summoned far more often. Sometimes just a phone conversation solves the problem and an ambulance is not needed. Knowing that, Kolind said, is a game-changer for vulnerable persons living alone.
thecarebutton.com

MobileHelp is another PERS company that is actively seeking post-acute care partners. The product line includes a couple of familiar emergency button systems but also includes a wearable that has some unique features. For $350 and a $25 monthly fee, an at-risk person who is not homebound can obtain a complete PERS system in a wristwatch. With its partner Samsung, MobileHelp has developed a wearable that does not look like a medical device. It is an attractive watch that reports steps, heart rate, and calories burned but can also summon emergency help at the touch of a button. It uses a popular 4G cellular network and GPS tracking. It functions as a phone to speak directly to emergency operators. It’s battery should last about two days per charge.
mobilehelp.com

Tellus is a company responding to the upcoming EVV mandate for Medicaid providers. Its smartphone-based system makes it simple for a care worker to check in upon arrival, check off tasks completed, and check out when ready to leave. It uses GPS geofencing to verify check-in location. We were told by company Training Manager Augusto Sandino, however, that the system goes beyond that. The app can also be used to verify eligibility, schedule appointments and track time and attendance, generate alerts when visits are missed or late, integrate with billing and claims processing, generate business reports, pre-adjudicate claims, and integrate with financial management systems. Device security and management can be added as an option.
4tellus.com

Next week: There was more we found while wandering the NAHC Conference exhibit hall besides these new remote patient monitoring companies. In our next issue we will look at the rest, including familiar companies with big product announcements.

©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 House and Senate agreed to a rare bi-partisan bill to fight the opioid crisis last week, agreeing on many of the pieces the individual chambers passed in recent months. The final legislation included a rollback of the Medicaid payment exclusion for substance abuse treatments in mental health facilities with more than 16 beds — a change strongly backed by public health advocates as a means to get more people into treatment and easing waiting lists for inpatient care.

According to The Hill, the 660-page bill takes a wide variety of actions aimed at fighting the crisis.

It lifts some limits on Medicaid paying for care at treatment facilities, undoing part of a decades-old restriction that many lawmakers called outdated. It cracks down on illicit opioids being imported through the mail from other countries, fueling the epidemic. It encourages the development of nonaddictive painkillers as an alternative to opioids. [The expected curbing of the opioid crisis is noted at the close of this short news release. It’s noted halfway through this article that “Sen. Elizabeth Warren (D-Mass.), for example, has a bill to provide $100 billion to fight the crisis over 10 years, which she says is more in line with what is necessary to fight the epidemic. Overdoses involving opioids killed more than 42,000 people in 2016, according to the Centers for Disease Control and Prevention. Other activity focused on drug company involvement in the opioid crisis and costs involved are also indicated near the end of this article.Drug pricing groups and some Democrats came out strongly against including the provision in the opioids bill, saying it was a “handout” to Big Pharma.]

©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

Eatontown, NJ — October 3 — Yorktel, a global leader in cloud and managed services for healthcare, government, and enterprise organizations, is announcing the integration of its Univago HE telehealth platform-as-a-service with Epic MyChart. Expanding on existing integrations in various clinical workflows, the latest advancement in the collaboration between Epic and Yorktel allows for Univago HE to be leveraged within MyChart so patients can participate in both scheduled and ad hoc virtual visits with their providers from their personal computer or mobile device….

Univago HE is an end-to-end telemedicine services platform that delivers the versatility, reliability and security vital to a broad range of telemedicine applications. An extension of Yorktel’s proven Univago™ video services platform, Univago HE was created specifically for healthcare to stabilize and simplify video technology so clinicians can use it and rely on it for delivery of virtual care in all clinical environments. The platform is versatile and flexible enough to scale across entire healthcare systems and comes with a rich set of tools to manage proactively and keep operational 24/7/365.

[Yorktel’s  telemedicine technology has expanded to meet  healthcare needs of patients  receiving treatment in a variety of settings. Extensive information about Yorktel’s capabilities in healthcare operations  are provided at the end of this article.  These capabilities include: “Yorktel enables customers to successfully integrate secure and reliable video into their healthcare operations – from telemedicine and organizational collaboration to consulting and managed services. Yorktel designs, integrates and manages healthcare system-wide video communications solutions.”

©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