Healthcare at Home: The Rowan Report

Washington, DC/San Diego, CA– The Visiting Nurse Associations of America (VNAA) and the Alliance for Home Health Quality and Innovation (the Alliance) will host the Home-Based Care National Leadership Conference, Transforming Leaders in Home-Based Care April 19-21 in San Diego, CA. As the the premier event for senior and emerging leaders from home-based care providers from across the country, conference attendees will hear from leading experts, strategic thinkers and executives in the home-based care industry on topics ranging from best-practices to new innovations in the field.

Presented as TED-style “talks” led by health industry leaders, the 20-minute keynote presentations will provide attendees with maximum exposure to key insights within the home-based care and hospice communities. Concurrent sessions will cover topics such as integrated systems and partnerships, chronic condition management, advanced illness and end of life, and non-profit leadership. Pre-conference sessions discussing innovations in workforce development and pathways to performance will also be available for attendees.
A joint partnership between VNAA and the Alliance, “Home-Based Care Events” promote innovation and excellence in home-based care. Together these organizations conduct conferences and forums, and lead the industry through advocacy and impacting policy. VNAA and the Alliance annually present the National Leadership Conference, Public Policy Leadership Conference, and the Financial Leadership Forum to further the success of home-based care providers and patients. [A listing of keynote speakers is provided near the end of this news release.]

KEYNOTE SPEAKERS:

• Tracey Moorhead, President and CEO, Visiting Nurse Associations of America
• Dr. Robert Fazzi, EdD, Managing Partner, Fazzi Associates
• Marcus Osborne, Vice President, Health and Wellness Transformation, Wal-Mart
• Joseph Scopelliti, Jr., President and CEO, VNA Health System
• Norene Mostkoff, MBA, CEO Visiting Nurse Health System
• J. Mark Baiada, President and Founder, BAYADA Home Health Care
• Marcia Reissig, RN, MS, CEO Sutter Care at Home
• Dr. Richard Popiel, MD, Executive Vice President and Chief Medical Officer, Cambia Health
• Charlotte Weaver, RN, PhD, FAAN, FHIMSS, Board Member, Visiting Nurse Health System
• Barry M. Smith, Chairman and CEO, Magellan Health
• Erik G. Wexler, Chief Executive, Providence St. Joseph Health-Southern California Region
• George Kellar, Executive Director, Zen Hospice Project
• Roy Remer, Director of Education and Training, Zen Hospice Project

WHEN:                  April 19 4:00 PM (PT) – April 21 12:00 PM (PT)

WHERE: Hilton San Diego Bayfront

by Audrey Kinsella, MA, MS

A new pilot study underway at University of California, Riverside Medical Clinics, dubbed “MS-CONNECT” (Clinicians’ Online Neurology Network Empowering Communities through Telemedicine – Multiple Sclerosis), will evaluate home telehealth service delivery to patients living with MS.¹

MS is a progressively debilitating chronic neurological disease affecting the brain and spinal cord. The disease seriously impacts mobility and cognition of more than 2 million people world-wide. There is no cure for MS and treatment results vary widely.

In this one-year study, UC Riverside researchers and clinicians will follow 200 MS patients. 100 will be randomly assigned to a control group, receiving traditional care in clinics. The other half will be seen at home, both by a visiting NP and via tele-video by the developer of the MS-CONNECT pilot-study, physician Elizabeth Morrison-Banks, M.D., a UC Riverside health science clinical professor.[Details are provided about funding by Genentech, maker of a range of MS pharmaceuticals, and about objectives of this pilot project reaching out to the MS patient population which is relatively unknown-to-telehealth studies.]

MS-CONNECT is being funded for $100,000 by Genentech, maker of a range of MS pharmaceuticals. According to Dr. Morrison-Banks, she and her team of UC Riverside researchers and clinicians have as their objective to determine whether telehealth improves care of MS patients. “They will compare data from the telemedicine intervention group with the control group,” she explained, “and compare a number of variables, including pain and fatigue levels, visual impairment, bladder and bowel control, plus mental health, sexual satisfaction and overall quality of life.²

Another telehealth study. Needed?
This one is different. While over the past decades countless home telehealth pilots have achieved measurable success with patients living with other chronic diseases such as diabetes, CHF, respiratory failure, etc., none has focused on homebound MS patients, even though this painful and debilitating neurological disease affects at least 400,000 people in the U.S.

Few MS patients currently receive any home health care services. Most of us live under the radar, with many studies showing that large numbers are not even diagnosed.³ Consequently, home health providers may be less familiar with the pain and fatigue MS patients experience.

Pain may be understandable but what is this excruciating fatigue like? Perhaps a first-person account would shed some light. Imagine the uneasiness of a life-long writer whose work habit has always been to write first drafts in longhand before turning to the computer. Then, one day, she is not able to hold an ordinary pen because it is too heavy and her hand wears out before completing a single sentence.

After 35 years of this, I can see that little has changed. There is no miracle drug yet, and though many MS sufferers of any age qualify for Medicare, few can be judged to be homebound, even though getting out to see a neurologist is extremely difficult and, therefore, only attempted about once a year. Inventing work-arounds in order to perform what used to be normal tasks is the order of every day.

Telehealth for MS patients
Dr. Morrison-Banks described her early results. “While our preliminary data suggested that telemedicine is effective for and acceptable to patients with MS, outreach was limited by the complexity of scheduling visits to general neurologists’ offices in coordination with simultaneous telemedicine consultations. We are therefore proposing this new home-based telemedicine program at UC Riverside.” ⁴

She said that the difficulties of travel to UC Riverside clinics was a repeatedly voiced concern by MS patients. Those targeted for this study cited discomforts of travel and debilitating fatigue as major challenges to even getting to the clinic. Even when they were able to do so, they described to her, the challenges continued. Just getting from a vehicle to the clinic door in Riverside’s triple-digit desert heat dramatically increases fatigue.

Heat is one of the primary triggers the onset of painful MS symptoms. Avoiding just this one trigger is argument enough to opt for care in the comfort of one’s home. Hence, the very act of moving the medical clinic into the home via telehealth already increases the level of care and the patient’s quality of life.

Dr. Morrison-Banks explained the process to me in an email:

The video group visits with the clinical team will be similar to typical neurology office visits except that the nurse practitioner will be present in person to conduct the visit and I will participate by a HIPAA-compliant video connection. Together, we will review the participant’s medical history, perform a neurological examination (which the nurse practitioner performs in person as I watch by remote connection), and go over available test results before discussing any necessary testing and treatment with the participant and any family members or friends whom the participant may wish to invite.

In both study groups, the number of visits is determined by each participant’s individual needs.  There will be a minimum of two visits, including an initial visit when the participant first enrolls in the study. If the participant is doing well with very few symptoms, her or she may only need one final visit at the end of the six-month study period. On the other hand, if the person is experiencing MS complications, he or she might need to be seen monthly or even weekly until stable again.

If at any point a participant requires in-person care for serious MS complications, we will help arrange for face-to-face care as soon as possible. In other words, we don’t expect that telemedicine will ever replace face-to-face care 100% of the time for everyone living with MS. It’s important to recognize when a video visit has reached its limits and needs to be replaced with – for instance – an ambulance ride to the hospital.

The promise of this project is that it can provide more frequent contacts with a patient’s neurologist than the cursory annual exam most MS patients typically receive. So, while not intended to be definitive, this study will certainly become fodder for more research to improve care for MS patients.

According to the National Multiple Sclerosis Foundation, about 200 new cases of MS are diagnosed each week in the United States.⁵ Dr. Morrison-Banks’ email concluded:

It is certainly possible that participants in the [telehealth] video group may experience fewer acute care service needs, if they can get these needs met more effectively through the video visits. Sometimes those who most need MS care are the ones who have the hardest time getting into the office. We hope that, by bringing the care they need into their homes, the telemedicine platform will help these people achieve better and more frequent communication with the MS doctor, which will hopefully translate into better outcomes. In our study, we will be measuring how participants in both study groups rate their own MS-related quality of life by asking them to complete a battery of questionnaires at the beginning and end of the study. Some of the issues these questionnaires address include fatigue, pain, the impact of various MS symptoms (including vision, bowel and bladder control), mental health and social support.

Thanks to Dr. Morrison-Banks’ work, the next generation of research projects in MS care may lead to new and better ways to keep tomorrow’s MS patients well at home.

¹ “Telemedicine for Treating Multiple Sclerosis Patients, https://www.healthcanal.com/brain-nerves/multiple-sclerosis/235793-using-telemedicine-treat-multiple-sclerosis.html

² http://www.healthcareitnews.com/news/uc-riverside-kicks-telemedicine-pilot-treat-patients-ms

³ http://www.nationalmssociety.org/What-is-MS

⁴ https://www.healthcanal.com/brain-nerves/multiple-sclerosis/235793-using-telemedicine-treat-multiple-sclerosis.html

⁵ http://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic

Audrey Kinsella, MA, MS, is HCTR’s telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at audreyk3@charter.net or 828-230-0895
©2017 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

Clearwater, FL (April 4, 2017) – KanTime Healthcare Software has announced its integration with OperaCare to make the Albuquerque-based company’s OASIS claims, pre-submission claims, and proactive OASIS analytics software and services available to users of KanTime’s EMR system for home health and home care providers.

Developed by a former CMS/State OASIS coordinator, OperaCare is a unique offering that provides real-time quality assurance, data driven census management and a standardized OASIS process. Written from the perspective of the regulator, OperaCare remediates ZPIC surveys and helps prevent the likelihood of ADR and ZPIC reviews. The data derived enable the provider to identify the likelihood of hospital re-admissions, and allow for acuity-based staffing and outcome-based marketing. The software is optimized for OASIS-C2, Home Health Value-Based Purchasing (HHVBP), and Pre-Claim Reviews.

“We are very excited to work with KanTime,” said Michael McGowan, President and Founder of OperaCare, LLC. “The ability to submit your OASIS with the click of a button into a data analysis system, and immediately have your report returned to you, makes the lives of home health agencies that much easier. After all my years in regulatory consulting, I identified a gap between what CMS wanted and what was being presented by HHAs. OperaCare closes that gap. Plus, to help with the ongoing home health nursing shortage, we have also been able to increase productivity while sending nurses home at night with no more OASIS documentation to do. We give nurses their lives back. Ultimately this is the biggest return on investment.  Increasing margins and submitting claims hourly are natural byproducts of the process.”

Integration into the KanTime system allows bi-directional communication between KanTime and the OperaCare platform. Essentially, OASIS data from KanTime is sent to OperaCare to be reviewed. Within a few seconds, a report is sent back with recommended changes to the OASIS from the point of view of a ZPIC investigator, based on Mr. McGowan’s depth of experience. A RAP ready report is also completed within 2-3 hours of the visit. This allows for the submission of OASIS assessments that do not raise red flags.

“We are very excited about the functionality found in OperaCare,” said Kristen Duell, VP of Business Development & Marketing at KanTime. We know it will proactively help our home health agency customers submit compliant data to CMS, which is what they need to to in order to survive and thrive in today’s increasingly regulated post-acute care market.”

About KanTime Healthcare Software

Silicon Valley-based KanTime Healthcare Software provides cloud-based enterprise software to home health, hospice, pediatric, and private duty agencies. KanTime helps agencies improve clinical compliance, increase operational efficiency and, most importantly, deliver quality patient care with its two core philosophies that are “Do It Right the First Time,” and “Manage by Exception.” KanTime software works on any point-of-care device be it iOS, Android, or Windows based, both online and offline. Additionally, KanTime offers a business intelligence tool that allows upper level management to drill down into the KPIs that affect agency performance.
kantime.com

About OperaCare

Headquartered in San Antonio, New Mexico, OperaCare specializes in CMS/MAC Claims review auditing. Service for home care agencies include OASIS Analytics for value-based payment outcomes modeling and patient re-certification management. Led by an experienced State/OASIS Coordinator, the company’s mission is to protect HHA provider revenues, enhance business growth and increase financial stability.
operacare.com

©2017 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

Illinois
Before CMS announced the Pre-Claim suspension to the world, the Illinois Home Care & Hospice Council had an idea that it was coming. They had been invited to meet with Administrator Seema Verma in March and sent Executive Director Sara Ratcliffe and some board members to the Washington HHS office, where they were joined by NAHC’s Bill Dombi and some Florida providers.

Susan Platt, administrator and co-owner of Spoon River Home Care in Peoria, told us, “For the first time in eight years, Home Care has a seat at the table! This is a very exciting and hopeful time for us,” she said. “They are finally asking for our input.”

Ms. Verma said she wanted to meet with providers in person in order to get insider views of the PCR experience by those who have been living with it for eight months. That meeting ended with the CMS administrator’s request that they come back to her with a list of suggestions for improving the PCR system before expanding it to other states and resuming it in Illinois.

The IHHC board is responding quickly. A meeting is set for April 6 to brainstorm the change requests they would like to submit. Ms. Ratcliffe told us they are keeping their minds open to the process but are likely to resonate with some of the suggestions Seema Verma already mentioned during their March meeting. Those possible changes include:

• Making PCR voluntary, but with the expectation of additional MAC/ZPIC/RAC scrutiny for providers that do not participate.
• Allowing providers to “graduate” from PCR when their approval rate exceeds some threshold in the high 90 percent range.
• Excluding hospital referrals from the requirement.
• Limiting the requirement to initial episodes, eliminating successive consecutive episodes.
• Limiting the requirement to certain diagnosis codes.

Asked about the fear that some providers would be swamped by the PCR paperwork burden and close their doors rather than bear the expense, Ms. Ratcliffe said she has not seen that happening in Illinois. “Maybe one or two agencies that were already on the edge called it quits but not because of PCR alone,” she said. “In fact, we are hearing that many agencies like it. They like getting specific feedback about their documentation errors and they like knowing pre-approved claims will be paid without question.”

Florida
We also spoke with Bobby Lolly, Executive Director of the Home Care Association of Florida, who was in the group that met with new CMS Administrator Seema Verma last month. “We were in DC for our advocacy meetings,” he told us. “We met with our two Senators, Nelson and Rubio. Then we sat down with Ms. Verma. She was very interested in hearing our thoughts about PCR.”

Not only was she interested in the thoughts of association representatives, he continued, but “The day after we got home from DC, she called us and said she wanted us to pick three providers to fly to DC to meet with her in person. They did, and she actually listened to them.”

During that meeting, the same one the Illinois delegation attended, the CMS administrator expressed her surprising opinion that Pre-Claim Review was never intended to be a fraud, waste, and abuse prevention activity. She said the primary purpose was to be assured that Medicare beneficiaries receiving home health services were genuinely eligible for the benefit and the services for which providers were billing. The only way to know that is if agency documentation clearly shows it.

Well, maybe.

In response, both association executive directors told the same story: “The criminals that have infiltrated Medicare Home Health do not see patients, they just manufacture claims. If they have to submit PCR documents to prove their ‘patients’ are homebound and that there is medical necessity for a nurse to provide services, they will have no trouble forging those documents just as easily.”

After listening to provider concerns at the in-person March meeting, Ms. Verma assured them she would be making a decision about continuing or delaying the demonstration and would let them know. She did. “On Friday, March 31, at about 4:20 pm, Eastern Time, we got the notice that PCR would not be starting in Florida the next day,” Lolly reported to us.

Hope for the other 49
After PCR resumes in Illinois and starts in Florida, CMS is likely to keep with its original plan to expand the demonstration to Texas, Michigan and Massachusetts before going nationwide. Everything still hinges on efforts in Congress to change the Affordable Care Act, of course, but it remains possible that every provider will be submitting pre-claim documents by 2018 or 2019. One additional change on Ms. Verma’s mind would make that roll-out easier on the rest than it has been on Illinois.

Bobby Lolly told us how that might work. “She said she was concerned about all the trained and, by then, experienced reviewers at Palmetto that would eventually be idled when Illinois and Florida providers bring their approval rate above the 90+ percentile and no longer have to participate. Her idea is to manage the roll-out in such a way that one state would start as a previous state began its expected decline in the number of pre-claim submissions. That would even out the workload and allow each MAC to keep its staffing needs more predictable. That alone is enough reason for CMS to make the modification that would let providers ‘earn’ their way off the program.”

Both state association directors promised to let us know what suggestions they submit to CMS, as well as anything they might hear from Ms. Verma in advance of the next public announcement. We will pass along everything we learn. Regarding restarting the demonstration, both directors are guessing the promised 30-day in advance alert will come toward the end of April.

©2017 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 Michael McGowan, former OASIS coordinator for CMS Region IX, and currently president and founder of OperaCare, a healthcare at home software company

It was a true story. “The Perfect Storm,” a book by Sebastian Junger, made into a 2000 film by Wolfgang Petersen and starring George Clooney, chronicled the tragic story of the Andrea Gail, a fishing boat that encountered a rare confluence of three meteorological events, all hitting at once, destroying the ship and its entire crew.

Though these events occurred in New England, home health agencies in Florida are about to find out exactly what the Andrea Gail crew experienced during their final day on Earth. A perfect regulatory storm is approaching Florida from the north, from Security Boulevard in Baltimore, to be precise:

• Unless last-ditch efforts to delay are successful, the CMS Pre-Claim Review Demonstration (PCRD) will be introduced on April 1.
• In January 2018, revenues for 50% of the agencies in the state will either rise up to 3% or be cut up to 3% with the Home Health Value Based Purchasing payment system.
• HHAs that failed the first round of probe and educate, and then fail round two, will be headed toward increasing ADRs, according to CMS contractors.
• ZPIC probes, audits, and investigations will increase in frequency and intensity in Florida and nationwide throughout.
• Do not forget the annual March Madness from MedPAC, who for the fifth year in a row continues to advocate for the removal of therapy visits as a payment driver, with an additional 5% reduction in the base rate.

Florida is used to its storms, but nothing like this.

So, what does this mean to the HHA striving to meet compliance standards and hoping to still be in business next year? [McGowan provides advice and instructions to Florida healthcare at home agencies regarding appropriate face-to-face documentation, preparing appropriately for pre-claim reviews, submitting appropriate OASIS documentation, advice on submitting HHVBP and undertaking a 2-person OASIS system]

1 – If you are using a form to capture the Face-to-Face requirement, you are missing the point.

Many agencies believe the F2F “form” is the actual F2F encounter note. This is a mistake. Contract auditor review teams require the actual F2F note or discharge summary note from the physician, the one that includes the date of the encounter by the NPP or Physician.

The note must include the date of the encounter and the documentation in it must be related to the primary reason home health services are necessary. There is no requirement the note contain a declaration of “homebound status,” however, if the physician does incorporate such a statement, it can only help. In short, no note = no referral.

2 – Pre-Claim Reviews
Pre-Claim Review is no more and no less than the evaluation of compliance with long standing requirements established in regulatory statutes. There is nothing new about what is required other than the form to fill out and submit to Palmetto and the date  it has to be submitted.

The early submission date moves your referral intake process and your OASIS processes to a status where they become the key factors to your success. Agencies starting a case before assuring compliance with these requirements are frequently being presented with pre-claim denials.

Even worse, in some Florida areas, ZPIC investigations have discovered “altered” physicians’ documents being utilized in home health episodes to authorize care. Consequently, more and more physicians in these areas are growing extremely reluctant to share their notes with agencies, for fear that something nefarious may happen with the documents, resulting in their own ZPIC visits.

In our consulting practice, we teach a proprietary process through which QA staff in the office engage with the nurse in the home during the OASIS visit, producing a RAP-ready, compliant claim shortly after the clinician is done.

3 – OASIS
The implementation of OASIS C-2 and the changes in the grouper and case mix compilation make it much more difficult to obtain accurate acuity scores reflective of the patient’s actual abilities and deficits. Many agencies make the mistake of submitting “light acuities” with heavy service utilization, a practice that always triggers ZPIC radar. The result is further problems in the form of probe edits, prepayment review, and occasionally millions of dollars in extrapolation.

Our consulting practice acknowledges that clinicians have an inherent understanding of what their patients need, yet they often struggle to translate those needs into OASIS data supportive of the care they want to provide. In light of that, we teach a unique, two-person, live QA process. This technique aligns the clinical expectations of the clinician, detailed in the plan of care, with the transmitted assessment data. The result across our client base is substantial increases in case-mix accompanied by near zero ADR risks.

4 – HHVBP
The inability to and effectively score OASIS assessments, meaning accurately and consistently across all clinical staff, virtually dooms an agency to failure under an HHVBP payment system as currently envisioned by CMS. If no room is left for improvement between start of care and discharge, it is impossible to demonstrate positive outcomes.

The difficulty lies primarily in the limitations inherent in the practice of sending a single clinician into the home without any accountability, until much later, of how an assessment is to be performed. Lack of consistency among assessing clinicians in the same agency creates a haphazard data pattern, which is all MAC, ZPIC and Pre-Claim reviewers have to go by to determine if an agency is compliant. What you submit to CMS, you own.

A growing number of HHAs in Florida and other states have begun to use the two-person OASIS system we teach. Generally, they find they can accurately complete four or more OASIS events per clinician per day. They routinely submit each day’s RAPs and Plan of Care documents prior to the close of business that same day. In Illinois, they have PCR submission ready as well.

We have found this to be a practical, cost-effective business practice, possible for most agencies to achieve. It enhances compliance, increases case-mix revenue, and accelerates cash flow. To help with the impending perfect storm, we will be making this system known to Florida agencies through a number of means this month and next, including live sessions and webinars through HCAF and Curaport.

Michael McGowan is the former OASIS coordinator for CMS Region IX. He is currently president and founder of OperaCare, a software system to streamline clinical process, improve compliance, and protect home health agencies against the appearance of fraud, waste and abuse. He can be reached at michael@operacare.com

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

If the Republicans pass their adaptations to the Affordable Care Act, a bill they are calling American Health Care Act, Medicaid could be cut by $880 billion over 10 years, according to the Congressional Budget Office. This alarms one Colorado advocate for people with disabilities, who fears her state stands to lose $14 billion of that total.

Dr. Patricia Yeager, PhD, is the CEO of The Independence Center, which provides services for the disabled, including home healthcare services, under a number of state waiver programs in 16 Southern Colorado counties. She spoke to the local press this week, with a stern warning that the overall cost of healthcare would skyrocket if Medicaid is cut this deeply.

“The Colorado Health Institute estimates that this will likely cause nearly 600,000 Coloradans to lose their eligibility for Medicaid by 2030,” she said. “These people would be left with little to no health care options. Those who cannot afford to pay out of pocket for medical services would be forced to go without care, increasing their risk of injury, illness, and mental health crisis.” [Details about these expected cuts to the Medicaid population’s varied health-related funding are described in this article. the populations living with disabilities being singled out as the most negatively affected by the Medicaid cuts. Types of much-needed services that will be lost with the cuts are delineated in multiple tables.]

In its current form, she continued, the bill converts federal funding for Medicaid to block grants and per capita caps, which will likely result in cutting funds from critical programs (see tables below). While reducing Medicaid, the AHCA would give states more power to minimize health care coverage for vulnerable people. Proposals in the AHCA would also result in an enormous transfer of wealth from low income to high income populations, according to “Disability Rights Maryland.”

She fears that funding cuts could mean the loss of Medicaid services and supports for close to 100,000 children, adults and seniors in Colorado who live with disabilities.

“More than others, people with disabilities are likely to have serious health issues and rely on long-term services in order to work and live in the community,” Yeager explained. “Without long-term services and support, people with disabilities would have no choice but to move into nursing homes, each person costing the state and federal government an average of $6,900 per month. In addition, many who are caregivers today would have to choose between going to work and caring for their loved one who has a disability.

“For all the risk cutting Medicaid will pose to human lives, this will not solve problems; it will create new ones. People with disabilities will continue to need financial support. Any net savings in federal spending will have to be reallocated to fund additional hospital charges, and the extreme costs of institutionalization.”

According to Dr. Yeager, until an alternative solution to Medicaid exists, cutting funding will create drastic consequences in the daily lives of people with disabilities, including those who are able to hold down a job if a home health aide helps them get ready in the morning:

• Loss of the basic right to live in the community
• Loss of safety net
• Loss of access to resources
• Loss of hearing aids and other assistive technologies
• Worsening health or disabilities
• Loss of ability to work
• Loss of housing
• Loss of life

TABLES: Endangered Home and Community Based Services for Adults and Children with Disabilities:

For more information, visit:

National Council on Independent Living

Colorado Cross Disability Coalition

Colorado Health Institute

Disability Rights Maryland

©2017 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  Roger McManus, MBA (who has held several positions as Director of Strategic Relationships)

US businesses spend $360 million on advertising every day. And every day, 80 percent of people who are not familiar with an advertised business will check it out online before spending a dime.

Certainly it used to be different, and not that long ago. A few years ago, you could run a clever radio or television ad and people would call you (on a landline phone) or drop by to check out your business in person. Not anymore!

21 Century marketing is different
Companies that provide healthcare services at home have always had to carefully spend advertising dollars but the definition of “carefully” has changed. To put it another way, the objective is still to get new clients but the tactic is now to move people to go to their computers and smart phones, not to knock on your door. [A chain of reactions to learning more about one’s products/services spurred by customers is described by McManus, who also provides this advice about advertising/marketing in today’s new world:

1. Deliver a top quality product
2. Capture the reactions of customers who are pleased with the effort.
3. Invest in traditional advertising.

He also covers the realm of “reputation marketing”–which ” has the effect of ‘insuring’ advertising dollars” and multiplying one’s positive reviews online.]

This is the best you can hope for today. People do not call you first anymore. Calling you will be their third move, if they call at all. What causes them to pick up the phone? What they find out your current customers say about you online. Google star ratings and Yelp reviews and other online rating systems, such as Facebook reviews on your own Facebook business page, are king today. After they see what other people — yes, perfect strangers — have said about you, they may then go to your web site. If they like what they see there, they may call.

Good, bad, or indifferent, this is the way people shop today. At its best, advertising only gets people to go online, where they will believe the opinions of people they do not know before they decide to spend money with a business. In home care, this means before they decide to entrust their elderly mother to you.

In this new world, today’s reasoning goes, you spend your attention and your resources in this order:

1. Deliver a top quality product
2. Capture the reactions of customers who are pleased with the effort.
3. Invest in traditional advertising.

He also covers the realm of “reputation marketing” which has the effect of “insuring” advertising dollars and multiplying one’s positive reviews online.

The unfortunate fact is that happy customers expect to be happy. While perhaps appreciated, good service is not so exceptional that it inspires people to rush home and comment about it online. A bad experience, however, is entirely different. It is always exceptional. People will go to the extra effort to warn others — yes, perfect strangers — by vilifying a business that has not served them well.

Logic would suggest that a business that has survived for a while must be pleasing more customers than it displeases. This does not matter if those happy customers are less vocal than the few unhappy ones. The whole system of online reviews skews toward a negative bias. It is simply human nature to use the anonymity of online review tools to criticize rather than praise.

In with the good, out with the bad
This is no time to kick yourself if you have not yet modernized your marketing efforts. It is not your fault that the world changed around you. However, now that you know, it is imperative that you make use of the information before your competitors do. Reputation Marketing is a two-pronged tool. Savvy businesses use it to promote positive reviews and to find, and dialog with, the writers of negative reviews. Preventing a small situation from becoming a big broadcast is another form of “insurance,” protecting future advertising spending. Making it easy for happy customers to express their experience with you in a public forum turns the insurance into an annuity.

Roger McManus is an online marketing consultant. He teaches businesses how to automate the solicitation of online reviews. He can be reached at mail@rogermcmanus.com.

©2017 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