Healthcare at Home: The Rowan Report

Advanced TeleHealth Solutions (Springfield MO) , a telehealth services provider, conducted a study that looked at how improving the post-discharge care of chronic heart failure patients could be a strategy for reducing hospital readmissions. Full details about the study of 83 heart failure patients followed between Feb. and Oct 2011 are provided in this article. The results of the study are summarized as follows: The Results: Better Patients, Fewer Hospitalizations, Lower Costs.]

Problem and Background
Chronic heart failure patients are at the center of the national effort to reduce hospital readmissions. Nearly one in four patients is readmitted for events that likely were preventable, and more than one in 10 patients is readmitted within 15 days of being released, according to the Medicare Payment Advisory Commission (MedPAC). The leading cause of death in the U.S., heart failure is the most common hospital discharge diagnosis for Medicare patients, and treatment of them is among the most expensive. As the Affordable Care Act requires hospitals to take more responsibility for patient outcomes, health care officials are determined to reduce the number of heart patient readmissions.

In October 2012, Medicare began refusing to pay for unnecessary readmissions of patients with heart failure, heart attacks and pneumonia, and in August 2013, Medicare fined 2,225 hospitals $227 million for excessive readmissions in those categories. [To address this problem for the healthcare at home industry (which was seriously affected  by Medicare’s refusal to pay for readmitted patients with heart conditions and pneumonia, Advanced TeleHealth Solutions  developed a telemonitoring program  for heart patients

Solution: Monitoring Heart Patients Reduces Readmissions
The study evaluated 83 heart failure patients, who also had four to five other co-morbidities and had been released from an integrated health system in Southwest Missouri between February and August in 2011. The patients were divided into two groups: one received telemonitoring services for six months, and the other, a control group, did not. The results were analyzed by a Missouri State University researcher who found that patients who received telemonitoring services were less likely to be readmitted and more likely to take their medications than patients in the control group. Heart failure patients often suffer from depression because their illness can seriously limit their activities, sleep and social relationships. Compared to the control group, the patients in the telemonitoring group indicated a greater quality of life, as measured by the scores on the Minnesota Living with Heart Failure (MLWHF) scale, a commonly used Likert-scale patient self-assessment of how heart failure affects patients’ daily lives.

How Telemonitoring Works
The 83 patients in the control group and the telemonitoring group were sent home from the hospital with medications and instructions provided by their discharge nurse. Patients in both groups may have also received home health services paid for by their insurance companies. For the purposes of the study, the patients in the telemonitoring group received an additional layer of care: remote patient monitoring that included daily measurements of their biometric readings and questions regarding their symptoms along with daily phone conversations with an Advanced TeleHealth Solutions nurse, who was certified in chronic care and trained to coach patients through their recovery.

Every day the patients used peripherals such as a pulse oximeter to measure oxygen levels and heart rate, weight scales and a blood pressure cuff to record vital sign changes. With a touch of a button, these measurements and answers to questions regarding the patients’ symptoms were transmitted to the Advanced TeleHealth Solution nurses.

The patients had established parameters for their vital signs. Anytime the patients’ vital signs were outside the acceptable parameters or the patients replied to the questions regarding their symptoms in a negative way, the patients received a call from their Advanced TeleHealth Solutions nurse. The information provided a framework for the daily conversation between the patient and caregiver about the specific health issues the patient was having that day.

The nurse also provided proven clinical interventions and coordinated with the patients’ other care providers. After ongoing coaching, patients and their families were able to determine on their own when a vital sign had changed enough to be a cause for concern. When problems occurred, patients were instructed to call Advanced TeleHealth Solutions’ telehealth department, which provided nursing help around the clock.

The amount of time the nurse and the patient spent on the phone calls depended on the condition of the patient, education provided and care coordination. If a physician needed to be contacted, the Advanced TeleHealth Solutions nurse made the call and coordinated any changes to the plan of treatment with the patient.

“The work was intensive for everyone involved. Heart patients are among the most difficult to care for because there are so many vitals and symptoms—e.g. shortness of breath, fatigue and swelling in their legs, ankles and feet—to monitor,” said Tresa Marlow, Advanced TeleHealth Solutions’ Director of TeleHealth. “Adding to the anxiety is the knowledge that heart patients can deteriorate quickly and a patient’s condition can change dramatically overnight. Successful telemonitoring nurses have good communication and relationship-building skills, and the nurse responsible for the study was no exception,” Marlow said. “She had a very close-knit relationship with everyone involved.”

The Results: Better Patients, Fewer Hospitalizations, Lower Costs
A study of discharged heart failure patients who were monitored remotely shows that telemonitoring is a promising strategy for reducing hospital readmissions. Telemonitoring can keep even the most fragile heart failure patients connected to health care providers after they are sent home from the hospital. In addition to preventing costly readmissions, telemonitoring has the added benefit of helping patients comply with their medication instructions and improving their quality of life.

While patients have the comfort of knowing their vital signs and symptoms are evaluated daily, hospital administrators are learning that telemonitoring can help them reduce health care costs and keep hospital rooms free for patients with the most urgent needs.

©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

On March 13, the Senate confirmed Seema Verma to be the Administrator for the Centers for Medicare and Medicaid Services on a 55-43 vote, with four Democrats joining 51 Republican Senators voting for confirmation.

Who is Seema Verma and what healthcare philosophy does she bring to the office that affects the businesses of nearly 12,000 home health agencies, not to mention thousands of hospitals, physicians and insurance companies? We took a tour through her history to try to get a feel for what we can all expect.

A first-generation American whose parents emigrated from India, Ms. Verma earned a Masters in Public Health, Health Policy and Administration from Johns Hopkins in 1996 and a Bachelor’s degree in Life Sciences from the University of Maryland in 1993. In 2001, she founded and served for 16 years as President and CEO of SVC, Inc., a national health policy consulting company. In that capacity, she worked with Governor’s offices, State Medicaid agencies, State Health Departments, State Departments of Insurance, as well as the federal government, private companies and foundations to redesign policy and strategic projects involving Medicaid, insurance, and public health.[Extensive  details about Verma’s involvement in Medicaid funding issues, particularly her work in the “Healthy Indiana Plan,” described as the first consumer-directed Medicaid program.  Other work of hers in other states’ Medicaid programs is noted as are her views on the federal government’s supporting the Medicare population through a voucher system, as promulgated by the new HHS Secretary Tom Price.]

Her passion for Medicaid surfaced in her first official action, minutes after her swearing-in ceremony. With Health and Human Services Secretary Tom Price, M.D., Verma co-signed a letter to the nation’s governors affirming the Department’s intent to “work with states to improve the Medicaid program and the lives of those it serves.”

Experience tilts toward Medicaid
Ms. Verma’s claim to fame is the “Healthy Indiana Plan,” described as the first consumer-directed Medicaid program. She was the architect of the program under Governor Mitch Daniels of Indiana and continued it into the administration of his successor, now VP Mike Pence, who has been called her mentor.

Referred to by SVC as a historic program, Indiana Medicaid under HIP includes premiums, health savings accounts, deductibles and a work requirement for able-bodied adults. Each qualifying participant in HIP receives a $2,500 grant toward the deductible. SVC describes it this way:

“In line with commercial market consumer-driven plans, HIP members receive a $2,500 deductible health plan (HDHP) paired with a $2,500 “POWER” account, similar to a health savings account (HSA). The POWER account is HIP’s paramount feature. It acts as both a payment mechanism and a terminal through which HIP’s incentive structure flows. Members use the POWER account to pay for health care services until the deductible amount is met, at which point the HDHP becomes solely responsible for paying any further claims. Preventive services are provided outside the deductible and members do not face any barriers to seeking these services.”

SVC managed every aspect of designing and winning approval for HIP since its inception in 2007, from development of the enabling legislation, negotiating the financing plan with the State’s hospital association, developing the federal waiver, supporting federal negotiations and leading the implementation of the program, including the operational design. One of Verma’s final victories before leaving Indiana for Washington was to win approval of HIP under the Affordable Care Act’s Medicaid expansion provision.

Criticized by some as confusing for beneficiaries, some of whom have incurred penalties through no fault of their own, Verma defended her approach during her Senate confirmation hearing by saying that low-income people are fully capable of making health care decisions based on rational incentives.

Verma and Mitch Roob, then the head of the Indiana agency that administers Medicaid, touted the philosophy behind the program in a 2008 blog post, outlining a vision for health policy that “melds two themes of American society that typically collide in our health care system, rugged individualism, and the Judeo-Christian ethic.”

Internal Medicare battle looming?
Though there is little to be found in the record for Medicaid expert Verma’s thoughts on Medicare, she has stated that she does not support turning the public insurance program for seniors into a voucher plan under which beneficiaries would get a fixed federal contribution to purchase private coverage from government-regulated private insurance plans. On this policy she is 180 degrees from her new boss, HHS Secretary Tom Price, who is a prominent advocate of such an approach. Stay tuned.

©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

Boston, MA — Responding to increased growth, innovative home care management software vendor Ankota has announced an expanded management team.

• David S. Cole joins as Chief Operating Officer. He will be responsible for company operations, product development and customer satisfaction.
• Burgess A. Harrison will serve as Vice President for Marketing and Sales.
• Hamilton G. Temple joins as Regional Sales Director.

A 25-year veteran of the healthcare at home industry, David Cole brings an extensive management, healthcare, telehealth, business development and customer support background to Ankota. He is a certified Chronic Care Professional and one of the original pioneers in the use of telephony by home care providers. Cole co-founded StatChek, Inc., one of the industry’s first telehealth companies and now a part of Wi-Pro (NYSE:WIT), in 1993. His credentials include a role on the startup team at AccentCare, Inc., which has grown to over 150 offices in 11 states. He has founded and managed healthcare at home provider agencies and served as the Medicare administrator for Interim Healthcare of Atlanta, Georgia.

Cole bring to Ankota a novel model he helped develop for post-discharge patient management that has proven to achieve the Triple Aim of lowering costs while improving outcomes and patient satisfaction.

Burgess Harrison is a seasoned marketing, advertising and sales executive with extensive experience in telehealth, communications, technology marketing and sales. A pioneer in electronic visit verification (EVV) and telephony, Burgess has spoken at National Association for Home Care. Most recently he co-founded Triple Aim Technologies, an innovation in remote patient monitoring with its Multi-Morbidity Engine™ technology for the post-acute care market. Previously Harrison led marketing efforts at American TeleCare and StatChek and the healthcare division of InfoCrossing (now WiPro).  He also is a member of the board of directors of the 109 retail store chain, Tradehome Shoes.

Hamilton Temple, most recently with Savii Care, brings 20+ years of sales and marketing experience in high tech and enterprise software with the last 9 years being exclusive to the post-acute technology space. He has worked with providers of home health, home care, DME and Infusion.

“The addition of these three experienced leaders will accelerate the growth of Ankota exponentially in the coming months,” asserted Ken Accardi, CEO. “We promise ‘next generation’ home care software and I cannot think of any other people that embody that mission more than David, Burgess and Hamilton.”

About Ankota 
Ankota™ offers the post-acute care industry a customizable home care management system on a Software as a Service (SaaS) platform. The software offers telephony, GPS, fixed number generator fobs, biometric authentication and verification schema. It manages people, payers and programs via configurable business rule sets and supports optimized delivery of care in homes, readmission reduction, individualized plans of care and cost controls. Sophisticated scheduling algorithms support managing non-skilled and professional workers in post-acute markets that include AAA’s, Medicaid, DME, therapy staffing, infusion and phlebotomy.  Foresight Care™, an innovative remote patient monitoring service and patient engagement platform, helps avoid hospital readmissions at the lowest possible cost.
ankota.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

The Centers for Medicare and Medicaid Services awarded five contracts to three new collection agencies on October 31 [2016] and they are just about ready to begin to examine your claims and documents, looking for overpayments and underpayments.

The contractors are (full contact details below):

Region 1 – Performant Recovery, Inc.

Region 2 – Cotiviti, LLC

Region 3 – Cotiviti, LLC

Region 4 – HMS Federal Solutions

Region 5 – Performant Recovery, Inc.

If you are still wrestling with overpayment accusations from a previous RAC investigation, you will continue to deal with that legacy collection agency. CMS stated that their original Medicare FFS RACs will be under contract with CMS until 2018 for administrative purposes. Providers may still receive correspondence related to claims adjusted under the original RAC contracts. [A thorough overview of the Medicare Fee for Service (FFS) Recovery Audit Program’s mission is provided in this article; and new RACs as of Oct. 31, 2016 are identified by region and purposes. The goal of RACs, it’s noted, is to “identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.”]

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From the CMS announcement

Mission – The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.

Background – The Medicare FFS Recovery Audit Program began as a demonstration required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The demonstration was conducted from March 2005 to March 2008 in six states to determine if Recovery Auditors could effectively be used to identify improper payments for claims paid under Medicare Part A and B.

This demonstration allowed for additional review of Medicare claims for payment by utilizing Recovery Auditors on a contingency fee basis to identify and investigate claims with calculated risk. The demonstration established Recovery Auditors as a successful tool in the identification and prevention of improper Medicare payments. Section 1893(h) of the Social Security Act authorized the Recovery Audit Program expansion nationwide by January 2010.

Only one RAC for HHAs
The RACs in Regions 1-4 will perform postpayment review to identify and correct Medicare claims that contain improper payments (overpayments or underpayments) that were made under Part A and Part B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice.

The Region 5 RAC will be dedicated to the postpayment review of DMEPOS and Home Health/Hospice claims nationally. Region 5 contractor, Performant, will conduct a webinar on March 21 for Home Health and Hospice providers. Click here for further information.

[A©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

July 13, 2017 will arrive before you know it. On that date, Healthcare at Home organizations that participate in the Medicare program will be under new Conditions of Participation. According to the rules, the new CoPs become law six months after they were published in the Federal Register, which happened on January 13.

Between now and July, providers need to prepare operational adaptations with two central goals: interdisciplinary cooperation and patient independence. Software systems must evolve as well but protocols and practices must change more. We spoke with some software developers to learn the extent of the required changes. The consensus is that provider adjustments are the more extensive but that EMR vendors will help where they are able. [Rowan reviews the more extensive changes that non-accredited agencies will need to make to comply with the new Conditions of Participation (CoPs). In addition, Rowan notes industry spokepeople’s views on key issues of the new CoPs (such as interoperability of Healthcare at Home EMRs with hospital and physician EMRs,.  Attention is also paid to the new CoPs’ focus on  Healthcare at Home’s personnel’s supervisory visits and exactly CMD is looking for in this regard.]

Easier for accredited agencies
Many of the new conditions will be familiar to agencies that are accredited by the Joint Commission, CHAP or ACHC, we were told. New forms to track infection surveillance, completing discharge documents in seven days and transfer documents in two days, emergency disaster plans and new documents to show that patients with Low English Proficiency were adequately informed of certain rights are already in place in accredited agencies. “The new conditions emphasize interdisciplinary cooperation and will call for changes in operational practices more than software adaptations,” explained Bonnie Yingling, a Senior Product Manager for Delta Health Technologies. “Other changes are already in place in other software, such as hospice QAPI, and easily added to home health software.”

As an example of an operational change, she described how the new CoPs encourage therapists to speak with patients about wounds and medications and nurses to talk with patients about the importance of the exercises the physical therapist gave them. In other words, all disciplines are being asked to more often say, “How can we support each other?” rather than, “That’s not my job.”

Care planning as well will have to be more patient-centered and interdisciplinary. These requirements will not require developers to reformat plan of care screens in your EMR. They will have more of an impact on how providers manage planning for patient care, with an emphasis on interdisciplinary cooperation aimed at teaching self-care to encourage patient ownership over their chronic conditions.

Interoperability opportunity?
Looking on the positive side, CEO Tom Peth of Thornberry Ltd. wondered aloud whether the new CoPs might instigate some streamlining. Thinking ahead to the perennial, elusive quest for interoperability with hospital and physician EMRs, he hopes this might be an opportunity to issue the new discharge and transfer summaries in C-CDA format rather than merely PDF. “That would make it possible for the data to be consumed by the receiving provider’s EMR,” he speculated.

Supervisory visits
You may see revisions in your software in the way it formats home health aide assessments. CMS wants to see nurses comment about quality of care more than about whether specific tasks were completed. “A patient may be served by different individual aides during an episode of care,” we were told by Donna Baldwin, Delta’s hospice product manager and compliance consultant. “CMS is interested in how the patient was taken care of, not in how an individual caregiver behaved.”

One of the elements will be a standardized format for recording aide assessments, another relatively easy requirement for software developers to meet, though perhaps a little more work for supervisors. “They can no longer just click the box for ‘supervision done,'” Ms. Baldwin added.

“The 5-star agencies are already doing most of this,” Ms. Yingling concluded, “either at the behest of accrediting agencies or contracts with Medicare Advantage firms. Adapting EMR software systems for OASIS updates is much more complex than this will be.”

More to learn
With the new emphasis on capturing patient preferences to make the plan of care more patient-directed, many vendor developers are curious to see exactly how CMS wants providers to accomplish that. “I think we’re all interested in seeing upcoming interpretation/guidance,” Thornberry’s Peth mused.

©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