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By Tim Rowan, Editor & Publisher of Home Care Technology Report  Elizabeth Pearson, esq. You cannot pick up a newspaper, turn on a TV news broadcast or visit a news web site today without hearing stories about Congressional town hall meetings. Either they are invaded by Affordable Care Act supporters or they are being avoided by representatives who do not want to face those supporters. Times of rapid change are rife with uncertainty, and loud voices. The uncertainty we are currently under is as hard on healthcare providers as it is on insurance purchasers. With all the Affordable Care Act’s flaws, the Healthcare at Home industry is growing accustomed to it, and now it is at the epicenter of the change that was voted for in November. When everything seems to be changing, grab onto an anchor, any anchor available. At last month’s Compliance Conference, home care attorney Elizabeth Pearson calmed agency owner fears with a list of anchors to grab. “Regardless of what the new administration changes,” she stated during the last week of the Obama administration, “some things will stay in place. You can count on BPCI and ACOs, for example.” (see sidebar) [Pearson provides needed details about the The Bundled Payments for Care Improvement initiative (BPCI)– what she calls “the future” in the Healthcare at Home industry. Information is provided about the expected rise of Next Generation ACOs to handle large patient populations of needy groups through their pre-acute to post-acute continuum and the expected very important roles of healthcare at home providers.]
The Bundled Payments for Care Improvement initiative is comprised of four broadly defined models of care, which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare. Calling BPCI “the future” and predicting that they will expand from Complete Joint Replacement surgeries to cardiac cases, Pearson reminded her audience that ACOs are still the present, still moving forward, and still looking for post-acute care partners. “Next Generation ACOs seem to be the most popular,” she observed. “They are still mostly found in population centers, such as the DC to Boston corridor, Los Angeles, Seattle, Houston and Miami (see map below), but they are worth watching. They virtually force hospitals to engage with post-acute providers.” She went so far as to say she can envision HHAs being asked to coordinate patient care through the pre-acute to post-acute continuum. “There are consultants specializing in creating bundles and attorneys specializing in guiding you through these partnerships. Even insurance providers are creating ACO-like groups of their own.” There are, however, some issues to watch out for, Pearson continued. Next Generation ACOs, for example, must serve a pool of at least 5,000 people. This may explain why they are appearing first in or near large cities (see map). When partnering, you will note that boilerplate contracts heavily favor the ACO. “Get your own counsel involved,” she underscored. “Examine those contracts to see who writes care plans. Physicians who own these bundles have a fiduciary relationship with them. They serve their financial interest by controlling costs. We have seen blanket orders for 4-visit limits.” Dress up for the dance Also keep an eye out for “Accountable Health Communities,” a $157 million CMS demonstration project experimenting with ways to bridge the gap between social services and health care. The Future of Partnering Everybody wants to know the bottom line. In this case it is twofold. “Change is the only constant.” And read the new Conditions of Participation in the Federal Register.
CMS Next Generation ACO map, 2016
©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 Tim Rowan, Editor & Publisher of Home Care Technology Report
A new predictive analytics system has brought better patient outcomes and stronger revenue growth to nine branches of 30-state Encompass Home Health and Hospice. The results were so significant, management is set to expand use of the tool to all 225-branches.
One of a Medicare HHAs challenges is maintaining and growing census in an intensely competitive market. The manager’s nightmare’s is losing patients to other agencies. Sometimes it happens when they have a hospital admission in the middle of a home health episode and remember only that their nurse was Nancy. More often, it happens by losing contact with them after discharge, never knowing when they might need to come back on service, only to learn later they wound up in the hospital or with a competitor. [Rowan describes Encompass Home Health and Hospice’s 9-branch pilot use of Nurture, from Nashville-based Medalogix. Nuture tracks discharged patients and, using predictive analysis, identifies level of risk of discharged patients. Value of this system is at least 2-fold: healthcare at home agencies using it can use OASIS assessments and other EMR data to create models that accurately identify the risk that any one discharged patient is likely to need additional care (which will be facilitated by the healthcare at home agency (thus keeping the patient in its care),and this system also helps facilitate patient satisfaction, which in turn helps improve HH-CAHPS scores. Rowan provides details about this system’s use by Encompass Health and Hospice in its pilot study that it turn led to Encompass Home Health and Hospice’s adoption of its program by its 225 healthcare and home agencies.]
