Healthcare at Home: The Rowan Report

HEALTHCAREfirst, which announced this week that it closed 2016 with one of the strongest 4^th quarters in its history, has set its sights on new initiatives for 2017.

According to J. Kevin Porter, President and CEO, “We had an outstanding year in 2016. We continue to mature and innovate, confirming our position as the first choice solutions provider for home health and hospice. We are on track with key strategic initiatives and development projects, and I believe 2017 will be a banner year for our company, our employees, and our customers.” [Details about the planned initiatives are indicated, and will include: investment in product and service development, provision of “a unique, high-touch service experience through enhancements to implementation, training, and support programs,” and “additional staff across the organization to accommodate continued growth while maintaining focus on superior service and support.”]

New initiatives will address the growing needs of its customers to increase profit margins, improve quality of care, and effectively address compliance requirements in light of changing reimbursement models, heightened regulatory scrutiny, and increased transparency into quality.”

• Considerable investment in product and service development, including expansion of partner interfaces
• Providing a unique, high-touch service experience through enhancements to implementation, training, and support programs
• Additional staff across the organization to accommodate continued growth while maintaining focus on superior service and support

Steve Sablan, Senior Vice President of Products, stated, “We are laser-focused on innovating our products and services. We look forward to working hand in hand with our customers to give them the solutions they need for success in 2017 and beyond. There are so many exciting things happening at HEALTHCAREfirst, we are definitely a company to watch this year.”
healthcarefirst.com

©2016 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

Product comparison by Cybernet

An Industrial Grade Tablet is a rugged mobile tablet computer designed and built with military-grade components to operate reliably under harsh industrial environments, such as extreme temperatures, shock, vibration, wet, or dusty conditions. They are designed for the type of rough conditions frequently found on the manufacturing floor, in the field or warehouse, or in emergency situations.

An industrial tablet PC is rugged not only in the external casing but in the military-grade discreet components and the cooling system. The terms “rugged,” “ruggedized,” “industrial,” “industrial grade,” and “military grade” are interchangeable and apply to the same design robustness and set of features. Typical applications for the industrial grade tablet include the retail, manufacturing, healthcare, public safety, oil and gas industry, military, transportation and distribution, field services, construction, & agriculture. [Rowan provides extensive details comparing features and costs of industrial- and consumer-grade versions of tablets– with the “ruggedized-” and“industrial”-grade versions evincing a far superior choice for healthcare at home service providers in terms of lower cost of ownership, fewer failure rates, greater length of life cycle,  longer as needed battery life, and more rugged durability especially among typical in-home hazards like drops, spills, scratches, and so on].

When comparing an industrial tablet and a consumer tablet, the initial purchase price of the latter is lower. Yet, the purchase price is only a fraction of the tablet’s Total Cost of Ownership (TCO). In the long run, consumer tablets show a 15-30% failure rate when used in industrial environments, according to VDC. Failure rates result in downtime, replacement or repairs costs.

Failure Rates
Industrial tablets have an overall failure rate of less than 2% when used 24/7 in harsh industrial conditions. An industrial grade tablet’s lifecycle with military grade components is 5+ years, plus extended warranties and guaranteed availability of the same model and its spare parts.

Life Cycle
The lifecycle of consumer-class tablets is measured in months. Its rate of device churn – when a newer model is released and the older model is retired – is typically six months to one year. The manufacturers of consumer tablets are interested in pushing the newer model, so the older devices stop receiving OS updates and security patches. As older devices get discontinued, the newer models do not guarantee backward compatibility for applications or accessories.

An industrial tablet is upgradeable in the field and can be repaired on-site by your IT department with tool-less access. This minimizes the maintenance and repairs costs and time, as you don’t need to send the unit for repairs. This, too, makes the TCO of an industrial tablet significantly lower than that of a consumer device. Factor in the full disk imaging, complete with your already purchased OS license and whatever productivity software you use installed, and you get a device ready for work from day one, so the deployment costs are minimal.

Battery Life
Industrial environments require a full-shift battery power, which implies two things that the consumer devices don’t offer – a battery that can last a full shift under heavy use, and the ability to replace the battery fast. A typical consumer tablet won’t last a full shift. This leads to reduced productivity as the employee needs to swap devices, reduced ROI as the device is out of service for charging, and increased spending as the company needs to either purchase two devices per employee to ensure a full-shift uptime or purchase external accessories that provide quick charging or backup battery alternative.

Many military grade tablets come with hot-swap batteries that enable the employees to change the batteries without powering off the device. The battery of a military grade tablet is significantly more durable under intense use that that of the consumer device.

Rugged Durability
The tablet your employees use will inevitably be subjected to drops, spills, scratches, and extreme temperatures. Rugged durability is key. Without it, you are doomed to frequent repairs or replacements. A rugged Windows or a rugged Linux tablet comes with shock, vibration and ingress protection, MIL-STD discreet parts, a slew of certifications that ensure it has been tested to remain fully operation in rugged conditions. It can be cleaned with chemical solutions; its oleophobic coating ensures it remains presentable under the harshest of conditions while Gorilla Glass ensures its integrity.

Compatibility
The majority of industrial apps operate on Windows or Linux, while iOS and Android tablets offer mobile ports with crippled functionality at best. Industrial tablets are powered by Windows or Linux, so using the same productivity suites as the ones you have on the desktops is seamless and implies no learning curve for your employees and no scaling and programming costs for your IT.

Add in the RS232/422/485 ports, Ethernet and HDMI, regular USB port, and you have a tablet that can be connected to a fleet of devices in your company – something consumer devices do not provide.

Manageability
Centralized management of the entire fleet of your mobile devices is a must. Otherwise, your IT must physically access each device for the simplest of tasks. Consumer tablets do not support industry-class MDM solutions, so the support challenge is formidable & expensive. Windows or Linux-based industrial tablets are MDM ready, enabled for remote monitoring, updates, troubleshooting, locking, wiping, scaling, diagnostic, all of which reduces the annual maintenance costs per worker by as much as 85%, says VDC.

Embedded Scanners
Be it a barcode reader, RFID scanner, CAC, Smart Card, or biometric reader, the industrial tablet has your needs covered by embedding the required peripheral. This saves space & money you don’t spend on external scanners and ensures device durability in its rugged build. The high-end consumer tablet might come with a biometric reader at best, which means you need to purchase the external readers/scanners that would need to be carried around, mounted and charged somewhere.

External peripherals also tend to break and fail in an industrial environment. If your mobile device lacks industrial class barcode scanning capability, you may be losing on the productivity of your employees – a drain that is often not accounted for when calculating the TCO.

Connectivity
An industrial tablet remains operational and connected in the environments where Wi-Fi is unavailable. It ships with the broadband connectivity – Cellular 3G/4G LTE, GSM / CDMA, GPS, Bluetooth – and supports most wireless carriers – AT&T, Verizon, T-Mobile, or multi-carrier. Consumer tablets are often locked per specific carrier and have the basic connectivity options only.

Consumer tablets in industrial environments turn into a financial hog once you see past a brand or an attractive price tag. Hidden costs stemming from the increased IT time to manage diverse devices and to protect data, larger monthly fees as the carrier billing is not aggregated and discount opportunities are lost, or lost productivity due to downtime, returns & repairs amount to significant expenses.

The rugged industrial tablet, on the contrary, is the mobility with solid business benefits. 5+ years lifecycle, 24/7 uptime, superior performance, compatibility, security, and advanced functionality with embedded readers/scanners enable greater productivity. Factor in the availability of tech support, spare parts, updates, disk imaging & other customizations, certifications, extended warranties and out-of-warranty service & the math is, obviously, on the industrial tablet’s side.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article was adapted from a Cybernet, Inc. white paper, reprinted with permission in Tim Rowan’s Home Care Technology Report. homecaretechreport.com It may be freely reproduced. editor@homecaretechreport.com

Hardship may be the key to saving palliative care providers from the bind they are in following CMS’s implementation of MACRA legislation. (See HCTR, January 4 for background on MACRA.) We spoke with Stacie Sinclair, Policy Manager for the Center to Advance Palliative Care to understand the nuances of MACRA and learned of a loophole that may save hospice-based palliative care providers a year of headaches, not to mention unbearable costs.

In partnership with the National Coalition for Hospice and Palliative Care, of which the National Hospice and Palliative Care Organization (NHPCO) is a member, Ms. Sinclair offers training webinars on policy issues. Her webinars have focused recently on MACRA, The Medicare Access and CHIP Reauthorization Act of 2015, which required CMS to create payment systems based on quality outcomes for Medicare participating physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. CMS has clarified that this includes palliative care providers, whether they operate out of hospitals or hospices. qpp.cms.gov  

[Rowan describes in this article how palliative care providers operating within hospices can benefit from applying the new CMS “Pick Your Pace,”  rule which allows providers to gradually ease into MACRA compliance between now and January 2018 as they are able; and to to one of the two healthcare at home software products that have taken necessary steps to  become certified: HealthMEDX, now a NetSmart company, and NDoc Software from Thornberry Ltd. tacie Sinclair notes that Congress has built into the MACRA legislation a  “hardship exception” and provides great detail about conditions experienced by palliative care providers that will exempt them from the certified software reporting requirement. Additional MACRA provisions for palliative care providers choosing to participate in the Quality Payment Program are also  noted in detail. A brief description of the Center to Advance Palliative Care (CAPC) closes this article.]

Ms. Sinclair taught us two things during our recent conversation. In response to numerous comments on the proposed rule, CMS has introduced the concept of “Pick Your Pace,” which allows providers to gradually ease into MACRA compliance between now and January 2018 as they are able, even though the rule technically took effect on January 1 of this year. Second, she informed us, there may be a loophole to one particularly vexing requirement.

The Issue
The problem requirement affects palliative care providers operating within hospices. As we explained in our January 4 article, quality outcomes must be reported, according to the legislation, using certified EMR software. Hospital-based palliative care operations will have no problem reporting through the hospital’s certified EMR but hospice software vendors, as all healthcare at home software companies, have never had a reason to seek certification. Post-acute care was excluded from the ACA’s EMR incentive program. Non-compliance can result in future “negative payment adjustments.”

Faced with two bad options, either urge their current vendor to seek certification — unlikely, as the hospice-based palliative sector is very small — or, feasible but costly, switch to one of the two healthcare at home software products that did bother to become certified: HealthMEDX, now a NetSmart company, and NDoc Software from Thornberry Ltd.

The Loophole
According to Ms. Sinclair, Congress built language into the law that establishes a hardship exception. If a provider can make the case that one of four conditions applies, it can be exempted from the certified software reporting requirement. The third of those four conditions is highlighted below.

From the Federal Register, 11/4/16, printed page 77241:

Section 1848(a)(7)(B) of the Act provides that the Secretary may exempt an EP who is not a meaningful EHR user for the EHR reporting period for the year from the application of the payment adjustment under section 1848(a)(7)(A) of the Act if the Secretary determines that compliance with the requirements for being a meaningful EHR user would result in a significant hardship. In the Stage 2 final rule (77 FR 54097-54100), we defined certain categories of significant hardships that may prevent an EP from meeting the requirements of being a meaningful EHR user. These categories include:

• Insufficient Internet Connectivity (as specified in 42 CFR 495.102(d)(4)(i)).
• Extreme and Uncontrollable Circumstances (as specified in 42 CFR 495.102(d)(4)(iii)).
• Lack of Control over the Availability of CEHRT (as specified in 42 CFR 495.102(d)(4)(iv)(A)).
• Lack of Face-to-Face Patient Interaction (as specified in 42 CFR 495.102(d)(4)(iv)(B)).

Additional MACRA Provisions

Providers choose to participate in the Quality Payment Program in one of two tracks: Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Participants in APM may earn incentive payments through Medicare Part B. MIPS participants earn performance-based payment adjustments, up or down.

CMS made a change from its proposed rule, following comments from the public. MIPS is available to providers seeing at least 100 Medicare beneficiaries per year and it now has 4 parts:

1. Clinicians must choose at least six quality measures on which they will report, selected from a pool of nearly 300 measures.
2. Cost reporting: starting in year two, CMS will use claims data to calculate three different measures to determine how each provider’s costs compare to other clinicians’ costs.
3. Advancing Care Information is the part that requires reporting via certified software. Providers report five measures:

• security risk analysis
• eprescribing
• providing patients access to their own data
• ability to send summary of care to other care entities
• ability to request and accept summary of care from other care entities.

The fourth part is the only new category, the others having been based on previous programs. It requires reporting of “improvement activities,” programs and measures instituted to improve patient care.

About the Center to Advance Palliative Care
CAPC is a national, non-profit association organized in 1999 by Dr. Diane Meyer. It provides tools and training to palliative care providers to help improve program quality. CAPC develops materials for programs: operational training, new program establishment, and clinical training to ensure that not only specialists but all clinicians develop skills in palliative care. Founded to serve hospital-based providers, CAPC expanded services to post-acute care when changing payment models moved a majority of patients into the community, including private homes, Long Term Care facilities and physician practices.

©2016 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