by Audrey Kinsella

Now that the holiday gift-giving season is upon us, I’m reminded of an illuminating keynote speech on the value of wearable technology, presented at last year’s Partners Health Symposium by Dr. Robert Pearl, Executive Director and CEO of The Permanente Medical Group, Inc. (see “Kaiser MD Prefers Using New Technologies to Provide “Just Enough” Care, HCTR 11/18/15).

In the speech, Dr. Pearl asserted: “I can sum up wearables’ usefulness with one word: ‘December.’ It is an easy solution to the cross-cultural, multi-religion holiday season gift dilemma known as, ‘What the heck can I get for ________?’ The FitBit is something everyone wants to own, though its long-term use and value are questionable.”

He was talking about the rapid adoption of one type of popular tracking device, so many of which gather dust on shelves.[This article provides useable details for readers to “regift” their own wearables to seniors and less fortunate people through the new  nonprofit “Recycle Health” (recyclehealth.com)].

Regifting for a Good Cause
Here is some news you can use if you have received such a gift. A new nonprofit, “Recycle Health” (recyclehealth.com), offers an easy re-gifting channel for unwanted mobile technologies.

Begun for this purpose in 2015, it has since received over 900 wearable activity trackers including generous donations of new ones from Withings and Fitbit, according the Recycle Health’s founder Lisa Gualtieri, PhD, ScM. She is an assistant professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine. She told me, “Most donations arrive one at a time, such as from a person who upgraded and wants their old device to have a second life. But many arrive unwrapped, not even taken out of their factory packaging.”

According to Dr.Gualtieri, what RecycleHealth is doing with these items offers value to both donors and recipients. As she noted:

“RecycleHealth was founded on the belief that the people least likely to purchase activity trackers may benefit the most. Our first study indicated as much and we have others planned, some already underway, each with elderly and/or disadvantaged people who have never previously used activity trackers.

“Ultimately, we see RecycleHealth as accomplishing three purposes.

  1. We help people reduce clutter and feel good that they are helping others.
  2. We help people increase their health and fitness.
  3. Through our research we learn more about acceptance and use of activity trackers by older adults and other populations less likely to use these devices.”

If you see the value of this kind of re-gifting this holiday season, find more details about RecycleHealth at http://www.recyclehealth.com/donate.html.

 

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.

©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

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

Clinicians new to home care as well as seasoned veterans have much to learn from “Home Care Nursing: Surviving in an Ever-Changing Care Environment,” published by the Sigma Theta Tau International Honor Society of Nursing, Indianapolis ($49.95). Tina Marrelli, MSN, MA, RN, FAAN, has pulled all of her years of home care experience together to help clinicians, administrators, and owners alike become successful businesses that provide top quality care.

In nine comprehensive chapters and four detailed appendixes, reviewed by a who’s who of 10 equally experienced home care veterans, university professors, consultants and state association executives, “Home Care Nursing” skillfully walks the line between text book and professional guide. It will find a home in the classroom as well as on the desks of agency owners, administrators and Directors of Nursing.

A founding member of the International Home Care Nurses Organization and former editor of Home Healthcare Nurse, Ms. Marrelli is uniquely qualified to develop such a guide. She practiced as a visiting nurse or agency manager for more than 20 years. She also spent four years at CMS, building policies and operations for Medicare Part A home care and hospice and serving as the Interim Branch Chief for Medicare Part B. For the last 20 years, she has served as President of Marrelli and Associates, Inc., the healthcare publishing and consulting firm she founded. Her undergraduate degree in nursing is from Duke University and she holds  master’s degrees in health administration and nursing.[Effusive recommendations of this book are provided in this article, as are many details about its thoroughness of the home health field. Ordering information is provided.]

We could not have
stated it better

This book “should be required reading for all current or prospective home care providers.

“Tina’s work is especially timely as home care navigates the transition to new care delivery and payment models requiring expanded care teams, new business models, and performance improvement.”

—Tracey Moorhead, President and CEO, Visiting Nurse Associations of America

Every chapter useful to someone
Format as well as expertise makes this manual as accessible as it is comprehensive. It is designed to make it easy to dip into chapters as needed rather than read the book in order. Every chapter cites references and offers suggestions for further study. Skilled nursing home health and private duty home care organizations will find something of value in categories like these:

  1. Healthcare: Overview of Change and Complexity
  2. Home Care: What is Home Healthcare and Home Care Comprised of Exactly?
  3. What Makes Home Care the Most Unique Practice Setting?
  4. Becoming a Home Care Clinician or Manager: Information Needed for Success
  5. The Environment of Care: The Home and Community Interface
  6. The Fundamentals: The Interface of Law, Regulation, and Quality
  7. The Home Visit: The Important Unit of Care
  8. Documentation of Care and Related Processes
  9. Where to from here? Or Welcome to the Most Exciting Healthcare Setting There Is!

Something for Everyone
Within these broad categories, readers will find advice when they are deciding whether to make the leap to a career in Healthcare at Home. Experienced home healthcare nurses will read about everything from catheter care techniques to Diabetes, CHF and COPD tips, to documentation standards.

Home Health administrators will benefit from an accessible summary of the Medicare policy manual. Private Duty owners and staffers will want to study the chapter on working within a team.

There are section on Alzheimers, spirituality, pediatrics and nutrition. Appendix A features a complete list of national and state associations, with contact information. The discussion of telehealth is especially useful.

Summary: It is an owner’s manual
This is a textbook that will certainly be adopted by nursing schools. But it is just as much an owner’s manual for everyone in Healthcare at Home who owns an agency, owns a department or owns his or her professional reputation. Tina Marrelli and her 10 expert reviewers have produced a reference that will help newcomers to this healthcare field get started. Many agency owners and trainers give a copy to every new hire during orientation.

The resource will also provide constant reminders to home health veterans, including nurses, therapists and agency owners and managers why this field got under their skin as well as how important they are to the U.S. healthcare system.

Order from: NursingKnowledge.org.

©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

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

This seems to be happening more and more often lately. Investigators and auditors working for Medicare’s four Zone Program Integrity Contractors cite an error of care — or documentation of care — and demand repayment from a healthcare provider. Upon appeal, the payment is restored because the ZPIC employee misunderstood a pertinent rule, or mistakenly applied a hospital or physician rule to a home health claim, or completely made up a rule that never existed.

We wondered what it might be about the ZPIC working environment — training, salary, vacations, and management-employee relations — that would lead to such frequent errors. So we turned to the place where employees themselves could answer that question, online review sites.

This may not be entirely fair. Unhappy customers and employees tend to complain and happy customers and employees tend to keep quiet. Nevertheless, the way ZPIC employees talk about their employer and working environment reveals quite a lot about the skills and mental preparedness they bring to the task of examining your claims.

For your enlightenment, we compiled the following representative sample of comments from current and former employees of some of CMS’s Zone Program Integrity Contractors. All comments are posted and available to the public, edited here only for clarity (apparently, grammar is not a ZPIC job requirement). [Rowan provides a thorough examination of all of these points in this article.]


 

UPIC UPDATE

To improve efficiency and coordination of federal data analysis and audit/investigation work within each region, CMS is developing a Unified Program Integrity Contractor (UPIC) strategy. Under this strategy, Medicare and Medicaid program integrity audit and investigation work at the federal level will be consolidated into a single contractor within a defined multi-state area, which will complement audit and investigation efforts by states. This contractor will conduct Medicare, Medicaid, and Medi-Medi investigations and audits within designated geographic jurisdictions. In July 2013, CMS released a Request for Information and conducted an Industry Day targeted at gathering information from the vendor community on possible requirements for combining Medicare and Medicaid program integrity functions.

As a result, UPICs will perform many of the functions currently contracted to ZPICs and MICs. For CMS integrity contractors, this consolidation will result in more data and knowledge about healthcare claims and payments. For the provider community, this will mean increased and improved surveillance as well as the potential for more government scrutiny of claims payments by federal healthcare programs.

Awardees include:

  • AdvanceMed
  • Health Integrity LLC
  • HMS Federal
  • Noridian Healthcare Solutions
  • Safeguard Services LLC
  • StrategicHealthSolutions LLC
  • TriCenturion

CMS awarded UPIC’s first task order to AdvanceMed for services in the contract vehicle’s Jurisdiction 1 area that encompasses Minnesota, Wisconsin, Illinois, Indiana, Michigan, Ohio, Kentucky, Iowa, Missouri, Nebraska and Kansas.

Further details on the GSA web site.

Utter laziness from upper management. CMS, our client, has no idea what they want. Too many changes to keep track. Everyone walks on pins and needles because management can’t be trusted. Stay away, especially now that AdvancedMed has won the UPIC. Apply there. SGS is a dead zone now. People dropping like flies.


Safeguard Services … has great benefits such as healthcare, sick leave and vacation. You are doing a great service for the Medicare Trust Fund and protecting everyone’s future. It looks good on your resume. But that is it!
They DO NOT TRAIN you to do the job and expect you to read all the work instructions they’ve created, so they can tell you, “if you don’t understand, read the work instructions!” Their so-called training is a one week session in which everything that would take you about one year to learn well, is read to you like a 5 year old! This is the only training they give you … before giving you investigations.

CMS, the contractor, sets up extremely strict time frames and metrics for investigators to meet. They are nearly impossible to meet and extremely difficult to remember when you are new. Then, they blame you for not meeting the metrics, when they never gave you in depth training. If you must take a day off, they tell you, “CMS doesn’t care if you were out.” They expect you to come back and work over 40 hours a week just to catch up when you return, otherwise you get written up for not meeting the metrics!!!! I’ve been here for 4 years and seen so many innocent people be put on “improvement” plans and then quit, due to how difficult they make it for you during this 30-day plan they place you on.


Management from President down is unaccountable for anything; always point fingers at us investigators. They provide no training and unreasonable caseloads, and cause a stressful environment.


 

Work load is crazy and insane. It’s a system that setting you up for failure. There is no such thing as work/life balance here.


Pros: Some team members are excellent, too bad they rarely remain with the company more than three years.
Cons: Client (CMS) constantly changing priorities and working requirements. Lack of focused direction from client. High turnover rate.
Advice to Management: Pay more attention to education, training and experience and less attention to who you would like to go to lunch with.


Pros: There are a few good employees that make the place less than horrific.
Cons: The company relies on winning a contract from CMS, so it is very stressful around the award time because you are not sure if they will give the contract to another company. Management only cares about making CMS happy and makes unreasonable deadlines to try and appease them; then they let everything go to Hell once CMS is off their backs. Nobody is held accountable for their lack of initiative and for the crap work they are doing. Everyone is miserable there. One year, we lost 20 people.
Advice to Management: Find other jobs so someone else can come in and actually care about the company and it’s people.


Pros: The mission of the company is a noble one – fight fraud and abuse and protect the Medicare trust fund.
Cons: CMS has ADD. In recent years it has granted and pulled contracts from companies multiple times. SGS was on a Corrective Action Plan (CAP) from CMS and just recently got off of it. The work has been reduced to a dull, paper shuffling, bean counter, production oriented job, from what was once an interesting, sometimes exciting, thoughtful career.

This company has added only management positions in the last 2-3 years, promoting those managers from staff and then not back-filling staff. Then, when the parent company, HPE, has a Work Force Reduction (WFR), be prepared for SGS to do that as well, even when more staff is needed. We have had situations where an employee was placed on WFR, the same day a new employee was starting their first day!

Most managers employ fear-based tactics to harass, bully, micromanage, and threaten employees. Most staff work plenty of unpaid, unrewarded hours week after week. I am now an ex-employee and I can tell you that the negative reviews here are very much true.

Advice to Management: Not worth the time to tell. There has been much prior advice given and I can assure you none of it was heard.


When I joined SafeGuard Services 5-6 years ago, it was fun, exciting. I felt like I was contributing, making a difference in controlling fraud and waste in our Medicare system. Two years ago a new management team took control of SGS and I have never been so confused as to my daily function. The rules change on a daily basis. We have such a large turnover in employees.


Protecting the Medicare System could be a worthy cause but, OMG – it is a horrible place to work. There are about 6 managers in the Miramar office and each one is mean spirited, abusive and all around not decent human beings. If you like being insulted, intimidated and bullied while working in daily fear under unnecessary, manager-imposed stress, then this is the place for you. The managers will do whatever it takes to keep their own jobs, even throw you under a bus in a heartbeat.

Advice to Management: Quit!


Pros: Entering salary is not too bad. The SMEs in all areas are very friendly and willing to help. Some flexibility with work hours and bonuses. If you are self-motivated, you can develop great skills and make wonderful contacts to help in future employment.

Cons: Management is useless. They have been in their positions for decades and haven’t had new ideas for most of those. They also are unwilling to fight for their employees in salary negotiations with Medicare or HP or to assert themselves generally with Medicare. Raises are virtually non-existent. There is almost no mobility within the organization. With management staff being so few in number and so entrenched there is no opportunity for advancement.

Advice to Management: Retire and allow others with more experience and new ideas to drive the company forward.


Pros:
Benefits were great. The other investigators were professional and worked long hours for little or no recognition. Just a job.
Cons:
Worst job I ever had. Worst management. Worst company policies. Micromanagement like I have never seen before. Management by intimidation. High turnover.
Advice to Management:
Wouldn’t take any advice when I was there. No need to start giving advice now. Not willing to consider other views. No teamwork.


Pros:
Great benefits, including plenty of PTO and unlimited sick days. My colleagues were among the nicest people I’ve ever met.
Cons:
Low morale, high stress environment, constantly being threatened with losing the contract and being unemployed. Lack of communication, no real organization, caseload not spread evenly throughout investigators. If you can close cases fast you’re gonna be expected to hold a high caseload to make up for the slackers in the office. Micro managing to the extreme due to the stress.
Advice to Management: You have great employees but you are losing them left and right because you don’t appreciate them and they’re all afraid of losing their jobs any day. Focus on the bigger picture and stop gigging the investigators for petty mistakes.


Pros:
Nature of the work, ability to work from home once a week, unlimited sick time, but strictly monitored.
Cons:
No raises, no training, upper management does not have managerial skills, favoritism, employees being harassed and disrespected. Lack of respect for employees from managerial staff. No open door policy. Bonus structure is extremely based on favoritism. Employee feedback is never requested but when required by company policy, it is ignored. Human Resources is non-existent. Legitimate complaints to HR or upper management by coworkers against manager wrongs results in no changes and the complainer will usually be let go.
Advice to Management:
Improve employee morale, provide raises, invest in training employees. Communicate with and support employees. Invest in working phones, faster network, etc. Hardworking employees who do their job are pushed out and weak employees that do nothing are left alone. If you notice that employees are quitting left and right, do something to stop it.


Pros:
Parent company Hewlett Packard has decent benefits.

Cons:
Misguided, incompetent management. Managers have little leadership skills, no compassion, no understanding and have never had to work investigations under the same unreasonable expectations they have imposed on investigators in the current environment. Everything is blamed on the customer/client. Employees feel harassed and intimidated by management.
Advice to Management:
“Because that’s what the customer expects” is not good enough anymore. Your high turnover rate should be telling you something is not right. Managers need to be leaders not task masters.


Cons:
Large salary discrepancies for veteran and newly hired employees doing the same work. Few, irregular, and low raises and bonuses, mostly going to the same individuals year after year. Management is acutely aware of these issues and year after year refuses to correct these unethical practices. Managers rely on fear-based management style. Constant fear of losing Federal contract, no control over work, no decision making ability. High stress, tight time-lines, human error is not tolerated, constant fear of job loss over minor errors. Management is top heavy with multiple layers and overlapping roles. High turnover of staff due to dissatisfaction.


Pros:
Freedom to pursue your own work with relatively little supervision. Being actively involved with Medicare and Medicaid fraud detection is a positive experience professionally and personally. CEO seems to have his heart in the right place and wants to make SGS a quality work environment but middle management and the recent purchase by HP make it an impossible task.
Cons:
Management is all but useless. Never worked for a more poorly managed company in three decades of work. They do not supervise or manage employees.

Since HP bought EDS, the SGS parent company, salaries have been cut and frozen. No incentive to stay. Even no salary increase if you get promoted from staff to manager! Bonuses seem to be used mostly to compensate for lack of salary increases rather as a reward for quality work.
Advice to Management:
Lower to middle managers need training on how to manage staff and projects.


Pros:
You get a paycheck. I met a few friends in 5 plus years. The hours of operation were nice. You got free coffee. You were off for the major holidays.
Cons:
WOW…were do I start? First and foremost, “management”, if I must refer to them as management, must have gotten their degrees from a box of Cracker Jacks! “Management” personnel are VERY UNPROFESSIONAL!!!!!! A lot of back stabbing, inconsistencies, poor judgment, and lack of physically being at the office. There are some managers that work 5 hours away, some 3,000 miles away, and get to work from the comfort of their homes. How can you manage anything from home? Management would not accept any ideas from employees. It is their way or the highway! There are a lot of cliques and if you are not part of the right clique, you fear for your job. This is definitely a Good Ol’ Boys place of employment! Some employees could do as they please and others could not! Very unfair, stressful, hostile work environment. A lot of GREAT people have left this place either on their own or were fired because of not being in the clique! Always walking on egg shells!
Advice to Management:
Get rid of all of them that have been causing the most problems and start fresh. The CEO is a horrible person and is out to get everyone that she can!


 

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NurseCalls

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

According to a December 3 news release from the University of Wisconsin-Madison School of Medicine and Public Health, a recent study has demonstrated that weekly telephone contact with a nurse can substantially reduce hospital re-admissions for high-risk patients.

Dr. Amy Kind is the lead investigator and assistant professor of medicine ( geriatrics) at UW Madison who designed the study. She explained that the study measured the efficacy of Coordinated Transitional Care (C-TraC), a program used by 605 patients discharged over an 18-month period from the William S. Middleton Memorial Veterans Hospital. Patients were phoned by a nurse case manager 48 to 72 hours after discharge. The nurse met with each patient before discharge to make arrangements for the phone calls and with each patient’s hospital providers to help ensure that the patient’s transition home was as smooth as possible. [Rowan details the types of patients and their costs (and cost savings) identified in this study, and provides details, too, on the types of setbacks experienced by discharged to home patients when not contacted in a timely manner by nurses. Contact types and timing are noted, and Kind suggests use of the C-TraC program’s use for other healthcare at home transitional service care delivery populations.

Dr. Kind’s findings also determined that health care costs were decreased by approximately $1,225 for each patient enrolled in the program, when compared to similar patients who were not enrolled. The study was funded by a grant from the VA. Kind estimates the program saved the hospital $741,125 in health care costs over its first 18 months of operation.]
High-risk patients were defined in one of three categories: having dementia or some other impairment in memory, over 65 years old and living alone, or over 65 years old with a previous hospitalization in the last year. Patients in the program were one-third less likely to be readmitted than similar patients who were not in the program.
“The nurse engages the patient in an open-ended discussion,” she said. “They spend a lot of time talking about the proper use of medications, follow-up, and the appropriate response to any signs and symptoms that the patient’s medical condition could be worsening.”
“Many patients, within two days of discharge, were not taking their medications properly,” she said. “They may not have understood what they should have been doing, or became confused about their medications when they arrived home. Our nurse can help them work through those issues and make sure they are doing things as they should.”
Kind said the patients got weekly phone calls for up to four weeks or until they were transitioned to a primary-care provider. That provider was updated at each step of the process and immediately informed if problems were detected. “Our role is not to complicate the process, but to more seamlessly bridge the patient’s journey from the hospital to the home and to primary care,” she said.
“This means more money for the VA to provide medical care to veterans in need,” she said. “C-TraC was very popular and only five patients of more than 600 approached declined to participate. “Patients don’t mind a phone call. Also, since most traditional transitional care programs use home visits and most of our patients live beyond the reach of a home visit, transitional care wasn’t even an option for them until C-TraC.”
Kind said 75 percent of the patients lived outside the Dane County, Wisconsin area, and the nurse made phone calls to patients as far away as South Dakota and Florida.
“Because it is phone-based and our nurse doesn’t spend a lot of time traveling, we can communicate with many more patients per month than in traditional home visit-based transitional care,” she said.
Kind believes C-TraC could eventually be used in other clinical settings, and become a useful tool in lowering the cost burden on the health care system while minimizing re-hospitalizations of patients with high-risk health conditions, but notes that the program does need additional testing.

“This model requires a relatively small amount of resources to operate and may represent a viable alternative for hospitals seeking to offer improved transitional care as encouraged by the Affordable Care Act,” she said. “It provides an option to hospitals that previously could not effectively access transitional care services, especially those in rural areas or other areas challenged by a wide geographic distribution of patients, or those with constrained resources.”

©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

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By Stephen Tweed, CEO of “Leading Home Care,” a consulting, research and publishing firm serving the Private Duty Home Care industry

The 2016 Home Care CEO Leadership Study is coming to a close.

If you have not yet completed the online leadership assessment, you have until December 31, 2016 to be part of this elite group of CEOs from top tier companies in home health care and private duty home care.  Our goal is to get 300 CEOs to take a look at themselves in the mirror. Our purpose is to clearly define what it takes to be successful as the CEO of a high performing home care agency.[Tweed provides details about the online leadership assessment tool called the TriMetrix DNA, a tool that Tweed’s company has used for leadership development, coaching, and selection for over 20 years.  It has been refined and validated several times, and we believe it is the most powerful tool available for assessing leadership potential.  Details about the 3 sciences that the assessment tool measures (namely behavior, workplace motivators, and core competencies are described in detail.  The author also provides readers with three reasons to participate in the 2015 Home Care Leadership Study, and indicates two categories of participants. A list of co-sponsors of this study is  provided, as are details for potential entrants to the CEO Leadership study.]

The Assessment Tool Measure Three Sciences:  Home Care CEO Study - three sciences

The tool we are using for this study is an online leadership assessment tool called the TriMetrix DNA.  This is a tool that we have used for leadership development, coaching, and selection for over 20 years.  It has been refined and validated several times, and we believe it is the most powerful tool available for assessing leadership potential.  The tool measures three things:

  1. Behavior— what is your core behavioral pattern as a leader? Every person has a natural behavioral style, and an adapted style.  Your natural style is how you are wired. Your adapted style is based on what you think your job requires.
  2. Workplace Motivators— everyone is motivated.  We are just not all motivated in the same way.  The workplace motivators tool looks at six values, and gives you a clear picture of which values are most important to you and  your work.
  3. Core Competencies — there are 25 core leadership competencies that have been defined.  This section of the assessment gives you the opportunity to define which of these core competencies are most developed, and which may need to be developed.  By creating a ranking of the core competencies of top tier CEOs, we will be able to define what leaders need to know and do to be effective in the next generation.

Three Reasons to Participate

There are three specific reasons why you will want to be part of this industry-leading research project:

  1. You will get a clearer understanding of your own leadership style when you receive a copy of your personal report.
  2. You will learn more about how your leadership style compares with other CEOs in home care when you receive a copy of the final research report.
  3. You will contribute to this industry wide effort to develop the next generation of home care leaders.

Two Categories of Participants

This study is open to two groups of CEOs. If your title is owner, CEO, President, Administrator, or Executive Director, you are invited to complete the questionnaire.  We are inviting CEOs from two types of home care companies:

  1. Medicare Certified Home Health Agencies
  2. Private Pay In-home Care companies or “Private Duty Home Care”

The opening of the survey will ask you about the size of your agency, your annual growth rate, and your profitability in five categories.  This will allow us to compare larger, faster-growing agencies to all the others. For the study of home health agencies, we will also be dividing the participants in to for-profit and not-for-profit.

If you are the top executive of either type agency, we would love to have you participate.  Our focus is surveying leaders of companies in the top 20% of each sector, but any CEO is invited to participate.  We’ll be comparing leadership styles for CEOs form home health and private pay, from large agencies and small agencies, and for-profit and not-for-profit home health.

Special Thanks to our Co-Sponsors

An industry wide study of this magnitude would not be possible without the help of our association co-sponsors.

How to Participate

Participation in the Home Care CEO Leadership Study is easy.

  • Set aside about 30 minutes of uninterrupted time
  • Click on the link below and follow the instructions
  • When you have completed the assessment,  you will receive by email a copy of your personal leadership report

You will also receive a copy of the final research report once it is finalized. Our goal is to have that report by the end of the first quarter of 2017.

Don’t Delay.  Participate Today!

https://leadinghomecare.com/blog/2016/12/07/your-last-chance-to-participate/

Stephen Tweed is the CEO of “Leading Home Care,” a consulting, research and publishing firm serving the Private Duty Home Care industry for over 20 years.

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

Whenever a new administration moves into the White House, it brings advisers, cabinet members and staffers to replace those appointed by the previous President. Even when the incoming ideology is 180 degrees from the one it is replacing, it takes time for the thinking of the people at the top to filter down through Congress and on to the regulators and bureaucrats who write the specific rules that implement policy.

Therefore, though great disruption is expected from the designated Secretary of Health and Human Services, it is not going to happen overnight. So it still makes sense to listen to the bureaucrats and to assume their policies and methods will be a part of the lives of healthcare at home owners and workers at least through the end of FY2017. [Rowan advises healthcare at home agency decisionmakers to attend next month’s Rowan Resources-organized 6th Annual Compliance Cruise Conference, and provides a head’s-up to attendees about important information to be provided by its  2 key speakers–healthcare attorneys Lucian Bernard and Liz Pearson. Focuses in their talks will be on expected actions of the Justice Department to eliminate Medicare fraud. Details are provided about attending the 6th Annual Compliance Cruise Conference.]

Home healthcare attorneys Lucian Bernard and Liz Pearson, the organizers of next month’s 6th Annual Compliance Cruise Conference, attended the American Bar Association’s 2016 Health Law Summit this week and shared with us what they learned.

They report that the primary takeaway from this conference is that the Justice Department is turning its focus from fining organizations to imprisoning individuals in its quest to eliminate Medicare fraud. Here is a summary:

  • Every U.S. Attorney has been instructed to begin scrutinizing every corporate investigation to determine if there are individuals to be held accountable.
  • All False Claim investigation will now include a review to determine if there are individuals who should be charged criminally.
  • The number of cases filed against Providers for employing excluded individuals tripled this year and will yield more than $300 million in civil monetary penalties.
  • One in every six defendants in Medicare Strike Force actions is a home care agency
  • The OIG was clear that despite accounting for about 3% of Medicare expenditures, home care and hospice agencies will continue to be fertile targets for fraud and abuse investigations.

Attorney Bernard told us that he and Ms. Pearson will be discussing these and other matters of vital interest to home care and hospice providers during their sixth annual Compliance Cruise, January 15-22. Details are here.

“For those who have never attended one of our Compliance Cruises, we’re at sea together for a week.  In addition to the group sessions, we traditionally meet one-on-one with folks on issues specific to their agencies. Nobody gets billed. Same is true for all our faculty.”

 

©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

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Frustration

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

[Rowan presents a  very long list of  discrepancies in and challenges to the pre-claim requests (PCR) provided by Palmetto Government Benefits Administrators [PGBA]. The lack of thoroughness demonstrated by the

PGBA reviewers are noted in detail. Most disturbing about these reviews, Rowan notes, is their rapidity. He says that  PGBA reviewers are under such extreme pressure to quickly resolve cases, they appear to have resorted to speed-reading submitted documents. Misinformation provided by PGBA officials to home health agencies are noted; Comments by Bill Dombi, lead legal advisor at NAHC, are noted. CMS’s role in decision-making about Pre-claim requests as of Nov. 2016 are discussed.  Observations about views toward -claim requests (PCRs) held by Tom Price (HHS Secretary nominee) are noted.  In addition, it’s noted that CMS intends to inaugurate  a pre-claim requests (PCR) demonstration project for home health services in the state of Florida. Finally, information about the costs of home health agencies of undertaking PCRs is provided.]

 

PGBA reviewers are still citing non-existent regulations when they do not affirm some pre-claim requests.

PGBA reviewers frequently fail to place mandatory phone calls to home health agencies to discuss non-affirmed pre-claim requests.

PGBA supervisors, when challenged on this telephone failure, swear that these calls were actually made.

Appeals for guidance to the head of the CMS Center for Program Integrity, who will be replaced on January 20, go unanswered. Apparently Dr. Shantanu Agrawal, M.D., Deputy Administrator and Director of the CPI, is using accumulated leave time, enough to carry him through the last day of the Obama administration.

A discrepancy exists regarding the number of Illinois agencies that have yet to submit their first pre-claim request. PGBA says it is “a handful.” CMS reports between 200 and 300.

In a December 15 conference call, representatives from NAHC and the Illinois HomeCare & Hospice Council reported on these and other signs of progress and setbacks, and offered predictions for post-January 20 changes.

The most disturbing revelation is that PGBA reviewers are under such extreme pressure to quickly resolve cases, they appear to have resorted to speed-reading submitted documents. Several providers cited instances where they received a non-affirmation for a missing document. Over and over again, during the follow-up phone call, they had to tell the reviewer, “Please look again,” and heard in response “Oops, you’re right. There it is.”

All medical leaves canceled?
Almost as disturbing is the way PGBA reviewers tend to make up rules on the spot when searching for reasons to dis-affirm requests. More than one provider mentioned that they were told by a PGBA reviewer that their request was non-affirmed because “it took too long for the doctor to sign the documents.”

“Wait a minute,” NAHC’s Bill Dombi interrupted. “The federal rule only says the signature date has to precede the final claim date. There is no CMS language that says anything about two weeks or two months.” Doctors, everyone agreed, are allowed to go on vacation.

Just call me!
That is only if those required phone calls actually happen. Many providers on the call strongly asserted that they absolutely do not receive non-affirmation explanation calls from PGBA. In its defense, PGBA has reminded provider agencies that they ask for their one contact person when they call. If that person is not available, they move on to the next call. Providers on the call generally pooh-poohed that excuse. “Our point person is always in the office, always available,” many of them insisted.

On the good news side, PGBA is reporting, and the Illinois Council confirms, that the pre-claim affirmation rate has climbed to an average 87 percent. Only about 5 percent of these were partial affirmations, a significant improvement over the early days of August and September. (See “CMS Continues to Assert Pre-Claim is Going Well,” HCTR 11/9/16).

NAHC has put off filing its planned lawsuit to stop PCR, instead electing to push CMS to change the regulation to excuse high performing agencies from the pre-claim requirement. “They have proven they are doing things right, some of them at 100%, so why should they have to continue to prove themselves,” asked NAHC’s Bill Dombi.

Reviewers forget they are not nurses
Everyone on the conference call was alarmed and disgusted to hear reports of non-affirmations with the reason, “aide services were not reasonable and necessary,” or “I disagree with the doctor’s wound care treatment plan.” Dombi urged providers to document every such instance and help him bring them to CMS’s attention. “These people are acting outside their authority,” Dombi told them.

Far outside their authority
Some providers were furious about non-affirmations of second consecutive episodes. One provider reported getting a denial over the Face-to-Face document, a document that had been approved for the first episode. “They simply can’t do that,” Dombi asserted. “There is no such rule that allows this. I want you to send me the name of the reviewers that are doing this so I can report them to CMS.”

PGBA is not the only party acting outside its authority. CMS itself has not been playing fair, Illinois providers reported. At first, they declared a provision for agencies situated near state borders. An Illinois agency with patients living in Iowa or Wisconsin or other border states did not have to submit pre-claim requests for those patients’ episodes. Suddenly, on November 17, a policy statement came out that said they not only have to start submitting PCRs for out-of-state patients going forward but that the policy is retroactive to August 3. Dombi said he intends to fight this decision.

What about Price?
HHS Secretary-nominee Tom Price, a physician and Congressman, has been the leading opponent of PCR in the U.S. House of Representatives. Dombi’s expectation is that the Senate will take up his nomination as soon as possible after Inauguration Day. Once in office, Price may take action to stop PCR right away, or he may take the time to meet with CMS personnel first. Only time will tell but there is good reason to be optimistic.

Apparently, Representative Price’s opinion of PCR is even more negative than that of Florida’s senators, Republican Marco Rubio and Democrat Bill Nelson, who wrote to CMS asking them to delay PCR in Florida for an additional year.

BREAKING NEWS UPDATE: As this issue was going to press, CMS thumbed its nose at Rubio and Nelson with the following announcement:

Notice for Expansion of the Pre-Claim Review Demonstration for Home Health Services to Florida

CMS will expand the Pre-Claim Review Demonstration for Home Health Services to Florida for services that begin on or after April 1, 2017.  CMS and the Medicare Administrative Contractors have provided education to impacted providers on how to submit pre-claim review requests, documentation requirements, and common reasons for non-affirmation decisions.  The Medicare Administrative Contractors will continue to conduct outreach in Florida.

Can PGBA handle it?
According to CMS data, there are 755 certified home health agencies in Illinois. As mentioned above, PGBA reviewers are already resorting to skimming documents stacks in an effort to keep up with the workload.

According to CMS data, there are 1,120 certified home health agencies in Florida, bringing the total workload to 250% of what it is now. The reader is invited to draw his or her own conclusions.

Bottom line
What does PCR cost? CMS promised early last summer that the impact on agency time and resources would be somewhere between minimal and insignificant. According to the Illinois experience, PCR requires at least one additional FTE for small agencies and two to three for agencies with a census of 300 or more. “Plus lots of overtime and weekend work,” one caller added. About $25,000 per month for a 300-patient agency was a general consensus.

©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

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SUNNYVALE, CA — November 21, 2016 — Pathways Home Health and Hospice became the first home health, palliative care, hospice and private duty organization in the San Francisco Bay Area to adopt Epic’s electronic health record system (EHR). A company news release announcing the decision indicated that this will connect them “to the largest group of hospitals and physicians in the United States” and ease patient transfers from hospital to home-based care.

“My sister recently moved to the Bay Area from Hawaii. She was having complications from a dog bite that she received before moving. She couldn’t find any of her paperwork, prescriptions, or anything related to the incident from her doctor in Hawaii,” said Laurel Ashcraft, RN, a Pathways nurse. “But when we went to the doctor at Palo Alto Medical Foundation, they were able to pull up her chart in Epic. We knew all we needed to know and she got the care she needed. It was such a relief to us both and now we are able to offer the same service to our Pathways patients.”

The Epic EHR was turned on November 1, connecting Pathways to almost 2,000 hospitals and over 34,000 clinics nationwide. Better data exchange capabilities with California’s major healthcare providers will help patients keep their primary physicians informed as they recover from surgery or an illness or receive more help with daily tasks. When a patient or his or her family choose Pathways, they will be connected to this same system. [More details are provided in this article about the value of easily accessing patient records on a national level and so improving patients’ quality of care. Senior players at Pathways provide comments on the value of using the Epic system for providing patient-centered care.  Additional details about Pathways’ history and wide range of services is also provided.]

“Being able to bring patient data together from different sources is one of the biggest challenges in healthcare,” said Pathways IT Director Brad Miller. “Not having all the information available in one place can cause problems such as delays in treatment, duplicate testing or conflicting prescriptions. Epic is helping us overcome that challenge by connecting us to other health systems — regardless of what EHR they use — and consolidating all of our data into one place. It makes a big difference to the quality of care we can provide.”

“More than 12 million patients are currently on the Epic system in Northern California,” said Pathways CEO Barbara Burgess. “That’s at 19 different facilities. Now, they will be able to experience a seamless transition of care from their hospital or clinic to service at home with Pathways.”

Since August 2015, a diverse group of Pathways clinical leadership including registered nurses, physician assistants, nurse practitioners, therapists, home health aides, and hospice providers have worked with the leadership of El Camino Hospital to tune the Epic system to fit Pathways culture.

Burgess explained that patients’ health goals had to be at the center of the plan of care. “From our first conversation with a patient to our last nursing visit, Pathways makes patient wishes the core of our care.”

Other organizations in the San Francisco Bay Area that have implemented the Epic system include Palo Alto Medical Foundation, Contra Costa Health Services, El Camino Hospital, John Muir Health, Kaiser Permanente, Santa Clara Valley Medical Center, Stanford Health, Sutter Health, and the University of California Health System including UC Davis and UCSF.

About Pathways
Pathways Home Health and Hospice, a Bay Area not-for-profit founded in 1977 by a group of Stanford physicians and community members, is moving care forward with its home health, hospice, private duty home care, palliative care, and geriatric care management services. Known for its innovative pilot projects, Pathways recently launched a unique in-patient program in partnership with Stanford Healthcare.

With offices in Sunnyvale, South San Francisco, and Oakland, Pathways family of services reaches more than 5,000 families annually in five Bay Area counties. Pathways cares for patients wherever they live—at home, in nursing homes, hospitals, and assisted living communities.

Affiliated with El Camino Hospital and Sequoia Hospital since 1986, Pathways Home Health has been a HomeCare Elite Top Home Health Agencies award winner for the past four years. Pathways Private Duty has been a Home Care Pulse Best of Home Care Provider of Choice award winner for the past two years.

For more information about Pathways, or to donate, call 888-755-7855 or visit pathwayshealth.org

©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

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by Danielle Strachan-Scott, of the London, England home care agency, The Good Care Group, producers of an award winning guide: “Dementia: Through Their Eye.,”

The Good Care Group is an award-winning, London home care agency. As a public service, the company has produced “Dementia: Through Their Eyes,” a free, 15-page guide on how to deliver person-centered care to people whose lives have been affected by dementia. Providing practical tips on communicating, eating well and improving well-being, plus advice on assistive technology and creative therapies, it provides the reader with a compelling, informative and easy to understand resource, helping people better understand how to communicate and care for people with dementia. The authors note their mission as follows:”We believe sharing this valuable and informative resource with families of affected patients would help to improve the lives of many people who have dementia, and their loved ones. Educating and providing people with useful tips on how to care for the ones closest to them could make a huge difference and change their lives for the better.” Tips for using this guide are provided by the authors, along with numerous pointers needed for better understanding this patient population.]

 

We believe sharing this valuable and informative resource with families of affected patients would help to improve the lives of many people who have dementia, and their loved ones. Educating and providing people with useful tips on how to care for the ones closest to them could make a huge difference and change their lives for the better.

Independent Specialist Care Awards (England and Wales)

WINNER 2014
Independent Specialist Care Awards (England and Wales)

Tips from The Guide
The Guide seeks to educate people to about different types of dementia, noting that dementia is a “collection of syndromes resulting from damage to the brain” (page 3), with Alzheimer’s being the most common type. It also covers common functions which can be affected by dementia, including memory, thinking speed, mental agility, understanding and judgment.

The Guide highlights that although these symptoms are common among most individuals with dementia, the rate of progression varies from person to person and is dependent on the type of dementia, as well as the overall health and lifestyle of the individual. The Guide encourages anyone who is concerned about dementia to seek help by talking to their primary care physician.

Feelings more important than facts
The Guide explains that it often becomes difficult for people with dementia to store new factual information. Noting that the feelings a person experiences do continue to be stored as normal. Therefore a person with dementia will always know how he is feeling, but he may not know why. The guide quotes Christine Bryden, diagnosed at age 46 with Alzheimer’s Disease, “As we become more emotional and less cognitive, it’s the way you talk to us, not what you say, that we remember.”(page 4)

In the absence of recent factual memories, people with dementia are likely to search for much older factual memories, possibly from youth, to help make sense of their current situation. The guide offers tips on how to effectively communicate with the person, mentioning the importance of creating a calm and relaxed environment, and joining the reality the person is living in rather than contradicting them.

Adopt a ‘Person-First’ approach
The guide states we must adapt to a “person-first” approach in the household. Pam Schweitzer (1998, page 4) proposes that looking through family photos, listening to familiar music and visiting memorable places may help sustain a better relationship between family and person, as well as carer. This helps the person feel at ease by reminiscing about happy memories.

Three Golden Rules developed by “Contended Dementia” a person-first approach

The SPECAL® method is a person-centered approach that can greatly improve well-being and quality of life as well as strength your relationship with your loved one through positive communication techniques.

1. Avoid asking direct questions

It is important to avoid asking direct question that require factual information, this increases awareness of their disability which in return causes more stress and grief.

2. Listen to the expert

It’s important to listen to what the person affected is saying, to base our questions and answers from their perspective; any information they receive should generate good feelings for them.

3. Do not contradict

It’s important to not argue with them, we must not sidetrack them from pre-dementia memories, as they are used to make sense of the current moment. We must support and validate what they are saying as being correct.

Assistive Technology And Examples
The Guide promotes the use of assistive technology as an aid for greater autonomy.

Helpful technology includes:

  • Taking tracking devices on walks, which allow patients to have a greater sense of independence
  • Telecare sensors to monitor the person can notify a nominated person or call centre if they have fallen or have left home during the night
  • Introducing adapted versions of household appliances such as doorbells and telephones with larger buttons and bolder colours

It is important to note assistive technology is more effective when introduced in the early stages of dementia; gradual introduction of these technologies can prevent confusion. The guide also states assistive technology is best when combined with a ‘person-centered’ care service.

Explore dementia patients’ creative abilities
The Guide notes that; “people’s aesthetic and imaginative responses remain strong, music and art can be a positive and energising experience.”

“Arts 4 Dementia” have successfully organised events with arts venues, encouraging people with dementia to take part in art, music, dance and drama events around the country. The guide states that “attendees have remained energised, happy and stress-free for sometime afterwards, with 94% still benefiting overnight and 60% benefiting for a week or more.

“The creative part of the brain can remain undamaged for years” – Veronica Franklin Gould, CEO of Arts 4 Dementia

Staying active and keeping healthy
The Guide notes the importance of physical activity for people with dementia, offering suggestions on types of activities which promote happiness and well-being. The guide explains that walking the dog or gardening helps to maintain a connection to normal life, retain skills and improve sleep, appetite, circulation and digestion.

The Guide also states that people with dementia can have a preference for sweeter foods, finger foods and regular snacks as smaller portions are often more appealing.

Bringing carers into the home
The Guide recommends that care be provided in a familiar environment such as the home; here a person can receive an unrivaled level of support through one-to-one, live in care, whilst also continuing to enjoy their independence.

The guide informs us of the type of care one would receive, stating, “Carers using a ‘person-centered’ approach will deliver holistic care, taking into account personal and emotional needs, in addition to practical and medical tasks they may need help with.

What distinguishes “The Guide ‘Dementia: through their eyes” is that it offers different ways of thinking and understanding the person with dementia, and provides information and practical tips to help support the person with dementia live better, happier and more productive lives. The guide encourages good practice and explores dementia from the perspective of the individual.

This helpful guide offers a wealth of in-depth content, that also answers questions concerning sleeping patterns, medical support, funding and have listed a number of relevant resources, and organisations to support those affected by dementia.

Click here to download The Guide

The Guide was published by The Good Care Group, London, UK. http://www.thegoodcaregroup.com

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by Audrey Kinsella, Telehealth Reporter,  Home Care Technology Report

I remember it as though it were yesterday. It was the great Gene Tischer, former Executive Director of the Home Care Association of Florida, who taught me a memorable lesson years ago, as he did many audiences large and small over the years. An audience member had asked him, “Gene, what’s the best option for eldercare now? Nursing Homes? Assisted Living Facilities? Home care?”  He said, “Adult daughters.” I walked away shaking my head. I have one son.

I was reminded of Gene’s advice last month as one of the exhibits at the Partners Health annual “Connected Health” symposium caught my eye. MedSentry™ bills itself as “The Prescription for Medication Adherence.” The Westborough, Massachusetts company offers a modular medication management system designed for patients with a high number of prescriptions. Booth personnel explained to me that the system features custom medication packaging, cloud-based pharmacist management, imaging technology, and compartments that can manage a dozen medications or more. [ New wearables and mobile technologies are effecting needed changes in today’s elderly patients who want to live at home, it’s noted, but with some needed help provided by family members. Kinsella provides details about MedSentry™ use by an elderly patient/client and her assistance provided by her adult daughter. Details about successful use of such devices like MedSentry™ in a clinical validation study that had been conducted by Partners’ Center for Connected Health and Massachusetts General Hospital are provided. A general theme provided in many presentation at the Partners symposium focused on today’s new senior population at home is this: we must embrace [the new senior population] as “technologies as a service for life.” This is the new and different patient we as an industry are soon to meet. Not the dependent, homebound person but the active, independent senior, living well at home — and everywhere else — thanks to tools that enable self-management of chronic conditions.]

When I asked whether the dispenser was mobile, they told me the story of one devoted daughter who prepared her elderly mother’s dispensary every month with 12 different prescriptions drugs that had to be taken at varying times of the day. Once filled, the mother was able to self-manage when she was at home and when she visited other family members, often for days or weeks at a time.

After telling me that story, they quoted a clinical validation study that had been conducted by Partners’ Center for Connected Health and Massachusetts General Hospital. It found a 9% hospitalization rate among MedSentry™ users and a 50% rate for all-cause hospitalizations in the control group and a 36% rate of hospitalizations for heart failure.

I concluded, after my time in Boston, that seniors who live at home, get out more often, and remain active, are becoming more common. Connected technologies are making passive seniors obsolete, regardless of their chronic conditions. Robust new wearables help them share health data with their doctors and nurses. They are able to be more engaged with their care, even while away from home.

At all times, keynote speakers and product vendors returned to the theme that the technology must be usable to be worthwhile. Ease-of-use features were constantly cited as the key to new tools helping patients educate themselves and chart their own progress as they age. As mobile health tools evolve, they move in the direction of being easily used by people of all ages. That does not mean the adult daughter is not still critical. She may be able to use the tools more confidently.

The old joke comes full circle. When mobile computers were new and CMS first began requiring electronic forms and claims submission, Healthcare at Home agency staff often balked. “I will never be able to learn how to use this gadget,” they often said. The helpful manager would often reply, “Don’t you have an 11 year-old at home? She can teach you.”

Fast-forward to 2016 and that built-in 1980’s computer instructor may now very well be the person filling the retired home health worker’s MedSentry™ dispenser.

Coaching elders in technology use and engaging them in their own care are key to teaching self-management routines and keeping them at home, where they prefer to live. Ease-of-use features benefit these adult daughters as much as they do their elderly parents with multiple chronic conditions. Consequently, keeping seniors engaged in self-management may begin with coaching adult daughters, who, as Gene Tischer taught us years ago, are becoming essential to both their elderly parents and their parents’ care team.

As presenter Lauren Costantini, PhD, CEO of Prime-Temp, Inc., indicated in his keynote address, “Wearable Sensors Expand Human Potential,” “We should not look at today’s monitoring devices as “technologies in search of a problem.” Rather, we must embrace them as “technologies as a service for life.” This is the new and different patient we as an industry are soon to meet. Not the dependent, homebound person but the active, independent senior, living well at home — and everywhere else — thanks to tools that enable self-management of chronic conditions.

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.

©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

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